Most of a care gap outreach list is lost before anyone says hello

Start with a long list of members who are due for a colorectal cancer screening. Now follow them, step by step, from the first dial to a result that counts.

Every care gap outreach program runs some version of this list. Most teams judge it by its last number: how many screenings closed. Very few look at where the rest of the list went. When they do, the answer tends to surprise them, because the losses do not sit where the effort sits.

What happens to a care gap outreach list, step by step?

Walk the list in order. The numbers will differ from team to team, but ask any outreach team and they will tell you the shape is familiar.

1. On the listEvery member who qualifies for the screening and whose record doesn't show the one the measure requires.
2. A working phone numberA large share drops out here. Members moved, changed carriers, or the number on file was never right to begin with.
3. Someone picks upOf the members with a working number, many never answer or call back.
4. The member agreesOf those who talk to someone, a portion agree to be screened.
5. The screening is doneFewer still complete it, with the kit returned or the procedure done.
6. The result is recordedFewer again have the result make it back into the record in time to count.

Put it together and a long list turns into a fairly short stack of completed screenings. That alone isn't news to anyone who runs outreach. The useful part is the shape of the losses.

Most of the list is gone before anyone has a conversation. A big piece of it never gets past the wrong number. The member's decision, the step everyone works hardest on, accounts for far fewer losses than simply reaching people.

The pitch is where everyone focuses. Reaching people is where most of the list is lost.

Why do teams keep working on the script?

Because the conversation is the part they can see. A supervisor can listen to calls, coach a phrase, and hear the improvement the next day. A wrong number makes no sound. It shows up as a disposition code in a long column, and the next name on the list is already loading.

So when a closure rate disappoints, the response is usually more calls, a better script, or a second campaign later in the year. Each of those works on the middle of the list. But more calls against a bad contact list mostly produce more wrong numbers. The outreach team gets busier, the dial counts go up, and the share of members actually reached barely moves.

Picture Dana, an outreach coordinator, working the screening list on a Tuesday morning. Her first stretch of calls goes to disconnected numbers, a pharmacy, and a relative who says the member moved last spring. None of that is a persuasion problem. A sharper script would not have helped her reach a single extra person that morning. (Dana is a composite, not a real person.)

Where should outreach effort go instead?

The bigger gains sit at the two ends of the funnel, not in the middle.

• The start: accurate contact information. Every member with a wrong number is lost before any skill on the phone can matter. Fixing the list before the campaign begins, and keeping it current as members move and change plans, raises the ceiling on everything that follows.
• The finish: completed care that actually gets recorded. A screening that happened but never reached the record looks exactly like a screening that never happened. Those are the most frustrating losses on the list, because the member did everything right. We wrote about this in more depth in the mammogram that happened in July but still shows as open.

The middle still matters. A good conversation helps a member say yes, and following up after the order helps them finish. But the middle can only work on the members the start delivered to it, and its results only count if the finish records them.

There is a related problem upstream of the phone number: whether the member belongs on the list at all. When attribution is out of date, outreach teams call members who have already left the panel while newly attributed members wait. That is a roster problem, and we covered how it spreads into every workflow in a stale roster poisons every workflow built on top of it.

How does timing change the math?

One more variable hides in all of this: time. Every step in the funnel takes weeks. Reaching a member can take several attempts. Scheduling takes time. A kit has to be mailed, used, and sent back. A procedure needs an appointment. Then the result has to find its way into the record.

Start this list in October and many of the members who say yes won't finish before December 31. They did not refuse. The calendar simply ran out on them. Most quality measures follow the calendar year, so a screening completed in January helps the member but no longer closes last year's gap.

That is why the same list worked in the spring behaves so differently from the same list worked in the fall. Early in the year, a slow step costs a few weeks. Late in the year, it costs the gap. We laid out how much of the year is actually usable in you don't get the whole year to close a care gap.

How do you map your own outreach funnel?

If you have never mapped your own outreach funnel step by step, it is worth an afternoon. Take a recent screening campaign and count, at each step, how many members made it through and how many dropped out. Then ask three questions.

• Where is the biggest single drop? For many teams, it comes before the first conversation.
• How long does each step take, from the first dial to the result in the record?
• How many members completed the care but still show as open?

The answers tend to move effort away from the script and toward the list itself and the record at the end. They also tend to move the start date earlier in the year.

The finish line is where a platform can help most directly. ElevateCare 360 tracks open quality measures as data lands and matches completed screenings and results back to the measure, so completed care can count toward closing the gap. See how on the care gap closure page.