By Lauren Barca, MHA, RN, BSN, VP of Quality, 86Borders
LinkedIn: Lauren Barca
LinkedIn: 86Borders
Health plans are reaching more members than ever before, but that has not necessarily translated into better engagement or better outcomes because most of that effort stops after the first interaction.
Today’s outreach is designed to get a response in the moment. A member answers a call, reads a text, or gets a reminder about a screening. That interaction can help, but it does not ensure care actually happens or continues.
One interaction does not create engagement
A single outreach attempt can prompt intent, but it rarely leads to lasting behavior change.
Members still need to schedule, show up, and follow through, and without consistent follow-up, there is little visibility into whether that happens.
Plans often define success as contact, rather than completion, creating false engagement metrics that may not translate into care or gap closure.
The blind spot after the first conversation
Many engagement programs are built to initiate contact, not to carry it forward. After the first touchpoint, follow up is often inconsistent and difficult to track. It may rely on manual processes, disconnected systems, or care teams trying to manage too many moving parts at once. When that follow-up breaks down, there is often no clear signal.
As a result, engagement drops off not all at once, but in small, avoidable gaps.
Why this affects outcomes and cost
When care does not progress after the initial interaction, the impact shows up quickly.
Appointments are missed, conditions remain unmanaged, and members delay care until it becomes more serious and more expensive. The bigger issue is how this impacts the value of the outreach itself. Health plans are investing in campaigns, vendors, and care management resources to drive action, but without continuity, much of that spend stops at the first interaction.
Closing a single gap may check a box, but it does not change overall utilization or long-term cost. A screening alone does not prevent avoidable emergency visits or improve chronic condition management. That is where return on investment (ROI) starts to break down. Outreach may show activity, but it is not consistently reducing downstream spending or improving long-term outcomes.
Without follow-through, the model remains transactional, and the financial impact remains limited.
Transactional outreach limits long-term value
Outreach strategies that are built around isolated actions rather than sustained engagement can produce short-term results, but they do not support care over time. Members are more likely to follow through when there is a clear next step and someone checks back in.
Without that continuity, plans are often restarting the engagement process with the same member instead of building on prior interactions.
This also ties to trust. Most Americans still prefer getting medical advice from providers, with research showing about 85% rely on them, while far fewer turn to AI or social platforms, and only around 42% say they are open to AI playing a role in their care. That makes one-off, impersonal outreach even less effective when it does not connect members to a trusted, ongoing human-to-human experience.
Why this matters for higher-risk members
When talking about members with more complex needs, they are not just harder to reach, they are easier to lose.
They may be managing multiple conditions, dealing with financial or transportation challenges, or trying to navigate a system that is difficult to understand.
When engagement is inconsistent, they are the first to drop out of the process, which leads to higher utilization and more avoidable spending.
What needs to change
Fixing this is not about increasing outreach, it is about getting more value from the outreach that already exists.
To improve ROI, outreach has to be tied to what happens next. Each interaction should result in a defined next step, whether scheduled, confirmed, or tracked to completion, with clear visibility into where follow-up is needed.
That shift changes the model from generating activity to driving outcomes. When outreach is connected to completed care, it starts to reduce downstream costs instead of contributing to it.