The following is a guest article by Kevin Healy, CEO at ReferWell
Access to care is one of the most pressing challenges in healthcare. Members enrolled in health plans do not opt out of medical care due to disinterest but rather because systemic obstacles prevent them from completing their healthcare journey. People face a continuous loop of missed appointments and treatment delays due to scheduling problems, lengthy waiting times, and lost follow-up contacts. Recent data underscores the scale of these barriers: The average wait time for a new patient physician appointment in 2025 across 15 U.S. metro areas reached 30 days – a 15% increase since 2022 and a 43% rise since 2004.
Technology is beginning to shift this dynamic, offering health plans scalable solutions that improve member access, reduce costs, and drive better outcomes. New healthcare solutions have made it incredibly straightforward to direct patients to appropriate providers while facilitating smooth appointment scheduling processes and ensuring follow-through support.
Despite its impressive capabilities, member engagement technology requires additional input to reach full effectiveness. Health plans and providers need to combine these platforms with meaningful outreach strategies to effectively tackle earlier-mentioned challenges, including hesitation, trust issues, and system complexity. Health plans must develop personal relationships with members to build the trust necessary for both tool engagement and confident action on their care options.
Top Care Access Barriers
Scheduling Difficulties & Long Wait Times
Being able to secure an appointment with an in-network provider can be a challenging endeavor. Many people struggle to find their in-network provider list and face difficulties when trying to secure an appointment. Online scheduling availability at some practices is restricted by specific insurers or services which adds complexity instead of making the process more straightforward. Delayed visits can lead to higher utilization of the emergency room, increased hospitalizations, and avoidable complications for chronic conditions. The Washington Post highlighted how members are often waiting up to 26 days for a new primary care appointment, while a wait for an appointment with a cardiologist can be up to 32.7 days, and OB/GYN care can have delays of up to 231 days in some metro areas. These delays impact individuals with chronic conditions most dramatically, as lack of routine care can cause diseases to progress more rapidly, resulting in more trips to the hospital and worse long-term outcomes.
This problem emerges from archaic booking systems, along with insufficient staffing and incorrect provider information. Members who have chronic medical conditions face dangerous consequences because of these prolonged wait times for appointments. Postponing medical attention results in progressively worse health outcomes. According to the National Institutes of Health (NIH), delayed access to Medicare care heightens the risks of worsening health outcomes for certain populations and increases the likelihood that they will require more expensive and invasive treatment options down the road.
Lack of Care Coordination & Follow-Through
When transitions between primary care services, specialists, and additional services lack coordination, members fall through the cracks. The healthcare system presents multiple challenges for individuals who are ill and need medical attention. Care coordination becomes crucial when it helps people navigate their healthcare needs effectively. Without proper support to navigate their healthcare journey, patients often miss crucial appointments and essential care while facing repeated tests due to duplicated orders.
Proactive care coordination, which is more than simply sending reminders about upcoming care, is essential for getting people to the doctor. The function of dedicated care coordinators lies in providing personalized care management that helps members navigate their health journey with proper support and direction. The foundation of healthcare outcome improvement and participant experience enhancement comes from effective care coordination.
Transportation Issues
For many, getting to the doctor is a logistical challenge in itself. Residents of rural areas, in particular, experience considerable stress when attempting to reach their medical appointments. Reliable transportation options are scarce across many locations, which creates challenges for people trying to maintain regular medical appointments. According to the American Hospital Association, an estimated 3.6 million Americans miss medical appointments each year due to a lack of transportation. When screenings are missed and diagnoses are delayed, medical conditions remain untreated and become widespread.
Low-income members can struggle with transportation because they often neither own cars nor have access to affordable public transportation. Transportation barriers lead to operational problems but also create health disparities, which make it more difficult for vulnerable groups to sustain their healthcare practices. Without enhanced solutions, people fail to receive necessary medical care when they need it most.
A Step Towards Healthier, More Equitable Healthcare
Health plans must implement proactive and direct interventions instead of passive reminders to enhance member care access and empower members to take action in their health journeys. Plans need to adopt technology solutions that help members overcome barriers through intuitive scheduling tools and personalized care coordination programs.
Technology combined with heartfelt member support delivers much more than mere reminder services. Members need essential support to ensure they can attend their planned appointments successfully. Through the integration of intuitive scheduling systems alongside personalized support programs, health plans can eliminate barriers that prevent individuals from obtaining needed medical services. When easy access links with proactive outreach and empathetic guidance, people successfully make appointments and stay connected to their health journey.
About Kevin Healy
Kevin Healy is a seasoned healthcare executive with over 25 years of leadership experience spanning health plans, provider organizations, and healthcare technology firms. He currently serves as CEO at ReferWell, a digital healthcare company focused on improving care access and patient engagement. In this role, Kevin is leading the company’s next phase of growth by expanding the reach of its platform and care concierge services to better connect patients with the care they need.
