Most health systems assume their messages are getting through. But across apps, portals, and email, large segments of the population never even see the message. Digital tools continue to expand, yet much of that communication effort remains unseen and unanswered. Meanwhile, care teams spend hours chasing down patients who haven’t responded, repeating work across multiple channels, often reverting to phone calls.
This article examines three key challenges: which channels successfully reach patients, which ones support different care tasks, and how to scale the most effective option without adding staff burden.
Digital Outreach Misses Learge Segments of the Population
Apps, portals, and email look scalable on paper. In practice, they underperform across key patient populations, especially among older adults, lower-income groups, and individuals without consistent access to high-speed data.
Health apps have seen strong adoption among younger patients, but not among older adults. Only 28% of adults aged 50 to 80 report using a health app, and 78% abandon it within a week if they’re not properly onboarded. Push notifications fare even worse, with an average open rate of just 4% across healthcare apps.
Patient portals perform slightly better but still miss a wide swath of patients. While 78% of older adults report having a portal account, only 45% log in during a given month. In most systems, that means the majority of portal messages go unread.
Email remains the default for many health systems, but it rarely delivers meaningful engagement. In healthcare, the average open rate is just 21.5%, and click-through rates fall below 3%. For non-urgent updates or educational content, email may suffice. For any task that requires timely action, it consistently underperforms.
Texting offers better visibility. Ninety-eight percent of texts are read, often within minutes. But text messages only go so far. They work best for reminders and binary responses. When patients need to resolve a barrier or ask a question, texting stalls.
The phone still delivers the broadest reach. While only 19% of Americans answer calls from unknown numbers, 94% say they would respond if the caller ID clearly showed the clinic name. Phone ownership is nearly universal, even among patients with limited internet access. Seventy-nine percent of adults earning under $30,000 own a smartphone, and almost all have a working mobile or landline phone. In rural communities, where broadband access is often unreliable, 71% of adults still own smartphones, reinforcing the phone’s unique position.
Digital-first outreach looks efficient, but it leaves large groups behind. The phone remains the only channel with consistent reach across all age groups, income levels, and geographic regions.
Digital Handles Simple Tasks. The Phone Handles What’s Complex.
Even when a message reaches the patient, the next barrier is whether the channel can support the action required. A refill reminder doesn’t carry the same complexity as scheduling a specialist referral. Some tasks need a live conversation. Others need a click. When health systems apply the same outreach method across every workflow, engagement drops, and staff are left doing redundant follow-up.
Appointment scheduling is a clear example of a channel-task mismatch. While online tools are available, many patients still prefer to speak with someone. A plurality of older adults say they would rather schedule by phone. SMS can help with reminders and confirmations, but as a primary outreach tool for scheduling, it often fails to meet expectations. Patients who receive a text to book care may still choose to call, which can create delays and require additional staff intervention.
Referrals introduce more complexity. Forty-six percent of older adults prefer to coordinate referrals by phone. These tasks often require context, clarification, or troubleshooting to ensure effective completion. When messages about referrals are sent only by portal or email, they frequently go unanswered. Without a direct conversation, referrals stall, and the care gaps persist.
Medication refills are better suited to digital automation, but only when patients are already engaged in their care. Fifty-one percent of Medicare-eligible adults prefer to refill their prescriptions via a portal, but almost half of patients don’t access their portal consistently. Another 33% still call to refill medications. Texting is effective, but it still isn’t comprehensive. In one study, interactive SMS prompts improved refill rates by just 14 percentage points among Medicare Advantage members.
Provider discovery begins online. Patients overwhelmingly use search to find providers, three times more than any other channel. But once they’ve identified a provider, many still expect human outreach or scheduling support. Messages that arrive too late or require a login often fail to capture the patient’s attention.
Across every workflow, the same pattern emerges. When the task doesn’t fit the channel, contact rates drop, care delays increase, and staff spend more time reworking the same problem across multiple touchpoints.
Even when systems identify the right channel for the task, scale becomes the next barrier. Nowhere is that clearer than with phone outreach.
How to Automate Phone Outreach Without Losing Quality
Phone outreach works. Patients pick up, respond, and move forward. However, manual calls are expensive and limit the number of patients a care team can support. Most coordinators spend their time redialing the same numbers, leaving voicemails, or logging unsuccessful attempts—repeating work that adds cost without increasing value.
That staffing model doesn’t scale. Most health systems can’t afford to hire more staff to make more calls. And most care teams didn’t enter the profession to spend their day chasing patients.
The next step is automation. Specifically, voice agents are trained to handle phone-based workflows. These agents don’t replace the human role—they reduce the manual repetition that prevents staff from focusing on cases that need their attention.
To scale phone outreach effectively, systems can start in two places—each solving a different part of the bottleneck.
1. Automate the call attempts
This includes everything a human typically does before a live conversation happens: dialing the number, waiting for a pickup, leaving a voicemail, and tracking the outcome. These micro-tasks take up the bulk of a care coordinator’s day but rarely require judgment or empathy.
An AI agent can handle:
Persistent call attempts across multiple days
Voicemail drops with personalized audio
SMS follow-up if the patient doesn’t answer
Documentation of outcomes directly into the EHR
By automating the lead-up, staff only step in when a patient is ready to talk, eliminating the most inefficient part of the process.
2. Automate the conversation itself
For certain workflows, the entire call can be handled by a voice agent. This includes structured tasks with clear decision trees, such as scheduling an appointment, confirming interest in a program, or completing an intake checklist.
Voice AI agents could:
Ask and respond to patient questions
Navigate multi-turn conversations
Clarify needs and match them to the right next step
Escalate to a human if the issue is unclear or sensitive
These agents extend staff capacity without reducing quality. They also respond instantly, without wait times or limited hours.
The most efficient systems combine both strategies. They use automation to reduce waste, then reserve human time for the highest-complexity and highest-risk cases. It’s not about removing people, but about letting people work to the top of their license.
3. Evaluate Call Performance at Scale
Scaling the phone isn’t just about automation. It’s about evaluating whether the outreach is working and improving outreach over time. That means measuring both the reliability of the system and the effectiveness of the interaction.
Agent-led calls generate a level of insight that manual outreach typically can’t. Every call is logged. Every outcome is structured. Every patient interaction becomes an opportunity to learn and improve. Lena’s platform tracks this in real time, allowing health systems to monitor outreach like an operational system, not just a communication channel. To assess the system, key metrics must be monitored and analyzed.
System Health and Delivery Metrics
Call drops: Are calls completing, or ending early due to network issues?
Audio quality: Was the agent clearly understood by the patient?
Caller ID and anti-spam registration: Are calls being flagged, blocked, or labeled generically?
Answer rates by time and cadence: Are patients picking up during certain windows or attempts?
Conversation Flow and Friction Points
Introduction response: Does the patient hang up immediately, continue normally, or ask skeptical questions?
Abandonment moments: Where in the call are patients dropping off?
Signals of confusion: Do patients repeat questions, hesitate, or shift sentiment?
Emotional tone and engagement: Does the patient sound confused, cooperative, skeptical, or rushed?
Measuring Performance with Predetermined Call Goals
At the core of every agent-led workflow is a defined outcome. Lena structures each call around a primary goal, aligned with what the care team needs the patient to do. That could be:
Confirming interest in a program
Providing verbal consent for enrollment
Selecting a date for follow-up care
Updating contact information
Accepting a referral to a specific service
The system tracks whether the agent achieved the goal, escalated appropriately, or missed the opportunity, allowing internal teams to review performance and make backend adjustments as needed.
Care teams can also define their own custom goals and benchmarks within Lena’s platform, creating tailored performance metrics to fit their needs.
Agent KPIs That Guide Optimization
Tracking outcomes at the goal level is just one part of the picture. To improve performance, teams need visibility into how patients respond throughout the call, from the moment the phone rings to the final action taken. That’s where agent-level KPIs come in. These metrics highlight which parts of the interaction work, where drop-off occurs, and how to fine-tune the experience for each population.
Answer rate: How often patients pick up. Are certain time windows or attempt numbers more successful?
Intro acceptance: After the agent introduces itself and explains the reason for calling, does the patient stay on the line, ask questions, or hang up?
Conversation completion: Did the patient stay on through the full exchange?
Primary goal completion: From all possible tasks in a workflow, did the agent achieve the one that mattered most?
The system tracks whether the agent achieved the goal, escalated appropriately, or missed the opportunity, allowing internal teams to review performance and make backend adjustments where needed.
Conclusion: The Phone Still Reaches the Most Patients—and Voice Automation Makes It Scalable
The outreach challenge isn’t just about choosing the right channel. It’s about helping patients complete the right action.
Digital tools often fall short when they treat outreach as a one-way broadcast. Manual staff calls can’t scale when teams spend half their day leaving voicemails. And chasing patients with the same message on five platforms doesn’t fix the problem if no one responds.
The phone still reaches the broadest patient population. But its full potential is only realized when it’s paired with automation, not to remove the human touch, but to reserve it for where it matters most.
By treating agent-led outreach as a precision workflow—one that can be measured, improved, and scaled—health systems move beyond messaging and toward resolution. And that shift starts by asking a different question: not “What should we send?” but “What does the patient need to do—and what’s the most reliable way to help them do it?”