Blog Post
Meeting the New‑Member Challenge: How Health Plans Can Reduce Risk and Improve Outcomes Through Smarter Data and Better Onboarding
Every year, health plans welcome an influx of new members, often tens of thousands at a time. According to KFF data, total Medicare Advantage enrollment increased by about 4% year over year, rising from roughly 32.8 million members in March 2024 to about 34.1 million in March 2025, an increase of more than 1.3 million beneficiaries.
While growth is positive, this wave of unfamiliar members presents a significant and costly challenge. New members are less familiar with their benefits, less likely to be medication‑adherent, more likely to use high‑cost sites of care unnecessarily, and more likely to fall through the cracks of care coordination programs.
This “new‑member effect” can drive excess utilization, weaken quality performance, and put pressure on risk adjustment revenue. But there is a solution. Health plans can materially change the trajectory of new member behavior—if they leverage the right data and invest in targeted, effective onboarding.
Build a Better Onboarding Experience: Reduce Abrasion, Increase Satisfaction
A well‑executed onboarding program is one of the strongest predictors of member satisfaction, early engagement, and reduced administrative burden.
Too often, onboarding approaches rely on content-heavy materials, rarely personalized to the member. As a result, they become easy to ignore and quickly forgotten by members. Your onboarding and benefits education program should include:
- Campaign best practices: Honor member preferences, use warming communications, present clear calls to action and emphasize personalization
- Benefits education tied to real member needs
- Early identification of transportation barriers, falls risks, medication issues, and social determinants of health (SDoH)
- Personalized care pathways
- Timely reminders supported by behavioral science
- Accessible content (e.g., language support, health literacy-appropriate writing, ADA‑compliant materials)
By redesigning the onboarding campaign for a national plan using this approach, satisfaction significantly improved among 25% of the population.
Know Your New Members Better by Putting Insights to Work
The most powerful tool for capturing new member data is the Health Risk Assessment (HRA). Yet most plans dramatically under‑collect them. Strong HRA collection unlocks insights that directly reduce cost and improve quality, including:
- Recent hospitalizations and ED utilization
- Behavioral health risks
- Falls risk
- Social needs, such as transportation challenges
- Chronic conditions
But HRA data collection is just the beginning. Plans can combine HRA inputs with publicly available data and SDoH insights, to group new members into meaningful, actionable segments.
At Engagys, we often say: “target on need and segment on behavior.” Targeting on need ensures plans prioritize members with the highest clinical and financial risk. For example, those with uncaptured HCCs, behavioral health gaps, or elevated readmission potential that significantly inflate plan costs. Segmenting on behavior then sharpens that focus by grouping members according to refill patterns, benefit utilization, and engagement history. This approach enables more tailored interventions, such as 90-day supply nudges for non-adherent refillers or AWV reminders for prevention avoiders. It also improves outcomes by using personalized outreach that resonates with each member's actual behavioral patterns.
Key Takeaways
Membership growth is essential for long-term plan performance and retention. By proactively mitigating new-member risk, plans can capture more of the upside of membership growth while minimizing financial and operational downside.
Health plans should implement an integrated, data‑driven approach:
- Proactively drive HRA completion.
- Develop rich segmentation models.
- Deploy targeted, behaviorally informed campaigns.
- Ensure the onboarding experience is personalized and member-centric
- Measure and refine continuously to ensure your interventions are effective.
The surge of new members is both a challenge and an enormous opportunity. Not sure where to start? Reach out to request a complimentary engagement consultation.
