In Issues #41 and #42, we covered Accessibility (can patients reach you on their terms?) and Resolution (are problems solved in ways that build confidence?). Both are visible. Both generate operational metrics your team already tracks.

Continuity is different. It’s invisible on your dashboards. It lives in the gap between what your systems capture and what your patients experience. And that gap is enormous.

53% of Americans say the healthcare system treats them more like a number than a person. That’s according to MDVIP and Ipsos in their 2024 Patient Frustration Index. Think about that number. More than half your patient population doesn’t feel seen. Not because you don’t care. Because your systems weren’t designed to demonstrate that you do.

The academic framework that explains this comes from Haggerty et al. in BMJ (2003), and it identifies three types of continuity that together determine whether patients experience care as connected:

•       Informational Continuity: Does the data follow the patient? 96% of hospitals have EHRs. But the EHR captures clinical encounters. It doesn’t capture how the patient engages with your organization between visits: call history, scheduling patterns, billing inquiries, portal messages. That engagement data lives in separate systems, almost none connected to each other. In a smaller practice, the gap looks different but the effect is the same. The person answering the phone doesn’t know the patient already tried to resolve this online. So even informational continuity, the one most leaders think they’ve solved, has a massive gap hiding in plain sight.

•       Management Continuity: Is the care plan consistent across providers? Less than half of U.S. primary care doctors receive information from specialists about medication changes, compared to 70%+ in Norway and France. Mathematica and CMS found that patient and provider characteristics explain only 6% of fragmentation variation. It’s structural. AI-powered care coordination tools are starting to close these gaps: flagging conflicting prescriptions, surfacing care plan updates, triggering alerts when a patient’s journey falls off track. And roles like care navigators provide the human connective tissue that ensures the plan doesn’t fracture at every organizational boundary.

•       Relational Continuity: Does the patient feel known over time? This is the hardest to build at scale, and it’s where technology becomes the amplifier. An AI-powered system can surface that this patient gets anxious before imaging, that Mrs. Rodriguez prefers Spanish for clinical conversations, that this is her third interaction about the same referral. The person interacting with her didn’t memorize any of that. The technology surfaced role-appropriate context so a human could show up as someone who knows her story. That’s amplification. It works whether you’re a 500-bed health system or a 5-provider practice. Without it, relational continuity depends on individual memory and heroic effort. With it, it becomes a system capability.

Most leaders look at this list and assume at least the first one is checked. It’s not. The second one is held together by the patient’s own effort more than anything the system designed. And the third? That’s where the wheels come off entirely.

You’ve invested millions in clinical data infrastructure. The question is whether the patient can feel the data in their experience. A filing cabinet isn’t a relationship, no matter how organized it is. And a care plan that fractures at every handoff isn’t a plan. It’s a suggestion.

I want to name something I’ve been thinking about for a while. Call it the Re-Explanation Tax.

Every time a patient re-narrates their story, something small but measurable happens. They shorten their responses. They withhold details. They disengage from the conversation. They stop believing the system is paying attention.

This isn’t abstract to me. I’ve spent five surgeries navigating a system where every specialist saw their piece. Nobody saw the whole me. Each appointment felt like starting over. Each new face meant rebuilding context from scratch.

The clinical team was competent. The handoffs were terrible. And the cumulative effect wasn’t frustration. It was erosion. Of trust. Of willingness to share. Of belief that the system could hold my story.

That’s the Re-Explanation Tax. It’s invisible on your financial statements, but it shows up in patient behavior. Shorter responses. Withheld information. Avoided appointments. And eventually, a switched provider.

Pereira Gray et al. published a systematic review in BMJ Open (2018) that examined 22 studies across 9 countries. The finding: 81.8% of high-quality studies found statistically significant reductions in mortality with increased continuity of care. Not satisfaction improvements. Not engagement scores. Mortality reductions.

Continuity doesn’t just make patients feel better. It keeps them alive.

And the mechanism is trust. When a provider demonstrates knowledge of the patient’s history, the patient perceives competence (“they understand my situation”), benevolence (“they care enough to remember”), and integrity (“this system works as one”). That’s the trust trifecta. And it predicts everything from medication adherence to preventive screening completion.

Meanwhile, 61% of patients who switched providers cited feeling like a number as a primary reason. That’s from Accenture Health. Not clinical outcomes. Not wait times. Not billing confusion. They left because nobody made them feel known.

The cost of that invisibility? At a 48% national churn rate, with patient acquisition costs averaging $900 per new patient, you can do the math on what “feeling like a number” costs your system annually. For a 500-bed hospital, we’re talking millions in preventable patient leakage. Every year.

From our partners at Healthcare Brew: You're reading this because you think strategically about patient experience. The business decisions happening upstream (hospital operations, pharma pricing, payer strategy) shape the environment your patients walk into. Healthcare Brew covers that context daily, for free, so you're never caught off guard when a deal or policy shift changes the room. Join 135K+ healthcare professionals reading Healthcare Brew →

Before the first meeting. Before the inbox chaos. Before a deal reshapes the room.

Healthcare Brew’s free newsletter delivers the business news shaping healthcare—covering hospital operations, pharma pricing, and everything in between—so you have the context behind the headlines when it counts.

Built for healthcare professionals whose work touches budgets, deals, and strategy.

Join 135K+ reading for free

In Issue #34, I introduced the concept of the phygital handoff: the moment where digital experience meets physical care. That intersection is where continuity breaks most violently.

A patient messages through the portal about a billing concern. Then calls the contact center. The agent has no idea the portal message exists. The patient starts over.

A patient completes an intake form online before a visit. Walks into the exam room. The provider asks the same questions. The patient wonders why they bothered.

A patient chats with an AI assistant about medication side effects. Gets transferred to a nurse. The nurse says, “How can I help you today?” The context vanished at the handoff.

Patients are 4x more likely to defect after a negative phone experience, and Gen Z and millennials are nearly 6x more likely to switch providers entirely. Your digital front door is beautiful. Your back-of-house is a broken telephone game.

The technology was never the problem. The strategy was.

The Trust Algorithm translates Haggerty’s framework into three measurable operational dimensions. All three can be designed within HIPAA compliance. The key: not everyone needs to see everything. Each role needs role-appropriate context for how they engage with the patient.

Context Retention Across Channels. Does information carry from one interaction to the next? When a patient calls after a portal message, does the person answering know that message exists? This breaks everywhere: in health system contact centers where channel data lives in silos, and in smaller practices where the phone conversation never makes it into the chart. The patient is the only one holding the full picture.

Recognition of History. Once you know who you’re talking to, what do you equip your people with before they speak? It doesn’t matter if it’s an agent, a coordinator, a nurse, or a provider. “What brings you in today?” is a fine question. But if this is the patient’s third interaction this week, how much more powerful is “I see you’ve been working with us on this since Tuesday. Let me pick up where we left off.” Same inquiry. Patient feels held instead of invisible.

Personalization Accuracy. Is the experience tailored to who this person actually is? Generic recommendations dressed up as personal destroy trust faster than no personalization at all. AI makes this distinction more visible, not less.

The typical Medicare beneficiary sees 7 providers across 4 practices. Think about that. Seven different people, four different organizations, each with their own systems, their own intake processes, their own version of the patient’s story.

Who owns the patient narrative?

When nobody owns the whole story, the patient becomes the integrator of their own care. That’s not patient empowerment. That’s system abandonment. You’re outsourcing the hardest coordination job in healthcare to the person who’s sick.

Contact centers can be the connective tissue in a health system. In a smaller practice, it might be the front desk coordinator or the office manager who holds that role. The point is the same: someone, or something, in your organization needs to own the patient narrative across touchpoints. Right now, most organizations treat every interaction as independent. Calls in, calls out, tickets closed, visits completed. The patient’s story resets each time.

Flip your thinking. What if the job of every person who interacts with a patient wasn’t just to answer the immediate question, but to know the patient well enough that they didn’t have to start from scratch?

If you don’t preserve context across channels, the friction disproportionately impacts patients who already distrust the system. Patients with lower digital literacy switch between channels more often. Patients with complex chronic conditions interact across more touchpoints. More touchpoints, more context loss, more re-explanation, faster trust erosion. This isn’t a technology gap. It’s a design choice with equity consequences most organizations aren’t measuring. We’ll go deeper on this in a future issue.

Continuity isn’t a patient experience initiative. It’s a retention strategy, a clinical quality lever, and a competitive moat all wrapped in one invisible signal.

Start with the financial math. Every re-explanation costs time and erodes trust. At a 48% national churn rate and $900 to acquire each new patient, the cost of “feeling like a number” compounds fast. For a 500-bed system, that’s millions in preventable patient leakage annually. For a 5-provider practice, it might be $150,000 a year in patients who quietly switch. The scale differs. The mechanism is identical.

Now layer in the clinical reality. Patients who feel known share more. They disclose medication concerns, lifestyle factors, and symptom changes they’d withhold from a provider who doesn’t know them. That disclosure gap is a clinical quality gap. Research across 22 studies shows that continuity doesn’t just improve satisfaction. It reduces mortality. The mechanism is trust: accumulated knowledge enables better treatment, better adherence, better outcomes.

And the competitive dimension is accelerating. Younger patients are nearly six times more likely to switch providers. They value personalization, digital engagement, and feeling known. The health system that builds genuine continuity captures the generation making healthcare decisions for both their children and their aging parents. The system that doesn’t? It keeps acquiring the same patients its competitors are quietly taking.

The question your leadership team should be asking: How often does a patient who starts on the portal and moves to the phone have to repeat information? If you can’t answer that, you have a Continuity measurement gap. The Trust Algorithm Assessment can show you exactly where the breaks are.

Give your people role-appropriate patient context before the conversation starts.

Not clinical notes broadcast to everyone. The right context for the right role. The person answering the phone needs to see the last interaction reason and any open issues. The provider needs the last visit summary and recent engagement patterns. The front desk needs the scheduling history and any unresolved administrative questions. Each person sees what’s relevant to how they serve this patient. HIPAA-compliant. Operationally powerful.

In a health system, that’s a screen pop or CRM integration. In a smaller practice, it might be as simple as a dashboard view before the next appointment. The sophistication scales with your size. The principle doesn’t change.

When a patient hears “I can see you’ve been working with us on this billing question. Let me make sure we get it resolved today” the entire interaction shifts. The patient doesn’t have to earn the right to be remembered. They just are.

Accessibility opens the door. Resolution builds the foundation. Continuity builds the home.

Without it, every visit is a first visit. And no trust account ever accumulates.

The organizations that will dominate the next decade aren’t the ones with the best EHR or the most advanced AI chatbot. They’re the ones where a 12-year patient doesn’t have to say her date of birth for the third time in a single call.

What does it cost you NOT to invest in continuity? Ask the 61% of patients who left because nobody made them feel known.

They’ll tell you. If they haven’t already switched to the system that does.

Ready to go deeper?

Let’s get to work,

Ebony

Take the Trust Assessment: Find out where your Continuity signal breaks. patientexperiencestrategist.com/#/assessment

Book a Discovery Call: “Journey Mapping: Where Your Continuity Breaks” — a 30-minute diagnostic conversation about your cross-channel patient experience.

What’s one interaction where your patients have to repeat themselves that you could fix this quarter? Hit reply and tell me. I read every response.