Key takeaways
- A member churn model scores every member for the risk of leaving, from claims, service, billing and plan history you already hold.
- Reason codes show what drives each member's risk, such as a service issue, a premium change or a gap in care, so your team can act on the cause.
- A second model ranks which retention offer a valuable member is most likely to accept.
- Scores and drivers can feed a dashboard by region, plan and premium band, so leaders see where members are leaving and where service falls short.
You learn a member has left after they are gone
Most plans see churn in the enrollment file, weeks after the decision was made. By then the member has already chosen another plan, and the retention budget went to members who were never going to leave.
The signals were there earlier. They sit across claims, call center contacts, billing history and plan changes, and the pattern that matters is how a member's recent behavior differs from their own history. A list nobody acts on does not keep anyone; your team needs a score, a reason and a next step for each member, in the channels you already use.