Sarah Matt will argue that “hard to reach” patients were never the problem
Sarah Matt, M.D., MBA, is set to bring a familiar clinical complaint into sharper focus at TEDxJacksonville on Jan. 16, 2027: the idea that some patients are simply hard to reach. Her message is blunt. The system was built for a narrow default patient, and everyone who falls outside that template is forced to absorb the friction.
Matt’s talk will center on a framework she calls the Five Distances, a model she introduced in her 2025 book, The Borderless Healthcare Revolution. The framework treats missed care not as a patient defect but as a design failure. In practice, that reframes poor follow-up, delayed diagnosis, and incomplete access as predictable consequences of a healthcare structure optimized for people who are insured, digitally connected, fluent in English, and ready to trust institutions from the outset.
The choice of TEDxJacksonville theme is not incidental. This year’s event is built around “You Are Here,” and Matt’s own framing uses the same visual logic: a red dot on a map, and the invisible distances that keep many people from ever reaching it. The image works because it is familiar. Patients do not usually disappear in a single dramatic moment; they drift off course through cost barriers, language gaps, transportation failures, digital exclusion, and the slow erosion of trust.
A framework built around access friction, not patient blame
Matt’s core argument is a direct rebuke to a common clinical shortcut. In everyday practice, labels like “nonadherent” or “hard to reach” often function as explanations, when they are really abbreviations for system-level obstacles that remain unmeasured. Her framework invites health systems to stop treating those labels as conclusions and start treating them as prompts for redesign.
The clinical relevance is obvious. If a patient cannot navigate a portal, cannot take time off work, cannot understand the instructions in front of them, or does not believe the institution will treat them fairly, then missed care is not random. It is built into the pathway. A system designed for convenience among the already connected will repeatedly fail the people who need the most help crossing the gap.
One sentence captures the disruption in her message: the distance is not in the patient, but in the architecture.
Matt is well positioned to make that case. She is surgically trained and provides internal medicine charity care in rural upstate New York, a setting where access barriers are often visible in real time rather than hidden inside dashboards. Her career has also moved through health technology and strategy roles, including vice president of health care product strategy at Oracle Health, vice president of solution strategy at NextGen Healthcare, and chief strategy officer at Sovato. That combination gives her a perspective from the exam room, the executive suite, and the digital infrastructure that increasingly mediates both.
Why the assumed “default patient” still shapes care delivery
The TEDxJacksonville speaker profile describes a U.S. health care system constructed around an assumed patient who is insured, digitally connected, fluent in English, and willing to trust institutions. That description is clinically useful because it identifies a hidden norm. Once the norm is exposed, the failures around it become easier to see: referral pathways that assume stable broadband, scheduling systems that rely on online access, consent processes written in inaccessible language, and care plans that presume both time and confidence in the medical system.
For chronic disease management, those gaps are especially costly. Missed appointments delay treatment intensification. Confusing instructions undermine medication adherence. Limited transportation and work flexibility can turn routine follow-up into a logistical impossibility. When those barriers accumulate, the result is not just inconvenience; it is avoidable morbidity.
Her framework’s emphasis on “distance” offers a practical way to think about the problem because distance is measurable in more than miles. Distance can be linguistic, cultural, financial, digital, or institutional. In that sense, the metaphor is clinically sharp. A patient may live two blocks from a clinic and still be far from care if every step of the process is built around assumptions they cannot meet.
Rural charity care and health tech strategy converge in one message
Matt’s background gives the talk unusual credibility. Rural charity care exposes what happens when access is thin and trust is fragile. Health technology leadership exposes how digital systems can either compress barriers or harden them. She has spent time in both worlds, and that matters because access failures are rarely caused by a single broken handoff. They come from a chain of small assumptions that all point in the same direction.
The talk arrives at a moment when health systems are increasingly judged on navigation, equity, and patient experience rather than volume alone. Yet many organizations still respond to missed visits and delayed follow-up with operational fixes that do not address root causes. More reminder texts will not solve language barriers. A portal will not solve distrust if the portal is built for people who already know how to use it. Expanded access hours will not close gaps if transportation, childcare, or cost remain untouched.
Matt’s framing pushes the conversation back to design. If the system is built for a very specific patient, then every deviation from that model becomes a predictable point of failure. The result is a care environment that rewards fluency in institutional norms and penalizes everyone else.
The Jacksonville appearance turns a health equity argument into a public challenge
TEDxJacksonville is scheduled for 11 a.m. to 5:30 p.m. at the Lazzara Performance Hall in the Fine Arts Center at the University of North Florida. Matt will be one of 11 speakers, alongside Roberto Benzo, M.D., a pulmonologist and behavioral scientist. The event’s structure matters because TEDx stages are built to translate specialized ideas into public language, and Matt’s topic is one that can easily disappear into jargon if it stays inside healthcare administration.
Her talk title and framing suggest a deliberate attempt to move the conversation away from patient blame and toward system accountability. For clinicians, that shift has immediate implications. It changes how missed visits are interpreted, how outreach is designed, and how care teams think about the patients who do not respond to conventional messaging. It also forces health systems to ask whether their processes are efficient for the people they already serve while remaining opaque to everyone else.
Early-bird tickets are priced at $99 for general admission and $49 for students through Nov. 6, after which prices rise to $125 and $59. Tickets are nonrefundable but transferable up to 24 hours before the event. Those details are logistical, but the larger issue is clinical: healthcare delivery still rewards the patient who fits the default mold, while too many others are asked to overcome distances the system never bothered to see.
Matt’s talk is likely to land hardest on that point. The patients are not the problem. The distances are.