In an increasingly digitized world, the healthcare industry has invested heavily in technology to streamline communication and manage care, yet a profound engagement gap persists for the most vulnerable populations. Health plans serving Medicare Advantage, Medicaid, and dual-eligible members often find their sophisticated automated outreach systems failing to connect in a meaningful way. While technology can provide scale and efficiency, it cannot replicate the empathy, trust, and nuanced problem-solving that define human interaction. For these complex populations, the most effective path to better health outcomes is not found in an algorithm but in a genuine, person-to-person connection that prioritizes individual needs over standardized protocols.
The Limits of Technology and the Need for a New Approach
The Failure of Impersonal Outreach
The struggle to engage high-risk members is a persistent challenge for health plans, as these individuals are frequently hard to reach, often miss essential preventive screenings, and tend to receive care in costly settings like emergency departments. The prevailing strategy of using mass communication tools, such as automated text messages, robocalls, and direct mail, has proven to be profoundly ineffective. The data paints a clear picture of this failure: a mail campaign designed to boost Medicaid enrollment yielded a response rate of less than 2%, demonstrating that merely delivering a message does not guarantee it will be seen, let alone acted upon. Similarly, a health survey, which even offered the chance to win multiple iPads as an incentive, only garnered a 7% total response rate, with fewer than 4% of participants completing it fully. These figures underscore a critical disconnect between the outreach method and the member’s reality, suggesting that impersonal communications are easily ignored or dismissed.
This problem is compounded by the growing phenomenon of “message fatigue,” where the sheer volume of automated outreach becomes counterproductive. Research has revealed the alarming extent of this issue; one 2023 study found that some Medicaid and Exchange plan members in California were receiving as many as 20 automated messages per week. This constant bombardment leads to information overload, causing members to tune out important health reminders. Worse, a separate study of over 428,000 adults showed that patients who received 10 or more text messages or two or more automated calls were significantly more likely to opt out of all future communications. In doing so, they sever a crucial channel for the health plan, making it nearly impossible to provide support, close care gaps, or coordinate essential services. The very tools designed to increase engagement are, in many cases, actively driving members away and erecting barriers to care.
Redefining “Engagement” for Real Results
A core issue hindering progress is the fragmented and often superficial way the healthcare industry defines and measures member engagement. Many vendors in this space use disparate definitions, making it difficult for health plans to compare the effectiveness of different programs. A significant flaw in common metrics is the practice of counting the mere receipt of a communication—such as a delivered text, an opened email, or a completed automated call—as a successful engagement. This approach is fundamentally misleading because it equates passive reception with active participation. It fails to capture whether the member understood the information, was motivated to act, or took any concrete steps to improve their health. This focus on vanity metrics creates a false sense of accomplishment while obscuring the reality that true engagement has not occurred, leaving critical care gaps unaddressed and members no healthier than before.
To drive meaningful improvement, the industry must adopt a more robust, outcome-oriented definition of engagement. Meaningful engagement should be defined as the active participation of a member in their own health journey. This includes tangible actions such as consistently attending required physician visits, completing recommended preventive screenings like mammograms or colonoscopies, and accessing care in the most appropriate, lowest-cost settings, such as a primary care office instead of an emergency room. This redefinition shifts the focus from the quantity of outreach attempts to the quality of the resulting health behaviors. The lack of this deeper engagement is a pervasive problem that extends beyond high-risk populations; even among commercial plans, data from 2021 showed that 37% of members had no meaningful engagement, a figure that climbed to 44% for Pre-Boomer and Baby Boomer generations, highlighting a systemic failure to connect with members in a way that inspires action.
The Blueprint for a Human-First Strategy
Building Trust by Solving Real-World Problems
The transformative power of the human touch becomes most apparent when it is used to navigate the complex, layered challenges that often prevent members from accessing care. Technology can send reminders, but it cannot listen, empathize, or solve the real-world problems that stand in the way of a member’s health. This is best illustrated through the case of “Maria,” a 61-year-old Spanish-speaking member. From the health plan’s perspective, the primary goal was to close outstanding gaps in her breast and cervical cancer screenings. However, a human care coordinator, through a simple conversation, uncovered a far more urgent issue. Maria revealed that her primary care provider (PCP) had stopped accepting her insurance, and for six agonizing months, she had been unable to find a new doctor to manage her thyroid condition and refill her essential medication. Her immediate crisis had nothing to do with preventive screenings; it was about maintaining her fundamental health.
By prioritizing what mattered most to Maria, the care coordinator fundamentally changed the dynamic of the relationship. Instead of pushing the health plan’s agenda, the coordinator focused on solving Maria’s immediate problem. This involved navigating the provider network to find a new, in-network PCP who could see her promptly. This single, empathetic intervention did more than just secure a prescription; it built a foundation of trust. During Maria’s first visit, the new PCP performed the necessary cervical cancer screening, and with the coordinator’s help, Maria scheduled her breast cancer screening shortly after. In the end, all care gaps were closed, not because of a series of automated reminders, but because a person listened and addressed the member’s most pressing need first. This example encapsulates a core principle: solving a member’s primary problem creates the trust and rapport necessary to address the health plan’s long-term wellness goals.
Key Ingredients of a Successful Program
Crafting an effective person-to-person program requires a deliberate focus on several key characteristics that automated systems cannot replicate. First, communication must be accessible and convenient for the member, feeling more like a supportive conversation than an institutional directive. This means moving beyond impersonal mass outreach to create interactions that are genuine and tailored to the individual’s specific needs and circumstances. It is through these authentic conversations that care coordinators can foster the trust necessary for members to share their vulnerabilities and accept guidance. Second, successful programs understand that a health plan’s clinical objectives are rarely a member’s top priority. They are designed to first identify and respond to the most urgent needs, which are often related to social determinants of health (SDOH). A 2023 report highlighting that nearly 50% of families experienced a diaper need illustrates this perfectly; for a parent, the inability to send a child to daycare is a far more immediate crisis than a missed wellness visit.
Furthermore, a truly impactful program adopts a holistic, family-centric approach, recognizing that a member’s health is deeply intertwined with the well-being of their entire family. By offering support that extends to dependents, these programs can achieve greater overall member satisfaction and improved health outcomes for the household. Finally, the most effective initiatives employ local people who are part of the communities they serve. These staff members bring invaluable cultural competence and knowledge of local resources, helping to build stronger relationships and increasing the likelihood that members will follow through on recommendations. While a human-centric program may have a higher per-member cost than a tech-only campaign, its return on investment is vastly superior. The trust and support generated lead to tangible improvements in quality metrics like CMS Star ratings and HEDIS measures, which directly impact revenue, while also fostering the member loyalty and retention that are essential for long-term success.
