From Duals to Digital: Segmenting Your Health Plan Marketing by Need, Not Age

In healthcare marketing, we like clean categories. “Seniors.” “Duals.” “High utilizers.” “Boomers.” “Chronically ill.” Despite these neat boxes of categories, the healthcare industry still struggles with meaningfully engaging the people who need care the most.

Medicare Advantage plans, especially those serving dual-eligible and high-risk populations, are under mounting pressure to close care gaps and improve outcomes—without alienating the very members who are least likely to answer a call, click a link, or show up for a wellness visit.

So, what gives?

Here’s the hard truth: your personas might be outdated. Segmenting your outreach by age, plan type, or even condition isn’t enough anymore. 

If you want to move the needle on engagement—especially among high-risk or underserved groups—you need to rethink your strategy from the ground up.

It starts with this shift: Segment by need, not age.

The Engagement Gap for Duals and At-Risk Members

Dual-eligible beneficiaries (those who qualify for both Medicare and Medicaid) represent just 20% of Medicare enrollees, but account for 34% of total Medicare spending due to their complex medical and social needs. They are more likely to have multiple chronic conditions, face food insecurity, live alone, or have low health literacy.

Despite these risk factors, health plans still see the lowest engagement rates from these very populations. Outreach campaigns often fail because they are:

• Too generic (e.g., “Seniors aged 65–74 in Florida”)
• Too digital (without accounting for device access or comfort)
  
  
• Too clinical (without plain language or cultural relevance)
  
  
• Too transactional (e.g., “Schedule your Annual Wellness Visit now” with no context)

But the real culprit is deeper: most segmentation strategies assume that demographics = behavior, when what really drives action is need, mindset, and experience.

The Case for Need-Based Segmentation

Need-based segmentation focuses on the full context of a member’s life—factors like:

• Health literacy
• Social drivers of health (SDOH)
• Behavioral risk
• Technology access and comfort
• Caregiver involvement
• Care utilization history

Instead of assuming that all 70-year-olds act the same, you can create personas like:

1. A dual-eligible member with multiple chronic conditions and low literacy, overwhelmed by paperwork and distrustful of phone calls.
2. A tech-savvy adult child managing her father’s care through a portal, seeking simplified communication and fast access to services.
3. A homebound widow who doesn’t consider herself sick but is skipping preventive care due to transportation barriers.

Today’s consumers—regardless of age—are seeking more personalized messages without compromising on privacy. We have to meet that moment with the right content, on the right channel(s), at the right time. 

Real-World Impact: Segmentation Success Stories

Need-based segmentation isn’t just theory. Plans that have adopted more nuanced personas have seen real results.

1. UPMC Health Plan: Using Need-Based Data to Prioritize Outreach

Randy Rice, a Senior Business Intelligence Developer at UPMC Health Plan shared: “I completed a data dashboard that has the potential to shape marketing campaign design and execution, and it represents another step toward personalizing interactions with UPMC Health Plan members according to their unique needs. We want UPMC Health Plan’s marketing to be engaging, promote health and wellness, and inform the management of significant health concerns for all individuals. At UPMC, our fundamental focus is Life Changing Medicine. Good medicine is rooted in good data and information.” 

By honoring member privacy, you can leverage data to run personalized workflows. For example, if you have members who haven’t yet scheduled their annual physical, send them a message once a month with a tip on how to stay well. This keeps wellness top of mind without being overbearing or pushy. 

The plan also backs up their marketing efforts and member satisfaction efforts with outbound phone, live website chat, and email support, to make sure that members are supported on the channels they seek support from. 

Data from Community Health Assessments (CHA) and more, can be used to further inform persona, communications, and marketing efforts. 

2. Geisinger: Developing Personas With Diverse Populations

Geisinger had a particular plan that they wanted to boost enrollment in during AEP and developed a series of personas that resonated with diverse groups across Pennsylvania. 

Some people are more swayed by financial or cost signals, while others are more motivated by more exclusive features and benefits that align with their current or future health needs. 

They also use an approachable tone throughout their website and collateral, creating a cohesive brand experience across channels. Here are some messaging examples:

• “Here for you in all the moments that matter.”
• “Better health, built around you.”
• “Every moment counts.”

These messages are health-centered but also life-centered. Members and their families don’t think like us or how providers do. They think of their life in context, of being sick and it keeping them from going to a relative’s sports event or wedding. Or, having pain that makes work harder, and needing a full paycheck to make it by.

Getting healthcare (most of the time) doesn’t stem from pleasantries, it’s often need-based at a vulnerable moment in the member’s life. And we need to keep that in mind as we shape the messages they see, in what could be some of their most troubling and confusing times. 

How to Shift to Need-Based Segmentation

Making this transition isn’t easy, but it’s achievable—and urgently needed. Here’s how marketing teams can start:

1. Revisit Your Data Stack

Look beyond age and diagnosis codes. Incorporate:

• SDOH (via CMS Z codes or community-level datasets)
• Health literacy proxies (e.g., education level, language preference)
• Utilization data (ED visits, care gaps, call center interactions)
• Technology access and usage patterns (e.g., portal logins, SMS opt-ins)

Partner with clinical and data teams to create layered member profiles.

2. Build Realistic Personas

Use mixed methods (quantitative + qualitative) to build ethnographic personas that reflect both clinical needs and emotional context. Interview members, caregivers, call center reps, and care coordinators. Go beyond the what to understand the why.

Ask:

• How does this member feel about their health?
• What barriers get in the way of accessing care?
• Who supports or advocates for them?
• How do they prefer to receive information?

3. Design Channel Strategy by Comfort Level

Don’t assume digital is always better. According to Pew Research, 61% of adults over 65 own a smartphone—and the rates are lower among low-income or rural populations.

Map channels to personas:

• Text/SMS: Great for reminders to tech-enabled caregivers
• Phone calls: Preferred by many older adults—but it must be human and live (not robotic spam calls from AI agents).
• Mailers: Still effective for non-digital members, especially when personalized
• Field outreach or community events: Ideal for building trust with the hardest-to-reach

4. Rewrite for Literacy and Cultural Fluency

Use plain language. Translate materials. Co-create content with community partners. Avoid clinical jargon. Test messaging with real members.

Resources like the the Flesh-Kincaid Readability Test (ideally fifth grade or below), the CDC Clear Communication Index, and PlainLanguage.gov are great starting points.

Here are some examples:

Here is an example of hypothetical communications created for members with high English fluency versus low fluency. 

5. Measure Engagement by Member Type, Not Just Campaign

Shift away from generic metrics like “open rate” or “call volume.” Instead, measure:

• Uplift in care gap closure by persona
• Wellness visit conversion by literacy segment
• Text opt-ins by caregiver involvement
• Hospital readmissions in engaged vs. disengaged segments

This allows you to refine and retarget more intelligently.

Rethinking Value-Based Communication

As your organization makes the transition toward value-based care, your communication needs to follow suit.

Think of your outreach as a form of intervention. Just as a care manager wouldn’t offer the same services to a healthy 67-year-old and a bedbound 87-year-old, your marketing should flex to meet each member where they are.

Need-based segmentation ensures your campaigns don’t just inform—they influence behavior.

From Insight to Impact

Let’s look at members beyond the lens of demographics and start seeing them through the lens of lived experience.

Yes, it’s more complex. But it’s also more human—and more effective.

By segmenting based on real-world needs and behaviors, your campaigns can do more than just nudge members. They can empower them.

Let’s move from flat personas to empathetic, insight-driven communication that reflects the full complexity—and dignity—of the people we serve.

Want this work taken off your plate? Reach out to NextJenn Copy today and I can create your member engagement plan with VBC priorities in mind.