A Whitepaper by O’Neil Digital Solutions
Health plans are at a crossroads. With soaring healthcare costs, an aging population, and increasingly complex member needs, traditional approaches to communication and engagement are no longer sufficient. In this competitive landscape, plans must shift from viewing communication as a compliance requirement to seeing it as a strategic lever for transformation. Member engagement is no longer optional—it’s a critical differentiator that directly impacts health outcomes, operational efficiency, and financial performance.
Despite a growing awareness of these challenges, most health plans still rely on fragmented, outdated communication models that fail to resonate with today’s digitally savvy consumers. Members expect the same level of personalization, convenience, and responsiveness from their health plans as they do from companies like Amazon, Netflix, or Apple. Unfortunately, many health plans are falling short, resulting in widespread dissatisfaction, low engagement, and costly inefficiencies.
This white paper argues that to survive—and thrive—health plans must embrace a new era of intelligent, data-driven communication. By leveraging modern technologies such as AI, machine learning, big data, and omnichannel platforms, plans can deliver hyper-personalized, timely, and meaningful experiences at scale. The payoff is significant: improved health outcomes, higher member satisfaction, reduced churn, stronger Star Ratings, and millions in potential cost savings.
In the pages that follow, we explore the root causes of the current engagement crisis, examine how technology is reshaping the future of communication, and highlight best practices from leading organizations already seeing results. We also provide actionable strategies for health plans to modernize their communication ecosystems, streamline vendor relationships, and harness data to create a more connected, proactive, and compassionate member experience.
The stakes are high—but the opportunity has never been greater. By rethinking how they engage with members, health plans can become not just healthcare payers, but trusted partners in every member’s health journey.
The Engagement Gap: A Costly Disconnect
Health plans today often rely on outdated communication methods: generic emails, paper mailings, and clunky portals that fail to capture attention or inspire action. Members are often left feeling frustrated, overwhelmed, and underserved. These poor experiences lead to low adherence to care plans, underutilization of preventive services, and poor chronic condition management. The result is not only disengaged members but also billions in avoidable healthcare costs that burden the entire system.
In stark contrast, companies in industries such as retail, entertainment, and finance have mastered the art of customer engagement. Tech-savvy organizations like Amazon, Netflix, and American Express have redefined customer expectations by offering proactive, hyper-personalized, and seamless experiences.
Members now expect the same level of engagement and responsiveness from their health plans. Failure to deliver on these expectations results in diminished trust, lower satisfaction, and ultimately, member attrition.
Key Statistics
Seventy-two percent of members say they expect personalized communication from their health plan. Over half of members—58%—report difficulty understanding their health benefits, while health literacy challenges alone cost the U.S. economy up to $238 billion annually. Additionally, according to a JD Power report, overall member satisfaction with commercial health plans in the U.S. has stagnated at a score of 719 out of 1,000, with significant dissatisfaction linked to a lack of clear communication, poor digital experiences, and unhelpful customer service.
New data from JD Power’s 2024 U.S. Commercial Member Health Plan Study reveals that the experience gap between the highest- and lowest-performing plans has grown—from 144 points in 2023 to 161 points in 2024. This widening disparity highlights how top-performing plans are rapidly adopting consumer-first, personalized communication strategies, while others fall behind. The poorest-performing plans scored lowest in clarity of communication, usability of digital tools, and perceived empathy—areas directly addressable through intelligent engagement.
This dissatisfaction has direct financial implications. Disengaged members are less likely to use preventive services, more likely to have unmanaged chronic conditions, and are prone to seeking high-cost emergency care. For example, avoidable hospital visits alone cost health plans an estimated $32 billion annually. Moreover, low satisfaction correlates with higher member churn, which can cost plans between $500 and $1,000 per lost member in acquisition and administrative costs.
