Medicaid Insights Brief · 2026

What real-world engagement teaches us

5 Medicaid Insights from 40M+ Patient Interactions

Across a decade of real-world care delivery, a consistent pattern emerges: the highest-value engagement does more than send outreach. It reconnects members, prepares them for care, surfaces risk in real time, and helps limited care teams intervene where it matters most.

• 40M+ patient interactions supported by Florence
• 10+ years of real-world clinical use
• 100+ independent clinical studies across care settings

This brief distills five practical lessons for Medicaid leaders responsible for quality, population health, care management, member experience, and clinical operations.

The throughline: The fastest path to value may not always be another long-term program. It is finding the members already falling through the cracks and supporting the next critical step in care.

Insight 01

Reaching a member is not the same as closing the gap.

The meaningful measure of outreach is not message volume. It is whether members re-enter care and complete the clinician’s plan of care.

In one Medicaid deployment over 8 weeks:

• +17.7% increase in Annual Wellness Visit show rate
• +6.5% increase in Well Child Visit show rate

Why it matters for Medicaid

Measure engagement by downstream behavior: appointments kept, gaps closed, care plans advanced, and members reconnected to the system.

Insight 02

SDOH barriers often surface in conversation before they appear in the data.

Ongoing member conversations can reveal what is getting in the way of care while there is still time to act.

In one Medicaid deployment, Florence answered 4,277 questions from 2,844 unique members.

• 27% — 1,168 questions about appointment scheduling and details
• 10% — 449 questions about social needs
• 4% — 189 questions about visit education

Operational implication

These conversations give care teams visibility into scheduling friction, social needs, and education gaps that may never surface clearly in claims data, helping plans identify barriers earlier and intervene before they contribute to missed care or avoidable utilization.

Insight 03

Immediate value often starts with members already at risk of falling out of care.

Chronic disease management can create deep long-term value. But when Florence starts with a new organization, some of the fastest opportunities are often more immediate: find lost members, prepare people for scheduled care, and intervene before a reschedule becomes a no-show.

Lost member re-engagement

21,672 members lost to care for 18+ months entered active outreach.

More than 1,000 members responded within the first two weeks.

Within just two weeks, Florence more than doubled the organization’s existing digital engagement rate among members who had been lost to care.

Appointment readiness

81–90% of enrolled members completed AWV and WCV appointment-preparation protocols.

Structured outreach can help members confirm visits, prepare for appointments, understand next steps, and surface scheduling friction before the appointment is lost.

• 1,171 members confirmed appointment attendance in real time
• 351 reschedules identified before they became no-shows
• 24/7 members could respond without requiring routine care-team outreach

Why this is a useful starting point

The intervention is concrete, the workflow is measurable, and value can show up quickly: members found, appointments preserved, care gaps advanced, and care-team time reserved.

How Florence works: clinical outbound, intelligent inbound

Validated clinical protocols guide proactive outreach. AI interprets inbound responses, prioritizes needs, and surfaces actionable insights so care teams can focus on members who need human intervention.

Insight 04

Transitions of care are a high-impact window for intervention.

Discharge is not the end of an episode. The next 30 days depend on medications being obtained, follow-up being scheduled, warning signs being recognized, and practical barriers being resolved outside the hospital or the ER.

Florence extends structured support into this high-risk period while giving care teams visibility into patients who may need additional intervention.

• Roxborough Memorial Hospital — 55% lower 30-day readmission rate. 6.3% Florence vs. 14.0% non-Florence. 3,148 Florence discharges vs. 1,228 non-Florence discharges. June 2025–May 2026.
• St. Michael’s Medical Center — 44% lower relative risk of 30-day readmission. 7.0% Florence vs. 12.6% non-Florence. 872 Florence discharges vs. 381 non-Florence discharges. March–May 2026.

What happens between discharge and recovery

• Medication support. Checks whether medications were obtained and identifies cost, side-effect, confusion, or adherence issues that may require follow-up.
• Follow-up connection. Confirms PCP access, prompts appointment scheduling, and tracks whether patients completed follow-up care.
• Early risk detection. Checks for worsening symptoms and helps patients understand when to contact their clinician, seek urgent care, or call 911.
• Barrier identification. Surfaces transportation, food, housing, utility, medication-access, and home-support needs that may disrupt recovery.

The lesson

Transitions of care provide an immediate, measurable opportunity to extend the care team beyond discharge: consistent follow-up for every eligible patient, with targeted human intervention when Florence surfaces risk.

Insight 05

Scale should increase reach, not routine workload.

Population-scale engagement cannot require proportional growth in staffing. Technology has to absorb routine follow-up while preserving human attention for the moments that require it.

• 462 — starting scale: active care management patients
• 20K+ — 30 days later: members across live protocols
• 0 — additional FTEs required for the expansion

The care team multiplier

Florence automates clinically validated outreach and routine conversation, then organizes inbound needs so staff can spend their time on exceptions, escalation, and human intervention.

Executive implication

Capacity is not just how many members a platform can message. It is how many members a care team can meaningfully support.

Executive takeaway: start where the member is most likely to fall through.

The strongest engagement programs do not begin with technology for technology’s sake. They begin with a measurable care-management problem where timely conversation can change the next action.

1. Measure completed care, not message volume.
2. Use member conversation as a real-time signal.
3. Start with lost members and appointment readiness.
4. Extend support through the 30-day post-discharge window.
5. Scale reach without scaling routine workload or staff.

For Medicaid leaders, immediate value can start with a surprisingly practical question:

Where are members already getting lost today, and what could change if the care team knew about it in time?

About Florence

Florence is a clinically validated automated care management platform designed to support ongoing, two-way patient engagement between visits.

Evidence base

10+ years | 40M+ interactions | 100+ studies | 20+ peer-reviewed publications

Evidence note: Findings in this brief are drawn from multiple real-world Florence deployments and analyses across Medicaid, value-based care, and transitions-of-care settings. Individual results reflect the populations, programs, and comparison groups described for each finding and should not be interpreted as outcomes from a single Medicaid cohort.

Florence by Generated Health

Care management that keeps the conversation going between visits.