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HealthEdge Horizons: The Changing Face of Healthcare Engagement in 2024

From rapidly changing regulatory requirements and new competitive forces to changing payment models and rising consumer expectations, 2024 is shaping up to be another challenging year for health plans. In this 5-part blog series entitled HealthEdge Horizons, we dive deeper into the trends that are shaping our industry and explore how HealthEdge solutions are helping payers address their biggest challenges head-on. Be sure to check out the entire series:

A pivotal moment has arrived in the ever-evolving landscape of the healthcare insurance industry. Healthcare consumers are no longer content with traditional engagement methods and seek more personalized experiences from their health plan providers. It has never been more important for health plan leaders to be aware of the key issues surrounding members’ rising expectations. The challenge is two-fold:

  1. Consumer buying experiences in other industries: Consumers now expect a level of engagement and convenience from their health plan providers that mirrors their experiences in other sectors, such as retail and banking. The days of primarily relying on phone calls for problem-solving are giving way to more digital and automated solutions. They want omnichannel communications that adhere to their lifestyles and interests.According to a recent HealthEdge survey of more than 2,800 healthcare consumers, the number one way health plans can improve member satisfaction is by adhering to members’ communication preferences. This shift underscores the need for insurance companies to adapt and equip their teams with modern, omnichannel engagement solutions.

  2. Increased access to healthcare information: With more health and wellness information available on the internet, members have unprecedented access to healthcare information. They are more educated about their conditions, treatment options, and even the costs associated with healthcare services. They can more easily find doctors on the internet who meet their specific needs. When they do engage with their healthcare provider, they typically leverage digital tools, such as appointment reminders, portals, and even text messaging.

This newfound knowledge and availability of more modern tools empower consumers to play a more active role in managing their care. As a result, they also expect greater access from payers regarding benefit information, authorizations, costs, and even clinical guidance that can help them make better decisions about their health.

A New Generation of Members Requires New Engagement Strategies

Health plan leaders must be cognizant of the changing preferences of consumers in a post-COVID world.  According to the same HealthEdge consumer study, today’s members seek self-service mobile tools and prefer to engage with their healthcare plans and providers on their own terms. Furthermore, when assigned a care manager, members want care managers to:

  1. Communicate with me in the ways I prefer
  2. Enable me to actively participate in my care plan
  3. Refer me to social services and resources
  4. Help me get and manage my medications
  5. Have my health information on hand when we communicate

Healthcare consumers are not the only ones pushing for greater transparency and better experiences. One significant regulatory development driving change in the industry is the Transparency in Coverage Act, which requires health plans and providers to provide members with greater visibility into the cost of services before they receive them. This transparency places additional pressure on healthcare payers to offer solutions that enable their members to access pricing information easily and make informed decisions about their care.

Additionally, CMS announced that it is doubling the weight of member experience when calculating payers’ 2023 Star Ratings.

Never before has there been a more important time for health plan leaders to address their members’  evolving demands when it comes to digital engagement strategies.

The HealthEdge Approach

HealthEdge recognizes these challenges and offers health plans a comprehensive strategy to address them. By providing both data and software solutions, the company aims to support healthcare payers in meeting the demands of the evolving healthcare market. From clinical engagement tools to benefit and health risk predictions, HealthEdge’s solutions are designed to enhance member experiences and improve overall wellness.

Here are some practical examples of how the HealthEdge portfolio of solutions helps payers create more personalized and meaningful member experiences:

HealthRules® Payer

    • Enabling health plans to provide superior customer service with first-call resolution
    • Real-time data allows members and providers to make decisions at the point of care
    • Enable self-sufficiency for members seeking cost transparency
    • Faster and more accurate claims payments lead to higher member satisfaction
    • Learn more about our core administrative processing system.

HealthEdge Source™ payment integrity platform

    • Delivering accurate and transparent claims payments reduces the clerical burden on clinicians, which leads to burnout
    • Minimizing clerical burden on providers by removing rework, review, and waste
    • Ensuring that member eligibility and benefits information is accurate and available
    • “Every minute they spend on administrative tasks reduces the time they spend practicing medicine”
    • Learn more about our payment integrity platform

GuidingCare® care management platform

    • Drives secure member communication with their designated care team
    • Mobile clinician application enables offline access for care management staff in the field, enabling connection to members anytime, anywhere
    • Designed to meet NCQA health plan guidelines for Member Self-Management
    • View care plan goals and actions, access personal health records, track health and wellness data, complete health assessments, and more.
    • Learn more about our care management platform

Wellframe member experience platform

    • Enables highest needs members to get access and support outside of traditional care delivery settings
    • Omni-channel communication seamlessly connects members
      to designated care teams, with an average of 34 digital touchpoints/member/month
    • Self-service digital resources empower members to reach their health
      and wellness goals proactively
    • Modern user experience increases both member satisfaction and engagement
    • Learn more about our member experience platform.

Visit to learn more about how HealthEdge can help your organization engage with your members more personally and meaningfully, proactively reduce costs, and address ever-evolving regulatory requirements.