Most health systems answer that question the same way. Either they focus on clinical quality measures and care gaps, or they look at Press Ganey scores, portal utilization, and satisfaction surveys. These tools do provide useful signals. They tell you who needs a mammogram this year. They tell you whether your front desk was polite. They identify opportunities to improve communications about billing. They help you understand whether patients are able to log in to MyChart. But they don’t tell you what your patients actually need.
Here’s what I mean. Your patients walk in your doors and see your physicians maybe four or five times a year. What happens the other 360 days? You don’t *really* know. Nobody in your organization does.
Over the past decade, I’ve had a front-row seat to what happens when healthcare organizations actually show up in that space between visits. What patients say when you’re actively listening is very different from what they tell you on a survey. And the distance between those two things — between what your metrics capture and what your patients actually experience — is where the real risk to your health system lives.
Experian Health’s 2026 State of Patient Access survey put a number on this disconnect: 46% of providers believe patient access has improved over the past year, but only 18% of patients agree. What’s behind that disconnect?
The patient experience challenge isn’t one problem. It’s three.
These problems reinforce each other. If you fix one problem in isolation, it will resurface again and again.
Health systems have no shortage of clinical data — EMR records, lab results, claims data, risk stratification scores. But clinical data and patient-reported context are fundamentally different things. Clinical data tells you what diagnoses are on file and what happens within the walls of your clinic. But it doesn’t tell you what the patient is worried about, struggling with, confused by, or avoiding between visits.
Patient experience surveys try to bridge the gap. But let’s say a patient rates your system a 9 on a satisfaction survey. What does that 9 actually mean? It means the waiting room was clean and the front desk was friendly. It doesn’t mean she told you about the headaches she’s been having for three weeks. She didn’t want to “bother” her doctor.
And the patients who don’t respond to your surveys at all? You know even less about them. The silence is worse than a bad score, because it means you’ve lost the signal entirely.
One patient told us: “I didn’t call because I didn’t think it was worth bothering anyone over. Then it got worse.”
That patient isn’t an outlier; she’s the norm.
In real life, meeting someone a handful of times makes them (at best) an acquaintance. To build a relationship with them, you need ongoing two-way communication over time.
The same is true in healthcare. Building a relationship with your patients requires continuity between encounters. Most health systems have no mechanism for that. When a patient walks out of the clinic, the relationship effectively pauses until the next appointment.
Now, I can already hear the pushback: “We have nurse triage lines. We have the portal. We even do monthly care management calls.” And that’s true. But those are reactive channels. They only work when the patient initiates contact, or when a protocol fires. In the case of care management calls, they are typically restricted to only a small percentage of patients.
Meanwhile, there are patients who really need your ongoing support: those managing chronic conditions, confused by post-discharge instructions, or dealing with behavioral health challenges. But these patients are hesitant to pick up the phone.
There’s a subtler problem, too. Patients may trust their physician’s clinical judgment, but that doesn’t mean they trust them enough to open up about what’s really going on in their lives. Trust and openness require a different kind of relationship than a 15-minute visit three times a year can build. Physicians don’t have the time to build those relationships individually, but someone in your organization should.
For the fourth consecutive year, “I can’t see a practitioner quickly” is the number one patient-reported challenge, according to Experian Health’s 2026 survey. This access challenge was cited by 27% of patients.
Think about what happens when your patient walks out of the clinic. What’s their path back to you? Do they spend time navigating a phone tree? Figuring out how to log in to MyChart? Will they get a call or message back 48 hours later? That’s not access. That’s a barrier with your brand name on it.
So we go back to the idea that each of these problems reinforces the other. Without easy access, patients can’t build relationships with your system. Without relationships, you can’t learn what they actually need. Without that insight, you can’t intervene before things go wrong. And the cycle repeats, visit after visit, year after year — until the patient finds someone easier to reach.
This has always been a care quality issue. What’s changed is that it’s now simultaneously a market share issue and a financial viability issue.
The U.S. retail clinic market is projected to grow from roughly $2.9 billion in 2024 to $6-7 billion by 2030 (depending on the analysis). To achieve that compound annual growth rate of between 9-12%, retail clinics will be coming for your market share.
Sure, some retail players have stumbled: Walmart closed its health centers, Walgreens scaled back VillageMD. But Amazon is doubling down. One Medical is partnering with Cleveland Clinic, Montefiore, and Hackensack Meridian to open primary care offices. Hims & Hers continues to grow in direct-to-consumer care (legal battles notwithstanding). AI-first care companies are multiplying.
My point isn’t that every retailer succeeds. It’s that patients have learned to expect a different level of access. That expectation doesn’t go away just because one company exits the market.
These competitors aren’t winning on clinical quality. They’re winning because they’re easier to reach. And the economic impact they have on your market share compounds over time. It starts with a flu shot at MinuteClinic, then a prescription refill through an app. A patient may drop in once when their primary care provider was unavailable, but soon convenience becomes a habit. Once a patient builds a routine of easily accessing care outside your system, they start going there for everything. Eventually you lose the full picture of your patient’s longitudinal care needs, not to mention the associated revenue.
According to Accenture research featured by the AHA, one in five healthcare consumers switched providers in the past year — and nearly 90% said they did so because the organization was “hard to do business with.” Not hard to trust clinically. Hard to do business with. Among those who switched, 70% cited access as a deciding factor in choosing their new provider.
This is the argument that’s harder to dismiss. Payment models are shifting toward value-based care. These models reward exactly the thing the relationship gap undermines: longitudinal care management, proactive outreach, early intervention, keeping patients out of the ED.
If you don’t have relationship infrastructure between visits — if you don’t know what’s happening during those 360 days — you can’t perform in these models.
The question isn’t just “will you lose patients to a retail pharmacy-based clinic.” It’s “can you succeed in the payment models of the future without solving this first?” The answer is no.
The health systems that will hold market share and perform in value-based contracts are the ones that show up 365 days a year, not just the 5 days when the patient is within your walls. That means rethinking access as a strategic asset, not a call center metric. It means building relationships that extend beyond the exam room. And it means having real insight into what patients need: not what they tell you on a survey, but what they say when someone actually shows up and asks.
The flip side is encouraging: Accenture also found that patients who find their providers easy to work with are 84% more likely to stay. The loyalty upside of getting this right is enormous.
At Phamily, we’ve had millions of conversations with patients over the past decade. What those conversations reveal is consistent: patients want to be known, followed, and reached proactively. The care model and the technology to do that exist. The question is whether health systems will build this capability — or cede that ground to someone else.
We’re exploring this topic in depth in an upcoming live webinar. We’ll share original research on what patients actually say they need, walk through real patient journey composites, and lay out a strategic (and self-funded) framework for closing the gap.
If this resonates, join us for our upcoming webinar.
Darshan has 15+ years experience co-founding and building high growth healthcare technology businesses committed to improving access to care and quality of care. More about Darshan…
