2025 Health Plan Guide: Transforming Member Engagement & Satisfaction

Section Guide:

Key Investments For Member Engagement

Overcoming Barriers To Member Satisfaction

6 Key Strategies For Boosting Member Engagement

Impacts Of Transforming Member Engagement

Key investments for member engagement

Today’s healthcare consumer expects seamless, digital-first interactions with their health plan. They demand transparency, self-service options, and personalized experiences—which required a departure from traditional in-person and telephonic member engagement methods. In addition to improving satisfaction and clinical outcomes, maximizing member engagement can enable health plans to meet strategic business goals.

In the HealthEdge® Annual Payer Market Planning Report 2025, we uncovered the key areas health plans are focusing on to enhance member engagement. Improving health equity and addressing disparities came in as the top priority for health plan executives (59%). The dual focus on equity (59%) and transparency (51%) signals a broader commitment to bridging care gaps while building trust. Plans that prioritize equitable access to information and services position themselves as true partners in health.

To achieve these goals, payers are investing in the following solutions to help educate and empower members while streamlining processes for payers and providers:

• Member Portals – Centralized digital hubs that give members easy access to their benefits, claims, and personal health information.
• Mobile Apps – User-friendly mobile apps designed to bridge gaps between members, payers, and providers by enabling seamless outreach and communication.
• Enhanced Member Service Centers – Deliver personalized, real-time support to resolve issues effectively.

Overcoming Barriers to Member Satisfaction

Despite advancements in member engagement technologies, several challenges still inhibit scalability and member impact:

Legacy core administrative processing system (CAPS) can cause data sharing bottlenecks that create inefficiencies and frustrate members with inconsistent, disconnected healthcare experiences. Health plans without access to updated, integrated data and analytics will be stuck reactively addressing gaps in care.

Social determinants of health (SDoH) add layers of complexity to healthcare access and engagement, making one-size-fits-all solutions ineffective. Tailoring member engagement efforts to diverse populations is critical to earn members’ trust and build lasting relationships. But gathering and analyzing the data necessary to provide a personalized experience can be challenging with outdated and disparate systems.

In addition to data access and analysis, health plans and members are increasingly concerned about data privacy. While members expect tailored interactions, concerns about data usage and security persist. Regulations from the Centers for Medicare and Medicaid Services (CMS) encourage health plans to be transparent about data use and security measures to reduce cybersecurity risks.

Health plans must adopt modern technology to make healthcare more accessible and empower members to engage with their plans and take an active role in their wellness.

6 Key Strategies for Boosting Member Engagement

To meet member demands and overcome barriers to member engagement, health plan leaders are developing proactive, technology-forward strategies. Based on their priorities for 2025 and beyond, we suggest 6 strategic solutions health plans can adopt to meet member engagement goals.

1. Enhance Accessibility with Self-Service Tools

Customer experience has evolved beyond face-to-face interactions, with technology playing a crucial role in customer service. This shift aligns with consumer preferences —an estimated 73% of customers prefer the ability to resolve issues on their own.

According to the Market Planning Report, 45% reported the “inability to self-serve” was one of the biggest hurdles to member satisfaction. Providing members with user-friendly tools can help give them control over their health and make more informed care decisions. Platforms like GuidingCare® and Wellframe integrate personalized health information with streamlined care workflows, helping members manage their health and benefits from a mobile device.

Self-service tools, such as member portals, digital care programs, and care management, allow members to easily:

• Check benefits and coverage.
• Access educational content tailored to their health conditions.
• Reach out to care teams and health plan representatives.

Where can we go next?

Streamlining Member Touchpoints: Focus on reducing friction in member interactions, whether digital or in-person, by eliminating silos and simplifying processes.

2. Personalize the Member Journey

Each member has unique health and wellness needs, and engagement preferences. Advanced artificial intelligence (AI) and integrated data analytics enable health plans to offer personalized health recommendations and prioritize member outreach.

AI-powered tools are helping plans stay ahead of industry shifts by anticipating member needs, simplifying care management, and creating more personalized experiences. By automating workflows, these solutions help reduce inefficiencies and reallocate vital resources. In fact, AI-enabled solutions are well received among consumers— 65% expressed a preference for health plans that leverage AI to create a more personalized experience for members.

Leveraging insights from platforms like Wellframe, health plans can suggest tailored care programs based on a member’s demographics, health goals, and survey responses—improving member engagement and satisfaction.

Where can we go next?

Deepening Personalization Through Data: Use AI and advanced analytics to deliver relevant, contextual information to improve member experiences while maintaining transparency around data use.

3. Address Health Equity

Closing the health equity gap is one of the most critical initiatives for health plans. This involves ensuring that all members, regardless of socioeconomic background or geographic location, have equal access to high-quality care. By investing in digital health management solutions, health plans can expand their reach to underserved populations.

Learn more about how digital care programs can improve outcomes for high-risk maternity populations by reading our blog, Reduce Maternal Morbidity Risk for Black Women with Digital Care Management.

Where can we go next?

Embedding Health Equity into Core Strategies: Ensure your health plan’s member engagement strategies account for potential disparities and help create equitable experiences for all members.

4. Simplify Healthcare Communications and Information Access

Healthcare data is often difficult for members to understand, which contributes to confusion and frustration. There are a few ways health plans can help members better navigate the healthcare system. Health plans should consider making the member communications and educational materials easier to understand and more accessible.  Leverage plain language, visual aids, and interactive elements to explain complex health information. This approach can help members feel more confident in managing their health and make informed decisions.

Health plans can also focus on simplifying access to key healthcare and coverage documents, including:

• Real-time benefits information
• Detailed explanations of out-of-pocket costs
• Resources for making better health and financial decisions

Clear and accessible information about healthcare coverage and access builds trust between health plans and their members. It also empowers members to make more informed and confident decisions about their health .

Where can we go next?

Promote Health Literacy and Improve Healthcare Navigation: Develop member communications and documents with the intent of improving health literacy. This helps members understand what to expect when it comes to making appointments and using their coverage.

5. Streamline Claims and Administrative Processes

Efficient claims processing ensures that members receive timely and accurate reimbursements, which directly impacts their perception of care and coverage. When claims are processed smoothly, members experience fewer billing errors, delays, and frustrations, leading to a more positive overall experience.

Transparency in billing and claims processing is equally vital, as it helps members understand their financial responsibilities and prevents surprises. By providing clear, detailed explanations of benefits, coverage, and out-of-pocket costs, health plans can build trust and reduce anxiety about unexpected bills. This transparency fosters collaboration and leads to stronger partnership, ultimately improving health outcomes.

Where can we go next?

Streamline Claims and Simplify Billing: Implement efficient claims processing and enhance transparency in billing for accurate reimbursements and clear communication. Utilize advanced solutions to manage complex needs and ensure a seamless healthcare experience for members.

6. Leverage Mobile Apps for Omnichannel Engagement

Mobile apps are more than just convenient—they’re essential. Up to 64% of health plan members are comfortable using mobile apps to engage with their health plans. This gives  health plans more opportunities to learn about members’ unique needs and provide proactive support. Integrated digital health apps combine communication tools (such as HIPAA-compliant messaging) with biometrics and activity tracking to keep members engaged and on track with their health goals.

Wellframe, for example, creates an average of 34 digital touchpoints per member per month through the mobile app. Touchpoints include a combination of high-value interactions such as:

• Dismissing medication reminders
• Logging biometrics or physical activity
• Completing digital surveys

Where can we go next?

Building Proactive Engagement Models: Shift from reactive service to proactive outreach, using insights to address potential engagement gaps before they become issues.

Impacts of transforming member engagement

When health plans integrate intelligent engagement strategies, the impact is clear:

• Higher Member Satisfaction – Clear communication, self-service tools, and accurate claims lead to decreased frustration.
• Improved Health Outcomes – Care management workflows and personalized actions encourage better adherence to care plans.
• Greater Retention – Positive experiences cultivate loyalty, ensuring members remain with their health plans longer.

By meeting members where they are and aligning strategies with consumer expectations, health plans have an opportunity to redefine their relationships with members. The integration of innovative technologies and personalized experiences will be critical in 2025 and beyond, allowing health plans to differentiate themselves in an increasingly competitive landscape.

Are you ready to make member engagement your competitive advantage?