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For years, health plans have used terms like “hard-to-reach” and “unengageable” to describe members who do not respond to outreach. The language is familiar. So is the challenge: phone calls go unanswered, texts are ignored, digital messages are never opened and important care gaps remain unresolved.
But what if we are asking the wrong question?
Instead of asking why some members are hard to reach, health plans should ask: Why are they hardly reached?
That subtle shift changes the conversation. It moves the focus away from labeling the member and toward examining whether your engagement strategies are designed to effectively reach and support people in the first place.
Engagement is more than a channel
A common response to low engagement is to add another outreach channel. For example, if phone calls aren’t working, try text. If text doesn’t work, try email or another means of digital outreach.
Omnichannel engagement is important—but simply adding channels does not make an engagement strategy “omnichannel.” Reaching a member with the right message to meet their needs, using the right intervention does.
Effective engagement considers which message, messenger, channel and intervention are most appropriate for the individual and the situation. A member may respond to a text at one point in their care journey but need a conversation with a clinician at another. Someone who does not answer a phone call may not be unwilling to engage; the message or reason for the outreach just might not fit their circumstances.
In other words, the channel itself is not the intervention. It’s the ability to connect with a member in the best way for them, given their situation and preferences. And once the member is successfully reached, it’s important to understand what might be preventing them from taking a recommended action, such as filling a prescription or attending a doctor’s appointment.
Look beyond the behavior to understand the barrier
The goal of outreach is to understand what is getting in the way and reduce the friction between a member and the action they need to take.
A missed refill or an unanswered outreach attempt tells us what happened. It does not necessarily tell us why.
This distinction is critical.
Behavioral science reminds us that what people do is shaped by context—including competing demands, available resources, cues, confidence, complexity and friction. A member who does not refill a medication could be experiencing cost concerns, transportation challenges, confusion about their regimen, concerns about side effects, competing priorities or simply a disruption in the routine that previously helped them stay on track.
Calling that member “nonadherent” describes the outcome. Calling them “unengageable” describes the response to outreach. Neither explains what is preventing them from completing a behavior.
Understanding the underlying barrier gives health plans a better opportunity to determine what needs to change to make it easier for the member to complete a behavior—and what kind of intervention is most likely to help.
It’s important to understand that barriers are not static. For example, a strategy that works today may stop working after a hospitalization, financial setback, treatment change, new caregiver responsibility or other change in circumstances. For engagement to be effective, it must be able to adapt as the member’s needs and barriers change.
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Design engagement around the member’s needs
Health plans must shift their perception to design programs that effectively engage members.
Rather than starting with, How do we get this member to respond? plans should start with:
- What might be making the desired behavior difficult?
- What information or support does this member need?
- What creates friction in the current experience?
- Is our outreach arriving with the right message and through the right channel?
- Are we asking the member to do too much?
- What would make the next step easier?
These questions lead to a more member-centric approach—recognizing that people interact with healthcare within the context of their everyday lives.
And that has implications well beyond medication adherence. The same thinking can be applied to preventive care, chronic condition management, care coordination and other health plan priorities.
From “unengageable” to better-designed engagement
Rather than eliminating the term “hard-to-reach“ simply because it is politically or linguistically preferable, it’s important to change the thinking behind it.
Some members will remain difficult to reach. But that does not mean they are unwilling to engage or that they cannot be supported. It means our traditional approaches may not be reaching them effectively.
For health plan leaders focused on improving quality, closing care gaps and creating better member experiences, this distinction matters.
The next generation of engagement will require more than additional outreach. Instead, it will require better-designed outreach—grounded in behavioral science, informed by barriers to care, enabled by omnichannel capabilities and able to adapt as members’ circumstances change.
The question is no longer, “How do we engage the unengageable?”
It is: “What would we change about our approach if we stopped assuming the member is hard to reach—and started asking why they are hardly reached?”
That is where more meaningful engagement begins.
Rethinking member engagement?
AdhereHealth can help
AdhereHealth helps health plans move beyond traditional outreach strategies to create more meaningful, member-centric engagement. Our approach combines predictive analytics, behavioral science, clinical expertise and omnichannel engagement to identify members who need support, understand their barriers and deliver personalized interventions.
Better engagement starts by asking why members are hardly reached—and what we can do differently.
Learn how AdhereHealth can help your plan create more effective member engagement.
