One of the core strategies of driving ROI in risk-based contracts includes reducing unnecessary utilization by trading high-cost care for lower-cost services. For this shift to occur, patients must have access to a consistent source of care—but data show that many vulnerable populations do not. With 25% of low-income patients missing or rescheduling appointments, providers need to have a clear sense of the root cause of primary care underutilization. In our research, we found three reasons why inactivated patients may not make it to their appointments: