A thought experiment on making healthcare outreach smarter and more balanced.

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Every Monday morning, clinics across the country print out the “care gaps” list—a long spreadsheet of patients overdue for screenings, check-ins, or medication reviews.

Dedicated professionals work diligently to address these gaps, aiming to support every patient. However, the system itself inherently focuses on easily measurable tasks: scheduled screenings, simple lab values, or medication refills. Over time, this focus creates a subtle bias—patients with more complex or less easily defined needs unintentionally receive less attention.

What if we could redesign this decision-making process? Instead of relying on a static checklist, what if we adopted a dynamic system that gives everyone a fair chance at receiving timely and appropriate care?

How the Fair Shot Lottery Could Work

Imagine a system that redefines daily outreach:

1. From “Gaps” to Evidence-Based Opportunities: Rather than viewing patient care purely as gaps to be closed, the system identifies opportunities to meaningfully improve health outcomes. Each opportunity is assessed using established clinical research, population health data, and real-world feasibility. The care team then adds local context—such as patient availability or transportation constraints—to refine these assessments.

2. From Ranked Lists to a Weighted Lottery: Instead of simply ranking opportunities, a weighted lottery is used. Opportunities with greater anticipated benefits receive more “tickets,” ensuring high-impact care remains prioritized. However, every opportunity maintains at least some chance of being selected. This approach helps maintain a balanced focus over time, preventing persistent blind spots that naturally occur with ranked lists. By design, a lottery prevents entrenched patterns. Over time, this helps clinical teams learn and refine their understanding, ensuring more comprehensive coverage for all types of patient needs.

3. Realistic Resource Management: The lottery fully acknowledges practical constraints—limited nurse hours, appointment availability, and budget limitations. It only selects actions that can realistically be carried out, considering the available resources.

How This Changes the Work

Maria (62, lives 45 minutes from the clinic)

Maria’s potential benefit from remote heart failure monitoring is high, but traditionally her geographic isolation might deprioritize her care. With the Fair Shot Lottery, her opportunity remains consistently in play and eventually gets selected. A nurse enrolls Maria, her health stabilizes, and a hospital admission is avoided.

Imani (28, complex chronic condition)

For patients like Imani, who face conditions with limited historical data and uncertain outcomes, the system occasionally selects opportunities for exploratory purposes. By addressing Imani’s needs, the care team not only supports her health but learns valuable insights to improve future care decisions.

Jake (49, gig worker with limited availability)

A cancer screening opportunity for Jake is highly beneficial if it occurs during a weekend slot and via text message outreach. The system automatically factors these constraints into the opportunity’s evaluation. His care is prioritized precisely because the anticipated health benefit justifies the use of limited weekend resources.

The Human Impact of a Fairer System

A ranked list approach is logical, but it often reinforces narrow patterns, repeatedly favoring the same clearly defined opportunities.

By contrast, a weighted, resilient lottery balances immediate known benefits with opportunities for exploration and learning. It helps clinical teams consistently revisit their full patient population without losing sight of high-impact care.

In daily huddles, care teams review opportunities identified by the system, each accompanied by clear rationales for prioritization. Clinicians use their expertise to adjust recommendations based on real-world context. They’re no longer merely executing a static list; they’re actively guiding the system.

Potential for Deeper Analysis

While designed to function effectively without requiring sophisticated analytics, the Fair Shot Lottery approach naturally supports deeper evaluation and continuous improvement. Clinical teams could choose to analyze opportunity coverage, resource allocation, or patient outcomes to inform future adjustments—providing the option for greater insight if and when desired.

Ultimately, this approach allows clinicians to concentrate on what matters most: delivering compassionate, personalized patient care, supported by a system thoughtfully designed to give everyone a fair shot.