Turn missed dates into meaningful membership actions

As health program leaders seek to close the care gap and improve membership experience, it’s time to miss out on the opportunity to shift the paradigm of care from failure to impact. Missed dates are a major and often overlooked issue, spending about $150 billion a year on the U.S. health system. But it is not just a matter of an ineffective appointment program, it is also a symptom of member participation, health equity and systematic design issues. For payers, missed appointments can be when interrupting the continuity of care, avoidable health care costs, reducing potential savings and permanent inequality, especially among historically marginalized and rural populations.

The real reason why people don't show up

It’s no secret that health determinants can affect care outcomes. What is often underestimated is the extent to which these non-clinical factors hinder members after making the most important first appointment.

1. Financial barriers

Whether it’s just uninsured or expenses of deductibles and copays, 28% of U.S. adults reported delays in care in the past 12 months due to costs. But even with insurance, costs can prevent patients from getting care. For Medicaid patients, despite insurance, the chance of not making appointments is 56% higher than that of commercially insured patients. The consequences of these missed care appointments are cumulative as we are now seeing, for example, delayed care is attributed to the 19th pandemic. The remaining untreated care gap can lead to unmanaged chronic diseases, increased ED usage, and even more quality scores. However, when payer partners help close the gap by making this care easy for patients to access, the impact can be transformative.

2. Logistics Challenge

Even if a member wants care and is eligible for care, he or she may miss out on care due to logistical obstacles. Reliable transport can be a huge obstacle to members’ care. Due to the lack of reliable transportation, there are an average of about 3.6 million missed nursing attacks per year. Those who are more affected by transport disorders include: older people, rural populations, and members facing physical or cognitive challenges. These missed care costs don't even take into account the cost of missing future health issues with earlier appointments. As health involves compounding, the costs associated with care increase.

Many Medicaid and Medicare Advantage Plans offer the benefits of non-emergency medical transport (NEMT) to address these access barriers, but few members use NEMT benefits to get their care. In fact, between 2018 and 2021, only 4-5% of Medicaid members use NEMT services. This low utilization is due to poor member experience, heavy processes and NEMT options that are not fully integrated with the appointment itself. Just making transportation available is not enough. Transportation solutions are only effective when easily arranged, convenient and ideally connected to the care point with the workflow that coordinates care. Otherwise, this is just another friction point in the nursing journey that can lead to absent care.

3. Motivation and communication gaps

Just because there is a benefit, it doesn’t mean that members know how to take advantage of it. Many members don’t know where to start, how to find an in-network provider, and what to do if qualifies or next. The solution is not to send more messages to members, but to send them better messages. It sounds like there are robots, non-context and impersonal universal one-time will be deleted or ignored. A clear overview of the next steps of personalization, understanding and human information will be read and taken more seriously.

Message is important, framework is important. The difference between membership hearing “We reserve for you this time” and “It depends on how you spend time meeting your provider” is not just communication and messaging, but reminding you about the difference between the members you are with and the expectation members to take on their own burdens.

When health programs are human, communication and education are accessible, personalized and effective, and members are more confident, engaged and likely to take action when they meet with their members.

4. Systematic disengagement: “Reminder and Wait” is invalid

If you are part of a health plan that sends automatic “reminder” messages (email, text, phone voicemail) and then does not do anything that makes members interact, you are not alone. “Reminders and Waiting” means a static, sometimes outreach activity, followed by what. Worse, it is usually from untracked, unblocked phone numbers, so it is impossible to ask questions, clarify details or find help.

This approach is alien to the way most of us solve any complex, emotionally filled decisions. But that's exactly what we expect from chronic illness, high risk, low income, multiple burdens and language diversity members will do their own, no relationships, no response systems, and no plans.

And, when referrals to less than 35% completion rates, this means that most referees fail and miss out on care, not because members don’t care or try, but because we are not effectively involved.

Fixing undisplayed by “reminders and waits” indicates that the problem is messaging rather than interaction. Engagement is about connecting in person or remotely, finding where members are trapped and helping them get rid of, actively reach out instead of responding passively, and closing the loop and opening them.

Design a better system: reminder relationships

Improving the rate of unshowed is not only a reminder to perfect ours, but it also involves redesigning the member experience from scratch. It's about creating systems that reflect and adapt to the reality of members' lives. Here are three ways to put design first when driving care is completed:

1. Eliminate friction – When arrangements are too difficult, members will listen. From passive recommendation to real-time scheduling, ideally, it eliminates important sources of friction when participating. Integrate this capability into member-oriented channels such as nurse hotlines, reward portals, and over-the-counter (OTC) welfare platforms, making immediate access and friction-free.

2. Driven Behavior – When communication is personalized and tailored to its unique needs and environment, members are more likely to feel seen, valued and supported. Time, tone, and contact points can all be adapted to reflect each member's preferences. By showing members how you care and their role in the nursing journey is active, you can earn their trust, strengthen relationships and drive them to close the gap in care.

3. Adapt to real life – Members are diverse and they can receive barriers to care. For some it is transportation, while for others it is a limit on mobility, living in rural communities, or having pre-existing care and work needs. Members’ first approach to care access identified these challenges and tailored access to meet their challenges. This may include providing transportation assistance, telemedicine, after-get off work appointments or care coordination, to name just a few. Regardless of the solution, the goal remains the same: remove as many obstacles as possible and provide truly accessible care.

What can health plans do now

The transition from reminder to relationship begins with intentional system design. Each member’s engagement touchpoint is an opportunity to bridge the nursing gap and ensure continuity of care. Each interaction between members and members of the nursing management team is an opportunity to schedule an appointment. Starting today, here are four simple ways health plans can make a difference.

• Investment shutdown cycle smarter recommended infrastructure. Use past arrangements as the finish line. Plans should ensure members follow up to complete care and report data to fill care gaps.

• Ensure arrangements are related to participation and care coordination to avoid silos and unnecessary friction.

• Use data to identify high-risk members and then actively participate to prevent them from falling into cracks.

• Track the entire nursing journey, not just recommendations. If you don't measure done, the gap won't be narrowed.

From missed dates to measurable impact

Not showing is not just about operating pain points. They missed opportunities to improve results, close equity gaps and deepen membership relationships. They may change when programs move from passive advocacy to positive, relationship-based outreach activities:

Better results – Recommended visits are not completed yet, chronic conditions are not optimally managed, preventable complications are not captured early, and are not as effective when members miss out on appointments. When we reduce and do not display, population health indicators increase.

Reduce inequality – Low income, rural and ethnic minorities are more likely to miss appointments. As we engage in understanding things about obstacles and help members overcome them, we will address complex causes that are not present and take important steps to achieve healthy equality.

Improve quality scores – Complete care is what drives the performance of CAHP, HEDIS and Star Ratings. However, if we do not address the core issues facing members in terms of visits and care, then we cannot expect to change members’ thoughts about completing dates or have members give us a good rating.

It's time to take it from the back burner. Let’s stop thinking of missed appointments as membership issues and start seeing them as a strategic opportunity to achieve better membership and business by building trust, closing gaps and providing care that is not only accessible, but actionable.

Source: Nuthawut Somsuk, Getty Images

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