5 Ways to Improve Member Engagement with Outbound Calling

Call center

I was recently reminded of something a health plan member said in a recent forum, “I don't understand much [about my benefits]. The book comes and I never read it. I'm mostly just concerned about seeing my primary or my specialist. If I need more advanced care, I will probably have to call customer service and have them explain to me... it's the whole healthcare system in this country, it's exceedingly complex.”

Because of this inherent complexity, call centers and representatives become essential guides and the public face of your plan. They bridge the gap between printed materials and what members need to know.

Sometimes, that information is so important that agents need to proactively call out to members – which is a great way to ensure members get what they need. With outbound calling campaigns, health plans can proactively alleviate member frustrations, improving satisfaction and member engagement.

Proactive Communication

Effective health plan communications significantly influence member satisfaction rates. Recently, we had a chance to work with a plan on their CAHPS scores. They shared survey data with us that included more than 40 different questions. The strongest correlations to overall plan rating, by far, related to how members seek and get information, including:

  • Getting help from written or online sources
  • Getting help from customer service
  • Understanding costs at point-of-service
  • Paying costs they thought were covered

The data highlights a simple story: members looking to get care want to know what to expect. Many seniors are on fixed incomes, so planning each expense is critically important and requires careful budgeting. First, they’ll reference your website or whatever documents they may have handy. Then, they call. If they can quickly get helpful information – great. However, if they cannot, trouble is coming… they will not know what is covered, ending up confused and disappointed.

The need for specialized help often creates a system that mirrors the complex and siloed nature of the US healthcare system. This means that access can be challenging, and getting to the right expert can require patience and perseverance. As one member said, “You finally get to a person, you give them all this information, well they can't do it [help], so they transfer you to another representative.”

The good news is this frustrating cycle can be broken. The plan’s agents proactively reached out to more than 400,000 members over the course of a few months. By delivering relevant and timely information to members about their benefits, the plan reduced grievances, a leading indicator of satisfaction, by an impressive 50%.

Addressing Barriers

Outbound outreach can be an incredibly effective way to address member challenges and barriers to care. For instance, we helped a regional Blues plan concerned about both their member experience ratings in CAHPS and their medication adherence measures. An analysis of call center disposition codes revealed that pharmacy-related calls comprised nearly one-third of all calls to the call center. It was only a few points behind benefits-related calls, which are almost always the top code.

Instead of passively waiting, the plan took action—launching a campaign to proactively help members. They focused on members most likely to have trouble: those with multiple prescriptions and those most likely to impact Stars adherence measures (those on diabetes drugs, statins, and select antihypertensives).

They used a team of pharmacists to make the calls. Here, and at other plans, pharmacists are particularly credible, and members tend to be quick to engage with them. In this case, more than 85% of those who picked up the phone spoke to the pharmacist, and more than three-quarters committed to refilling their prescription. The clinicians were able to overcome many barriers immediately, such as lack of knowledge about the medication or difficulty finding lower-cost options.

The program was not without challenges. The plan did not use any sort of automated dialer, and many of the phone numbers were inaccurate. Both issues can be fixed. Using a dialer and having a well-configured CRM interface can dramatically increase efficiency. Simple fixes, such as phone number scrubs, can increase the rate at which agents connect by at least 10%. This is often cheaper and easier than executing initiatives to improve data collection at onboarding.

Engaging the Unengaged

Connecting with members, particularly those who tend to be unengaged, can be extremely difficult. This was evident in our work with a large national health plan seeking to recruit members for a series of focus group sessions. Not surprisingly, “unengaged” health plan members were the hardest to recruit.

To get their participation, we needed to change our approach. We expanded our outreach to include another channel, in this case, text messaging. We also streamlined the scripting for agents. This dramatically reduced the effort behind the scenes, enabling us to allocate effort to recruitment. The unengaged group did “no-show” at a higher rate than the other groups, but due to our communication approach for the “unengaged,” we successfully filled all the focus group panels and wrapped up on time.

Leveraging Existing Technology

To further enhance member experience and engagement, health plans can leverage technology in innovative ways beyond traditional communication methods. Utilizing data tools to clean up incomplete member information is a foundational step toward establishing a more reliable connection with members. By ensuring that member contact information is accurate and up-to-date, health plans can significantly improve the effectiveness of their outreach efforts. This not only facilitates smoother communication but also reduces the likelihood of miscommunication and member frustration due to outdated or incorrect information.

Additionally, the deployment of advanced analytics plays a crucial role in understanding the specific challenges and needs of the member population. By analyzing patterns in member interactions, feedback, and grievances, health plans can gain insights into the most common barriers to satisfaction. Armed with this knowledge, they can tailor their outbound communication outreach to address pain points directly. Coordinating these communications to ensure they present a cohesive and unified message further reinforces the plan's commitment to its members, fostering a sense of trust and reliability. Through these technological advancements, health plans can not only improve their operational efficiency but also significantly enhance member engagement and satisfaction, ultimately leading to better health outcomes and loyalty.

Keeping Pace with Innovation

As we look toward the future, the horizon of healthcare technology is bright with innovative advancements poised to transform health plan member experiences even further. Among these, Machine Learning (ML) algorithms are set to revolutionize how health plans interact with their members by predicting the "next best action" for maintaining their health and happiness. This proactive approach not only enhances the member experience by offering personalized health recommendations but also optimizes health outcomes by preventing potential issues before they arise. The ability of ML to analyze vast datasets means health plans can identify patterns and needs at an individual level, ensuring every member receives care and outreach tailored to their unique situation.

Natural Language Processing (NLP) is another game-changer, in that advances in AI-driven speech generation have revolutionized automated outbound calling systems. This innovation enables health plans to extend their reach, efficiently touching base with a significantly broader member audience. Automated calls now deliver messages that are not only clearer and more personalized but also capable of engaging members in ways that feel intuitive and human-like. When a member indicates availability and interest to engage further during an automated call, NLP technology seamlessly facilitates a quick transition, connecting them with a live outbound agent. This blend of automated efficiency and human touch ensures members receive timely, relevant information and the opportunity for immediate, personalized interaction. Such advancements significantly enhance member satisfaction by streamlining communications, making it easier for health plans to proactively address needs, disseminate critical information, and foster a stronger member-provider relationship.

Moreover, the advent of generative AI applications is making content creation and engagement with health plan members easier and more effective. By utilizing guidelines to generate high-quality, personalized content, health plans can ensure communications are not only consistent but also highly relevant to each member's needs. This means everything from health tips to benefits information can be tailored in a way that resonates with members, encouraging greater engagement and adherence to health recommendations. The potential of generative AI to automate and personalize content creation represents a significant leap forward in how health plans communicate with their members, promising a future where every interaction is both meaningful and impactful.


Too often, plans sit back and wait for members to ask for help and seek solutions. By the time they do, they’re already getting frustrated. Instead of passively waiting and reacting, take the initiative. Call them. By focusing on specific populations with timely and tailored messages, you can turn calls into opportunities to keep members satisfied and engaged with your plan and their care.

Special thanks to Joe Mastrangelo, Shannon O’Connell, Malaika Pasch, Ana Brown-Cohen, Lolli Fleming, and Molly McLaughlin

Jack Newsom
  • Jack Newsom

During a 25-year career in healthcare, Dr. Newsom has specialized in building teams focused on improving consumer engagement with an emphasis on integrating communications, analytics, and delivery. At Engagys, Dr. Newsom continues the practice of using analytics to drive better health outcomes and improve the results of consumer communications. Additionally, he has led the Healthcare Consumer Engagement Practices survey since its inception in 2017. As Chief Program Officer at Caravan Health, Dr. Newsom lead a team of more than 40 professionals across analytics, quality, events, content management, and delivery to help practices succeed in accountable care frameworks. Prior to that, he created the analytics functions at Silverlink Communications and CenseoHealth. Dr. Newsom holds a bachelor’s degree in Economics, Master of Business Administration, and Master of Science in Clinical Evaluative Science from Dartmouth College, as well as a Doctor of Science in Health Services Research from Boston University where he taught at the School of Public Health for five years.