How to Boost Member Engagement in Your Health Plan

Member engagement isn’t a “nice to have” anymore. It’s the difference between a health plan members trust and one they leave behind. Generic mailers and one-size-fits-all outreach used to be good enough. But these days, members expect a healthcare partner who knows their history, anticipates what they need and reaches out before a small problem turns into a costly one. 

When outreach stays generic, members disengage. They skip preventive care, rack up avoidable costs and eventually switch to a plan that gets them, taking their loyalty and your reputation with them. 

The fix isn’t more outreach. It’s smarter outreach. When you anticipate what members need instead of waiting for them to ask, everyone benefits.  

A proactive approach helps you build: 

• Healthier members. Proactive reminders keep members on top of screenings and vaccinations, leading to earlier detection and better management of chronic conditions. 

• Happier members. Personalized communication and readily available resources make the healthcare system feel less overwhelming to navigate. 

• Higher retention. Members who feel supported stick around, protecting your bottom line. 

• Stronger brand reputation. Members who have a great experience tell others about it, and word-of-mouth wins new business. 

For Christian Healthcare Ministries, intelligent routing with Five9 enabled the company to identify roughly 80% of inbound calls before an agent even picks up, connecting members to the right specialist automatically, improving retention and ultimately driving a 400% increase in collections.  

Personalization is paramount 

Generic messaging doesn’t just fall flat anymore. It costs you. The health plans pulling ahead on member engagement right now aren’t asking members to hand over more data. They’re finally putting the data they already have to work: claims history, chronic condition flags, past outreach and response patterns.  

And the gap between those plans and everyone else is widening fast. The experience gap between the highest- and lowest-performing health plans grew from 144 points in 2023 to 161 points in 2024. The leaders aren’t waiting around, and the window to catch up is closing. 

Picture a member with a family history of heart disease receiving targeted information on preventive screenings and healthy lifestyle choices instead of a generic newsletter. That’s the kind of relevance that makes members feel seen, without asking them for a single new piece of data. And don’t forget channel choice: some members prefer email, others prefer text. Offering multiple ways to connect lets each member pick what works for them. 

Trigger outreach before members have to ask 

Proactive outreach shows members you’re invested in their care, not just their claims. Three ways to put it into practice: 

1. Guide members through the system. Help them find in-network providers, understand treatment options and make sense of confusing bills. With 30% of consumers delaying or skipping care after finding inaccurate provider information in their health plan’s tools, clear guidance matters more than ever. 

2. Trigger reminders around real health events. AI-powered outreach can flag preventive screenings, chronic condition check-ins and post-hospitalization follow-ups the moment they’re due, not weeks later. Five9 Fusion for Epic can automate that kind of reminder, like nudging a member with diabetes about an upcoming A1C test before they even have to think about it. 

3. Turn healthy habits into rewards. Incentivize screenings, activity tracking or wellness workshops. Small nudges add up to lasting habits. 

Give your contact center a bigger job 

Your healthcare contact center holds more member context than almost any other channel. Put it to work with these steps: 

1. Train for proactive conversations, not just call handling. Equip agents to engage members before they ask, answer questions confidently and personalize support to each member’s situation. 

2. Arm agents with a real knowledge base. A well-trained agent with fast access to accurate answers turns a frustrated call into a trust-building one. 

3. Schedule the follow-up before members have to ask about it. Check in after screenings, support members managing chronic conditions, or close the loop on a previous concern. 

Get started with Five9 Fusion for Epic 

For health plans and providers running on Epic, that context can go even deeper. Five9 Fusion for Epic connects the contact center directly to patient records inside Epic, so agents see full context the moment a call comes in, cutting handle time and making every conversation feel personal, not transactional.  

It also helps clinical teams get more value from the Epic tools they already use: every call routed through Epic Cheers with Five9 becomes a step toward Epic’s Gold Stars utilization recognition, not just another ticket closed. See how Five9 helps fast-track Gold Stars. 

Building real member engagement takes time, but every proactive step compounds: healthier members, higher satisfaction, stronger retention and a brand people recommend. For more on what’s working in healthcare contact centers today, watch our on-demand webinar, "No More Friction: Five9 Epic Fusion and the Future of Intelligent Patient Access."