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Shifting the Mindset: How Health Plans Can View Members as Consumers in a Digital-First World

What can health plans learn from the retail industry’s success with consumer engagement?  

A lot, it turns out. Leading retail organizations have been using important digital-first principles for a couple of decades now. This approach has not only transformed the expectations of everyday consumers for all organizations they encounter (including healthcare) but has also driven profits through the roof for these companies.  

Take a moment to think about it. When you sign into Amazon, everything you experience as an end user is seamless and customized. From the presentation of personalized recommendations on your homepage (which is different for every customer) to the fast and easy delivery of your items. It’s all frictionless and crafted for the consumer. 

Where does this leave healthcare? Well, even though health plans are not direct competitors of Amazon (or even in the same industry), their members live in an Amazon world and now have expectations set for this kind of consumer experience across all areas of their lives – food delivery, online retail, and yes, healthcare. The challenge for healthcare organizations now becomes leveling up to those expectations and harnessing these digital-first principles to improve their members’ experiences and inspire healthy behaviors. 

From Members to Consumers: How plans are adopting popular digital trends from leading consumer brands to drive better health outcomes » 

The first step toward that goal is understanding that members are no longer just members. They have become fully-fledged consumers of healthcare services and treating them as such is a critical way for plans to be competitive in a digital-first world. 

Beyond the Consumer Mindset: Implementing a Digital-First Experience 

Simply shifting your view of your members to consumers, however, is not enough. There are significant foundational and technological changes that must be implemented to truly realize this concept and transform the experience. 

  • Using Data to Customize the User Experience – Without data, customizing the experience in this way is impossible. Plans have more data at their disposal than you might think, though. From claims data and satisfaction surveys to engagement data from previous communications programs, it can all be leveraged to customize the experience. This results in tailored tools and resources at every point across their unique journey.  
  • Streaming Health Content – 5% of all Google searches are for health information. That is a lot of people turning to the internet for health education instead of their plan or provider. That also highlights the fact that health literacy is a prevalent issue and a contributing factor to inaction among members. Plans are in a unique position to increase health literacy by providing health education to their consumers with commercial quality streaming health content to sustain engagement, deliver the information that consumer needs at that point in time, and ultimately drive healthier actions at scale. 
  • An Omnichannel Approach – Combining an omnichannel approach with orchestration of resources and channels helps plans reach members in the way they prefer while allowing plan investments to perform with higher results and efficacy. Using a combination of 1 on 1 care coordination, interactive voice response (IVR), mobile web, resource triaging through AI short message service (SMS), multimedia message service (MMS) and rich communication services (RCS) channels are a few examples of digital ways to engage and activate more consumers. 
  • Behavior Science and Conversational AI – Behavior science is a foundational tool for large tech companies to drive specific behaviors in their consumers and ignite growth. It’s healthcare’s time now to take from those lessons and apply them to the health of their members. Health programs and services that seek to understand the intricacies of human behavior and leverage these techniques will significantly increase engagement. 

Want the full version of this content? Access the complete white paper, From Members to Consumers » 

The Members to Consumers White Paper 

By implementing digital trends that drive engagement in the retail landscape, health plans can replicate this success for their population. Leading brands have had to continually stay aligned to trends and keep a high-touch strategy in place to drive sales. Health organizations are in a unique position to leverage consumer insights to refine their strategy, inspire consumers to take action, and lower costs, because unlike Apple or Amazon, health is a necessity. Ensuring your health consumers continually have a positive experience and adopt healthier behaviors based on their individual health needs is critical to drive health outcomes.  

This article gives just a peek into the ways health plans can serve that experience to their members. To get the full version of this content, including case studies from plans who have implemented digital-first techniques, download the white paper, From Members to Consumers: How plans are adopting popular digital trends from leading consumer brands to drive better health outcomes.

Activating Healthcare Consumer Behavior Change: Make it Personal

Key takeaways from our interview with Solome Tibebu

In the last decade, behavioral health has grown from an ancillary service offering to a critical component of health services and care delivery. According to an OPEN MINDS Market Intelligence Report, spending on mental health services totaled $225 billion in 2019, up 52% from 2009. Companies like Talkspace and BetterHelp, founded in 2012 and 2013, recognized this spike and made it their mission to increase the availability and accessibility of mental health services to those struggling to access and navigate care. Behavioral health has continued to evolve, and it is incumbent on all healthcare organizations to adopt new methods of providing care to vulnerable populations. Learning from innovative companies and forward-thinking leaders is vital to building an effective care strategy for the one in five U.S. adults living with a mental illness.  

mPulse sat down with Solome Tibebu, a pioneer in behavioral health technology and innovation, whose passion stems from the care gaps that have existed and still remain in mental healthcare. At the early age of 16 years old, Tibebu started a non-profit online resource, Anxiety in Teens, to offer education and support for teens and young adults who were struggling with anxiety and depression. After ten years, she began working in startups and consulting, continuing to advocate for the role of technology in advancing behavioral healthcare. 

This year in June, Tibebu will be putting on her third annual Going Digital: Behavioral Health Tech summit, a conference where health plans, providers, health systems, employers, investors and startups convene to discuss the evolving landscape of behavioral health. The virtual (for now) event is a great opportunity to share best practices for implementing digital resources and innovative technologies to improve access to mental health services. We are proud to be a sponsor for the second consecutive year, and we look forward to contributing to discussions around how healthcare organizations can implement solutions to tackle barriers and make mental healthcare more accessible for all.

Improving Access through Technology Innovation

COVID-19 created an array of challenges to advancing mental health access, but it also sparked a digital transformation that brought innovation to the center stage. With more consumers staying home, “tech has exploded as a response to the pandemic,” Tibebu prefaces. Technology plays an important role in understanding and addressing the social dynamics that affect each person living with mental illness. Some of the challenges that plague mental health accessibility require more than simple one-way consumer interactions, however. 

Talking about health plans, Tibebu emphasizes, “stigma is a huge barrier even after they’ve procured some kind of solution, so they need to have a strategy around how they’re gonna address stigma, and engagement of the member.” Stigma can produce feelings of worthlessness and lead to social isolation while social determinants of health (SDOH) like transportation access or income level can prevent consumers from seeking care. To tackle barriers like SDOH and stigma, it is necessary to utilize technology to understand consumer needs and preferences. 

Conversational AI and Natural Language Understanding power the capability to deploy behavioral science strategies at scale when communicating with vulnerable populations. For instance, incorporating a strategy like Affect ensures that messaging is based in empathy, increasing motivation to engage with sensitive healthcare outreach. Social Proof is an effective strategy that helps assure consumers that they are not alone and can help reduce social isolation caused by mental health stigma.  

Applying behavioral science and identifying SDOH in conversational outreach enables a deeper understanding of consumers. Once individual preferences are captured, healthcare organizations can efficiently tailor relevant content to each consumer and activate meaningful behavior change. 

Delivering Tailored Content at Scale

Incorporating clinically validated behavior change techniques helps with understanding the needs and preferences of consumers. Tibebu asks, “now all of these payers have implemented their telehealth solution but it’s the next level – how do we get something more customized, personalized to their respective populations?”  

Plans and providers can drive deeper engagement and self-efficacy by adopting tailored engagement strategies that lift utilization of the programs they’ve invested in. Conversational AI enables the orchestration of programs and resource delivery across preferred consumer channels. Natural Language Understanding helps capture important data from consumer responses to help route them to the appropriate digital resource. 

A one-size-fits-all care model fails to meet the needs of each consumer, while customization empowers healthcare organizations to intervene with meaningful content that drives behavior change. “How can you identify the consumer’s need and triage them to the right end solution?” Tibebu reiterates. Certain individuals who prefer a visual learning experience may benefit from a course like Living with Anxiety & Depression, while those who respond better to audio can be directed to a podcast like Mental Health Matters. 

Providing on-demand, curated content can motivate consumers to take control of their health and execute healthier behaviors, leading to improved outcomes and a better consumer experience.

Impacting Beyond Mental Health

We asked Tibebu why personalization in mental healthcare should be important to payers specifically. She responded, “because mental health is at the vortex of all health…for all of these other conditions, expensive conditions, that are impacted as a result of poor mental health.” Consumers who are negatively affected by mental health are more likely to develop chronic conditions, which piles up costs for both the consumer and the organization providing services. This creates an opportunity for plans and providers to adopt innovative solutions that promote well-being through tailored engagement. 

MagellanRx Management serves a complex population and recognized the need to incorporate well-being content for their members who were experiencing loneliness and anxiety from COVID-19. They partnered with mPulse to deploy digital fotonovelas, which use culturally sensitive stories in a comic-strip format to improve health education and activate diverse populations. The program drove impressive outcomes, yielding over a 38% engagement rate and a 90% member satisfaction score. 

We questioned how organizations outside of payers and providers can “step up” to make mental healthcare more accessible. Walmart Wellness is a nationally recognized brand whose goal is to “help customers raise their hand and more easily access their hubs,” Tibebu clarifies. Walmart partnered with mPulse to implement SMS solutions along with streaming health education to drive their customers to the right well-being resources. The program included custom learning plans across several wellness topics and produced significant improvements in customer engagement. 

After chatting with Tibebu, we are reassured that mental healthcare should be the focal point of an effective engagement strategy. Innovative companies can promote mental well-being and health literacy by leveraging technology that personalizes outreach. Educating consumers with tailored content through timely and convenient engagement builds self-efficacy and lasting behavior change.

Learn more about Conversational AI and streaming health education here. 


CareSource Activates Hard-to-Reach Members with Conversational Outreach and Streaming Content

COVID-19 Accelerating Digital Engagement

It is no secret that COVID-19 has changed the way healthcare communication is delivered to consumers. The uncertain nature of the pandemic has forced healthcare organizations to incorporate digital strategies to continuously update their members on important COVID-19 information. Just this year, health plans have had to respond to the new mandate requiring reimbursements for at-home COVID-19 tests.  

Gaps remain in other facets of COVID-19 communication, like driving behavior change to increase vaccinations. Across the country, states are seeing lower vaccination rates among Medicaid beneficiaries. In California, the Department of Health Care Services (DHCS) released a January 2022 report indicating that 81% of the general population had received one dose of a COVID vaccine compared to only 54% of Medi-Cal (California’s Medicaid program) beneficiaries. Significant disparities in vaccination completion such has this have developed in states beyond California as well. 

CareSource, an Ohio-based managed care plan offering insurance coverage to vulnerable populations across five states, recognized a similar disparity in their diverse member population and sought a solution. Traditional methods of engaging members had failed to produce desired results, creating an opportunity to incorporate a new approach in their outreach efforts. The plan partnered with us to implement conversational outreach and streaming health education into their COVID-19 vaccine program strategy.  

Here’s some key takeaways from the program along with strategies that health plans can adopt to drive vaccine engagement.  

Strategies That Personalize Outreach

Delivering vital information about vaccines becomes more difficult when using a one-size-fits-all approach to communicating with vulnerable members. A successful COVID-19 outreach program requires personalized interactions with members to inspire healthier actions. CareSource identified a need to activate hard-to-reach consumers and sought a tool to tailor engagement based of range of factors including health beliefs. 

The plan leveraged our robust technology platform and Natural Language Understanding capabilities, which enabled tailored engagement through 25 SMS workflows, 1 Secure Survey, and 1 streaming video.  

We helped deploy SMS surveys to assess individual vaccine readiness levels, and members were assigned one of three personas based on their responses: Ready, Unsure, and Nonbeliever. Developing personas enables plans to tailor messaging according to personalized interactions with members to inspire healthier actions each member’s preferences and self-reported barriers. Messaging must be intentional and sensitive to inspire paradigm shifts for unvaccinated members or members who have no plans to get vaccinated.

Behavior science informs every communication we send, and this program was no different. An effective behavioral science strategy in the CareSource program was giving members Social Proof, which comes from the Social Determination Theory and suggests that people are motivated by feelings of competence and relatedness. Through the texting channel, members were sent a streaming video, “My Why,” which highlights a diverse range of people explaining their personal reasons for getting vaccinated. Plans can inspire confidence and healthier actions just by making members feel as though they are not alone.

Another behavior science strategy employed in the program was Authority, which is using trusted health experts to improve education, drive health literacy and reduce barriers like misinformation. Using sources like the CDC can ease doubt and motivate members to reconsider personal health beliefs that may contribute to vaccine hesitancy.   

CareSource provided zip code data, which we used to further tailor conversations based on socioeconomic factors. Providing members with personalized, familiar interactions gives the member a voice and drives self-efficacy. 

By incorporating behavioral science and SDOH into their COVID-19 engagement strategy, CareSource was able to tailor conversations and streaming educational content at scale. Social determinants of health (SDOH) can play an integral role in tailoring messaging to each individual inspiring vaccine readiness. 

Innovation That Drives Outcomes

We sent a total of 4 million SMS messages and delivered over 3 million automated dialogues to 664,000 members. The program yielded nearly a 15% engagement rate, an increase from traditional rates of 8-10%. Of the members who received a first dose, 81% reported they would follow through to get a second dose. By the end of the program, 57,000 of the 107,000 “Unsure” members moved into the “Ready” persona. 

Each member response led to additional tailoring, with automated responses covering topics like variants, availability, cost, fear/anxiety, effectiveness, and side effects. Upon conducting 30-day and 90-day reviews of the program, common themes were uncovered within each member persona. Gathering insights from member interactions can help influence future vaccine engagement programs and ensure that each conversation is tailored to drive the best results. 

As companies focus on highly tailored engagement, scalable intelligent capabilities are required.  CareSource has demonstrated the potential for Conversational AI outreach and streaming health education to drive healthier actions and meaningful outcomes.

Closing Diabetes Care Gaps

Diabetes care often faces numerous challenges, including patient adherence to screenings and understanding of the condition’s implications. By recognizing these significant gaps and the barriers that prevent patients from taking crucial steps in their care, we can guide them toward becoming more proactive advocates for their health. Leveraging advanced tools like conversational AI for healthcare and Natural Language Understanding, mPulse uniquely supports each patient in navigating their diabetes journey, ensuring personalized and effective care.

We’ll discuss these solutions that bridge the gaps in diabetes care:

  • SMS Messaging: Using tailored conversations
  • IVR & Email: Catering to those with a landline
  • Streaming health content: video and podcast learning proven to educate your patients.


According to the Centers for Disease Control and Prevention, over 34 million Americans have diabetes, and 88 million are prediabetic. Despite being one of the most common diseases in the U.S., it is still widely misunderstood. Providing education and resources to help those living with diabetes is critical to improving quality measures, managing diabetes, and preventing poor outcomes.

Adherence to diabetes medications alone reduces over 1 million emergency room visits annually, which accounts for approximately $8.3 billion in annual health spending.

Proper management of diabetes can be shown through data captured from routine blood work, A1c tests, specialist visits, prescription refills, and diabetic eye exam claims. However, many patients do not know they need to complete these visits or understand why they are important.

How to engage the hard-to-reach diabetes patients

You need to meet patients where they are. Through implementing a tailored omnichannel approach, you can engage with each patient in the ways they prefer while uncovering their barriers to care. This will help extend your reach, improve engagement at scale, and collect population insights to inform your enterprise strategy.

Each of your diabetes patients is on a different journey. Addressing the correct gaps and identifying each patient’s unique barriers will yield greater self-efficacy.

Using tailored health engagement to bridge gaps in diabetes care

SMS Messaging


Diane is a Type 1 Diabetic who is a new patient. Through SMS messaging, we can identify her barriers and provide her with care management to help support her and provide her with education on nutrition and resources to help her maintain routine care visits.

“At age 14, I was diagnosed with Type 1. My parents watched over and cared for me, but when I lived alone, I didn’t take care of my diabetes. I wasn’t checking my sugars and ate anything I wanted, whenever. I didn’t want to be the diabetic girl with her medical bag.” – Diane J. Type 1 Diabetic.

Interactive Voice Response and email


Charlotte is also a Type 1 Diabetic whose provided phone number is a landline. Through IVR and email, we can connect her to education on the importance of routine diabetic eye exams with a CTA (call-to-action) to schedule with her optometrist.

“I’ve been a type 1 diabetic for 30 years, and my hypo symptoms have changed. The first thing that happens is my vision starts to become abstract, and I have hallucinations; it’s terrifying! I don’t know if this is common or not cause it never used to happen to me during hypos.” – Charlotte L. Type 1 Diabetic.

mPulse, a digital health engagement solution provider, uses conversational Artificial Intelligence (AI) and Natural Language Understanding to fill gaps in diabetes care by overcoming barriers and providing the right support through the right channel to build trust with each of your patients. We deliver personalized interactions that inspire health literacy and behavior change over time.

The importance of health education and literacy

An essential part of building relationships with patients is providing more than appointment reminders, test results, and claims status updates. While tests and appointments are strong indicators that the patient is receiving recommended routine care, the management of diabetes goes beyond the doctor’s office. Living a healthy lifestyle with diabetes is just as essential as maintenance visits, especially when it comes to diet, exercise, and mental health. Investing in health and well-being resources, programs, and education throughout each patient’s health journey drives meaningful behavior change.

“People living with diabetes tend to focus on diet and meds (necessary, of course) that I think maybe we forget other important tools in this fight. I have found that stress, like an argument, financial worry, depression, etc., affects my bs. I’d love to hear some successful stress reducers that can help.” – Joey S. Type 2 Diabetic.

The Big Know is mPulse Mobile’s health education streaming solution. Our team of instructional writers and designers produces broadcast-quality content designed to inspire health literacy at scale. We leverage the expertise of nationally recognized health experts to teach video and podcast learning experiences that are proven to engage and educate your patients.

In addition to condition-specific content, we offer holistic well-being education that teaches the basics of living your healthiest life, with wide-ranging topics that include building resiliency, HSA planning, eating well, yoga, mental health, and more. Discover our content library by visiting The Big Know.

Dr. Reed Tuckson, a Doctor, Health Executive, and author, hosts our LiveWell Diabetes Podcast. In each podcast episode, he hosts a different health expert to discuss specific wellness topics related to managing diabetes, including eating well, movement, and understanding the science behind Type 2 Diabetes.

Listen to the podcast here:

Enroll in mPulse’s Newsletter to be notified when our Diabetes Essentials video series, taught.

by Ranelle Kirchner, launches in 2022.

Reimagining Health Engagement

mPulse Mobile partners with over 100 leading healthcare organizations and initiates 500+ million omnichannel conversations annually. As the leader in digital health solutions, including conversational AI, we help build relationships with your consumers that go beyond the transaction to inspire self-efficacy and health outcomes at scale.

Case Study: A1c Test Reminders

Client: Anonymous Health Plan

Goals: Encourage and remind Diabetic patients to get their monthly A1c Test to lower costs and increase self-efficacy and overall health.

Execution: Leverage SMS messaging to send tailored conversations to Diabetic patients overdue for their A1c test.


  • 29% Program Engagement
  • 32% of claims submitted were from previously un-engaged patients

Case Study: Insulin Rx Refills

Client: Anonymous Pharmaceutical and Medical Device Company

Goals: Increase conversion rate for diabetes insulin pump reorders.

Execution: Consumers reviewed and confirmed their supply reorder through SMS messaging and prior opt-in.


  • 11pp increase in reorders after program optimization
  • ROI of >360%
  • 92% program opt-in


To learn more about mPulse’s digital health solutions and outcomes, contact us at

To learn more about how to prevent and manage diabetes, visit The American Diabetes Association Website.

Reimagining CAHPS & HOS Engagement

When it comes to impacting and improving member experience measures, we can easily name more challenges than we can solutions. Blinded surveys, small sample sizes, black-out rules, and perception vs. reality are just a few of the historical challenges health plan partners have faced over the years. As if those weren’t enough, now we’re looking at new and increasingly difficult obstacles this year. Some challenges to keep in mind include the following:

  • 4x weighting for the 2022 CAHPS survey to round out the increased weighting for the member experience measures which will account for over 50% of 2023 Star Ratings. 
  • Recently released Westat reports revealed an upward trend in CAHPS cut-points making it even harder to attain and maintain top performance. 
  • The Extreme and Uncontrollable Circumstances policy which allows plans to use the higher of the current year or the previous year’s Star Rating is expected to leave over-inflated performance in its wake, which will be difficult to maintain over the next several Stars years. 
  • NCQA’s extension of its HOS black-out period from four to eight weeks before, during and after fielding left some plans in the lurch and forced them to pivot or scrap their planned outreach and educational strategies. 
  • The temporary removal of HOS’ two 3x weighted process measures, Improving or Maintaining Physical Health and Improving or Maintaining Mental Health from the active page and onto the Display page for both the 2022 and 2023 Star Rating years. While it might be welcomed as a breather, it should not be an opportunity to lose focus, but instead an opportunity to re-evaluate your overall HOS strategy.  

 CMS isn’t backing down on its promise to lend a bigger voice to the beneficiary and each year the Medicare population continues to embrace and adopt digital communication and technology. It’s time to ditch obsolete legacy outreach programs and reimagine CAHPS and HOS engagement using the modern innovative trends and technology your members interact with daily. What consumers expect from their favorite brands, they’ll expect from healthcare. 

 mPulse Mobile, the leader in Conversational AI solutions for the healthcare industry, drives improved health outcomes and business efficiencies by engaging individuals with tailored and meaningful dialogue. mPulse Mobile combines behavioral science, analytics and industry expertise that helps healthcare organizations activate their consumers to adopt health behaviors. 

 With over a decade of experience, 100+ healthcare customers and more than 400 million conversations annually, mPulse Mobile has the data, the expertise, and the solutions to support your CAHPS and HOS engagement strategy. 

 To ask a question or request a call, go to:

4 Largest Barriers to Treating Mental Health and Solutions to Address Them

1 in 5 U.S. adults live with mental illness which means that likely you or someone you know is struggling with a mental health condition. We’ve come great lengths in destigmatizing mental health in the past several years and the pandemic brought forward the need for access to mental health services. Still, over half of U.S. adults with a mental illness don’t receive routine treatment. 

Untreated mental illness accounts for $113 billion in annual health expenses. Identifying barriers to treatment and helping fill gaps in care for those living with mental illness will not only lower costs but allow us to provide resources, support and guidance. 

We’ve identified the 4 largest barriers and practical strategies to begin addressing each: 

1. Availability 

Challenge: The shortage of mental health practitioners in the U.S. is staggering, with some patients waiting between 3 months and 1 year before receiving treatment. Longer wait timesput patients at a higher risk for having a mental health crisis and increaselikelihoodthe patient will be a no-show. 

Solution: The availability and development of digital mental health programs and services has helped solve this challenge. The app market for mental health tech is predicted to reach $149.3 billion by 2028. Teletherapy apps such as Better Help and Talkspace offer therapy and mental health resources on-demand. Meditation apps like Calm and Headspace have gained popularity rapidly, with combined 165 million downloads in 2020 alone. What consumers expect from their favorite apps and brands, they’ll begin to expect from their health plans and systems.

Having user-friendly digital tools and resources that are on-demand and easy to navigate will drive access and utilization. Communicating and building relationships with your population through conversations allows you to understand their needs while also creating awareness. mPulse uses experiential and existing data to deliver these programs, resources and education to each member while meeting them where they are.  

2. Inequity 

Challenge: Minority populations, the elderly and people with disabilities are at a higher risk of developing a mental health condition, and also experience greater barriers to care. Accessibility to services despite limitations is crucial. 

Solution: Ensuring the services and programs you offer are easy to navigate, multilingual, and are indicative of the populations you want to reach allows your members to feel seen, heard and accounted for. At mPulse, we factor in several elements on each member’s profile including language, religion, gender, background and more. We send tailored dialogue and resources that support their preferences and allow them to access care that reflects each of their preferences. Learn more about how we tailor programs for each individual. 

3. Cost 

Challenge: The leading causes of stress among U.S. adults is financial insecurity. Poverty and economic strain create a number of elevated health risks, particularly disparities in mental health. 

Solution: Offering financial support services, financial education and low-cost programs can help give patients and members the support they need. Offering low-cost digital programs and creating awareness of these resources will also increase accessibility. mPulse can help identify cost barriers and send financial support programs or low-cost resources to members in need of these services.  

4. Education 

Challenge: Knowledge gaps are the biggest contributor to misunderstanding mental health. Roughly 90% of people living with a mental illness say that stigma and discrimination have had a negative affect on their lives. 

Solution: Mental health is vital part of overall health and educating your population will encourage members to seek help. Education helps destigmatize mental health, provides condition-specific knowledge and can support gaps in care, medication management and more. The Big Know is mPulse Mobile’s streaming health education capability. We leverage popular health experts to teach high-value topics that range from holistic wellbeing to condition-specific content. The commercial-quality education uses our trademarked learning model and behavioral data science to inspire health literacy at scale. To sample some of our mental health streaming content, click here. 

Interested in learning more about how our solutions and capabilities can help solve engagement and barrier challenges for your organization? Contact us to learn more. 

The Evolution of Member Engagement

Healthcare member engagement plays a crucial role in the success of health plans. With over 80% of healthpayers investing in member engagement, it’s clear that leveraging innovative technology, integrated care models, and frictionless communication is vital. 

This article explores how health plans can enhance member engagement, focusing on:

  1. Member retention
  2. Improved health outcomes, and
  3. Cost reduction.

Member engagement in healthcare involves creating meaningful interactions between health plans and their members. It’s about delivering personalized experiences ensuring members are informed, involved, and motivated to manage their health.

The importance of healthcare member engagement

Effective member engagement increases member satisfaction, better health outcomes, and reduced healthcare costs. It also contributes to positive survey results and protects the financial viability of health plans.

Challenges in healthcare member engagement

Many health plans face challenges in engaging their members due to fragmented communication, lack of personalized experiences, and evolving consumer expectations.

4 Strategies for improving healthcare member engagement

1. What consumers expect from their favorite brands, they’ll expect from healthcare.

The average US adult spends an average of 12 hours a day on media. This number continues to increase annually and highlights a clear message: if we want to engage members, we need to communicate with them through their preferred channels.

With consumer brands continually evolving their UX and products to get ahead of the competition, health plans will be expected to follow suit. Members associate quality and credibility with content and communication models that exceed their expectations. Preferred channels will help you reach your members; quality health content will keep them engaged in their care. To engage today’s health consumer, you need to begin looking at modern trends to inform your strategy.

2. Simplified and unified care models will be mandatory to increase satisfaction

Your favorite social channels and online shopping experiences likely have one thing in common: They are designed to bring you back to a single destination. You only log in once, and the experience feels effortless and caters to your preferences. When you’re frustrated with a product’s website interface, you probably won’t purchase now or in the future – this same principle applies to health care. A seamless member experience drives higher HEDIS ratings, HOS scores, and satisfaction surveys. Fractured and misaligned experiences will yield poor outcomes, stunted new member growth, increased complaints and appeals, and higher customer service line utilization.

This begins with the onboarding process. Straight out of the gate, establishing clear communication with new members will help them feel welcomed, inform them about their plan information, provide the opportunity to confirm data, and encourage members to submit an HRA. Setting high engagement expectations early on increases the likelihood of engagement throughout the membership. Ensuring all of your programs and services are accessible, easy to navigate, and play together nicely will save both you and your members time and money.

3. Focus on education, specifically for latent unhealthy populations

Empowering members throughout their health journey with tailored learning experiences will impact health outcomes and satisfaction

. Patients forget over 80% of what they’re told during POC and often will visit doctor Google to learn more about their health, which doesn’t always yield accurate results. The days of print-outs are coming to an end: streaming content accounts for over 50% of global time spent online, and viewers are over 9 times more likely to retain information from video vs text. Cinematic, tailored education delivered to members through their preferred channels will absolutely win your org brownie points while empowering members to own their health journey and sustaining member engagement time. This is particularly important when reaching latent unhealthy populations and providing them with the knowledge to prevent chronic conditions, determine the right care level, and navigate their benefits.

Through rich media, we can educate members on key topics such as medication adherence, nutrition, exercise, mental well-being, and more. For those living with chronic conditions such as heart disease and diabetes, health literacy increases quality measures and lowers costs for plans and members.

4. Sustained engagement = rich data

Gathering rich data across member services from specific populations will increase engagement and scale your efforts into the future. Sharing this data across your organization will strengthen internal efforts and improve alignment, ensuring better outcomes and higher quality of care.

The ecosystem of how members interact with their plans is evolving to meet the growing demand of what consumers expect today. Promoting and adopting innovative, streamlined, accessible resources and technology is the key to a lasting and impactful member engagement strategy.

Role of technology in member engagement

Advancements in technology, like conversational AI and streaming content, are transforming member engagement. These tools allow health plans to create personalized, engaging experiences at scale.

Measuring and evaluating member engagement

Monitoring key metrics and KPIs is essential to evaluate the effectiveness of member engagement strategies. This data helps in making informed decisions and refining engagement approaches.

Best practices to follow

  • Implementing a patient-centric approach from the onset, particularly during onboarding.
  • Utilizing digital platforms for effective communication and education.
  • Integrating behavioral science to understand and influence member behavior.

Health plans must adopt innovative strategies for healthcare member engagement to stay competitive and effective. Health plans can significantly enhance member satisfaction and health outcomes by focusing on personalized, technology-driven solutions.

For health plans looking to revolutionize their member engagement strategies and achieve sustainable success, Contact us to discover how we can transform your approach to healthcare member engagement.

What Type of Healthcare Chatbot Do You Need?

Chatbots play an increasingly important role in healthcare. In addition to improving member and patient satisfaction, many chatbots gather data through conversations, providing rich, new sources of health data that can inform care at the individual and population level.

This post walks through nine different types of healthcare chatbots, the role chatbots play in healthcare, and recommendations to consider when using a chatbot to help serve your patients or members.

Types of Healthcare Chatbots and Their Value


Scheduling (and rescheduling) healthcare appointments is a relatively simple process that has historically required at least one staff member for each appointment and been very time consuming. This is where appointment scheduling chatbots come into play. These chatbots make It easy for a patient to schedule an appointment on a website, inside a portal, through an app, or even via text message while including valuable information like reason for appointment, symptoms, etc.

In many cases, appointment scheduling chatbots need to be integrated with an EHR system to be most effective, which allows for automatic scheduling and re-scheduling with little to no human intervention. And when PHI is properly managed, these chatbots may also be able to deliver valuable information like lab results directly to the right patients.

Symptom Checker

At their best, chatbots provide more valuable and relevant information than a web search. They are able to do this because they are siloed; if a user is within a healthcare chatbot’s ecosystem, it can be assumed their questions are all healthcare related. When a user searches on the web, results often need to be broader to address a variety of intent.

In addition to an improved experience, as chat often feels more personal than search, symptom checker chatbots rely on a blend of healthcare experts to provide reliable data and Natural Language Understanding to analyze patient and member symptoms, return helpful information, and recommend care.

At their best, symptom checker chatbots align with appointment chatbots to help patients and members get necessary care with limited barriers.

Health Tracking

Many patients and members have ongoing health needs such as care prior to, day of, and following a procedure. These chatbots typically feature timely check-ins, medication / care reminders, and the ability to understand if a patient or member is reporting an adverse condition. These chatbots need to be able to log a record over time to be most effective and relevant.

Chatbots that help users with fitness or diet goals often fall into this category as well.

Chronic Condition Self-Management

Properly managing chronic conditions is an ongoing challenge for healthcare organizations and their consumers as chronic conditions require a blend of ongoing tracking and specific care as challenges related to the condition shift. Whether coordinating care, reminding people to take medication, providing valuable information or many other uses, these chatbots need to be able to both provide tailored information and react to changing individual needs.

Similar to Health Tracking chatbots, Chronic Condition Self-Management chatbots help users track and manage their condition on an ongoing, long-term basis. They typically require a more specific medical knowledge base than Health Tracking chatbots.


Everything people do impacts their health. One challenge healthcare organizations face is getting people to engage with their health and healthcare. Afterall, there are so many other things that fill time and mindshare. Patient and member engagement chatbots create meaningful experiences and find valuable ways to connect with people and engage them in their health, whether by providing an important health reminder, uncovering some new healthcare information / status, getting a mental health update in real-time, or many other uses.

Engagement chatbots typically focus on consistent touchpoints and a long-term relationship with patients and members.

Digital Front Door

Chatbots are a key component of many successful digital front door applications. Digital front doors provide a virtual experience similar to a really great waiting room where a nurse collects key information to help optimize your visit and route care accordingly. Chatbots play a vital role here as they act as a combination receptionist, nurse, and source of information.

Digital Front Door chatbots must be personable and useful to consumers while gathering key information that helps healthcare organizations optimize care resources.


While a symptom checker chatbot helps address patient and member questions about their health, FAQ chatbots help address questions about healthcare. The goal of FAQ chatbots is to provide a better experience and easier access to answers than scouring a healthcare organization’s website or portal in search of answers. Similarly, they reduce the burden on call centers by reducing inbound calls to find answers to common questions.

A smart FAQ chatbot is able to ask the user questions to refine and deliver the best answers.

 Inbound vs Outbound Chatbots

Like any conversation, an interaction with a chatbot can be started by a consumer (inbound) or by the chatbot (outbound). In most cases, chatbot conversations are inbound as they trigger when a consumer visits and app or website and begins a chat. The challenge with inbound chatbots is they require a consumer to take an action (sometimes a few actions) before the conversation can begin. Outbound chatbots are less common as they require an existing, open channel to work. The best example of outbound chatbots is those that communicate through SMS or RCS, reaching consumers directly in their text message inbox.

mPulse Mobile offers a variety of solutions that feature outbound chatbots.

How Chatbots Need to Work Together

The overall goals of healthcare chatbots are to improve patient and member experience, optimize healthcare staff, help people stay healthier, gather valuable data, and make organizations more efficient. While specific chatbots can help address specific needs, a holistic approach is needed to accomplish all of these goals.

Learn how mPulse Mobile is combining omnichannel patient and member engagement with streaming health education to help solve many of healthcare’s biggest engagement challenges.

3 Steps to Listen to your Members at Scale

Are you having meaningful conversations or talking at them?

There are certain human experiences everyone can relate to. One we have all felt is someone talking at you. It’s not a conversation. There are not two participants. You are just there to absorb whatever they say, and if you respond, they don’t listen. They just wait for their turn to speak again. We all know this feeling. It’s frustrating and leaves you looking for an exit.

Fortunately, people can become better communicators. They can learn to slow down, focus, and listen. They can learn to have a conversation instead of just dumping their message on an unwitting volunteer. And when they do, the rewards are clear. Two-way dialogues allow for feedback and new information that, when listened to, can drive the conversation deeper or take it in new directions that teach both parties something new.

The key difference between a one-way dump of information and a meaningful conversation is the ability to listen and have empathy. For healthcare organizations that aim to have these meaningful interactions with hundreds of thousands of people, the question is how to listen at scale.

Step 1:

Start Conversations at Scale

The easiest way to engage people in conversation is to find topics they care about then ask them about those topics. Most of us do this intuitively. Doing this at scale requires determining content / topics that are relevant to specific segments across large populations and leveraging technology that allows you to start and maintain thousands of conversations at once across communication channels. We call this member-centric outreach.

To properly conduct member-centric outreach and begin conversations, there are a few things you need to have in place.

  • Ability to deliver messages on high-reach conversational channels, such as SMS
  • Population segmentation to tailor content / topics
  • A way to track engagement and responses to verify and update population segmentation and tailoring

Using automated conversations with the ability to listen to member responses and handle those responses appropriately is crucial to making interaction between a plan and its members natural and easy

Step 2:

Orchestrate Engagement Across Channels

Imagine having a great conversation with someone at a party. You found a common interest and dove deep into it. Then days later you read an article your friend might find interesting, so you email it to them. A few days later, they text you a link to a related video. You are communicating across channels to maintain and deepen your relationship, all connected to that initial conversation.

Orchestrating engagement across channels is relatively simple to do at scale when your engagement channels are all hosted on a single platform. Think of your engagement platform as the person at the party – it’s easy to keep track of what content has been shared across channels when it’s all coming from and to the same place.

Digital communication occurs in real-time more often than traditional healthcare outreach. When you consider the outreach strategies of Pharmacy, Clinical, Quality, Care Management and Marketing, it’s vital to orchestrate engagement over mobile channels. And if a platform is not listening to data from member actions and adjusting appropriately, it is falling short of true omnichannel orchestration.

Step 3:

Use data to listen and empathize

During in-person conversations, people gather all sorts of valuable information in real time. We gauge sentiment based on vocal tone and body language that is not typically available with digital conversations at scale. To compensate for real time empathy, digital conversations rely on new types of data to listen and inform an appropriate, tailored response. To listen well, there are some important focus areas when it comes to data.

  • Focused Data: Determine what information you are trying to capture before launching a digital conversation program. Are you hoping to learn about channel preferences or something like barriers to care? Determine that and engage in line with that goal.
  • Sentiment: Leverage technology or a team to understand the sentiment of member responses.
  • Preferences: Analyze what channels, message frequency, language, topics, and content individuals and persona populations prefer.
  • Target Insights: If there are specific insights or answers you need, use your trusted relationship to have conversations about those topics.

Asking members questions on scalable conversational channels can create a wealth of new data that is almost impossible to gather otherwise. This data provides a fuller understanding of populations which allows for more informed decision- making.

Meaningful conversations and experiences are core to human relationships. The better you can create and maintain relationships with all of your consumers through conversations, the more aligned you will be about their care.

If you would like to have a conversation with us about how we can help you build more positive relationships with all your members, please contact us here.

2021 Medicare Star Ratings: What it Means for Member Engagement

The wait is over! Today 400 Medicare Advantage and 55 Part D plans received the final 2021 Star Ratings from the Centers for Medicare and Medicaid Services (CMS). This is always a milestone day for every Medicare organization. Plans who perform well receive higher quality bonus payments and rebates, and have been shown to outperform lower-rated competitors in member acquisition and retention.  

This is also a big day for mPulse as we look at the role of member experience and engagement in determining a majority of each plan’s summary rating. Even in this year’s release where CAHPS and HEDIS data is carried over from the 2020 ratings, we see how CMS changes and increasing Part D competition make a major impact on performance. So, as our team looks at the 2021 data, we are always looking at the implications for the dozens of Medicare plans we partner with and member engagement overall. 

Here are some themes that stand out to us: 

Mostly Neutral and Negative Movement for Plans 

The Medicare quality landscape got even more competitive this year, continuing a trend we’ve seen from CMS in recent years to push for more stratification between plans in ratings. While the number of 5-star plans increased by one, the overall number of plans at or above 4 stars declined by a net of 16. While the 2020 ratings saw an impressive 52% of contracts at or over 4, this year’s group will drop to 49% of MA-PD contracts. With many data sources remaining static, a lot of the negative movement plans experience will be due to cut point shifts, weighting updates, and the measures that weren’t impacted by COVID-19 changes.  

This year’s data aside, the number that jumps out the most at us today is 212. That’s the number of MA-PD contracts appearing as “too new to be measured” this time, compared with the 400 actually measured. Established plans have to prepare for these newer contracts to pursue higher ratings with intense focus, knowing that a poor start can be difficult to recover from.  

mPulse is working with both long-standing plans that are evolving their quality strategy to protect high rating, as well as newer contracts that want to compete with highrated plans immediately. The common theme we’ve heard from both types of teams is that they know they need to do more than the standard quality improvement playbook. They’re going beyond traditional engagement channels and provider-relations-centric approaches, using partners like mPulse to differentiate member experience and activate each of their members. Today’s news will only accelerate those trends.  

CAHPS Weighting Adjustments Have an Impact 

Member experience is a major topic in Medicare and these 2021 ratings are a reminder of why. This year was supposed to be a transitional period where non-flu CAHPS measures move from 1.5x to 2x weight before eventually moving to 4x in 2022 and 2023 ratings (the measurement year of 2021, coincidentally). But since CAHPS data was carried over from last year’s ratings due to COVID, plans are in the unexpected situation of seeing the same data impact their overall rating more, with good being better and bad being worse.  

While many plans will be frustrated to see CAHPS improvement efforts not reflected today, the work they have done and strategies they put in place now will have a huge impact soon. Plans that have relied on meeting call center requirements and fielding proxy CAHPS surveys are moving towards dedicated CAHPS/HOS strategies and member engagement solutions focused on Member Experience. As we see what a 25% increase in measure weight looks like today, plans are thinking about how they can understand and improve member satisfaction next year, where the weight will increase by another 100%.  

We’re working with our partner plans to create new, conversational touchpoints with members and feed critical experience data back to the entire organization – helping them make decisions driven toward improving CAHPS and HOS scores before the next major weight jump.  

Medication Adherence Is Even More Competitive 

As expected, the measures least impacted by the COVID changes were the ones to experience the most cut point movement. These measures represent an important area of focus for plans heading into next year. The Medication Adherence measures were at the top of this list with their traditionally narrow cut points and triple weighting. These measures saw a uniform drop in average MA-PD rating of .1 to .2 stars, and the SUPD measure, 3x weighted for the first time, dropped .4 stars on average. Plans that did well in these Part D measures will be very pleased today since they faced strong headwinds this year.  

Medication Adherence is one of the key measure sets for plans that work with mPulse since so much of success depends on member action. It’s another area where intense plan competition is only going to increase as more plans look to improve adherence in their entire populations and go beyond simple refill reminders. Connecting members to initiatives like 90-day supplies and mail order pharmacy, as well as gathering data on barriers to adherence helps plans improve their measures and make better decisions about pharmacy quality strategy.  

Understanding why an individual member isn’t adherent helps us get the right resource to them immediately via mobile channels while helping build a better understanding of what we need to do to help the entire population improve. That sort of understanding is critical as plans look to deal with ever-higher cut points and even more competitors going forward.  

The 2021 ratings are going to be remembered for all of the unusual circumstances impacting them. But for all of the carried-over data, impending weight shifts, and large number of new contracts, we think they tell a consistent story. Medicare Advantage plans will continue to succeed in large part by how well they engage their members to deliver a differentiated experience and drive vital actions to improve their health. We join our MA-PD customers in looking forward to a more “normal” 2022 rating set, and are excited to deliver solutions to help them reach their organizational goals, create innovative experiences for members, and ultimately better serve the people they care for.