If your data doesn’t connect, neither will your members. Rising churn, shallow engagement, and eroding trust aren’t just marketing challenges—they’re signals of a deeper issue: fragmented data. Health plans are swimming in it—claims systems, EHRs, social determinants platforms—all siloed and misaligned. And without a clear, consistent view of each member, even the best outreach falls flat.
That’s why identity resolution isn’t just IT “plumbing”—it’s the foundation for meaningful, measurable member loyalty.
Digital Expectations, Analog Realities
Consumers increasingly judge their health plans by the same standards they apply to retail, streaming, and banking. As a result, they desire seamless access, personalized touchpoints, and zero friction. When members see one version of themselves on a portal, another when they call support, and yet another when a provider pulls their record, trust erodes, engagement suffers, and retention falters.
Despite massive investments in member experience platforms and population health tools, many payers still struggle to unify member data across their own systems. That fragmentation leads to missed outreach, inaccurate risk scores, delayed care interventions, and inconsistent member experiences, undermining even the best efforts.
According to Forrester, only 56% of consumers trust their health insurer to act in their best interest, marking a three-year low in trust levels. This erosion of trust underscores the critical need for health plans to deliver consistent and personalized experiences.
Interoperability Isn’t Enough—You Need Identity Integrity
The CMS Interoperability and Patient Access Rule has made real-time data exchange a necessity. Health plans are now expected to make critical patient data available through standardized APIs, enabling members and providers to access information when and where it’s needed.
However, while this regulatory shift lays a technical foundation, it does not guarantee meaningful engagement or improved health outcomes.
APIs are only as effective as the data they ingest. And when that data is duplicated, fragmented, or tied to the wrong identity, interoperability becomes a liability instead of an asset. Without a strong identity resolution framework anchoring your ecosystem, real-time access can actually amplify the very issues it was meant to solve, as detailed below.
Without accurate identity resolution:
- APIs perpetuate duplications and disconnects. Members may see conflicting information across channels, leading to frustration and mistrust.
- Risk models misfire. Predictive analytics rely on clean inputs; a misidentified patient can trigger false positives or overlook those at true risk.
- Outreach misses the mark. Communication strategies that depend on outdated or mismatched data waste resources and erode member confidence.
But with identity integrity in place across your members and providers, interoperability becomes transformative. It turns raw data into actionable insight and every interaction into a trust-building moment. It also enables personalization at scale, supports compliance with data-sharing mandates, and improves collaboration across the entire care continuum.
Frost & Sullivan projects that the global healthcare interoperability market will reach $19.28 billion by 2028, growing at a compound annual growth rate (CAGR) of 18.3% from 2023. This growth reflects a regulatory push and a strategic pivot across the industry—one that advances us beyond information access to information intelligence. And at the heart of that shift is identity data that must be both interoperable and exceptionally accurate.
Closing the Gap Between Data and Experience
In the gap between raw data and actual experience, we see a critical disconnect. And it exists despite the proliferation of member experience platforms, payer-provider collaboration tools, and engagement analytics. Too often, health plans have the data but not the infrastructure to activate it in meaningful, real-time ways across the member journey.
To close this gap, payers must align two imperatives—data integrity and member engagement—and ensure they operate in lockstep. That means:
- Resolving fragmented records into a single source of truth. Consistency and coordination are possible when every system, from call centers to care managers, references the same member identity.
- Linking claims, clinical, and social data to power proactive care. Identity resolution is the glue that binds siloed datasets, enabling personalized interventions and more accurate population health management.
- Equipping teams with real-time, reliable member insights across channels. Whether a care coordinator follows up post-discharge or a digital chatbot guides benefit navigation, identity clarity ensures every touchpoint is relevant and aligned.
These steps are technical upgrades, but they’re also strategic imperatives. Member loyalty is earned through frictionless, personalized, and trustworthy experiences in a competitive landscape. That kind of engagement isn’t possible when identity is an afterthought.
Bain & Company highlights that loyalty among insurance customers, as measured by Net Promoter Score℠, has steadily improved over the past decade, in most countries by between 10 and 30 percentage points. This improvement indicates that focused efforts on enhancing customer experience and trust can yield significant gains in loyalty.
However, sustained progress depends on more than surface-level personalization. It requires an operational backbone that ensures every system sees the same person, every time. That’s the power of identity resolution—not just in closing the data gap, but in enabling payers to build trust at every touchpoint, across every stage of the member journey.
Explore the Next Step in the Journey
It’s time to close the gap between what payers have and what members expect. To dig deeper into how leading payers are turning interoperability into impact—and how to identify and retain high-risk, high-value members—check out The Payer Imperative: Moving beyond data silos with Customer 360
