Despite a broad – and growing – recognition that artificial intelligence plays a monumental role in enhancing member experiences and trust, health plan leaders share that their organizations’ strategic plans prioritize organizational efficiency over member engagement.
That’s according to a recent survey of 70 health plan leaders conducted by healthcare consultancy Sage Growth Partners. The independent survey commissioned by Lirio in Q1 2025 was intended to learn from decision makers about their initiatives to improve the member experience, their investment priorities, and perspectives on how AI will continue to shape the healthcare industry.
The full survey findings will be released at the end of April, but this sneak peek into some of those findings provides myriad noteworthy takeaways.
Efficiencies over outreach
By and large, plan leaders cited organizational efficiencies as where AI will have the greatest impact on their organizations in the next 18 to 24 months. Responses primarily focused on:
- – Claims adjudication
- – Prior authorization
- – Risk adjustment
- – Reading chart notes, images, HCCs
- – Reducing administrative burden
- – Clinical decision tools
Overall, the survey found that:
- 100% of health plan leaders say incorporating personalization into member outreach is important across all steps of the member journey, including preventative care through chronic care clinical communications.
- Less than half of health plan leaders say their current solutions empower users to design personalized outreach “well.”
- Above technology challenges, risk level, and age, health plan leaders report that members who lack trust in their health plan or health system are the most challenging to engage.
Survey respondents ranged from national to regional health plans, Managed Medicaid plans, provider-sponsored health plans, and technology or venture-backed health plans. Respondents were primarily distributed across the C-suite, Director, or Vice President or Senior Vice President levels, across diverse functional areas that included operations, provider relations, risk management, and analytics. Plan types included but weren’t limited to commercial, Medicare Advantage, Managed Medicaid, and Tricare.
Three noteworthy findings:
The soon-to-be released market report includes detailed insights related to each of the above findings.
Key data points:
Prioritizing personalization across all steps of a member’s journey is imperative
Plan leaders were provided five primary areas in which to rank the importance of personalized member outreach: general enrollment (such as benefit education); preventative care; follow-up clinical communications; chronic care management; and financial outreach. Across all plan sizes and geographies, each was considered important — underscoring the long-term shift from a sick-care system designed to maximize individual outcomes to a system that benefits the majority of members. Research shows that defining such outreach is less clear-cut, however, especially when many health plans blur the lines between traditional marketing segmentation techniques versus true personalization.
Learn more about Lirio’s N-of-1 member personalization here.
Well-designed outreach is lacking
Not all member personalization is created equal. Seventy-seven percent of health plan leaders say it’s very important to incorporate personalization for chronic care clinical outreach (such as for diabetes care management). However, fewer than 15 percent say that their plan’s level of personalization for chronic care outreach is optimal. Those numbers declined to less than 10 percent for optimized personalization around preventative care outreach. In order to make longitudinal health impacts rather than crisis-manage, the member engagement strategies and tools need to follow suit.
Lirio’s Precision Nudging® diabetes library includes over 500 tailored behavioral interventions to promote diabetes care utilization, and more than 300 interventions to promote digital engagement between care appointments. Read a case study here.
Lack of member trust is a major hurdle for health plans
Members who lack trust in their health plan or health system are the most challenging to engage, said respondents. In free-text responses, they shared insights such as:
- “Members fear that their plan is just trying to avoid expensive services.”
- ”Members trust providers more than their health plan.”
Interoperability has long been lauded as a way to connect the dots. But this new research shows that perhaps even more than the moderate crawl toward data sharing that’s primarily between healthcare organizations, connecting the dots between members and their plans with AI-powered personalization is a straightforward line to overcoming trust barriers.
Read more about how Lirio enhances member enrollment, satisfaction and loyalty, helps close gaps in care, and more here.
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