Blog | OCTOBER 2026
From Static Content to Trigger-Based Engagement: The Next Evolution of Member Education
Reducing avoidable utilization remains a major priority for TPAs and payer organizations.
A recent peer-reviewed analysis of more than 200,000 emergency department visits found that 29% were classified as avoidable or potentially avoidable — highlighting how much opportunity may exist earlier in the member journey, before a claim is ever filed.
Because avoidable utilization often starts before the claim. It starts when a member wonders:
Should I go to urgent care
or the ER?
Is this serious enough
to escalate?
What happens next
after this diagnosis?
What should I expect
from this procedure?
Those are the moments when trusted guidance can matter most.
Yet traditional member education often relies on a passive model: make information available and wait for members to find it.
Trigger-based engagement turns that model around — bringing relevant education into the member experience when it is most useful.
Static education creates friction.
Traditional health libraries can contain valuable, evidence-based information. The challenge is that members often have to know what they need, where to find it and what to search for.
That creates friction during the exact moments when they may already be uncertain about what to do next.
Without easily accessible guidance, members may instead rely on:
fragmented
internet searches
inconsistent
information
delayed
care decisions
higher-cost
utilization pathways
Simply making education available is no longer enough.
Consumers are already accustomed to digital experiences that surface relevant information based on what they are doing. Streaming platforms
recommend content. Navigation apps adjust routes in real time. Retail platforms anticipate needs.
Healthcare consumers increasingly bring those same expectations with them. According to PwC's 2025 Health Consumer Survey, seven in ten
consumers use some form of health technology — including apps, wearables or portals — on a monthly basis.
But many member portals still focus primarily on transactions such as claims, ID cards, provider directories and benefits information.
Those functions are important. But they do not always help answer the question that matters most in the moment:
What should I do next?
What trigger-based engagement looks like.
Trigger-based engagement shifts education from something members must actively seek out to something that can be surfaced based on what is happening in their healthcare journey.
Relevant education can be delivered:
- during claims activity
- after diagnosis events
- during care navigation
- after specialist searches
- before major procedures
- throughout care transitions
The goal is not more content. It is more relevant guidance delivered at the right moment.
A real-world shift toward embedded engagement.
One national TPA serving more than 8.6 million members recognized that simply making educational resources available was not driving the engagement it wanted.
Leadership identified several challenges:
- during claims activity
- after diagnosis events
- during care navigation
- after specialist searches
- before major procedures
- throughout care transitions
The organization began moving from a static-library model toward a more integrated engagement strategy that included:
claims-informed
outreach
portal awareness
campaigns
advocate-enabled
education
contextual engagement
workflows
exploration of
trigger-based engagement
It also began evaluating future-state opportunities such as search-triggered guidance, condition-specific pathways and "What Happens Next?" education following care events.
The strategic shift was simple:
Why timing matters.
By the time a costly utilization event occurs, the opportunity to influence the decision may already be gone.
The earlier opportunity exists while members are still navigating symptoms, diagnoses, providers, procedures and care options. That changes the role education can play.
Instead of functioning only as a passive resource, it can become a strategic engagement tool that helps organizations:
- support more informed healthcare decisions
- strengthen member trust and engagement
- improve the value of the member portal
- support more consistent advocate interactions
- reduce friction across the member experience
- create a foundation for future personalization
The financial opportunity may also be significant. McKinsey & Company estimates that digitally enabled member engagement capabilities could reduce U.S. medical costs by $175 billion to $220 billion annually.
The opportunity is not simply to give members access to more information. It is to make trusted information more useful by delivering it in context.
And that may be where the next evolution of utilization strategy begins — not with the claim itself, but with the member experience that comes before it.
How A.D.A.M. SmartEngage can help
A.D.A.M. SmartEngage helps TPAs and payer organizations move beyond passive content access by bringing trusted, URAC-certified health education into the digital experiences and workflows members and care teams already use.
Deliver education when it
matters
Provide condition-specific
education that can support
engagement tied to claims
activity, diagnosis events and
care-navigation moments —
rather than relying solely on
members to find information
on their own.
Integrate into existing
member experiences
Embed trusted health content
into portals, apps and other
digital experiences, reducing
the friction that can keep
members from engaging with
educational resources.
Support consistent
advocate guidance
Give care advocates and
member-support teams
access to evidence-based
education they can curate and
share during member
interactions.
Build toward more
personalized engagement
Create a foundation for
future-state approaches such
as search-triggered guidance,
condition-specific pathways
and "What Happens Next?"
education without requiring
organizations to create health
content from scratch.
For TPAs looking to evolve from static content access toward more intelligent engagement, SmartEngage provides a way to bring trusted health education closer to the moments that matter most.
This content is intended to support — not replace — provider advice, emergency care or clinical decision-making. Members should always follow the guidance of their treating provider and seek emergency care when needed.
References
- Evaluating Patient Characteristics and Trends of Avoidable Emergency Department Visits: Informing Community Health Services to Reduce Emergency Department Utilization. Peer-reviewed study, 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647383/
- PwC 2025 Health Consumer Survey. PwC, 2025. https://www.pwc.com/us/en/industries/health-industries/library/healthcare-consumer-insights-survey.html
- Next-Generation Member Engagement During the Care Journey. McKinsey & Company. https://www.mckinsey.com/industries/healthcare/our-insights/next-generation-member-engagement-during-the-care-journey
