According to KLAS research, care management increased in strategic importance for payer organizations in 2025, resulting in an expansion in investment in technology to support care management functions.
While data security and workflow integration were top-of-mind when building out care management solutions and partnering with vendors, member education proved to be one of the most important elements to improving outcomes, utilization, and compliance. For example, recent studies showed that behavior change techniques suggested through payer educational interventions result in fewer annual readmissions and emergency department visits for members, and that by encouraging preventive care and wellness, member engagement had potential to defray up to $8.3 billion in annual emergency medical costs for non-emergency treatments.
Industry statistics in 2025 revealed that 80% of identified at-risk members remained unreached by their plan’s care management programs. To continue on a path toward achieving improved health outcomes, closing care gaps, and enhancing performance metrics, payer member engagement strategies have to be prioritized in 2026.
Looking back at 2025: Progress in personalized care
Successful payer care management teams spent the past year focused on personalized care strategies, fueled by patient data and advanced analytics and aligning closely with the goals of value-based care.
Many experienced progress, including:
- Improved outcomes through tailored interventions and proactive care.
- Enhanced member engagement leading to better satisfaction and retention.
- Cost savings and ROI from effective chronic disease management.
A common denominator in all of these goals is care management-led outreach and member education, used to proactively address outcomes and help members better understand their diagnoses, recommended treatment plans, and overall holistic care journeys.
Since nearly half of patients report that they do not get all of their questions answered during provider encounters and 80% say they often or sometimes have follow-up questions, health plans that distribute personalized, engaging health content can help fill this gap and give members an opportunity to self-manage their health at home.
Looking ahead: Top 5 trends in care management strategies
Setting strategies for care management will be crucial for member health and operational success in the coming 2026 year. Experts advise that teams should focus on the following opportunities to solidify member relationships, expand outreach, and uncover new successes:
1. Continuing to develop personalized care
By targeting programming and education to specific populations with certain diagnosis codes or in certain risk groups, or even to individual members who opt-in for follow-up, care managers can help members make more informed decisions.
- Focus on tailored interventions for chronic disease management to help improve overall outcomes.
- Build proactive care strategies to improve member engagement and satisfaction: This may include prioritizing new member onboarding, an area a recent McKinsey report identified as a significant gap for many plans. Of Medicare Advantage plan members surveyed, 15% reported receiving no welcome or introductory information from their plan at all. While the majority received info packers in the mail, only 19% were asked to complete a health assessment or engaged more meaningfully by plans.
- Uncover ROI benefits: Appealing directly to members’ needs results in reduced costs from improved outcomes and increased retention. This can tie directly to Star Ratings – the same McKinsey report found that unengaged plan members will voluntarily disenroll during open enrollment periods. This can impact Star Ratings, which in turn, impact how new potential members view plans. The study found that 56% of Medicare Advantage consumers said Star Ratings were one of, if not the top feature they considered when choosing a plan.
2. Keeping up with content as population health needs evolve
To help members manage chronic diseases and maintain ongoing wellness, care management teams will need to invest in educational content that speaks directly to member population health needs and aligns with updated care strategies.
To help meet this need, UpToDate® Member Engagement solutions are developing new educational materials to address member health trends. Example topics include:
- Short-form diabetes videos
- Understanding the upper digestive system
- Basic content on understanding cancer
- Programs of varying lengths and levels of detail on coping with radiation treatments
3. Addressing privacy and data security concerns
Health plans have to evaluate how they can deliver a personalized care experience while respecting the data privacy of their members. For care management teams, that means building trust through transparent and secure data practices that balance the need for personalization with the need for privacy. With various technology requirements, state and federal privacy laws, and employer policies, the solution partners that payers consider need to offer integration options that can support flexible PHI data access, allowing care management to tailor content operations to member identifiers without accessing sensitive data.
4. Solution integration to streamline workflows
The need for seamless integration of tools and systems will be essential to help care management teams achieve the above goals, reaching more members more effectively without burning themselves out.
- Administrative tasks and context-switching between multiple applications can be cumbersome. Effective tool integration – particularly when solutions can integrate with existing, trusted care management workflow applications – reduces the time care managers spend in their applications.
- Additionally, the more time they spend working in different applications searching for information, the less time they have with members. Streamlined workflows improve user experiences and satisfaction for members as well as care teams.
5. Agentic AI considerations
The role of AI in care management is growing and will become more critical to improving workflow, including automating preparation and follow-up tasks to boost efficiencies and ability to reach more members.
No matter how exciting AI solutions may seem, ensuring human oversight of the information generated is essential in healthcare, especially if AI-enabled tools will affect critical decision-making or clinical outcomes. Clinical AI tools must be built with rigorous standards that prioritize transparency, evidence, and clinical integrity.
For AI to enhance member care decision-making, sophisticated solutions should be grounded in clinical intelligence and incorporate the real-world experience of their clinician experts and peer-reviewed insight into every recommendation. When AI-enabled tools come from a reliable source and don’t require a compromise between speed-to-answer and trust, they can deliver on the technology’s potential to improve care delivery and workflow.
Actionable strategies to prepare for 2026
Payers who invest in workflow solutions are positioning themselves for success. Accordingly, the payer workflow applications market is expected to grow from $3.5 billion in 2024 to $7.8 billion by 2033.
Having workflow applications in place is not enough to streamline processes and advance results for care management teams. They will need:
- Solutions that focus on integration and user-friendly workflows.
- Investment in member education with the ability to personalize content.
- Solutions that prioritize privacy and data security.
- The ability to leverage AI while maintaining human oversight.
Member engagement and education programs like UpToDate® Consumer Education are designed to integrate with various care management applications for intuitive workflows with the ability to efficiently and purposefully tailor programs from its robust content library to member populations at scale. Personalization of content without the need to access sensitive member data helps protect privacy while still enriching the member experience with specific outreach targeted to their specific health needs.
Learn more in our eBook, “The power of personal content journeys for members.”
