05-06-2025
Early Engagement With Members: The Key To Better Outcomes And Smarter Spend In Healthcare
Robert Gelb is the CEO of Valenz Health.
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Navigating the healthcare system can be a challenging and perplexing experience for many people.
According to a 2023 survey by KFF, 51% of adults with health insurance indicated having 'some difficulty understanding at least one aspect of their health insurance, such as what their insurance will cover (36%), what they will owe out-of-pocket for care (30%), or what their explanation of benefits statement means (30%).' The survey also found that 58% of respondents 'encountered at least one problem using their coverage in the past year.'
The good news? There is a solution.
I believe that by providing early, consistent engagement, the teams that support members (such as health insurance providers, employers, external brokers and benefits consultants) can create significantly better care outcomes and healthcare experiences.
By engaging with members during the prospective phase of their healthcare journeys (before it's time to receive care), we can empower them to make more informed decisions based on factors such as costs and outcomes—and as a result, reduce spend, improve the quality of services rendered and enhance their overall healthcare journeys.
An intuitive digital front door is often the foundation for creating better member experiences. By providing members access to the health plan information they need (what's covered, what isn't covered, in-network physicians, low-cost providers, etc.), healthcare leaders can encourage more frequent, smarter engagement by plan members.
Simply providing this information isn't enough, though. Websites and apps should be easy to navigate; patients should not have to dig through multiple pages to find the answers to their basic questions. Similarly, support staff should be able to quickly and accurately answer members' questions and concerns.
When members have easy access to information about their health coverage, it can improve their healthcare literacy and, in turn, allow them to make more informed medical decisions that support affordable, high-quality care.
For example, employees who attend webinars about their health benefits options during open enrollment will be better equipped to understand the differences between plan options and to select one that best aligns with their healthcare needs and budget. That knowledge can help them make more informed decisions down the line, specifically, enabling them to seek in-network, high-quality, affordable providers.
In addition to creating an intuitive digital front door, plan providers, employers and other constituents should take other steps to encourage frequent member engagement.
First, members should be incentivized to leverage their healthcare in a strategic, cost- and quality-conscious manner. For instance, members who get their annual physical exams might receive gift cards to select retailers as a reward. Another option is for members to be entered into a raffle upon enrolling in a health management program.
These rewards encourage members to stay on top of their health, while helping all parties manage costs more effectively. Consider this: Discovering a vitamin D deficiency during an annual physical and treating it early on with supplements or lifestyle changes will cost less in the long term than discovering the condition after related complications arise, such as reduced bone density, which necessitate more serious interventions.
Stakeholders should also prioritize providing ongoing, regular education and reminders to members about their plan benefits and how to maximize them. With a consistent stream of information, members are more likely to remember (and utilize) the benefits available to them. Moreover, continued education—monthly newsletters, quarterly town halls, etc.—keeps members updated about any plan changes.
Of course, as stakeholders provide this information, they should avoid making the process overly complex, as that could cause members to actively avoid or delay the care they need due to confusion and frustration.
Ultimately, engaging with members early and often can help healthcare stakeholders contain costs, improve patient outcomes and optimize the entire healthcare process for all.
When members are aware of and educated about their choices, they can make better decisions for their health sooner rather than later—which, in aggregate, can make healthcare more affordable for everyone and create a healthier society.
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