At Lena, we had a common problem I’ve seen all across the country: care management and navigation programs that improve outcomes and lower costs but don't scale. Hiring and managing telephonic care staff felt like pushing a boulder up a never-ending hill.

Staff caseloads are never high enough, hiring is harder each year, managing performance quality is challenging, and keeping staff from churning feels impossible.

Here I write about efficiency details we’ve found are overlooked but critical to solving bottleneck problems. I then write about how we used AI to successfully augment teams, improve the patient experience, and scale our programs.

The Hidden Cost of Phone Tag

Phone tag is a quiet but costly problem. It drains care team bandwidth and breaks the momentum of transitional care. While the industry has poured billions into portals and self-service apps, high-need populations are still most reachable by phone.

Over the past six years coordinating care, our team has tracked every outreach pattern we could. We’ve seen where the process breaks down—and what actually moves the needle. This article outlines the operational cost of phone tag, shares strategies that improve first-call success, and shows how Lena makes those strategies repeatable at scale.

What It Costs to Miss the First Call

Let’s start with the math. Programs like Transitional Care and Complex Care often assign nurses panels of 200 to 300 patients. It typically takes three to five calls to reach each one. Every attempt takes time: placing the call, leaving a voicemail, logging the outcome, and planning the next step.

That adds up. Twelve minutes per patient to connect. For a caseload of 300, that’s 60 hours a year lost to outreach that doesn’t land. At $90 an hour, that’s $5,400 per nurse per year chasing calls.

And that’s just the direct cost. The clinical impact cuts deeper. Phone tag stretches the window between discharge and support. One study found that poor post-discharge outreach delayed care by up to two weeks. That gap leaves space for unmanaged symptoms, unfilled prescriptions, and preventable readmissions.

The delay also erodes trust. When patients don’t hear from their care team, especially after a hospital stay, they feel forgotten. That undermines engagement and lowers answer rates. For patients managing multiple conditions, missed calls aren’t just inconvenient—they’re dangerous.

One of our care coordinators put it simply: they spend more time trying to reach patients than actually speaking with them.

Why Is Phone Tag an Issue at All?

The average age of patients in care coordination is around 70 years old. About 25% of households still have landlines, and that percentage is higher among older adults. Meanwhile, 83% of adults don’t use portals or self-service tools. For the majority of patients, phone calls are still the front line.

But even when calls go through, voicemails stay vague to comply with HIPAA. Most patients hear only, “Please call us back.” Some call back at night or on weekends. Others don’t call back at all.

Each missed attempt creates another follow-up, delay, and chunk of time pulled from direct care. The system becomes reactive. Nurses spend their days in the call loop instead of moving care forward.

Fixing this doesn’t mean reinventing the process. It means structuring what already works, at scale.

What Works

“Heads-up” Text:

Nobody answers an unknown number. That’s why a simple pre-call text changes the outcome. Something like, “Hi Mr. Jones, I’m Jesse, a care coordinator calling about your discharge plan,” creates clarity and intent. Patients know who is calling and why. One meta-analysis found that appointment attendance improved from 67.8% to 78.6% with a text reminder. At Lena, our data shows that a “heads-up” text improves answer rates by more than 30%.

“Hanging” Voicemail:

Instead of hanging up after leaving a message, advocates stay on the line for 30 to 60 seconds. That pause gives patients time to read the transcription, hear the start of the message, or answer before the call ends. Our care team sees live connection rates around 27% with this approach.

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Context & Timing:

Design outreach to follow a patient encounter. A follow-up shortly after a patient interaction, combined with a personalized and contextualized “heads-up” text and a “hanging” voicemail, can result in reach rates of over 70–80%, meaningfully higher than industry averages (30–50%).

These strategies don’t add work. They replace repeat effort with smarter timing and context. They help care teams spend less time reaching out and more time engaging.

When outreach is clear and timely, patients respond. That first answered call can unlock everything that follows—whether it’s a medication check, a referral, or help navigating their next step.

Telephonic AI Agents

Doing the right work is half the battle. Care teams can still lose by repeating the right work manually, without a structure to support it.

We created AI because our care managers struggled to scale their efforts. But where does AI make sense? Agents should automate while augmenting the patient experience.

Lena Multi-attempts Automated

Lena schedules calls using real-time data: time of day, attempt history, and call spacing. Each patient gets outreach when they’re most likely to answer. No one has to manage the sequence manually. This saves five to ten hours per nurse each week for high-volume programs.

Intelligent Texting

Lena sends short messages before and after call attempts. A pre-call message sets the purpose and establishes trust. A follow-up like, “Sorry we missed you. We’ll try again tomorrow,” opens the window for coordinating asynchronously when that is preferred and more convenient.

Smart Voicemails that Hang

Voicemails get smarter. Lena leaves personalized messages that reflect the purpose of the call, whether it’s a check-in after discharge or a reminder about test results. More importantly, Lena “hangs” on the voicemail for 30–60 seconds to give patients time to answer.

Patient Activation Agent

Getting patients on the phone is the first step. Lena will engage the patient in conversation, introduce herself, and explain the purpose of the call. For patients who are ready and available, Lena will “loop in” the care team member.

Program Enrollment Agent

Enrolling patients into care management programs like Complex Care Management (CCM), Transitional Care Management (TCM), or custom disease management programs requires calling the patient, a coordinator running through a well-crafted script, and confident answers to frequently asked questions. This function often requires a dedicated hire who becomes an “expert” at successfully enrolling and consenting patients into programs.

Agents like Lena AI can automate outreach and navigate conversations just like a highly trained coordinator. Lena will consistently handle the script and confidently answer common patient questions. When needed, Lena can escalate a call to a care team member.

With Lena, we’ve measured 70–80% enrollment success rates in our programs, alleviating a painful bottleneck as we needed to scale programs quickly.

How to Scale Your Care Teams with AI Agents

If your care teams spend hours trying to reach patients and you’ve experienced similar bottlenecks in your outreach as we have, you likely can leverage the Lena AI Agent to scale your patient activation or enrollment.

Message me directly, and we’ll set up a walkthrough to show how you can start using Lena—no integration lift required.

Alex Harb

Founder, CEO