A Customer-Centric Approach to Empower Health Plan Members

Effective communication plays a vital role in the relationship between health care payers and plan members. However, there are several challenges that payers face when it comes to plan member communications. Complex benefit explanations, limited engagement, and fragmented communication channels can hinder the overall customer experience. In this blog post, we’ll explore these challenges and propose a customer-centric approach to overcome them, ensuring a seamless and engaging communication process.

Simplify Benefit Explanations

One of the most significant challenges in plan member communications is the complexity of benefit explanations. Health care plans often include intricate terms, coverage details, and eligibility criteria that can confuse and overwhelm plan members. To address this challenge, payers can adopt a customer-centric approach that emphasizes clear and concise communication.

  • Use plain language: Avoid jargon and technical terms as much as possible. Use language that is easily understandable by the average plan member.
  • Break down complex information: Present benefits in a simplified and structured manner. Use bullet points, infographics, and visual aids to make the information more digestible.
  • Provide examples: Illustrate benefit scenarios through real-life examples to help plan members better understand how their coverage works.

Improve Engagement and Interactivity

Limited member engagement is another common challenge faced by health care payers. Plan members may feel disengaged if they receive communication that is generic, impersonal, or lacks interactivity. By incorporating a customer-centric approach, payers can create an engaging communication experience that captures the attention and interest of plan members.

  • Personalize communications: Tailor messages to individual plan members based on their demographics, preferences, and historical data. Personalization can include addressing plan members by their names and customizing content to their specific needs.
  • Utilize interactive channels: Embrace digital solutions, such as interactive portals, mobile applications, and chatbots, to provide plan members with real-time access to their benefit information and enable two-way communication. This allows plan members to ask questions, provide feedback, and receive instant responses.
  • Gamify the experience: Introduce gamification elements to make plan member communications more enjoyable and interactive. Offer quizzes, challenges, or reward programs that incentivize plan members to actively engage with the information.

Streamline Communication Channels

Fragmented communication channels can hinder the customer experience by creating confusion and inefficiency. Plan members may struggle to find relevant information or experience delays in receiving important updates. A customer-centric approach involves consolidating communication channels and providing a seamless experience across multiple touchpoints.

  • Centralize information: Create a centralized communication hub where plan members can access all relevant information, including benefit details, coverage summaries, claim forms, and contact information. This minimizes the need for plan members to search for scattered resources.
  • Optimize omnichannel communication: Utilize multiple communication channels, such as email, SMS, online portals, and mobile apps, to reach plan members effectively. Ensure that the information is consistent across all channels, providing a unified experience.
  • Enable self-service options: Empower plan members to manage their benefits independently through self-service tools. Offer online portals or mobile apps that allow them to view claims, check eligibility, download documents, and request assistance.


By adopting a customer-centric approach, health care payers can overcome the challenges associated with plan member communications. Simplifying benefit explanations, improving engagement and interactivity, and streamlining communication channels are key strategies to enhance the overall customer experience. By providing clear and concise information, personalized interactions, and convenient access to resources, payers can build stronger relationships with plan members, leading to improved satisfaction and loyalty. Embracing this approach will contribute to a more seamless and customer-focused communication process in the realm of healthcare payer services.

The right plan communications partner can make a world of difference in ensuring customer-centric communications. As the leader in CCM/CXM, O’Neil can advise you on digital solutions that deliver exceptional member experiences while aligning with your business strategies and priorities. Contact us for a consultation or to preview our ONEsuite CCM platform.