Chatbot Outreach in Value-Based Preventive Care: Retrospective Analysis

As health care delivery shifts toward value-based care, proactive strategies to close preventive care gaps are essential. However, patient engagement remains suboptimal due to logistical, behavioral, and socioeconomic barriers. Traditional outreach methods, such as phone calls, emails, and postal mail, have long been used, but emerging digital approaches, such as chatbot-based messaging, offer potential advantages in scalability and personalization. Their comparative effectiveness, however, remains underexplored.

This study aimed to evaluate the effectiveness of chatbot outreach compared with traditional communication methods (phone, email, mail, and multichannel) in promoting compliance with preventive screenings and wellness visits defined by the Healthcare Effectiveness Data and Information Set and the Centers for Medicare & Medicaid Services guidelines.

This retrospective study evaluated patient outreach campaigns conducted from 2021 to 2023 across an integrated health system in New York. The final analytic sample included 50,145 care gaps from 41,959 eligible participants, predominantly female (29,989/50,145, 60%), White (31,857/50,145, 64%), with mean age ranging from 49.36 to 72.81 years over the study period. All participants were residents of New York state, and 81% (40,553/50,145) maintained an active relationship with a primary care provider during the participation year. Outreach modalities included automated chatbot SMS text messages, nonautomated phone calls, and organization-led email or mail campaigns. Participant data were enriched with social vulnerability scores to account for community-level disadvantages. Exposure was defined as the outreach method (chatbot, phone, email, mail, or multichannel), with assignment based on engagement history and operational protocols. The primary outcome was care-gap closure or compliance with identified measure gaps annually. Logistic regression and chi-square analyses examined associations between outreach method, patient demographics, primary care physician relationship, social vulnerability index (SVI), and compliance.

Phone outreach consistently achieved higher compliance than chatbot or multichannel outreach across most groups and years. Chatbot messages outperformed phone calls only in diabetes care in 2023 (odds ratio [OR] 1.81, 95% CI 1.48-2.21; P<.001). Primary care physician continuity remained a strong predictor of gap closure, especially in primary care (ORs ranged 1.36-2.61; P<.001). Higher SVI quartiles were associated with lower compliance in blood pressure, cancer care, and diabetes care groups; however, primary care outcomes showed higher odds of compliance in the third quartile of SVI, contradicting the typical linear-deprivation narrative. Women, Hispanic or Latino individuals, and Asian patients demonstrated higher odds of compliance in some groups and years.

Outreach modality is an important, modifiable factor in preventive care adherence. While phone-based outreach remains the most effective overall approach, chatbot-based strategies may have targeted applications in digitally engaged populations such as the diabetic group. Segmented, equity-informed outreach strategies that integrate technology, patient preferences, and primary care continuity are essential to achieving high-impact, scalable outcomes in value-based care settings.