A new study on healthcare communication carries a familiar lesson for the credit and collection industry: consumers are growing more comfortable engaging through digital, asynchronous channels, and that shift tends to be additive rather than a clean swap for older modalities.
Messages that patients sent to their providers through online portals jumped 153% between 2020 and 2025, according to research published this week in JAMA. The analysis drew on Epic electronic health record data covering roughly 8 billion encounters across more than 2,000 hospitals and 47,100 clinics, making it among the largest looks yet at how Americans actually choose to communicate with the institutions managing their care and their accounts.
For collection operations that have spent the past several years standing up email and text channels, the most relevant finding may be what did not happen. The rise in portal messaging did not reduce in-person care. Office visits climbed 17% over the period, while telephone contact slipped only about 6%. Patients, in other words, added a channel rather than abandoning one, leaving providers to manage a third communication stream on top of the two they already had.
The data also map who is most comfortable in digital channels, a question that mirrors the ARM industry’s own debates over consumer outreach. Messaging was most common among patients aged 40 to 64, among women, and among those living in less socially vulnerable neighborhoods. Rural and micropolitan consumers lagged their urban counterparts. The pattern points to a persistent digital divide, and the study’s authors caution that leaning too heavily on electronic outreach risks widening access gaps for underserved populations rather than closing them.
There is an operational warning here as well. As consumer-initiated messages climbed, so did the labor of responding to them. The volume strained staffing models and schedules that were never designed around asynchronous communication, and the authors flagged generative AI tools for drafting and triaging messages as an emerging response that needs scrutiny before wide adoption. Collection operations weighing AI-assisted consumer communications face a strikingly similar calculus.
