Meeting Members Where They Are: How Managed Care Organizations Can Close Gaps in Care

In Medicaid populations, closing gaps in care isn’t just a compliance issue; it’s a matter of health equity, quality improvement, and long-term cost reduction. Gaps in care occur when members miss critical preventive services like flu shots, screenings, or annual wellness visits. These services are foundational to keeping populations healthy and catching conditions early.

Yet, too often, members fall through the cracks. Life gets busy. Mailers get ignored. Appointments get delayed.

That’s why health plans increasingly turn to proactive outreach strategies powered by digital engagement platforms to guide members through the steps needed to complete their care.

The Preventive Care Imperative

Preventive care is essential for identifying risk early, managing chronic conditions, and reducing the need for costly emergency or inpatient services. Despite its importance, many members miss key services every year.

For example, a Medicaid Member:

• Could skip their annual wellness visit due to a lack of transportation.
• May be overdue for a flu shot, but isn’t aware of their plan’s coverage.
• Might avoid scheduling a critical wellness appointment due to fear, confusion, or scheduling barriers.

Left unaddressed, these missed touchpoints lead to worse outcomes and higher costs for both plans and members. From a performance standpoint, unclosed care gaps impact HEDIS ratings, CAHPS scores, and value-based reimbursement opportunities.

To improve outcomes, plans must stop relying on members to act independently and meet them with timely, relevant, and persistent outreach.

Why Reactive Outreach Isn’t Enough

Many plans still rely on reactive outreach strategies or ones narrowly timed around reporting deadlines. Members might receive a phone call or a letter once or twice a year asking them to complete a screening they may not even remember needing.

This approach often falls short for several reasons:

• It doesn’t account for the members’ unique communication preferences or barriers.
• It’s too late in the year to create meaningful engagement.
• It places the burden on members to figure out the next steps.

Worse, it assumes that members are disengaged or indifferent when many simply lack support. That’s why health plans are shifting from transactional, one-off outreach to sustained, proactive engagement enabled by smart technology.

Proactive Engagement Through Technology

Proactive outreach isn’t about sending more messages. It’s about sending the right message, at the right time, through the right channel.

Platforms with these features give health plans the tools to identify care gaps, launch targeted campaigns, and monitor completion without overwhelming care coordinators.

Here’s how it works:

• Track Care Gaps in Real Time: Integration with claims and EHR systems enables plans to see who is due for screenings, immunizations, or wellness visits.
• Automate Outreach: Personalized campaigns are created based on condition, age, or history. For example, members overdue for a screening can be automatically enrolled in an educational SMS series followed by a scheduling reminder.
• Use Multichannel Communication: From text messages to voice calls and emails, HealConnect reaches members through their preferred channels, ensuring higher engagement rates and accessibility for all literacy levels.
• Monitor and Optimize: Care teams can see which members have acted, which haven’t, and why, allowing for targeted follow-ups or interventions.

Driving Follow-Through, Not Just Awareness

It’s not enough to notify members; they need support to take the next step. Proactive outreach must also include guidance, tools, and follow-through.

Platforms should help health plans:

• Embed scheduling links or warm transfer phone numbers in outreach messages.
• Connect members to transportation or social services when needed.
• Re-engage members who’ve missed appointments with empathy and persistence.
• Mark care as “complete” in the system and trigger the next recommended action.

By tracking the full journey, plans can ensure members don’t just know what they need to do, but actually do it.

Conclusion

Preventive care changes lives, but only when members complete it. Health plans must do more than check boxes. They must build systems that proactively guide members toward better health.

Platforms like HealConnect make this possible by combining smart automation, real-time data, and multichannel communication to close care gaps faster and more efficiently. Plans that embrace this proactive model improve quality scores and build trust, loyalty, and health equity in the process.

Ready to close more gaps in care with less manual work?

Schedule a demo with HealConnect today to see how your plan can deliver measurable impact through smarter engagement.