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Phone, Mail, Email, App, or Text Message: What's Best for Healthcare?

Today's healthcare organizations use a variety of mechanisms to communicate with patients and their caregivers, facility staff, and vendor partners. It's commonplace to see organizations use a mix of older channels, such as mail and phone, and newer approaches, such as email, mobile app, and text message, in their efforts to reach and engage with these stakeholders.

With multiple options, what should organizations rely upon the most? Let's examine each of these five channels and then evaluate them on three characteristics: initial setup cost, cost per outreach, and engagement effectiveness.


For years, phone was a highly reliable means of reaching an individual. Every phone call was either answered or answering message/voicemail listened to and usually followed up on. Organizations could expect that they would speak with the individual they needed to reach on the initial call or would eventually hear back from that person.

Phone calling can still be an effective means of communication — assuming the person on the other end answers the call. But the number of people doing so is declining. Fast. As a Pew Research Center survey of U.S. adults found, eight-in-ten Americans don't generally answer their cellphone when an unknown number calls. A 2021 Hiya study found that 94% of Americans don't pick up the phone for unidentified callers due to rapid rise of robocalls.

Meanwhile, voicemails may not be listened to for hours or days — or perhaps ever. There are many reasons why you should not leave a voicemail. These reasons have been contributing to the decline in voicemail. In fact, the fall of voicemail was already a topic of conversation back in 2013.

Phone calling is also expensive — and becoming more expensive essentially by the day. Phone calls require what quickly adds up to significant staff time, especially for those outreach efforts that require multiple phone calls (and with no guarantee of success). Pair that staff time with the surge in labor costs for healthcare organizations and it's easy to see how phone calls are largely an inefficient and costly use of resources.

While organizations still need the ability to make calls, especially to reach those individuals who may not want to communicate via any of the other channels discussed in this piece, it's clear that the less phone calls an organization needs to make, the better.

Evaluation criteria

Initial setup cost: It's fairly easy and not particularly expensive to set up staff to make phone calls. An organization needs a phone plan and the phones for staff to use. While not the cheapest communication channel, it's far from the costliest.

Outreach cost: This is what should be motivating healthcare organizations to move away from the phone as much and as quickly as possible. There's the time it takes for staff to enter in an individual's phone number. The time it takes to wait for someone to answer. The time it takes to speak with an individual or the time it takes to leave a voicemail. When outreach requires multiple calls, which is more often the case these days, the time — and associated cost — surges.

Engagement effectiveness: If someone answers the phone, calling becomes very effective. But that's a big if, and one that's growing bigger by the day.


Even when mail was a more common form of communication, it was never a great method of communication simply because of the time it took for a piece of mail to be assembled, sent, and then reach the intended recipient. That time has not decreased. In fact, we've only seen increases in the time it takes for a piece of mail to go from one location to another largely due to postal service staffing shortages and budget cuts. The increased prevalence of severe weather can add more time, as can the typical mix of factors that cause mail delays (e.g., traffic accidents, holidays).

Another problem with mail: There's no assurance that a piece of mail will ever reach its intended recipient. Reasons why include that individual moving to mail being lost to an incorrect address captured in a database. The U.S. Postal Services reports that more than 4% of mail is undeliverable as addressed. This is mail that could not be delivered to the address on the mailpiece.

Even if a letter reaches the recipient, there's no way to ensure they will read it. The correspondence could end up in the trash before its ever opened.

Finally, the cost of mail has steadily increased over the years, with plans for additional increases in the near future — without a corresponding increase in the value of sending mail.

Evaluation criteria

Initial setup cost: Getting staff set up to send mail is fairly easy and it's inexpensive. That's the good news.

Outreach cost: The bad news: The cost per outreach far outweighs any savings achieved via the low setup cost. There's the staff time required to produce and print the material that will be mailed, the time it takes to assemble the mail piece, and the cost of (rising) postage, envelopes, paper, and ink. This all adds up to a lot of money, fast. The cost of sending a single stuffed envelope, taking into consideration staff time and materials, typically runs around $1.20 to $2.00.

Engagement effectiveness: Another knock against mail: It's a highly ineffective way to engage with recipients for the reasons we've already noted. There's no practical way to ensure a piece of mail reaches its intended recipient and is read by this recipient. If the mail asks the recipient to perform a task, the organization that sent the mail will need to wait for the person to act, assuming they ever do so. If a person fails to act, the organization will need to follow up, likely using one of the other channels we discuss in this piece. This bodes the question: Unless absolutely necessary, or when requested by recipients, why send mail at all?


When email came on to the scene, it seemed like a perfect communication mechanism. Fast? Check. Easy to send? Check. Cheap to send? Check. Likely to be opened and read? Check.

But a few things happened as email became more ubiquitous for these reasons and smartphones became an integral part of everyday life. The number of emails people received in a day soared. And, of course, so did spam.

Statistics show the following:

  • The average person receives more than 100 emails per day.

  • The open rate for emails is between 20% and 40%.

  • Nearly 85% of all emails are spam. In fact, billions of spam emails are sent daily.

  • Many people have multiple email accounts — often at least one business and one personal.

It's easy to see why the value of email as a communication channel has declined over the years. When you combine the sheer number of emails people receive daily with the rise in spam and concern about cyberattacks via mechanisms like phishing plus the need to manage multiple email accounts, it's far from a sure thing to expect people to read and respond to their email and do so in a timely manner.

Evaluation criteria

Initial setup cost: The initial setup of email is similar in cost to that of setting up a staff member with a phone number. They need an email service provider, email address, and email plan as well as enough storage to handle their email responsibilities.

Outreach cost: Sending email remains cheap. Sending emails in bulk may require some additional expenses, but they're not so high as to significantly elevate the outreach cost.

Engagement effectiveness: Whereas email was once highly effective at engaging a recipient, it's quickly becoming as ineffective as paper mail. As we noted, most emails go unread. Those that are read may not be read in a timely email and may not be acted on. If someone provides an email address associated with a job and then leaves that job, the email address will no longer be a valid way to communicate with that individual. Unless you're running an email campaign through a program like Constant Contact or Mailchimp, you may never know if or when someone has opened an email. Ultimately, most emails sent will require follow-up outreach via another communication mechanism.


More and more of our lives are spent interacting with apps on our smartphones. Just how much time are we spending? A survey showed that Americans spent a third of their waking hours on mobile devices in 2021.

This is undoubtedly one of the reasons why healthcare organizations have explored setting up their own apps to communicate with stakeholders. If stakeholders are on their mobile devices so often, an app would seem like a great way to reach them. And there's certainly truth in this.

But, once again, there are some big "ifs" associated with using an app for communication. The stakeholder will need to add (download/install) the app to their phone and either log in with information provided by the healthcare organization or by setting up their own account. Once this is completed, the app would seem to be an effective communication mechanism — assuming that when the stakeholder changes phones, they bring the app with them to their new phone, and assuming that logging into and using the app is fast and easy.

There's also the fact that about 3 out of every 10 Medicare-aged adults cannot use apps. Organizations will need to develop out a separate communications plan for this group, which, for some organizations, could be rather large.

Evaluation criteria

Initial setup cost: Very, very high — and that's for just a basic app. The more bells and whistles, whether optional or required, the higher the expense. At a minimum, an organization is looking at many thousands of dollars for development of the app. Does it need to be HIPAA compliant? That's going to run up the costs. Then there's maintenance/update costs, the costs to ensure it can work on current Android and Apple devices, and the costs to train users on how to use the software that powers the app. There can be many others as well, depending on what is and isn't included in develop and maintenance.

Finally, there are the costs associated with getting the word out to stakeholders about availability of the app. This can include adding the app to mobile app stores and providing links to download the app on an organization's website.

Outreach cost: On a positive note about cost, once the app is developed and launched, sending messages through it is inexpensive. It's essentially on par with email.

Engagement effectiveness: Assuming a stakeholder takes the time to install the app and set it up on their mobile device, using an app as a communication channel can be a fairly effective means of engagement. The process of adding and logging into the app will make the user feel more compelled to interact with the app, assuming they find it user friendly.

But getting someone to download and set up an app is likely to prove very difficult for most healthcare organizations — and especially those not interacting with stakeholders on an ongoing basis. Patients who view a healthcare interaction as a short-term experience (e.g., surgery, urgent care visit) are unlikely to see great value in taking the time to set up and interact via an app — one that they will likely remove once the experience is completed — if alternative communication channels exist.

Text message

Finally, let's look at text messaging, which is a communication mechanism used daily and preferred by a growing number of Americans. There are several factors that have contributed to the rise of texting. The proliferation of cell phones and then smartphones — all of which come with built-in functionality to send and receive texts — is one of them. Another is the ease of texting, especially on smartphones that provide a full keyboard. A third factor is that text messaging is now generally included in cell service plans. Gone are the days of spending a quarter to send or receive a text. A fourth — and very significant — factor is that we're now at a point where it's fairly easy for people to keep their current cell phone number even if they move or change cell phone service providers. This means that a cell number has become a reliable way to identify and reach someone over time. One final factor worth noting is that the ability to include hyperlinks in texts has opened up new opportunities for senders to direct recipients to information that goes beyond what's included in the text.

Texting was initially a way to communicate with friends and family members, but as the popularity of text messaging rose and the cost to send and receive texts decreased, businesses saw it as a great way to reach and engage with customers. It's now commonplace for consumers to receive texts from financial institutions, airlines, hotels, e-commerce companies, and many more, including a growing number of healthcare organizations.

While spam texts are a concern, their frequency remains low compared to email and phone spam. The number of texts one receives is also likely to be much lower than the number of emails received. This increases the likelihood that the recipient of a text will take the time to review the message — and do so in a timely manner. Research has shown that about 97% of all texts are read, and 95% are read within just minutes of reaching a recipient. Age was once a barrier to texting, but that's no longer the case with nearly all Americans owning a cell phone with texting capabilities. In fact, 92% of American adults older than 65 text. In short, if you want to get a message out fast and with a high degree of confidence that the recipient will receive, read, and respond to it, send that message as a text.

Evaluation criteria

Initial setup cost: While not the lowest on this list (that goes to mail), the setup cost for a healthcare organization to leverage text messaging is likely to be similar to that of setting up phone and email service. There will be the initial cost of the text messaging platform and its implementation, setting up the platform to text with stakeholders, some ongoing maintenance and upgrades, and staff training.

Outreach cost: The bulk of the investment in text messaging concerns the costs discussed in the previous section. Once an organization is set up to text, outreach costs are very low. Each text ends up costing pennies. That's factoring in the time it takes to create and send messages.

Engagement effectiveness: This is where text messaging distinguishes itself from the four other communication mechanisms discussed in this piece. There is no other channel that will be more effective at reaching and engaging with the bulk of stakeholders — regardless of their age or location. Most people opt in to receiving text messages from their healthcare providers and few opt out. As we noted above, texts are likely to be opened and read fast.

Furthermore, text messaging platforms often include the ability to identify when messages are successfully delivered and opened. This provides helpful information staff can use to determine whether supplemental outreach via a mechanism like a phone call would be worthwhile.

The use of two-way texting provides organizations with another valuable engagement mechanism. Two-way texting allows recipients to respond to a mass text, with their response captured by the text messaging platform. Healthcare organizations are using such functionality for everything from confirming appointments, to conducting COVID-19 prescreening surveys, to checking in with patients following discharge to determine if they have questions or questions, to performing satisfaction surveys.

The ability to include hyperlinks in texts is allowing healthcare organizations to direct patients to any number of online sources, including patient portals, educational materials, payment systems, scheduling platforms, and maps and directions.

To learn how text messaging is being used to drive enterprise-wide healthcare communication, read this eBook.

The Unquestionable Winner

There's no doubt that texting should be the backbone for any healthcare organization's communications. The low overall setup and outreach cost combined with unmatched engagement effectiveness, ease of sending messages, and ability to monitor outreach success makes texting the best communication option for interacting with most stakeholders.

While organizations will need to use other mechanisms to communicate with stakeholders when those stakeholders either do not provide a mobile number, provide the wrong number (which can be corrected), prefer not to text, or do not respond to texts, organizations will benefit by communicating by text as much as possible. Text messaging is easy, fast, and inexpensive. And most importantly, research shows that it's highly successful in helping organizations achieve transformational results and improvements that would not be possible with any other communication mechanism.

Now that you have read this article, ask yourself: "What channel would I want my doctor or hospital to use?"



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