Transform consumer health by enabling behavior change

Despite two decades of investments in digital solutions, many health plans still aren’t seeing their return on investment (ROI). What will it take to move the needle? Payers should reimagine digital solutions as engines of behavior change rather than solely as cost-reduction devices or low-cost customer service alternatives. Digital solutions can be effective instruments for improving health outcomes and managing costs, and have evolved into holistic health management platforms powered by analytics and AI. By integrating technology with clinical programs and measuring concrete health actions, payers can reduce costs, improve outcomes and create sustainable competitive advantages that serve their members and their business objectives.

There’s a palpable urgency to transform healthcare as medical costs rise, chronic disease increases and many consumers can’t afford their healthcare. Prescription drug spending, inflation and behavioral health utilization are driving these trends. What’s more, payers face a trust barrier: In our 2024 US Healthcare Consumer Insights and Engagement Survey, payers rank fifth among the five main healthcare information sources, trailing behind doctors, the internet, pharmacists and close family and friends. Just as important, our consumer survey shows that consumers don’t seek healthcare until it’s urgent — signaling the need for interventions that direct consumers earlier to preventive care that can help them avoid serious and costly health issues.

Targeted, highly personalized interventions have the potential to create better outcomes by tailoring solutions to consumers’ specific needs. Digital solutions can offer a way to connect with members in innovative and authentic ways and to reach them where they are, because interventions are only as effective as their reach. For example, a health plan letter or an e-mail that goes unopened is a missed opportunity.

Payers should have a structured approach to behavior change. An effective behavior change engine runs on answers to three key questions:

• Who are we targeting and for which behaviors?
• How can we use data to find and support high impact opportunities for change?
• Where do we engage members?

Each step in this process requires strategic use of data, tailored interventions and a commitment to measuring whether interventions are delivering value and financial impact.

The first step in designing effective interventions is identifying the right populations — those at risk of costly health issues and more likely to respond to targeted outreach. Advanced analytics models, generated by machine learning, give payers the ability to identify these groups and prioritize interventions with the potential for influencing behaviors and significant financial impact. Following this strategy, those members identified as at risk for COPD misdiagnosis, for example, might receive tailored content encouraging them to consult with high-quality pulmonologists. These interventions help reduce unnecessary treatments and improve long-term health outcomes.

Developing effective interventions requires a blend of personalization, behavioral economics and rapid testing. Healthcare can take cues from retail and consumer packaged goods marketers, who use agile navigation marketing to refine outreach and engagement. This approach helps payers develop campaigns and business cases quickly while incorporating member-specific attributes and predicted barriers to action. For example, while payers may believe they already use personalization, many traditional approaches still rely on broad demographic segmentation and costly methods like direct mail or call centers, which have limitations in scalability and effectiveness.

The use of behavioral economics techniques can help address misconceptions about treatment options and the barriers that prevent members from making effective health decisions — whether due to cost, fear, convenience or habit. While traditional evaluation methods focus on isolated interventions, effective strategies recognize that behavior change compounds over time. When multiple interventions reinforce one another — such as pairing educational outreach with decision-support tools — their combined effect is often greater than the sum of individual improvements.

Ultimately, success also depends on breaking down silos and shifting to an integrated model in which health plan teams share accountability for delivering outcomes. This collaborative approach can make it possible for each intervention to function as part of a coordinated system designed to magnify impact across the member’s health journey.

Effective member engagement can take both digital and traditional channels. E-mail campaigns can deliver personalized health reminders, text messages can offer actionable prompts for immediate action and in-app notifications can streamline the integration of health guidance into daily routines. Meanwhile, traditional direct mail has value in cases of complex communications and reaching members who prefer physical touchpoints.

Through testing and refinement, payers can identify which messages resonate with members and determine the right timing for outreach and the most effective channel combinations for different member segments. This data-driven approach also improves spending across channels.

Education remains a cornerstone of these efforts. It’s important that members understand not only what actions to take, but why these actions matter for their health outcomes and financial well-being. People are more likely to embrace the digital tools that help them actively participate in their health when they know how preventive care or medication adherence impacts them. Leading with education and following through with multi-channel engagement helps generate lasting behavior change while building stronger member relationships.

Behavior change initiatives unlock value across four key areas, according to PwC’s analysis of cost savings and margin improvement.

Conditions like asthma and COPD highlight the potential of hyper-targeted interventions. These respiratory conditions are frequently misdiagnosed, leading to avoidable costs and ineffective treatments. By incorporating purchased data assets like lung function test results, predictive models can flag members who are more likely to benefit from a targeted campaign.

COPD and asthma illuminate the high stakes of diagnostic accuracy in respiratory care. With misdiagnosis rates reaching 86% for COPD underdiagnosis and up to 61% for asthma overdiagnosis, the traditional approach of broad clinical guidelines and generic member education proves inadequate. The cost implications are staggering — uncontrolled asthma adds $9,671 annually per patient, while overdiagnosis can result in unnecessary treatment costs exceeding $17,000 per year. ¹

Yet when organizations approach this challenge through the lens of sophisticated behavior change, the results can be transformative. By integrating advanced analytics with behavioral economics principles, leading healthcare organizations can create dynamic systems that not only identify at-risk members but predict the likelihood of their engagement with specific interventions. Tailored campaigns encourage members to seek appropriate follow-up care while reducing the costs of misdiagnosis and improving health outcomes. Additional examples of interventions, such as outreach from pharmacists or digital tools akin to educational programs on popular streaming services, further underscore the versatility of behavior change initiatives.

To boost the impact of behavior change initiatives, payers should take action in five areas.

Advanced analytics and measurement

• Leverage AI to help identify high-value behaviors and influenceable members.
• Develop strong frameworks to track and improve clinical and financial outcomes.

Agile intervention development and optimization

• Deploy rapid, personalized campaigns using behavioral economics principles.
• Continuously refine communications through A/B testing to compare two versions of a web page, e-mail or other digital asset to see which one performs better; and through randomized control trials and performance data.

Multi-channel engagement and education

• Orchestrate campaigns across e-mail, app notifications and traditional channels.
• Lead with education to help members understand the rationale behind health actions.

Clinical outcome integration

• Connect behavior change initiatives directly to measurable health improvements.
• Align digital interventions with clinical programs and care management.

Member-centric experience design

• Create experiences that are both intuitive and frictionless to help drive sustained engagement.
• Personalize interactions based on individual health journeys and preferences.

When payers use their digital strategy to focus on proactive health behaviors like treatment adherence and preventive screenings — and help members understand why this matters — they can not only enhance member satisfaction but also foster a healthier population motivated to take charge of their health.

_{1 “Cost and health care utilization in patients with asthma and high oral corticosteroid use,” Broder, M. S., Raimundo, K., Ngai, K. M., Chang, E., Griffin, N. M., & Heaney, L. G. (2017). Annals of Allergy, Asthma and Immunology, 118(5), 638-639}