The problem: manual calls, spreadsheets, and duplicate outreach

Most outreach still runs on a phone, a spreadsheet, and a coordinator's memory. A risk team pulls a list of members with open suspect conditions. A quality team pulls a separate list of open care gaps. A pharmacy team pulls a third list of members slipping on refills. Each list lives in its own tool, and each team works it on its own schedule.

The result is predictable. Reach is low, because manual dialing caps out at a few dozen completed conversations per coordinator per day, and a large share go to voicemail. Outreach duplicates, because the same member sits on the risk list, the quality list, and the pharmacy list at the same time. That member can get three separate calls in one week, sometimes in three different languages, none of which knows what the others said.

None of this is a staffing problem you can hire your way out of. Add a coordinator and you add another spreadsheet and another uncoordinated caller. The constraint is that the work is fragmented across teams and tools, with no single view of who has already been contacted, on what channel, and for what.

Multi-channel done right

Multi-channel does not mean blasting every member on every channel. It means choosing the right channel, the right time, and the right language for each member, then running every contact through one queue so the whole organization speaks with one voice.

Three channels, used for what each is good at

Right channel, right time, right language

The same care gap reminder should reach one member as a Tuesday-morning SMS in Spanish and another as a Thursday-evening voice call in English, because that is what each member responds to. Automation makes this practical at scale: channel and language preference, prior response history, and time-of-day patterns drive the routing, instead of a coordinator guessing.

One outreach queue across teams

This is the part that separates outreach that works from outreach that annoys. Risk, quality, pharmacy, and care management all draw from one queue against one shared record. When a member has an open care gap, an overdue refill, and a post-discharge follow-up due, the system sees all three and contacts the member once, with a sequenced agenda, rather than letting three teams call independently. De-duplication is automatic because there is only one queue.

Escalate to a human when needed

Automation handles the routine high-volume work. The moment a member raises a clinical concern, sounds distressed, asks a question outside the script, or simply asks to speak to a person, the contact escalates to a human coordinator with the full context of the conversation already attached. The goal is to free coordinators from dialing and voicemail so they spend their time on the conversations that need a human.

96%
Medication adherence achieved with Pelica's multi-channel member outreach
3x
Outreach capacity per coordinator after automating routine contacts
1 queue
Risk, quality, pharmacy, and care management work the same record, so no member gets three calls

Compliance considerations

Automated outreach touches two regimes at once: HIPAA, because you are handling protected health information, and the Telephone Consumer Protection Act (TCPA), because you are placing automated calls and texts. Treat both as design requirements, not afterthoughts.

HIPAA

Any vendor that handles protected health information on a covered entity's behalf is a business associate under HIPAA and must sign a Business Associate Agreement before any PHI changes hands. The agreement sets the permitted uses, requires Security Rule safeguards such as encryption and access controls, and obligates the vendor to report breaches. The HHS guidance on business associates spells out who qualifies and what the contract must contain. Outreach content should also follow the minimum-necessary standard: a refill reminder does not need to recite a diagnosis.

TCPA

The TCPA restricts autodialed and prerecorded or artificial-voice calls and texts to mobile numbers. The two facts that matter most for healthcare outreach: calls and texts made with the prior express consent of the called party fall outside the restriction, and calls made for emergency purposes are also carved out. The FCC has recognized limited exemptions for certain healthcare messages delivered by or on behalf of a HIPAA covered entity or business associate, with conditions on content and frequency. The boundaries are fact-specific and the rules continue to evolve, so confirm your consent records, message content, and opt-out handling with counsel.

Measurement: what to track

Outreach is only worth automating if you can prove it moved something. Track the funnel, not just the activity:

On a shared record, every contact is attributable to a member and a reason, so the funnel is measurable end to end rather than reconstructed from call logs after the fact.

"The members who slip through are rarely the ones nobody tried to reach. They are the ones three teams tried to reach badly, on the wrong channel, at the wrong time, in a language they do not speak."

Our flagship customer, a physician-led IPA in New York running risk on roughly 175,000 patients, reached 96% medication adherence by moving routine outreach onto multi-channel automation off a single queue. Across Pelica deployments, outreach capacity has tripled per coordinator.

Sources and further reading