The ROI of Personalization: How Member-Centric Outreach Drives Financial Performance

For healthcare payers, the pressure to control costs while improving care has never been greater. While the concept of member-centricity is far from new, the ability to personalize engagement at scale using advanced technologies has become increasingly imperative for strengthening financial performance and cultivating member loyalty.

Today’s consumers expect an experience tailored to their unique history, behaviors, and preferences, with over half reporting dissatisfaction when those needs go unmet. By making a strategic investment in member-centric technologies and approaches, payers can directly contribute to cost savings and improve their bottom line.

The Case for Personalized Engagement

At its core, personalization facilitates greater feelings of trust, loyalty, and collaboration between payers and their members. Personalized member engagement uses analytics and behavioral insights to deliver timely, relevant interventions based on each member’s unique health profile, communication preferences, and risk status. Given the trust barrier facing today’s payers, quality member relationships are crucial for moving the needle on cost savings and improving overall health outcomes.

In PwC’s 2024 U.S. Healthcare Consumer Insights and Engagement Survey, payers ranked fifth among the five main healthcare information sources–trailing doctors, the Internet, pharmacists, and word-of-mouth from friends and families. With 65% of consumers saying they only seek healthcare once the need becomes urgent, healthcare payers have much to gain from proactive, personalized intervention. That is, members who defer care are more likely to utilize emergency rooms and urgent care centers, increasing the frequency of preventable health expenses.

Meanwhile, personalized engagement fosters effective health member engagement and, in turn, leads to more efficient use of healthcare resources. In a report from Boston Consulting Group, personalized member engagement brought considerable cost-saving benefits for payers and providers alike: In as few as six months, consumer experience rose 10%, payers’ administrative costs fell by 10%, and hospitals’ 30-day readmission rates declined.

Personalization in Practice

In the past, disparate legacy data systems created a fragmented view of the individual, making it difficult for payers to capture a holistic understanding of their members’ health journeys. Now, innovative tools like artificial intelligence (AI) and predictive analytics can highlight at-risk members, guide proactive preventions, and ensure the continuity of care. Crucially, member-centric engagement can directly impact and prevent instances of care deferral by accounting for specific social determinants of health (SDOH).

For payers, care deferral and poor treatment plan adherence lead to higher downstream costs, including hospitalizations, complications, and disease progression. Individuals who are middle-aged, immigrants, urban residents, caring for children, or reportedly unsatisfied with their primary care provider are among the most likely to defer care. These individuals have poorer outcomes at a higher cost, underscoring the importance of consumer-centric health journeys.

Such is the power of member-centric outreach. Personalized interventions like refill reminders, pharmacist outreach, and timely nudges can significantly improve adherence when customized to a member’s language, literacy level, and behavior patterns. Likewise, tailored communications bolster consumer trust in the healthcare system and encourage preventative healthcare utilization: When payers address consumer pain points, members defer care 10% less frequently and are 14% more likely to seek routine care.

How Member-Centric Engagement Pays Off

With the right digital strategy, payers can build trusted relationships with members for faster rates of revenue growth and higher annual savings. By putting personalization in place, a health plan with 500,000 members could increase annual revenue by up to $150 million. To unlock these savings, payer executives must think beyond traditional outreach and embrace a proactive, tech-enabled approach to member engagement.

Notably, AI tools can serve as effective instruments for tailored communication, enabling operational efficiency through multiple channels and improving baseline administrative costs by nearly two percent. Further, advanced analytics enable payer organizations to identify at-risk members and deliver tailored campaigns that encourage the appropriate interventions.

When it comes to building trust with members, personalized touchpoints such as interactive voice response (IVR) call, email, text message, or live two-way chat can go a long way. In a recent study examining responses to consumer health questions on social media forums, evaluators ruled in favor of chatbot-generated responses, finding them higher-quality and more empathetic than physicians’ replies. As such, technology has the power to reshape the consumer experience and enhance member engagement–boosting transparency, simplifying digital interactions, and overcoming barriers to noncompliance for treatment plans.

Optimizing the Return on Digital Investment

By investing in strategies to proactively connect with members in meaningful, individualized ways, payers can reduce avoidable costs and cultivate stronger relationships. As the weight of consumer satisfaction continues to grow, investments in personalized engagement are key to improving financial performance and staying competitive in a member-first marketplace.

Paving the way for personalized engagement and greater care adherence, the TeleVox Payer Edition’s Member Relationship Management Platform facilitates omnichannel communication, accommodating members’ unique needs and preferences. Using on-demand, two-way conversation, payers can create seamless service continuity and engage members at every step in their health journey–ensuring timely communication translates to smarter care decisions and better financial outcomes.

Learn more about how TeleVox can help your organization invest in personalized engagement that pays off.