Access, Equity, and Unintentional Bias

Patient access sits at the front door of healthcare. Our field plays a pivotal role in building the infrastructure that determines who gets seen, how quickly they are seen, whether they can navigate the system, and ultimately whether care is delayed, deferred - or altogether abandoned.

Despite the centrality of access to the delivery of quality care, conversations about equity in access are often treated as peripheral, uncomfortable, or overly simplified. In reality, they are among the most operationally complex conversations health systems face. The challenge is not simply identifying disparities. Patient access leaders must understand how policies, workflows, technologies, staffing models, and even well-intentioned operational decisions can unintentionally create barriers for certain patient populations.

At the 2026 Patient Access Collaborative Symposium, access leaders shared examples that highlighted both the difficulty - and the promise of this work. The discussion was not framed around easy answers. Instead, the session centered on a more honest reality: improving equitable access requires health system leaders to continually examine the assumptions embedded within their systems.

The Operational Reality of Equity

Many inequities in access are not the result of overt discrimination. They emerge quietly through operational design.

One discussion focused on the unintended consequences of transitioning away from cash payments toward fully digital or card-based workflows. While operationally efficient, these changes can create friction for communities where cash payment remains culturally normative or financially necessary. Others discussed the growing digital divide. As health systems accelerate adoption of digital scheduling, eCheck-In, patient portals, and automated workflows, access leadeders must confront an uncomfortable question: who is unintentionally left behind when the front door to care is digital?

One team shared efforts to improve patient portal activation among Spanish-speaking families by redesigning portions of the portal experience and addressing language-related barriers. The result was not only improved activation rates, but also a measurable reduction in disparities between English- and Spanish-speaking patients. Importantly, these efforts demonstrate that disparities are not inevitable. Thoughtful operational design can materially improve participation and engagement.

Bias Can Live Inside Workflows

Some of the most important conversations focused not on technology itself, but on how humans interact with operational systems, thereby creating unintentional bias.

One access leader noted that many electronic health record systems prominently display race and language information at the commencement of scheduling workflows. While these demographic fields are clinically important, their visibility can unintentionally shape interactions long before a patient arrives for care. The operational consequences can be subtle but meaningful. Cases requiring interpreters may be perceived as more complex or time-consuming – and even the initial seconds of hearing an unfamiliar language may create a bias for an agent feeling pressured to reduce handle times. Scheduling teams incented to increase production may unconsciously deprioritize these discordant-language encounters, allowing these patients to sit longer in unscheduled work queues – or worse, be abandoned altogether.

Other examples include: care access for vulnerable patients (e.g., migrant workers, gender-affirming care, unhoused persons); workstreams related to patient dismissals (who and how patients are ‘fired’ from the practice or health system); automated waitlist inclusion based on delivery method and timing; the language, delivery, and cadence of appointment notifications; and parking fees for families and patients.

This is what makes equity work in access particularly difficult. Bias is rarely confined to individual intent. More often, it emerges through accumulated friction points inside operational systems. Recognizing this does not require assigning blame. It requires access leaders to thoughtfully examine where additional burden, complexity, or delay may be unevenly distributed across patient populations.

Data, Prediction, and the Opportunity Ahead

At the same time, access leaders also described reasons for optimism.

Health systems are increasingly beginning to use predictive analytics not only to improve efficiency, but also to proactively support vulnerable patients. One example discussed during the session involved using predictive models to identify patients who may face barriers in attending appointments, allowing teams to intervene before a missed visit occurs.

This represents an important evolution in how health systems think about access. Rather than waiting for disparities to appear in retrospective reports, access leaders are increasingly exploring methods to intervene earlier and more thoughtfully.

These efforts remain early, imperfect, and operationally demanding. But they reflect a broader shift: access leaders are beginning to view equity not as a separate initiative, but as an essential component of access strategy itself.

Patient Access Collaborative members can access a curated library of resources. Consider these for learning more about equity and join our next cohort meeting from 1-2pm EST on 7/30:

• Godsey EL, Gamble AB, Palaj A, et al. Improving Access for Priority Patient Populations Within Outpatient Specialty Practices. J Ambul Care Manage. 2022.
• Doherty C, Pepper H, Jessup R, Hutton J. Patient perspectives on telehealth access among people experiencing homelessness: a rapid review. International Journal for Equity in Health. Published online January 22, 2026.
• Tiwana A, Tran M, Draeger C, Mumford B. Spatial and social inequities in access to essential healthcare services: a case study of a fast-growing, diverse Canadian city. Health & Place. 2026.
• Chen A. Re-evaluating the access imperative in healthcare in the United States. Journal of Public Health Policy. Published online January 3, 2026.
• Lu T, Myerson R. Disparities in Health Insurance Coverage and Access to Care by English Language Proficiency in the USA, 2006-2016. J Gen Intern Med.