In 2025, health plans must navigate tightening regulations, capitalize on the opportunity of generative AI capabilities and deliver more personalized consumer experiences, all while creating efficiencies to address workforce capacity issues and operating in a more cost-conscious healthcare environment. As the healthcare landscape rapidly evolves, doing the above successfully will help health plans adapt to stay competitive and meet growing consumer expectations. With this backdrop, here are 10 trends that will shape health plan engagement strategies in 2025:
1 . LLMs in Market
Large language models (LLMs) have been a hot topic in the health plan space for the last couple of years. However, there is still hesitancy around their deployment by payors due to the levels of risk and the significant resources required for implementation with unproven value. In 2025, LLM based- programs will be deployed by innovative health plans and the value of these programs will become better understood. However, it is unlikely that these initial forays into generative AI will power large enterprise engagement programs. Instead, they will have more limited use across bots (with limited scope of engagement topics) and to augment existing engagement strategies.
2. AI Mix
While LLMs have dominated the AI discussion, many other types of AI have been delivering value for years. As the global hype around LLMs wanes, there will be more focus on other types of AI and their value. This will lead to discussions around AI mix and how different technologies can deliver value to health plans, such as machine learning analytics, causal AI and predictive AI.
3. Consent and Trust
TCPA regulations that come into effect in April provide new provisions for how consumers can revoke consent from IVR and autodialed SMS programs. These changes mean healthcare organizations must have robust processes to understand and prioritize all engagement and communications going out to their patients and members and implement robust strategies to manage consent. Healthcare organizations will focus on high value touchpoints that build trust and program opt-out rates will become a critical KPI.
Upcoming Changes to TCPA Consent Revocation Rules
At the start of 2024, the FCC outlined changes in how consumers can revoke consent from pre-recorded voice and autodialed text programs. Recently, the FCC has confirmed these requirements will become effective starting April 11, 2025. These updates will require health plans adopt cross-channel opt-out strategies and natural language understanding (NLU) capabilities to better identify messages […]
4. Engagability and Resource Prioritization
Robust digital engagement technologies generate deep insights about health plan members. By analyzing this data, health plans can create models about the ‘engagability’ of different members. This analysis provides key information about who should be engaged, on what topics and how they should be engaged over different channels. By aligning this data with organizational goals, health plans will prioritize their resources across engagement programs to optimize business outcomes.
5. Journey Visualizations
With detailed insights about member engagement touchpoints, health plans have access to retrospective and forward-looking journey views across digital and other touchpoints with the plan. These data will allow plans to map optimal touchpoints at the individual level to drive business outcomes and then align across departments around prioritization of touchpoints to optimize the experience and business outcomes.
6. Engagement Experiences
With the upcoming introduction of the Health Equity Index (HEI) and the need to engage culturally diverse populations, health plans will deploy more tailored, meaningful communications to different population segments. They will need to adopt a range of content strategies to create touchpoints that are captivating and generate engagement to be able to influence health attitudes and literacy levels that are necessary to drive program outcomes.
7. Consolidation of Vendors
As the TCPA imposes tighter regulations around engaging communications across IVR and SMS programs, health plans will consolidate communication vendors to manage consent and opt-out/revocation strategies confidently. Consolidation also reduces risk profiles around the security of PHI and allows for the development of broader enterprise-wide engagement strategies to improve alignment across departments, enable orchestration and holistic consumer journey mapping.
8. CRM Limitations
As healthcare organizations strive to deliver more consumer-centric experiences, many have adopted CRMs to capture and manage consumer information. While CRMs have strong foundational capabilities, they have significant limitations regarding the nuances of the healthcare industry and consumer needs. As health plans deploy CRMs, many will recognize these limitations and seek to augment their CRM investments with other healthcare-specific technologies.
9. Closed Loop Analytics
Healthcare organizations will realize the benefits of deploying engagement strategies across a connected ecosystem of technologies, enabling closed-loop analytics and measurement. This capability will improve understanding of program performance as outreach outcomes are measured directly and additionally, closed-loop analytics will measure the impact of predictive models and tailoring strategies. These sophisticated approaches will build the foundation for predictive modeling of program outcomes, a foundational element of AI-powered enterprise engagement strategies.
10. Payer API Efficiencies
As payers meet CMS requirements around payer interoperability standards, they will have the foundation to deliver better experiences for consumers and providers across 7 new APIs. Health plans that build broader CX and engagement strategies around these capabilities will improve relationships with providers, empower their members and be able to sunset inefficient manual processes across key areas of their operations.
As we enter 2025, health plans are at a pivotal moment in redefining consumer engagement and strategies put in place now to proactively adapt will shape their trajectory for years to come. By investing in innovation, plans can create impactful and personalized experiences for their member populations while also optimizing resources. The trends discussed above, from utilizing a variety of AI technologies to addressing regulatory requirements and focusing on enhancing member trust – can provide a roadmap for navigating this dynamic environment.
