It’s a familiar conversation in healthcare: how do we influence member behavior? How do we ensure employees make the best use of their benefits—seeing the right providers, using high-value facilities, and taking advantage of the carefully selected programs designed to improve outcomes and lower costs?
Despite years of effort, engagement strategies, and countless solutions, the challenge remains. If sheer energy and attention could solve this issue, we’d have figured it out by now. But we haven’t—so what’s next?
At Together with Collective Health, our panel of industry experts tackled this question head-on, discussing new perspectives and strategies for guiding behavior in a way that truly makes an impact.
The key takeaways for benefits leaders:
- Utilize data analytics to identify patterns in healthcare utilization and behavior to influence patient decision-making.
- Create easy-to-use tools, such as a directory of high-quality providers, performance-based ratings, or AI-driven recommendations, that help employees find and choose providers aligned with clinical guidelines and evidence-based practices.
- Introduce financial incentives to encourage employees to use providers adhering to best practices, while adjusting healthcare plans to reduce premiums, and co-pays, and increase coverage for preventive services, ensuring affordability and better health outcomes.
- Invest in primary care engagement strategies to improve chronic care management.
- Streamline healthcare access by simplifying the user experience and building trust with members.
The Voices in the Room
Larry Leisure
Co-founder of Chicago Pacific Founders & NearWater Growth
Dr. Matt Resnick
Chief Medical Officer at Embold Health
Dr. Jennifer Cho
VP of Clinical Programs at Collective Health
Why Behavior Change Is More Critical Than Ever
Before diving into solutions, it’s important to recognize the broader landscape. As Larry, an investor and former health plan executive, pointed out, employers are facing out-of-control healthcare cost trends. Many employees—especially those in lower-income brackets—are hitting a breaking point. They have insurance but struggle to afford care, a phenomenon known as being functionally insured.
Larry emphasized that this isn’t just about bending the cost curve for employers; it’s about making healthcare truly affordable for employees. “By doing the right things, employees really can afford health insurance and healthcare. But the challenge is, how do we help them navigate the system to both improve their health and reduce their financial burden?” he said.
This means that driving behavior change isn’t just about optimizing benefits—it’s about ensuring employees can actually access and afford the care they need.
Understanding What Drives Decisions
Camille, Collective Health’s Director of Insights, emphasized the need to deeply understand why members make the choices they do. Behavioral science teaches us that decisions around healthcare are rarely rational or purely financial. Fear, past experiences, trust in providers, and access barriers all play a role.
Dr. Matt Resnick, a urologic oncologist and Chief Medical Officer at In Embold Health, shared insights on how even small differences in provider behavior can impact patient outcomes. “When patients choose their providers, those providers set into motion everything that follows—MRIs, medications, surgeries. The way doctors practice medicine is often habitual. Spine surgeons perform surgery; that’s what they do. So, a key opportunity is guiding members to high-quality providers whose clinical practices align with best practices,” he explained.
This approach also involves removing financial barriers for seeing high-quality providers and, in some cases, creating more financial friction for seeing those whose practices are not aligned with evidence-based care.
Breaking Through ‘Solution Fatigue’
With so many programs, engagement platforms, and communication campaigns, it’s easy for employees to tune out. Dr. Jennifer Cho, a pediatrician and VP of Clinical Programs at Collective Health, highlighted that simplicity and trust are critical. If members don’t understand how a program benefits them—or if it requires too much effort—they’re unlikely to engage.
“Primary care plays a vital role here,” Jen noted. “Establishing a relationship with a provider, whether that’s traditional primary care, virtual care, or even AI-assisted care, creates an opportunity to truly understand the member’s needs and barriers. That relationship unlocks preventive actions and behavior change that can lead to better health outcomes.”
Larry added another layer to this discussion: “The market is telling us that the real challenge is intercepting and engaging chronic patients, keeping them within trusted care paths. The big players are all working on ways to use economic incentives to guide members into high-quality care pathways where providers are accountable for outcomes. The urgency now is driven by cost, and we have to get serious about solving it.”
Care Pathways: Creating the "Easy Button"
One of the biggest challenges in healthcare is ensuring that patients take the right actions. Many organizations have invested in patient education, care pathways, and provider networks, yet people still fall off track. Why? Because making the right choice is often too difficult. The key takeaway: "The whole job is to make it easy for people to do the right thing and hard to do the wrong thing."
An example: a structured "family-building care path" could guide patients step-by-step through fertility treatments, offering coaching, financial planning tools, and support services. Similar pathways could be developed for cancer, longevity, and chronic conditions—ensuring that patients not only trust the system but find it easy to navigate.
This concept extends beyond clinical care. A major employer once revamped their maternity program by making it simpler: instead of employees navigating complex benefits, a single call connected them with everything they needed. Participation skyrocketed. The lesson? People engage when it’s easy.
Personalization and AI: The Future of Provider Search
Part of that necessary ease and a critical issue in healthcare is how patients choose providers. Right now, provider search tools are one-size-fits-all, but different factors matter depending on the situation. If a parent is searching for a pediatrician, they may prioritize quality over convenience. But for a simple dermatology appointment, ease and availability might matter more.
"The search experience needs to be more like Netflix than a static directory," Dr. Matt Resnick explained. "If we apply AI and large language models to provider search, we can surface the best options based on what actually matters to each individual patient."
Imagine a system where a patient searching for a foot specialist is asked: “How long has this issue been going on? Have you tried conservative treatments?” Instead of defaulting to a foot surgeon, AI could guide them to the most appropriate care, improving outcomes and reducing unnecessary procedures.
Meeting Patients Where They Are
Even with the advancements of AI, there isn’t a one size fits all solution. Understanding patients’ preferences and behaviors can transform healthcare delivery. Some prefer online interactions, others need a phone call. Creating patient personas based on real data—just as experienced clinicians instinctively adjust their communication styles—can make healthcare more approachable. "Everyone eventually needs to get on the right care path, but how they get there should be tailored to them."
The ultimate goal? A healthcare system that is as seamless and trustworthy as the best consumer experiences—where getting the right care feels like water flowing downhill instead of pushing a boulder uphill.
Strategies for Driving Meaningful Change
- Personalization is Key
Generic outreach won’t cut it. Tailoring messages and interventions based on member data—like past utilization patterns or known barriers to care—can improve engagement. - Provider Influence Matters
Physicians and care teams have significant sway over patient decisions. Ensuring they are aligned with benefit strategies can help reinforce the right behaviors. - Make Navigation Seamless
If accessing high-value care requires multiple steps, members will default to what’s easiest—even if it’s more costly or lower quality. Reducing friction is essential. - Meet Members Where They Are
“We have to acknowledge that members don’t wake up thinking about their health plan,” Matt said. “They think about Google, their neighbor, or a family member for advice. We need to intercept them in those moments, providing trusted resources in the ways they already engage—whether through AI, SMS, or simpler digital tools.” - Connect the Dots Between Solutions
“Right now, members are being ping-ponged between solutions,” Matt added. “They have disease management programs, virtual and in-person care, and specialty services—but none of these talk to each other. Members just want their knee to stop hurting. Our job is to coordinate all these moving pieces so that the experience feels seamless and centered around their needs.”
Moving Forward—Together
The challenge of influencing member behavior isn’t new, but the stakes are higher than ever. As we continue to refine strategies and learn from both successes and failures, one thing is clear: the key to success isn’t just more engagement efforts, but smarter, more human-centered ones.
By working together—employers, healthcare providers, benefits leaders, and solution partners—we can drive meaningful change and make healthcare work better for everyone.
