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Somewhere in every access center there is a drop-down menu. No answer. Left message. Refused. Not interested. Wrong number. The person choosing from it has the least context in the building and the most pressure on the clock, and the choice takes about four seconds. That code then leaves the work queue, enters a report and becomes the evidence for not spending on those patients again.
Chris Boyer and Reed Smith open episode 504 by pulling apart two things health systems routinely treat as one. Capacity utilization measures whether you sold the inventory. It says nothing about who could not get in. Reed puts the distinction plainly. Capacity is the view from the provider's side of the desk and access is the view from the patient's. Marrying the two is the work.
Then the evidence. A cluster randomized trial across 44 primary care practices and roughly 12,000 patients found that electronic health record reminders alone moved nothing at all. Completion of overdue follow-up ran 22.7% with reminders against 22.9% for usual care. Adding a letter and a phone call took it to 31%. Ordinary contact, twice, with no technology in it. Chris keeps the ceiling in front of the audience for the rest of the episode, because even in the strongest arm roughly two thirds of patients still did not complete.
The second segment asks what a person is actually for. Medicare answered part of this in 2024 when it started paying for patient navigation, and the answer it gave is clinical severity, with a cancer diagnosis qualifying automatically. Patients owe 20% of the cost, which is one of the reasons practices report they have not started using the codes. Chris and Reed then sit with the finding that argues against them. In that same trial, adding a navigator on top of the letter and the phone call moved the number four tenths of one point. They work through what that does and does not prove, and land on three jobs a person can do that a letter cannot. Only one of them changes the system instead of recovering a patient, and it is the one nobody puts in a financial model.
Jessica Walker of Care Sherpa closes the episode with the case. A health system handed her a list of oncology screening patients its access team had marked unreachable after the auto-dialer sequence ran out. What she found in that list was almost never disinterest. Wrong orders, wrong referring physician, wrong location. Phone numbers and addresses that no longer worked. Carrier blocking. Patients in hospice, deceased or no longer eligible while the order sat and expired. Patients who would have had to cross a river. Her description of it is that the health system was asking people to pick up a part-time job to fix their own referral.
The most useful moment comes later. Her team heard the same thing from more than one patient, that the nearest location's hours did not work for a shift worker. The system added Wednesday evenings and recovered those patients. She also describes a referring physician who had quietly stopped sending patients because his patients were never getting their screenings done, and what it took to turn that back on.
If you cannot say what your people do that a letter cannot, you have bought a service tier rather than an answer.
Healthcare's Long Walk Toward the Patient, the free eBook marking 500 episodes: https://www.touchpointpodcastbook.com
Atlas SJ, Tosteson ANA, Burdick TE, et al. A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results: A Cluster Randomized Clinical Trial. JAMA. 2023;330(14):1348-1358. 44 practices, 11,980 patients: https://jamanetwork.com/journals/jama/fullarticle/2810508
Atlas SJ, Tosteson ANA, Burdick TE, et al. Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results. JAMA Netw Open. 2022;5(9):e2234194. Survey of 275 primary care practitioners across three health systems: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796828
CMS, Health Equity Services in the 2024 Physician Fee Schedule Final Rule. Principal Illness Navigation codes G0023 and G0024, plus the peer support codes, effective January 1 2024: https://www.cms.gov/files/document/mln9201074-health-equity-services-2024-physician-fee-schedule-final-rule.pdf-0
Pratt-Chapman ML. Navigation Refresh: Updates to Principal Illness Navigation Billing. Journal of Oncology Navigation & Survivorship. May 2026;17(3). Source for the 20% patient coinsurance as a reported barrier to adoption: https://www.jons-online.com/issues/2026/may-2026-vol-17-no-3/navigation-refresh-updates-to-principal-illness-navigation-billing
Care Sherpa: https://caresherpa.com
Jessica Walker on LinkedIn: https://www.linkedin.com/in/jessicawalkercaresherpa/
Eternal, the longevity startup founded by Alex Mather of The Athletic, which now generates a weekly AI audio recap of a user's own lab and wearable data. Fast Company, June 9 2026: https://www.fastcompany.com/91555441/eternal-startup-turns-health-data-into-ai-generated-podcasts
TP488, "If Marketing Owned Patient Activation," referenced in segment one on marketing capturing demand and access dispositioning it
TP482, "The Pilot That Never Graduates," referenced by Chris inside the interview when he asks Jessica how she broke out of perpetual pilot status
The TPS Report newsletter, at touchpoint.health
Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/
Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/
Chris Boyer website: http://www.christopherboyer.com/
Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social
Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social
Recommendations from this episode:
Chris: Earth, Wind & Fire (To Be Celestial vs. That's the Weight of the World), the Questlove documentary on HBO and HBO Max. Premiered at Tribeca June 3 2026 and released June 7 2026. 119 minutes. Covers Maurice White's jazz background and his plan for the band before it was a band: https://www.hbo.com/
Reed: the ETENWOLF P300 electric ball pump. Rechargeable, preset modes for basketball, football and soccer, custom PSI setting, inflates and deflates, ships with two needles and a pouch: https://etenwolf.com/collections/electric-ball-pump
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