The Overwhelming Economic Case for Digitally Activating Medicare Members
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Medicare Advantage (MA) plans are facing some of the toughest headwinds in recent years, including cost pressures, shrinking margins, and increased regulatory complexity. The landscape is only becoming more competitive, with the Centers for Medicare & Medicaid Services (CMS) tightening its focus on priority areas such as health equity, digital engagement, and member satisfaction measures, all of which directly impact Star ratings and, ultimately, plan profitability.
Yet, despite multi-million dollar investments in digital tools, most plans have captured only a fraction of their potential value. “Only 12% of adults in the United States have the health literacy skills needed to navigate complex health information in the digital age,” according to NCQA, indicating that the majority of older adults continue to struggle with understanding their devices, creating accounts, navigating portals, and accessing benefits. This digital adoption gap is not just a challenge to member experience; it’s a persistent drag on plan economics and strategic growth.
The Sizeable Upside of Digital Activation
Unlocking Savings and Margin Lift
- Administrative Cost Savings: Digitally engaged members' cost plans less in administrative spending, thanks to fewer inbound calls, reduced costly schedule management, higher self-service, and increased automation.
- Clinical Cost of Care Savings: Digital engagement also drives savings in clinical costs by enhancing adherence to preventive care, reducing hospital readmissions, managing chronic conditions, and facilitating overall benefit navigation. This translates directly to lower inpatient and outpatient utilization.
- Total Plan Spend Impact: The combination of administrative and clinical savings delivers a reduction in total plan spend for each newly activated digital member. For mid-sized plans, this can mean tens of millions in unrealized annual savings.
Boosting Member Satisfaction and Quality Measures
- Star Ratings, CAHPS, HEDIS, MLR: Digital engagement is proven to boost completion rates of HEDIS and CAHPS quality measures. Increased “engagement is a key driver of cost savings and revenue for health insurers,” according to a study—helping plans cross thresholds for CMS bonus payments, with additional uplift for Medical Loss Ratio (MLR) performance.
- Retention and Loyalty: Digitally active members churn less, with some companies reporting up to 89% lower voluntary disenrollment rates and higher satisfaction scores.
The Compounding Impact of Digital Education
Solving Digital Literacy, Not Just Onboarding
True economic impact comes not simply from onboarding members to apps and portals, but from equipping them for confidence, navigation, and true digital literacy. The GetSetUp impact study reveals that structured learning significantly increases ROI, delivering a greater savings potential by helping older adults confidently log in, navigate multi-factor authentication, locate their benefits, and utilize virtual care tools.
For example:
- Digital Literacy: Participants in GetSetUp’s programs demonstrated a 56% increase in their ability to use technology, such as smartphones and computers, quickly moving from frustration to fluency and becoming telehealth-ready.
- Medicare Literacy & Benefit Understanding: 88% of those who took a Medicare class on GetSetUp improved their plan and benefit understanding. Better understanding can lead not only to lower support costs but also to far higher satisfaction scores on CAHPS Ease of Getting Information.
From Activation to Advocacy: Unlocking Full Economic and Member Value
Digital activation is not a “nice to have,” it’s an urgent imperative for Medicare Advantage plans. Each additional digital member not only delivers direct cost savings but also amplifies plan quality scores, retention, and long-term member value. Importantly, when digital onboarding is paired with comprehensive member education, plans unlock further compounded ROI and margin lift.
Most plans have less than half their membership digitally activated. The evidence is clear: when older adults are empowered with structured digital education and support, they rapidly become high-value members, reducing costs, boosting engagement, and driving measurable improvements across all plan metrics: Stars, CAHPS, HEDIS, MLR, and beyond.
In a challenging economic environment for Medicare Advantage, the path to stronger margins, happier members, and sustainable growth is clear: invest in digitally activating and educating your members. The upside for plans is not just sizeable; it’s transformative.
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We partner with Medicare Advantage plans, dual eligible plans, healthcare providers, Departments of Health & Human Services, Government aging services and more.
