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Empowering member engagement: The shift to bottom-up health care activation

The health care industry has traditionally relied on top-down strategies to engage health plan members, where key decisions, programs, and initiatives are crafted and deployed by leadership and experts. While this approach has its merits, an emerging trend is redefining the playbook: integrating bottom-up member activation strategies. This shift empowers members to take an active role in their health care journey, creating a collaborative and dynamic engagement model. By combining top-down frameworks with bottom-up initiatives, health plans can achieve a more personalized, effective, and sustainable impact.

The limitations of solely top-down approaches

Top-down strategies are designed with a bird’s-eye view of the population. While these initiatives can provide uniformity and structure, they often lack the nuances required to address the diverse needs and preferences of individual members. Challenges include:

  1. Lack of personalization: Broad initiatives may not resonate with specific demographic or cultural groups, reducing their effectiveness. (Health Affairs, 2023)

  2. Engagement gaps: Members may feel disconnected or unrepresented in strategies that seem imposed or impersonal. (Health Affairs, 2023)

  3. Trust deficits: Historical inequities and systemic barriers can lead to skepticism toward top-down programs, especially among underserved populations. (NIH, 2021)

The rise of bottom-up member activation

Bottom-up member activation flips the script by putting members at the center of their health care experience. It leverages their insights, needs, and preferences to create a more engaging and responsive system. This approach is driven by:

  1. Self-management tools: Technology such as apps, wearables, and online portals empowers members to monitor their health, set goals, and track progress. These tools encourage proactive participation in their care.

  2. Peer networks: Peer educators and support groups provide relatable guidance and encouragement. Members are more likely to trust and act on advice from individuals who share similar experiences.

  3. Community-driven initiatives: Local organizations and community leaders often have deep connections with their populations. Collaborating with these groups ensures strategies are culturally relevant and accessible. (The Commonwealth Fund, n.d.)

The benefits of combining top-down and bottom-up approaches

By integrating bottom-up activation into traditional top-down frameworks, health plans can create a more holistic engagement model. Key benefits include:

  1. Enhanced personalization: Combining data-driven insights from top-down strategies with real-time feedback from members ensures initiatives are tailored to individual needs.

  2. Stronger trust and ownership: When members feel heard and empowered, trust in the system improves. This sense of ownership fosters deeper engagement and long-term commitment. (CMS, n.d.)

  3. Increased effectiveness: Engagement strategies co-designed with input from members and communities are more likely to succeed because they address actual, rather than assumed, barriers, and motivators. (Health Affairs, 2013)

An example in bottom-up activation

Digital self-management platforms: Health apps and platforms designed for member self-management are another example of effective bottom-up activation. These tools enable members to set health goals, receive reminders for medications or appointments, and track metrics like blood pressure or glucose levels. When combined with incentives or gamification, these platforms significantly boost engagement.

Implementing bottom-up strategies

For health plans looking to adopt or enhance bottom-up activation, several steps can ensure success:

  1. Engage members early: Involve members in the design and planning phases to understand their priorities and preferences.
  2. Leverage data and feedback: Use data analytics to identify gaps in engagement and solicit regular feedback from members to refine programs. (The Commonwealth Fund, n.d.)
  3. Build partnerships: Collaborate with community organizations, peer networks, and digital health innovators to create diverse and inclusive activation strategies.
  4. Train and empower staff: Equip health care providers, case managers, and community health workers with the tools and knowledge to support bottom-up initiatives effectively.

Looking ahead

The shift to integrate bottom-up member activation reflects a broader transformation in health care—one that prioritizes collaboration, personalization, and empowerment. By blending the structure of top-down strategies with the adaptability and inclusivity of bottom-up approaches, health plans can foster deeper engagement, better health outcomes, and a stronger connection with their members. This evolution is not just a trend but a necessary step toward a more equitable and effective health care system.

About the author

John Snyder is the chief operating officer (COO) of Wellth, a science-backed and award-winning behavioral change company that helps people create sustainable healthy habits. As COO, he oversees Wellth’s operations, growth strategies and business development.

Snyder has more than 40 years of executive leadership experience with both health systems and health plans. Before joining Wellth, he was CEO of Sanford Health Plan (SHP), serving members in rural areas across the Midwest. Under his leadership, SHP strengthened its integrated partnership with the Sanford provider system, becoming an invaluable partner in the organization’s approach to value-based care.

Prior to SHP, Snyder was the CEO of Health Alliance Medical Plans in Illinois. Before that, he served as executive vice president and system COO for Carle Health System, and as COO for Carle Foundation Hospital for over 22 years.

References

Carman, Kristin L., et al. "Patient and Family Engagement: A Framework for Understanding the Elements and Developing Interventions and Policies." Health Affairs 32, no. 2 (2013). https://www.healthaffairs.org/doi/10.1377/hlthaff.2012.1133.

Chase, Deborah. "Patients Gain Information and Skills to Improve Self-Management Through Innovative Tools." Commonwealth Fund, accessed February 5, 2025. https://www.commonwealthfund.org/publications/newsletter-article/patients-gain-information-and-skills-improve-self-management.

Fernandopulle, Navindi. "To What Extent Does Hierarchical Leadership Affect Health Care Outcomes?" PubMed Central, September 14, 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8683790.

Foubister, Vida. "In Focus: Health Care Institutions Are Slowly Learning to Listen to Customers." Commonwealth Fund, accessed February 5, 2025. https://www.commonwealthfund.org/publications/newsletter-article/focus-health-care-institutions-are-slowly-learning-listen-customers.

Health Affairs. "Patient Engagement." Accessed February 5, 2025. https://www.healthaffairs.org/content/briefs/patient-engagement.

U.S. Centers for Medicare & Medicaid Services. "Million Hearts Model Flyer 1." Accessed February 5, 2025. https://www.cms.gov/priorities/innovation/media/document/mhcvdrrm-case-study-familycare-hc.