How health plans can move beyond engagement volume to measurable behavior change

Every year at HLTH, I leave with at least one moment that lingers. Sometimes it’s a quick exchange between sessions or a line overheard in passing. This time, it was a simple line I overheard that stayed with me: “We communicate more than ever and nothing changes.”

The idea isn’t new, and most leaders have said some version of it themselves. After a decade of deploying omnichannel platforms, migrating CRM systems, automating campaigns, building AI content engines and assembling engagement pods, it’s reasonable to ask how we can reach anyone across any channel—and still struggle to influence what members do next. That gap sits at the center of payer engagement today and signals a conversation the industry is only beginning to have.

Like any good story, this one unfolds over several acts. I see three that matter because they explain where plans get stuck: believing volume drives action, skipping the work that gives communication meaning and missing the human factors that make behavior change possible.

Act I: Why communication alone rarely leads to member behavior change

Much of health plan communication has grown around the assumption that more outreach produces more engagement, and that engagement naturally leads to better outcomes. But outreach is only the first rung in a longer behavioral sequence. Behavior change requires movement across a chain. Outreach, engagement, experience, journey, trust and behavior change form a causal ladder—and most organizations never climb past engagement. Volume keeps climbing while meaningful change remains stubbornly flat.

Leaders are beginning to reexamine the assumptions behind this disconnect. It’s easy to equate activity with progress and to treat message volume as a proxy for strategy. The more useful question is whether all that activity is creating movement—or only creating noise. The difference between outreach and impact often depends on whether communication is shaped by the behaviors plans hope to influence in the first place.

Act II: What’s the difference between member engagement and outreach?

Plans often treat outreach and engagement as interchangeable, but they serve different purposes. Here are the key pieces of that behavioral ladder:

1. Outreach is the message itself. These messages include email, SMS, IVR, push, chatbot scripts, letters, calls and other communication intended to inform or prompt.

2. Engagement is the member’s response. This response may be a click, call, reply, portal registration or self-initiated exploration. Silence and access patterns often reveal as much as any direct action.

3. Experience reflects the meaning members take away from an interaction. This meaning is built through clarity, tone, friction and frequency over time.

4. Journeys are the sequence of experiences over time, shaped by context—not channels. A member can be frustrated by pharmacy outreach yet still appreciate the provider network, which is one reason journeys can bend trust in different directions.

5. Trust is the accumulated understanding of reliability. Trust grows when experiences align and erodes when they don’t. Its depth determines how difficult a behavior a member is willing or able to take on. Scheduling an appointment with your doctor requires modest trust, while others, like managing chronic conditions or seeking treatment, require far more.

Behavior change—that elusive endpoint—requires each rung on the ladder and depends on understanding the emotional, cultural, social and functional factors that shape decisions. Reaching members where they are, not where plans assume they are, creates the conditions for movement. Messages don’t change behavior. Meaning and context do.

Act III: How can health plans orchestrate outreach that changes member behavior?

Behavior‑changing communication creates the conditions for action by grounding outreach in three human dimensions. 

• Health literacy: “Can the member understand?” If members can’t understand a message, the ladder fails at the first rung.

• Language proficiency: “Can the member communicate?” If they can’t speak or receive information in a way that resonates, trust never develops.

• Agency: “Does the member want control, and can they exercise it?” Agency has two dimensions: capacity, a member’s cognitive, physical, and social ability, and desire, a member’s motivation toward autonomy or support. Together, they determine how people interpret responsibility and support throughout their journey.

A message asking someone to self-navigate assumes capacity and desire. Plans often assume members can self‑navigate even when capacity or desire is limited. AI can now generate volumes of content, but without attention to literacy, language and agency, those messages don’t become more strategic. They simply become more frequent. Behavior‑changing communication aligns each message with the mind receiving it, matches responsibility with capacity and respects the journey the member is actually on.

At HLTH this year, the contrast was hard to miss. The halls were full of AI claims, but the conversations that mattered weren’t about what AI can do. They focused on what it should be trusted to scale. Leaders were less interested in output for its own sake and more focused on whether the underlying models understand why people don’t act in the first place. That shift mirrors what plans are wrestling with now. Capability without context only adds to the noise.

AI can support meaningful progress when it focuses on the factors that matter most. In our work, we’ve seen it elevate outreach quality and strengthen the ability to predict member engagement. It can personalize experiences in ways that help members navigate benefits with less friction. It can also detect journey patterns and surface trust-related signals that allow plans to intervene earlier. When used this way, AI becomes a tool for measuring behavioral movement rather than amplifying volume.

Plans that apply this approach see measurable results:

• +0.03 PDC lift in adherence (p<0.003)

• 3%-5% reduction in nonemergent ER visits

• 20% increase in care‑management enrollment

• 12% improvement in pharmacy offer acceptance