Rethinking the Member Experience: Why Modernizing Health Plan Communications Is Long Overdue

Member satisfaction with health plans is falling across both Commercial and Medicare Advantage segments, and the gap between top- and bottom-performing plans is increasingly widening. According to J.D. Power, the difference often comes down to communication: “Leading plans are setting themselves apart by delivering clarity, digital convenience, and member-first communication. Others are falling behind as trust erodes, digital tools go underutilized, and members struggle to understand their coverage.”

While some plans have fully embraced digital transformation, others have been reactive—focused on getting materials online quickly rather than building cohesive, omnichannel experiences. Most send communications such as enrollment materials, welcome kits, and servicing correspondence filled with jargon and content irrelevant to the individual member, making them hard to understand. Printed documents are the norm, whether sent in the mail or as unresponsive PDFs posted to digital portals.

These outdated communications can undermine members’ ability to understand their coverage or make confident decisions. Confused or frustrated members turn to the call center for clarification or, worse, miss out on benefits they’re entitled to. For health plans, the business impact is higher servicing costs, lower retention, and declining STAR ratings.

Many health plans want to deliver clearer, more personalized communications across more channels, but feel constrained by legacy systems and processes. Most have heavily invested in print-centric platforms that are costly to maintain, slow to update, and too rigid to support today’s multichannel environment. The solution isn’t standing up new digital tools alongside the legacy ecosystem; it’s modernizing how communications are created, managed, and delivered across the organization.

1) Centrally Manage Communications Across All Channels

Members expect to choose how they engage with their health plan—through the mail, email, text, or a mobile app. Accommodating these preferences is essential to improving satisfaction, yet the fragmented way communications are managed makes it nearly impossible to do so sustainably.

Each time a new channel is introduced, a separate operational silo and management system is created to support it. Printed letters may be managed in a legacy system, emails in a newer one, while web, portal and mobile app content is managed each in their own different, disparate systems. This approach is costly and inefficient, with similar content recreated and maintained across multiple systems.

Leveraging a centralized content hub eliminates this complexity. In these systems, content is managed independently from templates tied to a specific delivery channel. Benefit descriptions, disclosures, and marketing promotions can be reused across communications and channels while being controlled from a single point of change. When content is updated, the change is automatically reflected everywhere it appears—improving both efficiency and consistency. No longer does an update mean accessing 5 different systems and dozens of communication templates.

This model also enables plans to support traditional composed formats, like print and PDFs, and dynamic digital experiences such as mobile apps, chatbots, and websites. Through modern, API-based content delivery, front-end systems can pull approved, personalized content in real time and display it appropriately for each channel. Plans can then support member channel preferences without intensive coding, duplicating effort or creating new silos from a single, centralized source.

2) Empower Business Teams to Control Changes

Most health plans struggle with long turnaround times for content changes. Whether it’s a midyear formulary adjustment or a regulatory change, even small edits can trigger a long chain of requests to IT teams or third-party service providers. Marketing, product, and compliance teams may know exactly what needs to change, but reliance on specialized IT resources stretches change cycles into weeks or month.

Modern no-code communication platforms eliminate this bottleneck. These tools enable non-technical users to create communications, update variables and data for personalization, manage rules, and make content changes through intuitive interfaces. Once approved, updates can go live with clicks instead of code. By putting content changes in the hands of business teams, plans can shorten change cycles from months to days—accelerating time to market and reducing the risk of missed regulatory deadlines.

3) Increase relevance and personalization

Members expect their health plan to know who they are and communicate accordingly. A member nearing renewal wants a clear comparison of coverage options, not a generic marketing brochure. A dual-eligible beneficiary needs to see only the benefits that apply to them, not a 60-page booklet that buries what matters under irrelevant details.

Health plans already have the data required to personalize communications—plan type, region, demographics, and even health indicators all sit in their systems. The challenge is that legacy systems are built around static templates, where each version is tied to a specific plan, state, or population segment. This document-centric approach makes personalizing communications beyond “Dear [first name]” and other basic variables too inefficient to manage at scale.

Modern systems solve this through intelligent content management. Instead of maintaining hundreds of static documents, communications are assembled from shared content components with built-in targeting rules. These rules determine which content is included in a communication, automatically adjusting text, images, and details to fit that individual’s situation. This allows plans to deliver relevant, personalized communications without maintaining endless document variations.

How AI can streamline modernization

Many health plans recognize the benefits of modern communication platforms but hesitate, anticipating a long and costly migration. If handled manually—or outsourced to a third party—those concerns are often justified. Fortunately, AI can automate the most difficult and time-consuming parts of migration. These tools can ingest legacy content, identify and consolidate duplicates, and prepare it for deployment in a new system. Some offer AI-assisted optimization, detecting unclear or off-tone language and suggesting rewrites aligned to readability, sentiment, or plain-language standards. By leveraging these tools, plans can compress migrations from months or years down to weeks and emerge with a clean, standardized content library as the foundation in their new platform.

Modernizing the member experience doesn’t have to be disruptive or costly. By centralizing control of communications, empowering business users to manage them, and using AI to make content clearer and easier to maintain, health plans can reduce operational burden while strengthening trust and improving satisfaction.

Originally published in Swaay Health