Times have changed. Consumers can get what they want, when they want it, however they want it – and
will be sure to mention their experience whether positive or negative. In fact, many of us have
likely made restaurant selections based on what we heard through our favorite medium of choice:
print ads, email or websites just to name a few. Consumer selection can even apply to open
enrollment. Employer and member perspectives
Activist employers —
the benefits leaders who want to drive change in the way US healthcare is delivered — are willing to
switch plan vendors if they aren’t satisfied. This presents an opportunity for health plans who also
know the importance of boosting member engagement and satisfaction.
Whether it’s the annual open enrollment period or a qualifying life event, many members are
concerned about finding their best-fit plan. Deciphering complex literature and not being able to
forecast future health costs can lead to over- or under-insuring. Many opt to just keep the plan
year over year regardless of financial consequences.
Looking at this challenge through the lens of COVID-19, it could be especially
prevalent among members who deferred care. The physical and financial costs of delaying necessary or
elective surgeries could drastically impact plan selection. Prompting members to think about their
upcoming needs could help lead them to selecting a more appropriate plan.
While employer clients try their best to educate their employees about benefits enrollment, it’s
frequently not scalable – staff-led webinars, flyers and individual email correspondence. And what’s
more: Everyone has their own preference.
In one innovative example, Juanita, the head of benefits for a self-insured employer, could work
with her health plan to deploy virtual agents for her population. This application uses
recommendation engine logic to improve enrollment and potentially improve satisfaction scores. Let’s
say one of Juanita’s company’s employees, Jeff, is seeking to switch health plans during open
enrollment. Jeff could use a virtual agent that allows him the ability select his best-fit plan
based on historical claims data and projected needs.
But some of Jeff’s colleagues might not feel comfortable enough to use a virtual
agent. That is why Juanita can use data to learn about her employees’ media preferences and send
them enrollment material built for their needs. Whether it’s a detailed health benefits statements
sent by US mail, a summary via email, or tools on a self-serve website, she is aware that we all
Start small on your own team
While the idea of increasing member engagement is reason enough to explore new benefits enrollment
processes, consider first trying this approach within your own health plan (as an employer). Test,
learn and observe how your employees react to customized benefits communications – are they still
selecting a default plan or are they taking the time to find their best-fit plan?
A successful pilot within your own organization can serve as an opportunity to
sell in data and AI-driven benefits communications as a channel partner to your employer clients.
Altogether, this could better demonstrate your value to employers, boost member engagement and help
secure incremental business.
Payer and provider collaboration
That’s not all. Let’s zoom out and look at the full picture. Investing in a member solution could
also benefit the relationship between payers and providers. According to Gartner, health systems of
all types can benefit by improving their ability to engage members and care teams during an episode
of care.³ Effective engagement within an episode of care improves a health system’s ability to
minimize patient leakage and lowers quality risks during care transitions within the episode.
Patients also report substantially higher satisfaction scores when their journey through a care
episode is coordinated among all parties. In other words, when patient data is securely shared with
health plans, it can help improve overall member experience when it comes time to enroll.
The result? Engaged employer clients – and members – who feel educated, empowered
and see consistency, can choose to stay with your health plan and not take their business elsewhere.
³ Gartner, The Evolution of Healthcare Consumer
Engagement Hub Architecture, Mark Gilbert, 25 February 2020 (PDF, 221 KB)