In healthcare, “hard to reach” is a familiar label. It’s used to describe members who do not return calls, miss appointments, or fail to engage with programs meant to support their health. Over time, the phrase becomes an explanation rather than a question.
But most hard-to-reach members are not unreachable. They are simply not being reached in ways that work.
Enrollment Does Not Equal Engagement
Across Medicaid, Medicare, exchange plans, and employer-sponsored coverage, enrollment is often treated as success. Once coverage is in place, engagement is assumed to follow. But in practice, it rarely does. Members delay care, skip preventive services, and rely on emergency departments when issues escalate. These patterns are often framed as noncompliance, but they are more accurately the result of systems that are difficult to navigate.
Outreach strategies still rely on assumptions that no longer reflect reality, including phone calls during work hours, messages filled with industry language, mailers that look like bills, and portals that require time, confidence, and consistent digital access. When outreach does not fit into daily life, disengagement is predictable.
Barriers Are Structural, Not Motivational
Members labeled as hard to reach often face barriers rooted in social determinants of health (SDOH). Unstable work schedules, transportation limitations, caregiving responsibilities, language barriers, housing instability, and limited access to technology all influence whether someone can respond to outreach or attend appointments. These factors shape daily decision-making long before motivation enters the picture.
Cost uncertainty compounds these challenges. Members who do not fully understand their benefits often avoid care to protect themselves from unexpected bills or financial strain.
Past experiences also play a role. Many members carry mistrust from feeling rushed, dismissed, or misunderstood in previous healthcare interactions. In these cases, avoidance is not indifference. It is a rational response to systems that have not felt safe or supportive.
More Messages Do Not Create Engagement
Digital tools have expanded the reach of outreach efforts. Texts, automated calls, emails, and portals can deliver reminders efficiently. But efficiency is not the same as engagement.
A reminder to schedule care does not address confusion, fear, or logistical barriers. Another notification does not explain where to go, what to expect, or how to make care fit into a busy life. When outreach feels generic or one-sided, it is easy to ignore.
Engagement Works When It Is Human
Members respond when outreach feels relevant and supportive. At 86Borders, engagement is built around trust and real connection. That means meeting members on channels they use, communicating in clear language, and offering help that goes beyond reminders. It includes explaining benefits, addressing concerns, and helping with the practical steps that turn intention into action.
When members have the chance to talk with someone who truly listens and understands what they are dealing with, barriers feel less overwhelming, and taking the next step becomes easier.
Engagement is not a single interaction. It builds over time. Members who feel supported are more likely to engage again. Preventive care becomes less intimidating, chronic conditions are addressed earlier, and ultimately, care shifts from reactive to proactive.
Hard to Reach Is a Signal
Calling members hard to reach should not be a stopping point. It should be a signal that current approaches are not working.
When organizations treat engagement as core infrastructure rather than an afterthought, members respond. Not because they change, but because the system does. Hard-to-reach members are not unreachable, they are waiting for engagement that reflects real life.