I was on a call last week with a colleague who works in healthcare technology. Smart. Experienced. Someone who has spent years building systems designed to improve how patients navigate the healthcare experience.

And in the middle of talking about platforms and AI and engagement tools, she said something that stopped the conversation.

“I don’t think my insurance company cares whether I’m okay or not. They just care about their bottom line.”

She wasn’t being dramatic. She was being honest. This is someone who understands the industry. Who knows what’s happening behind the curtain. And she still doesn’t feel like her health system is paying attention to her between visits.

She said: “If they actually cared, they’d reach out. And if they reached out, I’d come in. And if I came in, they’d be more profitable.”

That’s the Proactivity thesis in three sentences. She’s not asking for perfection. She’s asking for a signal that someone in the system is paying attention.

And she’s not alone. I hear versions of this in every conversation I have with patients, with healthcare consumers, with executives who are also patients themselves. The question they’re asking isn’t complicated.

Do you actually care about my health, or just about getting paid when I show up?

Your answer lives in what you do between visits.

In Issues #41 through #43, we covered Accessibility (can patients reach you?), Resolution (are problems solved with confidence?), and Continuity (do patients feel known?). Each of those signals responds to patient-initiated interactions. The patient reaches out. Your system either meets the moment or fails it.

Proactivity flips the equation. This is the signal where your organization initiates. Where you reach out before they have to chase you. Where the system demonstrates: we’re paying attention to your health even when you’re not sitting in front of us.

And here’s why it matters more than most leaders realize: proactivity is the signal that directly answers the question patients are quietly asking but never say out loud.

"Do you actually care about my health, or just about getting paid when I show up?"

Your answer lives in what you do between visits. And right now, for most organizations, the answer is: nothing.

Patient no-shows cost the U.S. healthcare system an estimated $150 billion annually. For an independent practice, that translates to roughly $150,000 or more in lost revenue per year. On average, no-shows contribute to a 14% loss in daily revenue for medical groups.

But the no-show itself isn’t the whole story. It’s what happens after the no-show that determines whether this becomes a trust failure.

Most organizations treat a missed appointment as a scheduling problem. The slot goes unfilled. Maybe an automated reminder gets queued for the next one. Maybe not. The patient who didn’t show up disappears into a data gap.

Nobody calls to ask if they’re okay. Nobody checks whether the reason they missed was a transportation barrier, a financial concern, or a deeper disengagement from their care plan. The system shrugs and moves on.

Now multiply that by the patients who were discharged last week and haven’t filled their prescriptions. The patients with open care gaps who are overdue for a screening. The patients who called three times about a billing issue and stopped calling because they gave up.

Every one of those silences is a trust withdrawal. And unlike the other signals, the patient isn’t going to tell you about this one. They’re just going to leave.

This isn’t theoretical. The research is clear.

A nurse-led discharge follow-up phone call program across 22 hospitals found that contacted patients had a 7-day readmission rate of 2.91% compared to 4.73% for non-contacted patients. A separate study found that patients who received a post-discharge call were 23.1% less likely to be readmitted within 30 days.

A completed discharge clinic appointment resulted in 36% lower odds of readmission. A second post-discharge call dropped readmission rates from 26% to 4%.

Medicare Advantage plans with strong preventive care initiatives see 20-25% fewer hospitalizations. That’s not a marginal improvement. That’s a structural shift in utilization.

The pattern is consistent across every study: when you reach out, patients do better. When you don’t, they fall through gaps that your data saw coming but your system didn’t act on.

Most organizations fail at proactivity not because they lack data, but because they lack the infrastructure to act on it. Three gaps explain most of the failure:

The Post-Discharge Gap. A patient is discharged with instructions, medications, and follow-up appointments. Within 72 hours, questions arise. The medications interact in unexpected ways. The follow-up appointment is three weeks out. The patient calls, gets a voicemail, and ends up in the ER. A single follow-up call within 48 hours could have intercepted that spiral. The data on this is overwhelming, yet most organizations still don’t have a systematic post-discharge outreach program.

The Care Gap. Your EHR knows which patients are overdue for screenings, which diabetic patients haven’t had an A1C check in six months, which patients skipped their follow-up after an abnormal result. The data is sitting in registries and dashboards. But in most organizations, nobody is responsible for acting on it. The care gap report gets generated. It doesn’t generate an outreach call. In a smaller practice, it’s the same dynamic at a different scale: you know Mrs. Chen hasn’t been in since August, but nobody has picked up the phone.

The Disengagement Silence. This one is the most damaging because it’s invisible. A patient came in three, four, five times. They were engaged. And then they stopped. Maybe the experience felt judgmental. Maybe life got in the way. Maybe they found another provider. Your system has the data: last visit was six months ago. But nobody has picked up the phone. Nobody sent a personal message. Not an automated reminder for an appointment they don’t have, a genuine outreach: “Hey, we noticed it’s been a while. We’re here when you’re ready.” In a health system, that’s a reactivation campaign that most contact centers don’t have the bandwidth or the mandate to run. In a smaller practice, it’s the office manager pulling a list of patients who’ve gone quiet and making ten calls on a Friday afternoon. The patients who leave quietly are the ones you never get back. Because they didn’t leave angry. They left feeling invisible.

If you’re operating under any form of value-based care arrangement, proactivity isn’t optional. It’s how you survive.

In 2024, Medicare Shared Savings Program ACOs generated a record $2.5 billion in net savings, with 75% of ACOs earning shared savings revenue. The highest-performing ACOs, those achieving 93% success rates, built their results on proactive outreach, preventive screenings, and chronic care management. They averaged $390,000 each in shared savings payments.

The math is straightforward. Under fee-for-service, a missed appointment is lost revenue. Under value-based care, a missed preventive screening is a care gap that drives up total cost of care. A missed post-discharge follow-up becomes a readmission that triggers a penalty. An unmanaged chronic condition becomes an ER visit that erodes your shared savings.

Proactivity is the operational strategy that closes the gap between “we have the data” and “we acted on it.” UC Davis Health’s risk-stratified approach demonstrates this at scale: the highest-risk patients (2%) receive intensive case management, rising-risk patients (6-20%) get proactive screening and disease control outreach, and even low-risk patients (80%) receive proactive engagement for preventive services.

Whether you’re a health system in an ACO arrangement or a smaller practice tracking quality metrics, the principle is the same: the outreach you don’t send becomes the cost you can’t recover.

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The Trust Algorithm measures Proactivity across three operational dimensions that apply whether you’re a 500-bed system or a 5-provider practice:

Proactive Contact Ratio. What percentage of your total patient contacts are outbound and initiated by you? If the answer is less than 15%, you’re a reactive organization that only engages when patients come to you. The target: 30%+ of total contacts should be proactive outreach, including care gap notifications, follow-up calls, and wellness check-ins.

Care Gap Closure Rate. Of the care gaps your system identifies, what percentage result in completed outreach and a closed gap? Most organizations generate the report. The question is whether anyone picks up the phone. Technology helps here: AI can prioritize which patients to reach first, surface the right talking points, and automate the routine reminders. But the complex outreach, the patient who needs to hear a human voice explain why that screening matters, that’s where people make the difference.

Anticipatory Timing. Are you reaching out before the problem, or after the damage? A new patient follow-up call within 48 hours versus hoping they come back in three months. Discharge calls within 48 hours versus readmission at day 12. Reactivation outreach at 90 days versus discovering the patient switched providers at 180 days. Timing is the difference between proactivity and damage control.

Proactivity sits at the intersection of clinical outcomes, financial performance, and competitive positioning.

Clinically, the evidence is unambiguous: post-discharge follow-up reduces readmissions by 21-36%. Care gap closure prevents the progression from manageable condition to acute crisis. For patients with chronic conditions, proactive outreach is the difference between controlled and uncontrolled disease.

Financially, the numbers speak in every payment model. Under fee-for-service, no-shows cost practices $150,000+ annually and the broader system $150 billion. Under value-based care, every unaddressed care gap erodes shared savings and risks penalty payments. The highest-performing ACOs built their results on exactly this: proactive outreach as core operating strategy.

Competitively, this is generational. Younger patients are nearly six times more likely to switch providers. They expect the organizations managing their health to act like it between visits. The pharmacy texts. The fitness app nudges. The insurance company emails. Your silence, by comparison, is deafening.

The question your leadership team should be asking: How many patients who no-showed in the last 90 days received a personal outreach? If you can’t answer that, you have a Proactivity measurement gap. The Trust Algorithm Assessment can show you exactly where the breaks are.

Call every new patient within 24 to 48 hours after their first visit.

Not an automated survey. Not a portal message. A phone call. From a real person.

“Hi, this is [name] from [practice/system]. I wanted to check in after your visit yesterday. Do you have any questions about what was discussed? Were you able to get your prescriptions filled? Is there anything we can help with before your next appointment?”

That call takes three to five minutes. And it sends a trust signal that no amount of technology can replicate: we were thinking about you after you left.

In a health system contact center, this becomes a structured outbound workflow. AI identifies new patient visits from the prior day, populates a call list, and surfaces relevant context so the person making the call knows what was discussed without asking. In a smaller practice, it might be the front desk coordinator or office manager making five calls before the morning rush. The sophistication scales. The principle doesn’t change.

Most organizations never make this call. The patient leaves, and the next interaction happens when the patient initiates it, sometimes months later. Sometimes never. That gap between the first visit and the second is where you either earn a relationship or lose a patient who decided to try somewhere else.

The organizations I’ve worked with that implemented new patient follow-up calls consistently report two things: patients are genuinely surprised that someone called (which tells you how low the bar is), and the calls surface issues, prescription confusion, scheduling questions, unspoken concerns, that would have festered into disengagement.

One call. First 48 hours. That’s your Proactivity signal in action.

Accessibility opens the door. Resolution builds the foundation. Continuity builds the home. Proactivity proves you care about the people living in it.

Without it, the relationship only exists when the patient initiates. And that’s not a relationship. It’s a transaction with a waiting room.

The organizations that will dominate the next decade aren’t the ones with the best technology. They’re the ones that use that technology to reach out before the gap becomes a crisis, before the balance becomes a grievance, before the missed appointment becomes a lost patient.

Your patient is sitting at home right now with an overdue screening, an unfilled prescription, or a question they’re too tired to call about. You have the data. You have their number.

The only question is whether you’ll reach out before they reach out to your competitor.

Ready to go deeper?

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

Book a Discovery Call: “Proactive Outreach Strategy” — a 30-minute diagnostic conversation about your outreach infrastructure and care gap closure rates.

Let’s get to work,

Ebony