After participating in our recent AHIP26 session, one thought has stayed with me: Maybe we’ve been asking the wrong question.
I’ve spent years working with members who are often labeled “hard-to-reach,” and the more I think about the phrase, the less comfortable I am with it.
What if they aren’t hard to reach at all? What if they’re simply navigating lives that are more complicated than the systems we’ve designed to serve them?
Throughout our panel discussion, leaders from health plans and care coordination organizations shared stories about members balancing work schedules, caregiving responsibilities, transportation challenges, housing instability, food insecurity, and confusion about benefits. We talked about the realities of rural access, limited provider availability, and the fact that healthcare often competes with dozens of other priorities in a person’s day.
None of those realities reflect a lack of motivation. They reflect real life.
One of the most important observations shared during the session came from Kari Gilson, MPH, CPHQ, Vice President, Quality & Risk Adjustment Process Improvement at Coordinated Care of WA: healthcare may not be the top priority in a member’s day-to-day life.
At first glance, that statement can feel uncomfortable. Of course healthcare is important. But when you’re trying to keep your job, find reliable transportation, care for a parent, pick up your children from school, or stretch your paycheck to cover groceries and utilities, preventive screenings and annual wellness visits don’t always rise to the top of the list.
That doesn’t mean people don’t care about their health. It means they need support navigating the barriers standing between intention and action.
Too often, healthcare responds by doing more of the same.
- More phone calls.
- More reminders.
- More outreach campaigns.
And while those efforts are well intentioned, they don’t always address the underlying reasons people struggle to engage.
Another comment from the discussion has stayed with me. Jessica Lampe, RN, BSN, CPHQ, Senior Manager, Quality Improvement at Ambetter Health noted that response doesn’t always equal engagement.
That distinction matters because as an industry, we’ve become very good at measuring activity. We can track how many calls were made, texts were sent, or letters were delivered.
- But did the member establish care with a primary care provider?
- Did they complete the mammogram?
- Did they schedule the specialist appointment?
- Did they receive the support they needed to take the next step?
Those are much harder questions to answer, but they’re also the ones that matter most.
At 86Borders, we’ve seen firsthand that engagement looks different when you start by listening instead of directing.
I’ve lost count of the number of times a conversation that started with an overdue screening ended up being about transportation, childcare, housing, or simply not knowing where to begin. The healthcare need was real. It just wasn’t always the first problem that needed to be solved.
- Sometimes a member needs help finding a provider.
- Sometimes they need someone to stay on the line during a three-way call to schedule an appointment.
- Sometimes they need transportation resources.
- Sometimes they simply need someone patient enough to hear their concerns before discussing the care gap that prompted the outreach in the first place.
Technology plays an important role in that process. Tools like ConnectAllCare help our teams stay organized, coordinate next steps, and ensure members don’t have to start over every time they interact with the healthcare system. But technology isn’t the relationship. It’s what allows relationships to happen more consistently.
The members we serve aren’t data points on a dashboard. They’re people trying to navigate an increasingly complex healthcare system while managing everything else life demands of them. So perhaps the question isn’t, “Why won’t members engage?” Perhaps it’s, “How can we make engagement feel more achievable?”
AHIP reinforced something I believe deeply: most people want to do the right thing for their health.
Our job is to remove as much friction as possible so they can. When we do that, “hard-to-reach” members often become something else entirely. People who finally had someone meet them where they were.
Lauren Barca, MHA, RN, BSN is Vice President of Quality at 86Borders, the human-first care coordination and member engagement company focused on helping health plans engage and support vulnerable populations.