A woman decides it is time to deal with her chronic knee pain. She has put it off for a year. She looks up a nearby health system, finds the orthopedics line, and calls. She is on hold for six minutes. When someone finally picks up, the first question is her date of birth. The second is her insurance. She is told a scheduler will call her back. No one does. A week later she calls a different practice, and this time someone books her that afternoon.
That first health system did everything right up to the moment she called. It ran the ads. It built the web page. It earned her trust enough to pick up the phone. Then it lost her in less than ten minutes.
This patient was a mystery shopper, and her experience is closer to the rule than the exception. Jessica Walker runs Care Sherpa, a firm built to fix the failure that too many people run into.
Care Sherpa manages what happens after a patient raises their hand: the stretch from interested prospect to a booked, kept appointment for high-value service lines like orthopedics, bariatrics, and oncology. Rather than route a new patient into a call-center queue, Care Sherpa assigns one person to guide them through scheduling and insurance, and tracks every step as a funnel the health system can see for itself.
Mystery shopping is how the firm finds the problem before it fixes it. Walker’s team calls a health system posing as a motivated, insured patient and records what happens at each step. She sees it all too often: The system spends to create demand, then drops the patient at the point of contact.
“This is the last mile, going from an interested patient to a booked one, and it is where health systems fall apart,” Walker says. “They spend hundreds of thousands of dollars to get someone to pick up the phone, and then they let that person sit on hold.”
The number is bad, and it is getting worse
When Walker started Care Sherpa in 2018, her team failed to get scheduled about 79% of the time, even when they were fully motivated and ready to book. Today that figure is around 81%. Roughly four out of five ready patients never get on the calendar.
These are not people on the fence. They are people who already decided they want care, did the work to reach out, and still could not get in. And the trend is moving the wrong way while patient access remains a top priority for many health systems.
Why systems lose people who already said yes
Health systems often run into two operational issues that cause them to lose patients.
The first is that intake opens with paperwork instead of the person. The greeting a patient hears is a request for insurance and date of birth. Walker flips the order.
“We don’t start with insurance and date of birth,” she says. “We ask what made you reach out today. Why now? Why are you finally thinking about that knee replacement? Then we work backward from the patient’s own goal.”
When a patient feels heard in the first thirty seconds rather than like a checklist to be completed, they stay on the phone.
The second is speed. A lead answered in minutes converts. A lead answered in days is already gone, usually to a competitor who called first. Walker’s team aims to respond within 20 minutes and averages about six. “My favorite thing to hear is a patient saying, ‘Wow, that was fast, I just submitted that form’,” she says. Most systems measure response time in hours or days, if they measure it at all.
The money nobody is watching
It doesn’t help that patient access often doesn’t have a single owner. The team that buys the demand and the team that answers the phone are usually not the same team, and they are not looking at the same numbers.
“Marketing spends all this money, buys the Google keywords, buys the ads, and then hopes it shows up later in the CRM,” Walker says. “If you don’t own the whole journey, how do you know?”
The spend goes out the front door. Whether it turns into a booked patient is someone else’s department. So, systems keep spending money to build demand without ensuring there’s follow-up to turn that demand into bookings. And without a central owner, there’s likely no overarching report that shows the leakage.
The fix is not a bigger ad budget
The access crisis is usually framed as a shortage: too few doctors, too little capacity, not enough money. While that’s true, it is also not the whole story. A large share of the problem is systems dropping patients who already chose to come in. The good news is that this process—and revenue—can be improved without spending more on attracting patients or physicians.
It starts with answering fast, centering the patient instead of the clipboard, and watching the whole journey end to end so the leak is visible to someone who can close it. Walker says this approach works for everyone and gives power to smaller systems that cannot win a spending war.
“You can’t outspend them, so you have to outsmart them. Make it easier for your patients to get through and get in.”
The patients are already calling. The only question is whether anyone picks up.
