Navigating the Build vs. Buy Debate for Member Engagement Solutions

Member engagement is a critical function of any health plan’s outcomes improvement strategy. How members interact with their health plans directly impacts satisfaction, health outcomes, and adherence to care plans. Studies show that engaged members reduce medical costs by 5.3% and lower hospitalizations by 12.5%.This is because providing members with information about their benefits, assisting with doctor visits, encouraging preventive screenings, and offering follow-up care recommendations makes a significant difference. Alongside a care coordination strategy focused on helping the more health-challenged members, a strong engagement strategy ensures all members receive the support and tools they need to start and stay on their healthcare journey.    

Effectively executing these engagement efforts requires a thoughtful approach. Health plans must determine whether to build these capabilities in-house, augment their staff during certain times of the year, or seek external expertise to support their efforts year-round. The evolving landscape of healthcare demands that health plans continuously refine their engagement strategies, making this decision more critical than ever. Plan leaders must consider key factors, including cost, speed, scalability, and effectiveness, to guide them toward the most impactful approach.

The case for in-house development

Keeping member engagement in-house gives health plans more control over their operations. This helps to ensure outreach efforts parallel their care coordination strategy and align with their goals and priorities. While keeping member engagement in-house provides more control, it also comes with hurdles such as internal processes often involving multiple approvals and coordination between departments, which can slow things down. When response times lag, it becomes harder to adjust to shifting market demands or evolving priorities.

Implementing outreach programs also requires significant investments in staff, training, technology, and office space. A campaign targeting 20,000 members over four months requires up to five call attempts per member to deliver the best results, resulting in up to 25,000 calls monthly, requiring on average 13 dedicated full-time staff members, which can cost a health plan more than $600,000 per year before taking into account the cost of the dialer and other infrastructure. Additionally, internal call center employees are usually juggling multiple tasks — including customer service, seasonal campaigns, and claims support, making it tough to dedicate enough resources to member engagement outreach. Ensuring high-quality interactions with members requires careful planning and resource management to maintain engagement and provide timely access to care, .

The case for outsourcing

Outsourcing member engagement to an experienced vendor can be a practical solution for health plans looking for flexibility, scalability, and faster implementation. Many vendors provide specialized training in empathy, ensuring their teams deliver meaningful interactions with members. With the ability to launch programs more quickly than building internally, outsourced teams focus solely on engagement rather than juggling multiple priorities. Outsourcing also provides health plans with the flexibility to focus on their specific goals. Plans can choose to prioritize areas such as member satisfaction, appointment attendance, Risk Adjustment, or closing care gaps, tailoring the vendor’s efforts to align with their overall strategy. With the right partner, outsourcing can streamline operations, reduce administrative burden and cost, and ultimately enhance the member experience.

Questions to ask when considering outsourcing member engagement 

• Can your internal team launch campaigns as quickly as within 4-6 weeks?
• How do the costs of in-house hiring, training, and infrastructure compare to outsourcing?
• Are your internal processes engaging members sufficiently?
• How does your internal team handle sudden spikes in demand or seasonal programs?
• How critical is maintaining direct control with in-house staff vs. building a coordinated partnership with a trusted vendor?
• Are your teams focused on member outreach or juggling multiple priorities?

Choosing the best approach

Choosing between in-house development and outsourcing depends on a health plan’s specific needs, resources, and priorities. Managing engagement internally provides greater control and keeps everything aligned with organizational goals. However, outsourcing can improve efficiency and provide access to specialized expertise. There is no universal solution — each health plan should evaluate its capabilities and long-term objectives to determine the approach that best supports its operational goals while enhancing member health and well-being.

Photo: Feodora Chiosea, Getty Images

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