Unlock the Secret to Scalable Personalization

Healthcare is personal, and member outreach should reflect that. Through personalization, health plans can ensure interactions with members continuously build trust and move them towards the next best health action. Understanding where members are in their journeys, what challenges they face and how they want to receive information enables plans to lay the foundation for personalized, targeted outreach.

When digitally engaged with Healthmine personalized outreach strategies, members complete four more health actions than unengaged members and are motivated to complete an average of three additional care gaps after their Annual Wellness Visits (AWV).

What is Personalization?

Personalization occurs when member outreach reflects the unique circumstances of each member. This includes the way plans use language, content, imagery and channels to deliver healthcare information. By making a member feel seen, plans can build trust, loyalty and engagement.

Personalization is not an added benefit for health plans. According to McKinsey, 71% of consumers want personalization from brands and 76% get frustrated when they don’t receive it. When asked what drives brand trust, seven out of ten Hispanic consumers stated they’re more likely to support brands that make them feel seen, according to MyCodeMedia. Striving towards personalization, especially for diverse communities, is vital for meeting health equity regulations initiatives, improving member experiences, maximizing engagement and increasing member retention.

Factors that influence personalization include:

• Health conditions and care gaps
• Member preferred communication channels
• Race and ethnicity
• Language preference
• Sexual orientation
• Gender identity
• Location
• Social determinants of health
• Member behaviors
• Healthcare experiences
• Digital health literacy

Ideally, plans should incorporate all relevant factors to ensure every touchpoint has the strongest impact on members, but plans can start small with the information they currently have and scale from there. The goal is to build a deep understanding of member needs so that plans can identify which factors will drive members to complete health actions.

“Personalization is marathon, not a sprint,” says Chris Gage, Director of Experience Strategy. “Starting with what we know will allow us to continue to learn more about the members, improving personalization and building trust.”

Gaps in Personalization

Unfortunately, most plans either do not invest enough in personalization or rely on limited personalization, which leads to several missed engagement opportunities. When polled about personalization, 61% of brands stated they personalized consumer experiences, but only 43% of consumers stated their experiences were personalized, according to Deloitte. This gap between brand and consumer perceptions highlights how brands need to focus on ensuring personalization meets consumer needs.

For example, consider a hypothetical health plan who tried to use physical mail to close care gaps. This plan segmented outreach lists based on care gaps and mailed each member a relevant list of health recommendations. However, due to a lack of data and time, the plan did not account for how diverse and complex their population is.

While the letters were useful for educating a handful of members about their conditions, they only scratched the surface of what those members needed. Some members needed the material translated into their preferred languages, others needed lower reading levels and several did not receive the letter due to being housing insecure or their addresses being incorrect.

As a result, these members were left alienated and confused by the letter. In turn, the plan lost money, time and resources on a campaign that had a limited impact on performance goals. Campaign metrics were also not tracked, and the plan did not follow-up with non-responders.

This was not the fault of any one team or department. Personalization requires constant alignment between data and outreach to enable teams to quickly tailor touchpoints based on updated member records. The wider the gap between data and outreach, the harder it is to scale personalization.

Plans do not need to uproot their entire engagement process or technology suite to fill these gaps, however. Achieving sustainable and scalable personalization is possible by shifting how teams align data and outreach through straightforward processes.

Where to Get Started

Scalable personalization is powered by a continuous feedback loop between data and outreach. Member data should inform all touchpoints, and all touchpoints should collect more data to support future interactions. Consolidating member records and campaign metrics in a single platform gives teams a complete view of member journeys to determine how they are responding to outreach.

Even if plans only have basic enrollment information to start with, data consolidation allows them to steadily build out a single source of truth for guiding engagement strategies. By monitoring campaign metrics at a member-level, plans can tailor strategies to address different dispositions, such as members who do not open emails, members who open but do not click links and members who open but do not complete health actions.

This approach enables plans to start small and scale personalization over time as more data is collected. Teams should prepare for larger data collection touch points, such as Annual Wellness Visits (AWV) and health risk assessments (HRA), by ensuring they have the processes in place to consolidate that data and are ready to action it in future campaigns.

Streamline Personalization with an Integrated Platform

Personalization is sustainable and scalable when health plans leverage the right tools and processes. By applying basic personalization techniques to member outreach, plans can test out personalization and see the results for themselves. Building up to larger personalization strategies will require an integrated engagement platform, however.

With Quality Relationship Management^TM (QRM®), health plans can accelerate member engagement with personalization best practices without having to start from scratch. QRM unifies all member data, outreach, campaign metrics and analytics into a single location to help teams create data-driven campaigns that fit their member populations.

Scaling personalization with QRM enables plans to:

• Accelerate performance under the Health Equity Index to maintain or improve Star Ratings.
• Increase completion rates for the HEDIS SNE-S measures and proactively target members ahead of the 2026 Star Ratings measures.
• Consolidate all data into longitudinal member records and monitor campaign metrics with regularly updated dashboards to improve performance transparency.
• Build data-driven engagement strategies to address evolving regulatory challenges with guidance from behavioral scientists, content strategists and regulatory experts.
• Streamline campaign development by segmenting outreach lists and personalizing white-labeled communication templates to reflect your member populations.
• Tailor member journeys around preventive care visits to reduce emergency room rates, control medical loss ratios, increase risk adjustment revenue, improve Star Ratings and lower costs of claims.
• Optimize daily operations by using automated processes to free up staff from having to manually aggravate disparate data, tailor outreach strategies and monitor performance goals.

Take the mystery out of personalization when you use QRM’s integrated engagement platform to unify data, outreach and analytics. Contact us for a demo.