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Revolutionizing Medicare Member Engagement: A Guide to Seamless Advantage Enrollment

By John Zimmerer, VP of Healthcare Marketing at Smart Communications 

Navigating the world of senior market member engagement poses unique challenges for healthcare payers. As you strive to enhance member satisfaction and enrollment processes, it's crucial that you address the rising complexities within the Medicare Advantage landscape.  

This blog will shed light on key challenges and provide insights into revolutionizing member engagement for a seamless enrollment process. 

The Challenge of Medicare Member Engagement 

Let's delve into the pressing issues and explore how a strategic approach can transform the member engagement experience.  

Increased Competition 

Picture this: in the 2023 plan year, the average Medicare beneficiary found themselves amidst a sea of choices, with over 40 plans to sift through, as per CMS data reported by KFF. This staggering number reflects a doubling of available plans over just five years. As a healthcare payer, the challenge lies not only in offering competitive plans but also in ensuring that your members can navigate this abundance with ease. 

Poor Customer Experience 

Adding to the complexity, the US Health Insurers Customer Experience Index Rankings for 2023, presented by Forrester, highlighted a persistent issue. The average health insurer's customer experience (CX) remained stagnant, placing them at the lower end of the ranking. What's more, Forrester's findings revealed that the CX of commercial plans tend to trail behind that of government plans. 

The Influence of Star Ratings 

Amidst the challenges mentioned above, the influence of customer experience on Star Ratings has undergone a significant shift. CX measures currently constitute a substantial 57% of a plan's Rating. This evolution is pivotal because Star Ratings, as numerous studies affirm, play a decisive role in driving enrollment. As healthcare payers, the question that beckons is clear: In the evolving Medicare landscape, are you positioned to retain or lose members as they transition into this critical phase of healthcare decision-making? Keep reading for strategies to not only meet these challenges head-on but also to redefine the Medicare member engagement experience at your organization. 

Trends Driving the Need for Better Medicare Member Engagement 

According to internal and external research, we’ve highlighted the key trends that will have an impact on Medicare member engagement for the 2024 plan year and beyond. 

1. CX Will Continue to Make a Big Impact to Member Enrollment 

For decades, Forrester has researched the realm of customer experience, consistently revealing its profound impact on customer loyalty and retention. Our latest Healthcare benchmark report aligns with Forrester's insights, emphasizing that simply one negative experience can drive customers away. Given the weight Star Ratings places on CX, this trend should be top of mind as you plan how you’ll prioritize enhancement to your customer. 

2. Technology Will Play a Pivotal Role in Attracting and Retaining Members 

While commercial plan members may find themselves with limited choices, the scenario shifts when it comes to Medicare Advantage, Medicare Supplement, or prescription (Part D) plans. KFF's data underscores that merely 18% of Medicare Advantage enrollees are in employer- or union-sponsored plans. Now, consider this: Most Medicare Advantage enrollees (88-94%) rarely switch plans voluntarily. It's a one-shot opportunity for you as a healthcare insurer to secure a new Medicare Advantage enrollee.  

The potential lies in leveraging data, artificial intelligence (AI), research, and technology to guide existing commercial members seamlessly into the "right" Medicare Advantage plan for them – and crucially, to retain them. Even if you haven't delivered optimal CX to your commercial members, offering them a seamless Medicare enrollment process—like the one made possible by SmartCOMM™ and SmartIQ™—can alter their perception of your company for the better. 

3. Seamless Processes Will Make or Break Your Medicare Member Engagement Strategy 

Let's dive into the numbers. An analysis of CMS data by KFF unveils a revealing insight. One-third of Medicare beneficiaries reported finding it challenging to compare plan options. This underscores the key role you play as a healthcare payer. By enhancing the enrollment experience, you're not just facilitating a process; you're transforming perceptions and cementing lasting connections with your members. The evolving landscape demands more than traditional approaches; it calls for a strategic shift in how you engage with and guide your members through the complexities of Medicare enrollment. 

Roadblocks to Increasing Medicare Member Engagement 

You know that the process of developing Medicare plans can be demanding and stressful, especially with disjointed systems. It’s a full-time job to enable members to retain their current (in-network) providers, to curate drug formularies, and meet regulated timelines. It doesn’t have to be, though. With the lack of integration and siloed processes, your current enrollment tools can't harness essential claim data that’s locked within your core systems. This limits your capacity to make personalized plan recommendations. By dismantling these silos, you can unlock valuable and necessary insights, empowering you to provide guidance to your members during the Medicare plan selection process. 

Cognizant’s Medicare Navigator, Powered by SmartIQ™ 

Streamlining the enrollment process for your Medicare Advantage (MA) plan can make all the difference. The American Economic Association emphasizes that reducing customer effort leads to higher completion rates. Building on this, Forrester's body of research has consistently shown that enhancing customer experience aids in retaining existing members and expanding your market share in the fiercely competitive MA landscape.  

The stickiness of MA plans offers a unique advantage, creating members for life and boosting Customer Lifetime Value (CLV) due to their higher profitability compared to commercial plans. With a simple, efficient enrollment process, you position yourself for greater competitive differentiation in a crowded marketplace, where happy members become your advocates. 

The good news is that the technology now exists to help you leverage members’ historical claim data, enabling you to identify the best plan option(s) for them. Cognizant’s Medicare Navigator, powered by our SmartIQ software, provides a friction-free process for your members to select and enroll into a plan. Together, we can integrate the front-end plan selection process seamlessly with solutions such as TriZetto® Elements Enrollment Administrations Manager (EAM) to streamline operations. Ultimately, a better process for enrollments will increase retention and profitability. 

Addressing Fear, Uncertainty, and Doubt 

If you're on the verge of losing members as they transition from commercial plans to the Medicare population, Smart Communications’ leading solutions are the key to boosting your conversion and retention rates. While your competitors lack the tools, experience, and relationships needed, we, in partnership with Cognizant, provide solutions that set your business apart. 

Through our large partner network and the integrations that make possible your Medicare member engagement goals, our solutions offer more than the necessary functionality. We're uniquely positioned to help your organization shine in the eyes of prospects, current members, and the C-Suite. 

And the best part? Our sophisticated cloud software has been proven to save money for enterprises in highly regulated industries, freeing up valuable resources for the initiatives your company leaders keep striking out of the budget. It's time to embrace a cloud solution that not only enhances Medicare member engagement but also propels you toward professional success. 

RELATED READING | ‘Forrester Opportunity Snapshot: Disjointed Experiences Cost Insurers Members and Money’ 


You're on a mission to boost senior market enrollment and retention, but member fear, uncertainty, and doubt (FUD)— coupled with past experiences with commercial plans— are roadblocks. The key lies in enhancing the plan selection and enrollment process and offering personalized plan recommendations based on individual claim histories to foster trust and convert commercial members into Medicare Advantage (MA) members. 

Partnering with Cognizant, we're here to guide you through the entire process, from segmentation and outreach to plan selection and enrollment. Cognizant's research validates our approach, analyst accolades showcase our capability, and customer testimonials, including success stories from healthcare payers like you, assure success. 

Streamlining the enrollment process holds the promise of lower abandonment rates, higher conversion rates, upselling opportunities, and reduced administrative costs. 

The cost of doing nothing outweighs the benefits of taking action. The resulting revenue and savings not only mitigate opportunity risk but also secure your position. It's time to turn challenges into triumphs with a solution designed to drive Medicare engagement. 

To learn more, access the on-demand webinar with Cognizant and Smart Communications hosted by Fierce Healthcare or request a demo of SmartIQ for Enrollment

About the Author
John Zimmerer is the Vice President of Vertical Marketing, Healthcare at Smart Communications, where he acts as a subject matter expert on the digital transformation of customer communications and data-centric, often form-based workflows. Most recently, John has been researching and writing about improving customer experience in healthcare and is regarded as a thought leader in this area. John has over 20 years of software product marketing experience. His areas of expertise include market research, analyst relations, public relations and digital marketing.