What True Member-Centricity Looks Like for Healthcare Payers in 2025

In today’s payer sector, member-centricity isn’t just a selling point––it’s the defining factor in a growing divide between the nation’s highest and lowest-performing health plans. For decades, efforts to increase access to affordable and high-quality healthcare through widespread reforms and structural shifts have paved the way for a care continuum that emphasizes personalized, high-touch pathways, placing an important premium on member satisfaction and meaningful interactions.

With consumer expectations continuing to grow, adopting a member-centric approach is mission-critical for payer executives looking to limit churn, reduce costs, and improve insight into members’ health journeys. By finding new ways to engage and empower members with a focus on personalization, payers can play an instrumental role in expanding access to quality care and improving healthcare outcomes––all while strengthening their competitive edge.

Understanding Member-Centricity

Far more than a buzzword, true member-centricity requires proactive and data-driven visibility into the entire health journey, as well as a focus on personalized care. A member-centric health plan prioritizes simplicity, transparency, and seamless interactions––designed with members’ needs and preferences at the center of service delivery. To meet the moment, forward-thinking payers are making substantial changes in how they operate, communicate, and leverage technology.

According to a 2024 study from Accenture, poor member experience is a leading factor behind individuals’ decisions to switch health plans. While accessibility, convenience, and digital engagement are among the top factors driving member loyalty, negative interactions such as unreliable or inconsistent information, disjointed or inaccessible digital experiences, and unsatisfactory customer service can have the opposite effect. With medical and technological advancements transforming the way that care is delivered and experienced, successful healthcare payers are making the shift from standardized solutions to personalized interactions.

Personalizing the Member Experience

Personalization is at the core of any truly member-centric strategy. In the past, health plans often used a one-size-fits-all model—providing the same benefits, communications, and outreach for every member. Currently, fewer than 40% of payers track members’ end-to-end healthcare journeys, indicating a significant gap between member-centricity in theory and in practice.

Meanwhile, leading payers are building more flexible systems that adapt to the individual and build member profiles that go far beyond basic demographics or claims data. These profiles might include health conditions, engagement patterns, language preferences, social determinants of health (SDOH), and even digital behavior. With this 360-degree view, plans can segment members and tailor their experiences accordingly. For instance, a new mother might receive postpartum care resources, lactation support options, and reminders for infant check-ups—all timed and delivered in her preferred communication method.
This shift from treating members as generic policyholders to engaging them as individuals is where real transformation––and member satisfaction––begins.

Building Digital Pathways to Meet Members Where They Are

Digital innovation plays a significant role in bolstering member satisfaction, enabling customization, convenience, and consistency across crucial touchpoints. Member-centric payers are investing heavily in digital platforms and tools that make healthcare more accessible and intuitive for users while reducing administrative overhead. For one, digital member access and omnichannel communication systems help payers build and sustain positive momentum with their members. These pathways support seamless transitions between conversational tracks and encourage collaboration between members, providers, and payers.

Whether through an interactive voice response (IVR) call, email, text message, or live two-way chat, these touchpoints enable continuous service and proactive communication tailored to members’ channel and format preferences––encouraging greater participation in preventative care, reducing cost per member for payers, and making care more affordable for members. When members receive communications on their preferred channels, overall engagement and satisfaction increases. In turn, payers can leverage these conversational pathways to send personalized reminders and educational resources related to members’ health conditions, treatment options, and resources––strengthening trust and leading to better treatment adherence.

Crucially, these digital experiences are being designed for usability and convenience, based on actual member feedback and insight into SDOH such as race, ethnicity, socioeconomic status, and other environmental factors impacting both health status and accessibility of care.

When it comes to leveraging technology that meets members where they are, healthcare data provides essential, end-to-end visibility into members’ health journeys. Utilizing artificial intelligence (AI) and machine learning, payers can implement platforms that process healthcare data in real-time and provide deeper insight into members’ backgrounds and pain points. Members are three times more likely to trust payers when their plans consist of accurate and tailored communications. In fact, one health plan saw a 35% year-over-year increase in completed osteoporosis examinations after sending their members tailored messages addressing historical reasons for non-compliance specific to their demographic cohort.

In practice, member-centric models and platforms enable dynamic, personalized outreach. Where static and standardized messages fail to engage members, communication that accounts for factors such as family history, regularity with annual screenings, and reasons for non-compliance can address specific concerns and increase the likelihood of an ideal outcome.

Answering the Call for Member-Centricity

Ultimately, proactive and tech-enabled outreach with personalized engagement is the hallmark of a member-centric service model—one that recognizes every interaction as an opportunity to help an individual achieve full health. To execute an authentic approach to member-centricity, payers require a comprehensive platform that can manage their members’ data and streamline proactive communication for personalized engagement.

Using the TeleVox Payer Edition platform, payers can unlock the digital maturity and end-to-end visibility they need to both scale and enhance their member outreach. From member onboarding through patient activation, payers can leverage a centralized member relationship management platform to meet members where they are—personalizing engagement, optimizing outcomes, and lowering healthcare costs across the board.

Learn more about how TeleVox can support your organization in becoming a truly member-centric payer.