Cracking the Member Experience Code: How Health Plans Can Truly Connect
The healthcare industry is grappling with a profound disconnect: members are more confused, frustrated, and disengaged than ever — while health plans are doing more than ever to engage them.
Healthcare is complicated. But it doesn’t have to be chaotic.
At Insightin Health, we believe it’s not about doing more. It’s about doing what works. At the 16th Annual Medicare Market Innovations Forum, we presented “Cracking the Member Experience Code,” where we shared why today’s fragmented approach to member engagement isn’t enough — and what a modern, predictive, and truly personalized experience should look like.
If you missed the session, here are the top takeaways and how the Insightin’s inGAGE™ platform is redefining the member experience.
The Problem: Members Are Navigating in the Dark
Member confusion is driving dissatisfaction, churn, and unnecessary operational costs:
- 87% of members struggle with health insurance literacy
- 75% don’t understand their plan benefits
- 62% prefer self-service, yet are forced into reactive, high-friction call center experiences
- 91% say speed of resolution is their top satisfaction driver
But most health plans are still operating at a transactional level — where every member call feels like starting over.
We asked: How can we make healthcare navigation feel as easy as booking a rideshare or tracking a package?
The Insightin Solution: From Confusion to Confidence
To close this gap, we built inGAGE™ — an AI-powered platform that breaks down data silos, personalizes outreach, and proactively supports members in the moments that matter.
Here’s how:
- Unified Data Lake Integration
Plans often have access to rich data — but it’s trapped across disparate systems. inGAGE™ ingests and harmonizes medical, behavioral, and engagement data to enable a true 360° view of the member.
- Predictive Analytics with Scorecard
Our AI-powered Scorecard predicts who is at risk, identifies key moments to intervene, and continuously learns from engagement to improve precision.
- Multilingual, Omnichannel Engagement
Whether by email, SMS, IVR, live agent, or microsite — inGAGE™ meets members where they are, in the language they prefer, on the channel they use most.
- Journey Orchestration and Smart Communications
Each member receives relevant, timely messages tailored to their health goals, plan design, and social determinants of health — turning outreach into outcomes.
Case Study: A Medicare Advantage Plan’s Transformation
A national plan serving 1.2 million Medicare members, including dual-eligible and hard-to-reach populations, partnered with Insightin to reverse declining satisfaction and retention.
Before inGAGE™:
- Limited visibility into root causes of dissatisfaction
- Disconnected surveys, benefits, and customer service data
- No way to prioritize high-impact populations
After deploying inGAGE™:
- Root cause analysis through predictive insights
- Personalized campaigns across multiple languages and channels
- Intelligent segmentation to reach members most likely to churn or struggle
The results:
- 64% increase in reach rate (41% vs 25%)
- 70% completion rate among those reached
- 95% satisfaction for completed interactions
- 23% fewer complaints related to benefits
- 35% drop in benefit-related customer service calls
This was not a better campaign. It was a better experience — for both members and the teams supporting them.
Real Lives, Real Impact: Meet Michael
We often talk about data, but it’s the member story that matters most.
- Michael, a 67-year-old member in California, faced multiple barriers: transportation gaps, food insecurity, and digital illiteracy. His plan’s static materials and disconnected outreach left him lost.
With Insightin, his journey was transformed:
- Proactive check-ins and care navigation
- Clear, personalized directions to services and benefits
- Follow-up support to ensure resolution and engagement
Michael is now part of the 95% of members who report satisfaction with the personalized guidance delivered through inGAGE™.
What Modern Members Expect — And Why It Matters
Members today do not compare your plan to other payers. They’re comparing it to every other experience in their lives. That’s why we designed inGAGE™ to match rising expectations:
| What Members Expect | How You Can Deliver with Insightin |
| Self-service and speed 62% prefer self-service over calling customer service |
24/7 digital access, live agent backup |
| Personalization 80% expect personalized communications from health plans |
Omnichannel, multilingual outreach |
| Proactive guidance Navigation that anticipates needs & simplifies benefits |
Predictive AI-driven scorecards |
| Simplicity Use of digital channels for routine healthcare tasks |
Coordinated, clear next steps |
| Consistency Consistent support across self-service & high-touch interactions |
Unified messaging across channels |
We’ve seen this model reduce grievances by 30–40% and cut operational costs by 25–30%. More importantly, it helps members trust, use, and value their plan.
The Future Is Personalized, Predictive, and Human-Centered
The path to a better Stars rating, stronger retention, and lower call volumes starts with transforming the experience — not just the output.
Insightin makes that transformation possible with the only member engagement platform that integrates:
- Deep health and SDOH data
- Real-time engagement insights
- AI-powered personalization
- End-to-end experience orchestration
Whether you’re supporting Medicare Advantage, Medicaid, or Commercial lines of business, now is the time to evolve from reactive outreach to predictive connection.
Let’s transform healthcare together — one member at a time.
