Member Personas Help Your Health Plan Get To Know You

by Darcy Lewis

January 30, 2017

Health plans are increasingly focusing on the experiences of individual members. And leaders who attended AHIP’s Consumer Experience and Digital Health Forum in Chicago learned a lot about an important aspect of customer relationship management: how to create member personas.

What Is a Member Persona?

A member persona is a “semi-fictional representation of [an] ideal customer based on market research and real data about existing customers,” according to the Internet marketing company HubSpot.

Here are some questions health plans ask when creating member personas.

  1. How old are our members?
  2. Are they single? Married? Divorced? Widowed?
  3. Do they have children? How old are the children?
  4. Do they live in the city, suburbs or country?
  5. How far are their workplaces from home?
  6. What do they do at work?
  7. How comfortable are they with technology?
  8. Are they active on social media? What platforms?
  9. What are their health care goals and priorities?

Health plans also interview actual members about their health care needs and priorities. This process helps refine the emerging personas.

A First-Name Basis

The finished product in creating a member persona is a one-page summary that, if done correctly, will become the equivalent of a local celebrity around the health plan offices. That’s because employees will focus on improving the experience that one “person” – and his or her real-life counterparts – has with the health plan.

The persona gets a first name and a backstory. The summary includes the persona’s demographics (age, education, etc.) and work and living environment, as well as a few comments about technology access, interest, and proficiency.

The summary also presents the persona’s health care goals and challenges using “I” language. An example might be, “I have diabetes and high blood pressure. I know it’s important for me to see my doctor regularly, but that’s too time-consuming when I work full-time and take care of my children and elderly parents.”

The persona summary will also include a “quote” describing how he or she perceives the company. Last but not least, the health plan marketing staff will select a stock photo to personify their fictitious composite member so employees can put a face with the name.

Meet Pauline and Maria

Melissa Cordial, director of Communication Services at Fallon Health in Massachusetts, introduced two Fallon member personas during her session on how to improve the member experience.

First was “Pauline,” a grandmotherly member of Fallon’s NaviCare Special Needs Plan, a Medicare Advantage HMO. She described Pauline’s health insurance challenges, like her difficulty navigating the health insurance system and using technology. Pauline needs some personalized attention to be able to get the answers she needs.

Then there was “Maria,” a 40-something Latina member who receives Medicaid benefits through Fallon’s Mass Health program. Maria works long hours and has little access to a computer, making it hard to complete paperwork on a timely basis.

According to Cordial, these are just two of 11 member personas Fallon has created to date. Now the company is working to integrate the personas into all company departments and how they operate on a daily basis. “We want all of our employees to remember the personas stand in for real people with real problems,” Cordial said. “They’re a reminder that our members are not just numbers on a computer or voices over a phone line.”


You can hear more amazing insights from industry thought leaders by attending AHIP’s Institute & Expo 2017 in Austin, Texas. Leading thinkers will gather to share ideas, learn from each other, and tackle some of our industry’s toughest challenges including disruptive technology, quality of care, and building a sustainable system focused on value.