ICYMI, Becker’s Healthcare recently hosted an insightful roundtable, From Member Frustration to Member Loyalty: And the Role of AI. Four of us participated – Robert Connely, Global Industry Market Leader of Pegasystems, Tina Galloway, Vice President, Enterprise Client Executive of Optum, Mike Gerrish, Chief Marketing and Experience Officer of Blue Cross Blue Shield of Kansas, and me. I am grateful to Becker’s and my fellow panelists for the opportunity to discuss how to improve health plan member experience.
Five Takeaways about Health Plan Member Experience and AI
I encourage you to listen to our full conversation by clicking here.
There were many nuggets and learnings shared, including five important takeaways.
- Competition is Consumer- and Enterprise-Driven and is Linked to the Affordability Crisis
Member experience matters much more now for three primary reasons:
- Competition in the commercial markets is especially fierce.
- The headwinds in the Medicare Advantage market mean payers need to strategically focus on their ASO (administrative services only) book of business and meeting member expectations.
- Poor member experience leads to higher administrative and medical costs, impacting plans’ ability to achieve affordability and necessitating premium increases.
Members compare their health plan experiences not just to other insurers but to top consumer brands. Personalization, convenience, proactive support and navigation are becoming critical to remain competitive and drive loyalty.
Mike Gerrish: “At Blue Cross Blue Shield of Kansas, we tell our teams we’re competing against the last company product or service that our member has interacted with where they had a good experience. So, when you think about being fast, predictive, helpful, efficient, engaging, all those good things, I mean we’re really in the content management business.”
- AI + Orchestration Reduce Friction
The future of personalization in health plans lies in orchestrating seamless, end-to-end experiences. AI plays a critical role in eliminating fragmentation, enabling proactive engagement, and supporting affordability—while still keeping human care at the center.
Tina Galloway: “Members are not expecting, and our customers are not expecting, health plans to just pay claims. They’re expecting health plans to improve the process, to navigate care, and they’re expecting us to reduce the friction in the system.”
Robert Connely: “If you realize what your experience is—let’s talk about that because that’s really what we’re after here—it’s a series of events that better occur in a proper orchestration; they should be synchronized.”
- Empathy + Journey Mapping Are Key
As I shared during our conversation, “It’s really critical that everybody understands what the member is going through in their personal situation, what benefits that they have to hold for them, how to help them navigate through that, and to reduce any friction along the way.”
Mike Gerrish: “The evolution is thinking beyond expectations. We’re really using AI and we’re using analytics and journey mapping to anticipate the ecosystem of what someone’s going through and kind of stitching it all together.”
- Failure to Build Member Trust Increases Costs
First impressions, such as onboarding and first calls, care transitions, and benefit navigation, are make-or-break moments in building member trust. Failure at these critical touchpoints causes immediate disengagement, poor outcomes, and churn, all of which can increase costs.
Mike Gerrish: “Much like other consumer categories, you don’t get a second chance, but a lot of people don’t have a choice in who their provider is. So, there’s this really interesting ecosystem. The way we’re building trust is the first call; the first interaction has to hit.”
Tina Galloway: “When members lose trust in the health plan, the operational impact is usually immediate, and it’s very costly. When members disengage, they delay care; they often turn to higher cost settings like the emergency room. If they have confusion around their benefits or billing, that erodes confidence really quickly…personalization is something that I believe helps to rebuild that trust.”
- Human-Led, AI-Enabled = Trust
Innovation should prioritize the member experience and align with the organization’s mission. Technology should empower people—not replace the human touch—ensuring efficiency without erasing empathy.
Digital tools and AI should serve as enablers—handling complexity, anticipating needs, and supporting frontline staff—while the human element delivers empathy and advocacy. This orchestration turns health plans from transactional administrators into trusted partners in members’ health journeys.
Robert Connely: “If that happens to be the example, AI will do the work in the background, recording the information, typing in the information, pulling together content, educating and coaching that call center representative through that experience, the idea being to provide that best experience for that member.”
Lori Logan: “Where AI can help is to make sure that payers get the basic matters right and tight and support whoever is on the frontline to offer that human-first approach to help the member. Where we see AI assisting is to advocate whatever the journey is. It’s really a role flip from administrative, which tends to be negative, to being my trusted advisor to help me navigate.”
Data stewardship also helps to build member trust. Health plans are advised to practice data minimization, apply strict governance, and use AI responsibly to protect member privacy. Purposeful, secure, and empathetic data use is essential to trust, personalization, and the health plan of the future.
To view our full conversation, visit: https://go.beckershospitalreview.com/payer/from-member-frustration-to-loyalty-how-ai-is-enabling-true-personalization