Why Medicare Advantage Members Ignore Your Messages—and How AI-Powered Personalization Changes Everything
Every Medicare Advantage (MA) plan faces the same paradox. Health plans invest millions of dollars in core and supplemental benefits. Members receive hundreds of communications every year. Yet outcomes remain disappointing:
3 out of 10 members use no supplemental benefits at all
Fewer than 50% use dental or vision benefits
Less than 10% utilize meal delivery or grocery allowances
The problem isn’t message volume. It’s relevance.
The Supplemental Benefit Utilization Crisis
Despite expanded benefits and growing engagement budgets, utilization remains stubbornly low. Members are overwhelmed by generic outreach that fails to connect benefits to their immediate health needs. Traditional engagement strategies focus on sending more messages, not on driving meaningful action.
The Click-Rate Trap
Many engagement platforms proudly report:
15% open rates
3% click-through rates
But what happens after the click?
Members are often met with:
“Call for details”
Providers located 20+ miles away
Confusing eligibility rules
Long hold times and phone trees
Most abandon the process. The industry measures activity, not outcomes.
Meanwhile:
HEDIS gaps remain open
Star Ratings suffer
Member dissatisfaction grows
Plans leave millions of dollars in benefits unused
Personalization That Actually Drives Action
Carelytics takes a fundamentally different approach.
We use clinical data, claims intelligence, and real-time benefit eligibility to deliver the right message at the right moment—with zero friction.
Example: Event-Driven Clinical Messaging
“Your A1c increased to 8.2%. At this level, your risk of vision loss is 3× higher.
Dr. Chen (2.3 miles away) specializes in diabetic eye care and has openings this week.
$0 copay. Reply YES to book.”
This is not a broadcast. This is event-driven, clinically relevant engagement.
How Carelytics Removes Every Barrier
Our messages are designed to convert intent into action by eliminating friction at every step:
Pre-qualified benefit eligibility
Geo-verified providers within travel radius
Real-time benefit balances and expiration urgency
One-tap booking—no calls, no research
Claims data reveals teachable moments:
Antibiotic fills trigger dental benefit education
Missed refills prompt pharmacy delivery options
Chronic condition changes trigger timely preventive care outreach
Results That Matter
Carelytics’ approach delivers measurable outcomes:
8× higher action rates using clinical-data-driven messaging
10× more engagement through event-driven timing
5–8× higher conversion with pre-qualified, frictionless steps
Our Commercial Philosophy - Shared Risk. Shared Reward.
Unlike traditional vendors who profit from message volume regardless of results, Carelytics operates on a hybrid performance-based model.
Health plans pay:
A baseline fee to cover operational costs
Performance bonuses tied to real outcomes, including:
HEDIS gap closure
Supplemental benefit activation
Member retention improvements
We don’t get paid for clicks. We get paid for results.
Our pilots target:
15–20% absolute improvement in benefit utilization
$15–$30 PMPM in recovered value
Direct improvements in Star Ratings and CAHPS scores, thus improving member retention
The Bottom Line
The member engagement market is crowded with platforms that deliver messages. Carelytics delivers outcomes.
We use AI to transform generic broadcasts into personalized, clinically relevant conversations—delivered precisely when members are ready to act, with every barrier removed.
Your members don’t need more messages.
They need the right message, at the right moment, with nothing in the way. That’s the Carelytics difference.
Ready to move beyond click rates?
Contact Carelytics to learn how performance-based personalization can improve your Star Ratings, member satisfaction, and retention. Contact us.
