Healthcare
Case Study
Challenge
Despite record spending, the U.S. healthcare system consistently underperforms on outcomes and engagement. Across populations—Medicaid, MA, Commercial, Employer—a core issue remains: people often don’t act in their own best interest.
Traditional approaches focus on risk scores, access, and system design. But they miss a critical layer: motivation. Without understanding what people need to feel before they act, engagement stalls and outcomes suffer.
Insights
Healthcare decisions are shaped as much by emotion as by logic. Yet most systems still treat motivation as a black box: too soft to measure, too hard to act on.
Rosemark’s belief-based model changes that.
By decoding the emotional posture and internal motivations behind health-related decisions, our approach uncovers why people engage, delay, or drop off. We’ve identified four distinct belief-based segments (Power Personas™):
- Proactive Health Managers
- Aspirational Improvers
- Event-Triggered Reactors
- Non-Engagers
Each persona reveals a different belief system—and a different path to trust, engagement, and action.
This framework opens the door to healthcare experiences that feel more personal, more relevant, and more likely to succeed. When journeys are designed to match how people already think and feel, we see:
- Stronger initial engagement
- Faster movement to key decisions
- Greater cost efficiency through targeted activation
The opportunity isn’t just to understand members better—it’s to move them, by aligning with what motivates them most.
One Belief-Based Framework.
Four Market-Ready Applications
Medicare Advantage
Success: Improve Star Ratings, retention, and preventive screenings
Barrier: Diverse health literacy, open enrollment churn
Our Edge: Align onboarding & outreach to beliefs about independence, control, and quality of life
Medicaid
Success: Boost prevention & equity, reduce avoidable ED visits
Barrier: SDOH barriers, eligibility churn, mistrust
Our Edge: Culturally relevant outreach, trusted messengers, tailoring intensity to belief + clinical and social complexity
Special Needs Plans
Success: Manage high-complexity conditions, coordinate care
Barrier: Multiple comorbidities, caregiver involvement
Our Edge: Map belief + complexity to care team touchpoints, integrate caregiver triggers & support
Commercial / Employer
Success: Reduce costs, increase preventive care use, boost productivity
Barrier: Engagement fatigue, low follow-through
Our Edge: Frame health as performance-enhancing, personalize incentives & messaging style
Shared Core Model: Segmentation → Experience Maps → Channel & Cadence Alignment → Integration Guidance
Takeaways
Rosemark’s belief-based segmentation framework provides a scalable, emotionally intelligent approach to activation and engagement across healthcare segments.
By uncovering the motivational drivers behind member behavior, the model helps organizations move beyond demographics and risk scores to address what people need to feel before they act.
This approach is market-ready across:
- Medicare Advantage: Aligning to beliefs around control and independence to improve Stars and retention
- Medicaid: Driving equity and trust through culturally relevant outreach
- Special Needs Plans: Integrating belief and complexity to better support caregivers and coordinate care
- Commercial/Employer: Boosting follow-through by aligning incentives to mindset and messaging preference
When healthcare journeys are shaped by belief, organizations see:
- Faster activation
- Stronger ongoing engagement
- More efficient resource use
- Better outcomes, at scale
Belief-based design closes the motivation gap, turning intention into action.
Medicaid Example: Behavioral Levers That Improve Performance and Reduce Cost
| Impact Area | Example Goals |
|---|---|
Preventive Care Compliance | +10–18% screenings → fewer high-cost chronic complications |
Avoidable ER Visits | 500 avoidable ED visits averted × $1,200 avg cost |
Care Plan Adherence | 12% uplift in appointment adherence
|
Equity Impact | Reduced disparities in preventive care use in high-need populations. |
These sample goals reflect realistic targets based on motivational alignment in similar populations. Actual outcomes may vary by program and implementation scope.
Proactive Health Manager
Aspirational Improver
Event Triggered Reactor
Non-Engager
Behavior Pattern
Self-directed and motivated to stay healthy, but often faces access challenges like transportation or appointment availability.
Uses digital tools when available and appreciates proactive reminders.
Wants to take better care of themselves but life circumstances: work, childcare, financial strain, get in the way.
Responds to encouragement, achievable goals, and support that feels personal.
Engages after urgent events (e.g., ER visits, sudden symptoms).
Rarely seeks preventive care unless connected immediately to follow-up support.
Distrusts the system or is focused on day-to-day survival. Avoids care decisions unless vital.
Traditional outreach has limited effect, requires trusted messengers and tailored, non-clinical entry points.
Shape Engagement
- “Health is my job.”
- “Knowledge = control.”
- “Catching problems early is smart.”
- “I like seeing my progress.”
- “I want to do better but need a push.”
- “Support and small wins help me stay on track.”
- “Please keep it simple.”
- “I need to feel cared for.”
- “I act when there’s a real problem.”
- “Routine care feels unnecessary.”
- “Get to the point.”
- “I care more about now than later.”
- “Health stuff stresses me out.”
- “I avoid this unless I have to.”
- “Too many messages = I check out.”
- “The system probably won’t help.”
Focus
Maximize self-care
& screening rates
planned care
Maximize self-care
& screening rates
Proactive Health Manager
Health Behavior Pattern:
Self-directed and motivated to stay healthy, but often faces access challenges like transportation or appointment availability.
Uses digital tools when available and appreciates proactive reminders.
Belief Shape Engagement:
- “Health is my job.”
- “Knowledge = control.”
- “Catching problems early is smart.”
- “I like seeing my progress.”
Incidence:
Engagement Focus:
Maximize self-care
& screening rates
Aspirational Improver
Health Behavior Pattern:
Wants to take better care of themselves but life circumstances: work, childcare, financial strain, get in the way.
Responds to encouragement, achievable goals, and support that feels personal.
Belief Shape Engagement:
- “I want to do better but need a push.”
- “Support and small wins help me stay on track.”
- “Please keep it simple.”
- “I need to feel cared for.”
Incidence:
Engagement Focus:
Event Triggered Reactor
Health Behavior Pattern:
Engages after urgent events (e.g., ER visits, sudden symptoms).
Rarely seeks preventive care unless connected immediately to follow-up support.
Belief Shape Engagement:
- “I act when there’s a real problem.”
- “Routine care feels unnecessary.”
- “Get to the point.”
- “I care more about now than later.”
Incidence:
Engagement Focus:
planned care
Non-Engager
Health Behavior Pattern:
Distrusts the system or is focused on day-to-day survival. Avoids care decisions unless vital.
Traditional outreach has limited effect, requires trusted messengers and tailored, non-clinical entry points.
Belief Shape Engagement:
- “Health stuff stresses me out.”
- “I avoid this unless I have to.”
- “Too many messages = I check out.”
- “The system probably won’t help.”
Incidence:
Engagement Focus:
Maximize self-care
& screening rates