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September 22, 2023

State of CareOps 2023

State of CareOps 2023

Welcome to the second installment of the State of CareOps 2023. This report has garnered input from nearly 250 healthcare professionals on how they build, implement and continuously improve the processes that support their care delivery. In partnership with Health Tech Nerds, we've again delved deep into practices, challenges, and metrics that shape the landscape of Care Operations.

You might ask, "Why do care processes matter?". Well, in a landscape marked by cost pressures, labour shortages and the rise of physician burnout make one thing clear: current care processes are driving us straight into the wall. If healthcare organizations want to succeed, they need to find ways to redesign processes from the ground up.

Our report explores questions such as "What is the ideal team composition to design and implement care processes that balance efficiency with sound clinical practice?", "What metrics do care teams use to measure performance?" and "What are the main factors that drive care flow iterations?". We don’t just identify the challenges; we aim to uncover solutions that can turn the tide.

New this year, we've added a benchmarking section to shed light on key industry metrics, including average utilization rates and the percentage of asynchronous care. These benchmarks serve as a yardstick against which healthcare organizations can measure their progress. If you are interested to see how you stack up against peers with the same size, care model and financial risk profile reach out to rik@awellhealth.com to create a tailored CareOps benchmark for your organization.

In a climate where every second counts, healthcare organizations that can rapidly adapt, scale, and refine their care processes will stand head and shoulders above the competition. This is not just about operational excellence; it's about patient lives and the future of healthcare. This is what CareOps is all about.

CareOps will be hosting a panel with leaders from Thyme Care, Herself Health, Inbound Health & Mindler to dive deeper into the results on 9/27. Register here.


After cleaning, we analysed 235 survey responses (up from 111 in 2022). 

Key insights:

  • 84% adoption of care flows in 2023 (up from 80% in 2022) signifies a growing trend, but resistance due to perceived loss of autonomy and misalignment remains a barrier.
  • Lack of a "standard team" in care flow design indicates a fragmented approach, with only 16% including all core CareOps roles, potentially affecting the quality and efficiency of care.
  • Decreasing time to design and implement care flows for a core group of organizations suggests we’re starting to see a split between high performers and the rest of the pack lagging behind.
  • Over-reliance on static tools (with only 10% using dedicated tools) may be causing inefficiencies and disconnects in care flow implementation and adaptation.
  • Monitoring gaps are alarming: only 7% of all respondents track metrics from the 4 crucial categories, risking uninformed decisions and potentially compromising patient care.
  • Underutilization of new medical research in iterations highlights a missed opportunity for evidence-based improvements.

How to read this report

We dive right in listing the key findings organized by the CareOps Lifecycle stages. At the end of this overview, we discuss what Elite performers look like this year. We then provide a section on industry benchmarks and end with the demographics and firmographics of the survey respondents.

Sections of the report for quick navigation:

Quick CareOps recap

CareOps is a framework and set of practices to build, implement and continuously improve care flows. It applies principles from agile software development, quality improvement and design thinking to healthcare processes.

CareOps brings people from clinical, operations, product and compliance teams together, overseen by strong clinical leadership. Ultimately, CareOps increases a provider organization’s ability to deliver higher quality care at lower cost by running improvement cycles more frequently than its peers.

For more context, read What is CareOps and why do we need it?

What are care flows?

The central concept of our research is the “care flow”. At different care providers different terms are in use for this term, such as care program, care pathway, care plan, patient flow, patient journey, care journey, clinical protocol, care process, (clinical) service line, care process model, clinical workflow or even digital therapeutic.

In essence they’re all sequences of activities completed by a care team and/or patient to maintain or achieve a desired health status for that patient. 

Care flows are often defined at the medical condition / population level: a care flow for “Anxiety”, “Type 2 diabetes”, “Total joint replacement with obesity for 65+”, “Menopause”, “Sexual health for LGBTQ+”, “Discharge after surgery”, etc. and can be patient facing only, care team facing only or include activities for care team and patient.

At CareOps we use “care flow“ as an umbrella term for all these processes.


Design & Validate insights

The majority of care providers uses care flows

The answers are in line with the 2022 report, with the Yea sayers slightly on the increase: 84% in 2023 vs 80% last year.

State of CareOps Report 2023 - % Organizations using care flows

When we look at the reasons why organizations are not using care flows we see lack of alignment (n=6) as a top reason. CareOps is all about creating this alignment across the whole organization, in every step of the lifecycle of the care flow from design all the way to continuous improvement.

State of CareOps Report 2023 - Primary Reasons for Not Using Care Flows

Looking in detail, compliance or regulatory requirements (n=5) and resistance to change from clinicians or staff (n=5) round out the top 3.

Lack of alignment and resistance to change are branches on the same tree: a culture that is not ready to embrace care flows as vehicles to improve. The perception that a care flow should be implemented as a standard is simply wrong - there is never an immutable standard in healthcare. New evidence gets published, you get new insights from your own data and standing still is going backwards. 

There is sometimes a perception that a care flow is a straightjacket, taking away from the autonomy of the doctor to make decisions. This could be a root cause of the resistance to change. However, a process can be standardized and still leave room for independent decision making by care team members.

“At Oak Street Health we think about standardization as a 70/30 split.  It is important that the largest aspects of what your care team does are standardized. (...) The bulk of the work that we do is to make sure not only that we set standards, but that we also disseminate standards, coach standards, review standards, and then update and iterate those based on the things we learned. Our standards are constantly evolving and improving.” - Dr. Ali Khan (Chief Medical Officer)

So this is a warm call to all Nay sayers to just adopt this practice, align on a v1 that is directionally ok for most stakeholders and which represents a small change, and then start iterating. If you need help convincing your organizations to adopt care flows and the CareOps practice, reach out to us and we’re happy to help.

What’s striking is compliance and regulatory reasons for not using care flows. It seems like the use of care flows would be an excellent practice for organizations that are worried about compliance and regulatory requirements as they provide an audit trail of how care should be delivered and how it is actually delivered in practice.

There is no standard team composition and not all essential roles are included in care flow design

In 2023 we spotted 79 unique team combinations, up from 66 in 2022. This continues to support the observation that there is no "standard team" for designing care flows.

When we look at which of these combinations include the 4 core CareOps roles (Clinical Operations, Clinicians, Product managers and Software engineers) in their care flow design we see a decrease to 16% (n=37) compared to the 27% (n=22) last year. Imagine soccer teams composed solely out of offense players and goal keepers.

Which roles are then most present in the team combinations designing care flows?

State of CareOps Report 2023 - Stakeholders involved in care flow design

At the top we see Clinical operations and care operations (n=108). As you’ll read later in the report, the main objective of these care flows at most organizations is driving performance and financial metrics. This means Clinical operations staff is expected - explicitly or not - to steer care flow performance to the performance and financial aspect rather than the quality of care aspect.

As a category, everything clinical related (clinical operations, clinicians, clinical experts, care coordinators, care managers) precedes the rest which is somewhat reassuring for the patients among us.

State of CareOps Report 2023 - Composition of stakeholders in care flow design
Note: Other clinical includes pharmacists and ancillary services.

The combination of roles was consistent across company profile, care model and other variables in the data set with the top 3 roles being clinical operations / care operations, clinicians and clinical experts.

Time to design care flows is on the decrease for high performers

The vast majority (82%, n=87) of organizations who responded to the question with a known duration need less than three months to design a single care flow, about equally split between the less than a month and between 1 and 3 months buckets.

State of CareOps Report 2023 - Time to design a care flow

Compared to 2022, this year hints at an overall decrease in duration to design care flows. 

Whereas last year 26% of respondents answered it took 3 months or longer and 78% spent at least one month, the numbers for 2023 are 18% (n=19) and 60% (n=64)  respectively. If we close our eyes for socially desirable responses this definitely counts as an improvement. A third year of data will mark the trend.

On the other side of the coin, we see that 54% (n=128) of all survey respondents either didn’t provide an answer, don’t know or are not measuring this; up from 38% last year. 

This could indicate that a group of high performers who are able to report this data and show improvements is getting ahead of the pack that is operating in limbo. As you can read below in the report we see a similar pattern in the data on time to implement a care flow.

With regards to factors impacting design length, it appears that alignment between stakeholders and resistance to change are core drivers for those organizations where it takes more than 6 months to design a single care flow.

State of CareOps Report 2023 - Top factors impacting care flow design length

There were no discernible factors related to organization or care model that impacted design length. It turns out regardless of size, patient population, specialty, geographic location or any other variable organizations face similar challenges.

Care flows are designed using mostly static/non-dedicated tools

This is still the case in 2023.

Below is a quote from a conversation we had with an organization using static tools. We’ve had 100s of conversations with care providers and they all follow the same pattern.

“We're doing a number of care pathways right now. In one of them, patient has a risk score based on clinician assessment, then they have additional care instructions. This is built in Lucidchart, then we do learning & development and we teach the staff. We were able to get the assessment into our EHR but there is no intelligence or ability to act on the result of the assessment. You can't see timelines, where patients are in pathways, etc. For every care pathway we create, this is the normal process. It's really up to the nurse educator to make sure the pathway gets adopted, i.e. they print it out and put it on the wall.”

The world largely moved on from paper to email - healthcare getting stuck in the fax state though - so why are we still stuck writing down and designing care flows in google docs, powerpoint and Lucidchart?

Using static tools means care teams lack interactive prototypes they can use for validation of the care delivery processes. Handing over the care flow design in the lifecycle to the ones building and operating them becomes more difficult. Have you ever seen a clinician explain a flowchart of their protocol to a software engineer? This ultimately causes a disconnect between the blueprint of what needs to happen and reality of what happens in clinical practice, directly impacting efficiency and quality of care.

State of CareOps Report 2023 - Most common care flow design tools

We do see improvement vs. 2022. About 10% (n=23) of respondents use a dedicated tool for care flows like Awell or similar.

Build & Operate insights

Time to implement care flows is on the decrease for high performers

The distribution of implementation time is similar to the 2022 results but there are 2 interesting observations. 

State of CareOps Report 2023 - Implementation time for care flows

First, for the organizations who provided an answer (20% of respondents or n=47) we observe shorter implementation times. In 2022, 90% of respondents reported that it takes more than a month to implement a care flow. This decreased to 65% (n= 43) in 2023. The bucket reporting more than 3 months to implementation dropped from 48% in 2022 to 30% (n=20) this year.

Second, 80% of all respondents didn’t provide an answer, don’t know or are not measuring this. This represents an increase from 62% in 2022. Just like the numbers we’re seeing in design time, our hypothesis is that there is a group of organizations who are building their CareOps muscle and investing in decreasing time to implementation whereas the larger group is lagging behind as they don’t even have visibility on this crucial metric. In other words, we see the formation of a group of high performers who are starting to run ahead of the pack.

This is a strong indicator of what CareOps promises: investing in a strong CareOps practice will create a sustainable competitive advantage over those who don’t.

Top factors impacting implementation time are related to resources. The number one being dependency on software engineering resources has been old news since the invention of software code. Hence the importance of finding ways to alleviate the burden to implement and update care flows by software engineers through low code tools.

State of CareOps Report 2023 - Top factors delaying care flow implementation

An additional observation: 78 respondents reported 2 or more factors at play in implementation delays. These challenges are solved by a well oiled CareOps practice: autonomous care flow builders, a culture of continuous improvement instead of trying to align on “the one version to rule them all”, prebuilt EMR integrations, having compliance and regulatory at the table early on are all aspects of running an excellent CareOps practice.

Hope my surgeon doesn't stumble upon this - I've got surgery lined up next month. All love to you surgeons 🤍

Number of care flows in use remains insufficient

A total of 105 respondents provided a numerical value to the question of how many care flows they have in use. Others mentioned In Development (n=2), Other (n=115), Too Many to Count (n=7) and Unknown (n=5).

State of CareOps Report 2023 - Number of care flows implemented per organization

Drilling down into these numbers, we see a majority of care flows that are both patient and care team facing for the representative data sets (0-50 care flows). This confirms a core aspect of care flows. It makes no sense building flows that are clinician facing only, or patient facing only. Can you think of an activity a patient should perform that is not relevant for the care team? Can you think of an activity performed by the care team that would not impact the patient in some way?

State of CareOps Report 2023 - Number of care flows per end user type

The majority of care processes doesn’t get implemented

However, the majority of care processes is still poorly documented, let alone implemented. Whereas the number of organizations that reported using care flows has gone up (85% of respondents this year vs 80% in 2022), those having more than 6 care flows live has dropped from 36% in 2022 to 24% (n=57) today and those having more than 10 care flows live has dropped from 24% in 2024 to about 20% (n=47) today.

If you think about the complexity in healthcare, whether caused by the breadth of medical conditions covered by a provider organization, or the variability in the population for all organizations, even those who narrowly focus on one medical condition or specialty, it's fair to say that these numbers indicate the majority of clinical processes doesn’t get implemented. They might live in those digital documents, on an intranet, on a yellow-ish piece of paper hanging up in the care team office right above the coffee machine, but not properly implemented in clinical practice.

State of CareOps Report 2023 - Meme on printed care flows hanging above coffee machineb

The way most care flows are implemented breaks workflow of the care team

But where do care teams access these implemented flows? Yes, 85% of respondents have to revert to tools outside their EMR to access care flows. We all know how much care teams like to interrupt their workflow and navigate away from their main system of work, the EMR. The insight here is that the vast majority of care teams are stuck in this paradigm that breaks their efficiency and cognitive focus, with detrimental effects on CareEx.

State of CareOps Report 2023 - Where do care teams access care flows

Moreover, 68% of organizations reported using 2 or more tools to access care flows, often a combination of software (EMR or home grown) and digital documents (word, powerpoint, lucidchart, you name it).

With a strong CareOps practice and the right tools, care flows get implemented fast and updated on a continuous basis with low dependency on scarce resources such as engineering. The majority of flows are available right inside the system of work for the care team members, whether EMR, care team portal or healthcare CRM.

Monitor & Improve insights

The majority of care teams are flying blind to some extent

For the question on what metrics are tracked to monitor care flow performance, we offered 4 categories in the survey:

  1. Performance metrics such as patient engagement and compliance rates
  2. Financial metrics such as revenue per patient / per member
  3. Clinician reported outcomes
  4. Patient reported outcomes (PROMs)

The picture in 2022 was pretty bleak. Only 10% of all respondents were tracking metrics in all 4 categories. It’s appalling to see that this even decreased in 2023, only 7% (n=16) have the ingredients to build a 360° picture of how their flows impact finances and quality of care.

Not so rosy either, a small 10% (n=23) respondents monitor neither Clinician Reported Outcomes nor Patient Reported Outcomes.

Equally worrying is the close to 60% (n=136) of non-responses including blanks, I don’t know and We aren’t measuring anything. Of all variables in the survey data set, this is one of the highest where respondents were not able (or willing?) to provide an answer. In any case it doesn’t bode well for payers nor patients.

State of CareOps Report 2023 - Top performance metrics monitored

You cannot reliably improve what you don’t measure and all of these categories are crucial - imagine an organization only measuring (and thus improving) financial metrics; it would likely have a severe impact on outcomes. Same the other way around, throwing everything but the kitchen sink at ensuring the best possible outcomes for patients will mean financial ruin for every care provider but the ones who maybe literally charge an arm and a leg for their services.

The concept of the balanced scorecard to track a set of metrics that represent the different aspects important to an organization has been in use at businesses as far back as 1987. With CareOps we support a similar approach to pick 2-3 core metrics from each category instead of an exhaustive list of metrics and missing one of the categories.

What’s definitely clear is that the 11 organizations who answered We don’t measure anything are lucky the survey was anonymous or Rik would have tweeted a scathing warning to the public never to seek care at these organizations.

If we look at how often each of the categories is mentioned in the different answer combinations, we see that in line with 2022 Performance metrics are the top category that is being tracked. Interestingly, there is no significant difference between organizations taking on risk and those who don't.

State of CareOps Report 2023 - Categories of metrics to measure care flow performance

The place where words go to die after conferences is littered with patient centricity, patient experience and patient engagement. Yet only 22% (n=51) of all survey respondents take the patient voice into account by collecting patient-reported outcomes (PROMs) like the PHQ-9, GAD-7, PROMIS-10, or others. So, the next time you see a CEO rambling about 'patient-centricity' on a conference stage, ask them, 'Are you collecting PROMs?' You'll likely be met with silence—or find security escorting you out.

This is a decrease from the 36% reported in 2022, and it is surprising given the scientific evidence supporting the benefits of PROMs. The decrease could be a consequence of the financial strain on the healthcare system post pandemic and a focus on short term performance and financial metrics, rather than those to scale a long term successful provider organization.

When we look at the data clinicians have access to we also see some interesting trends:

  • The most frequently accessible types of data for clinicians are patient-specific data for their direct patients, their own clinical performance data, and aggregated data of other clinicians' performance.
  • Only a small fraction (close to 5%) of organizations provide extensive access to multiple types of data, including their own performance metrics, peer benchmarks, and patient-specific data.
  • Remarkably, about 5% of healthcare organizations provide clinicians with no access to any data, reflecting a gap in data-driven decision-making capabilities.

The fact that only 17% (n=53) of all survey respondents enable their clinicians to see aggregated benchmark data is a glaring gap in our collective push for better patient care. Let's be real—clinicians are among the most competitive beings you'll ever meet. Give them a benchmark, and watch them hustle to not just meet but exceed it. This isn't just armchair psychology; there's hard evidence to back it up. A study from 2016 looked at almost 17,000 patient visits for acute respiratory infections and found that when clinicians were shown how their antibiotic prescribing rates stacked up against their peers, those rates dropped significantly.

New medical research is not commonly used to drive care flow iterations

So much for monitoring performance. How is that data used to determine the next, hopefully better version of the care flow? For the question on what is driving care flow iterations, we offered 6 categories in the survey:

  1. New medical research
  2. Performance metrics such as patient engagement and compliance rates
  3. Financial metrics such as revenue per patient / per member
  4. Outcome measures such as patient reported outcomes (PROMs) or clinician reported outcomes
  5. Patient feedback
  6. Clinician feedback

Less than 16% (n=37) of all survey respondents use new medical research to drive iterations. This is a further decrease from the already appalling 19% reported in 2022. This is really putting the famous statistic that it takes 17 years for the latest medical research to be widely adopted on the clinical work floor into perspective.

When 'tried and true' becomes 'tried and outdated.' Let's not be that 84%

On a brighter note, we observe that the bucket of outcome measures and feedback from patients & clinicians is used by 66% (n=156) of all organizations as drivers for care flow iterations vs. the bucket financial/performance metrics at 42% (n=98).

Last, less than 4% (n= 8) organizations use all 6 categories to inform care flow improvements.

State of CareOps Report 2023 - Top 10 most occurring iteration drivers

There is big variation in iteration frequency

Of the organizations who responded to this question, there was virtually no change vs. 2022 data. Around 97% (n=105) of respondents who answered the question iterated at least once, and 67% (n=72) iterated three times or more on a given care flow in a 12 month timespan. Three years of data will mark a consistent number that can act as a benchmark.

If you’ve read so far, you’ll start recognizing the pattern of organizations who don’t know, aren’t measuring or didn’t provide an answer to the question. This percentage went up from 44% in 2022 to almost 60% (n=139) of all organizations participating in the 2023 survey. 

Is it safe to assume that those who don’t know or can’t provide an answer are never iterating on their flows?

State of CareOps Report 2023 - Frequency of care flow iterations

Closing the loop and iterating on care flows is the last and crucial step in the CareOps lifecycle. Even iterating a single time more than a competitor can lead to additional efficiency or effectiveness gains of processes, driving higher revenue (see more patients with the same team, close higher value deals with payers), higher gross margin (lower operational cost to serve a single patient) and ultimately healthier patients who live longer, happier lives.

Because isn’t that last thingy the reason why we all got drawn to working in healthcare in the first place?

Insights on using dedicated care flow tooling

Impact of using dedicated tooling for care flows

We looked at whether using dedicated tooling for care flows* would impact any key variables related to care flow design, implementation and improvement. For this we looked at the following variables in the data:

  1. Design length
  2. Implementation time
  3. Iteration frequency
  4. Number of care flows implemented

Analyzing design length, though data is sparse we see a hint of a distribution skewed towards shorter design times for the dedicated tool bucket.

State of CareOps Report 2023 - Design length by tool type

When looking at implementation time the same pattern: sparse data but a hint of skewness towards shorter implementation times when using a dedicated tool.

State of CareOps Report 2023 - Implementation duration by tool type

Looking at iteration frequency differences between the two buckets there was no meaningful difference. This could be an indication that iteration frequency is determined in large part by the culture of an organization, i.e. organizations who want to iterate often will find a way to do it, rather than the tooling.

When looking at number of care flows live at the organization, the body of the distribution in the bucket that uses a dedicated tool sits in the 11-50 range whereas the other tools bucket is more heavy in the 0-10 range. This can hint at organizations using dedicated tools are more effective in implementing a larger % of the flows that are getting designed.

State of CareOps Report 2023 - Number of care flows by tool type

Again these insights have to be taken with a grain of salt as the data is somewhat sparse. We’ll see if these findings are confirmed in next year’s data set.

High performers

What does an organization with a great CareOps practice look like? Are we looking for unicorns or can we see a group of high performers emerge among respondents?

We mentioned high performers showing improved metrics vs 2022 several times in the report already. It’s always good to have an idea what good looks like so here it goes. An elite CareOps performer:

  • Uses care flows at their organization
  • Includes minimally all 4 CareOps roles (clinical operations, clinical, product and software engineering) to design care flows
  • Is able to implement care flows in their care team facing apps in under 3 months
  • Monitors care flow performance through a combination of clinical measures and financial/performance measures
  • Iterates more than once per year on their flows and uses new medical research for these iterations

Combining all of these criteria, we identified just 3 organizations that fit this profile. This is one more than last year; at these low bases that's a huge 50% more! Jokes aside - just over 10% (n=24) of all respondents use care flows and include all 4 CareOps roles for design. Then there is a significant attrition, with only 7 organizations implementing care flows in 3 months or less. Of these, only one fell through the bucket as they were only measuring performance metrics. The final carnage is in the iteration stage of the CareOps lifecycle, where our group of high performers is halved to leave 3 in the end.


For the first time, we publish a series of benchmarks for key industry metrics. If you are interested to see how you stack up against peers with the same size, care model and financial risk profile reach out to rik@awellhealth.com to create a tailored CareOps benchmark for your organization.

Average Utilization Rate

What percentage of work time should my clinicians spend with patients? 

This is a question that’s on everyone’s mind as the industry grapples with staff shortages, burnouts and 27 hours in a day needed to properly apply guidelines for an average panel of patients.

We believe this is the first research of its kind on average utilization rate (defined as % of appointment slots that are typically booked) across care providers. 

A total of 176 organizations provided an answer to this question in the survey, close to 75% of all respondents.

State of CareOps Report 2023 - Average Utilization Rate

Let’s drill deeper into this.

We’re interested in seeing whether there’s a difference in average utilization rate between organizations taking risk and those who don’t.

A total of 150 respondents provided data for both the average utilization rate and their risk profile. When looking at the two distributions, risk takers are slightly skewed towards higher average utilization rates.

Isn’t it so that if you take on risk, you want to make sure clinicians have ample time to spend with their patients and maximize outcomes? Or is the causal behavior the inverse, because you’re taking on risk as an organization you want to make sure you spread that risk over a larger patient population without blowing up your care team (if you take on risk and you see only 1 patient, it’s pretty much heads or tails - the larger the population you see the more potential spread of risk can take place)? Curious about your thoughts here.

State of CareOps Report 2023 - Average Utilization Rate by Financial Risk Category

Clinician time spent on non-clinical tasks

It’s worthwhile looking at the other side of the coin. More than 50% of all respondents (n=169) spend more than 20% of their time on non-clinical tasks.

State of CareOps Report 2023 - Non-clinical time spend

Percentage of asynchronous care

Asynchronous care is defined as activities where communication is not in real-time, such as email or chat. Video visits are synchronous but virtual so don’t count as asynchronous care. The importance of using asynchronous care is the alleviation of the need to have a care team member available to interact with patients in a predefined slot. A registered nurse, care coordinator, care manager can open up a software and handle many patients in an asynchronous way at the same time: chatting, emailing, reviewing activities, sending out nudges, escalating cases, etc.

The majority of organizations, constituting 52% (n=87), adopt a relatively low percentage of asynchronous care. Notably, a select 10% operate at asynchronous care percentages higher than 75%, with 4 organizations (just under 2% of all survey respondents) providing 100% asynchronous care.

State of CareOps Report 2023 - Percentage of asynchronous care

Let’s look at whether the risk profile of a provider has an impact on the % asynchronous care. Of a total of 134 respondents who provided answers to both asynchronous care percentage and risk profile, we see that those taking on risk are geared significantly towards less asynchronous care.

State of CareOps Report 2023 - Distribution of asynchronous care by financial risk category

Our hypothesis is that organizations taking on risk prefer having a human in the loop in a synchronous interaction, maybe out of fear that in an asynchronous model things will fall through the cracks. Something to discuss in the community.

Time spent working in spreadsheets for ClinOps-related tasks (data entry, data analysis, reviewing or tracking information)

Spreadsheets have long been a staple in various industries, but how much do they dominate the daily routines of healthcare professionals? 32% of healthcare organizations report that their care and operations teams spend between 11-30% of their workday on spreadsheets. On the higher end, close to 13% spend between 50-70% of their time, and 5% spend more than 70% of their time in spreadsheets. As healthcare becomes increasingly complex, the question arises: Is this the most efficient use of valuable time?

Demographics & Firmographics 

We collected demographic and firmographic information from each survey respondent. Categories include years of experience, care delivery model, number of employees and more. 

This year we saw a high representation of companies that provide virtual care only (x%). Over x% of respondents work in a clinical operations or clinical role. Additionally, we see a good representation of different levels of experiences.  



We’re seeing the emergence of the “CareOps” role. What are the job responsibilities for someone with a CareOps title? They oversee the CareOps lifecycle, bring the three major viewpoints (clinical, product/engineering and operations) together, get alignment between stakeholders, ensure handoffs between the different CareOps lifecycle stages and report on the realized  improvements in outcomes and care team efficiencies.

State of CareOps Report 2023 - Role



The vast majority of respondents is active in North America.

State of CareOps Report 2023 - Region

Care delivery model

In 2023, about 43.44% of organizations provide care exclusively virtually. This is a slight increase from the 42% observed in 2022. On the other hand, 25.79% of organizations in 2023 provide care mostly in person but with a virtual component, which is a decrease from the 33% recorded in 2022. The percentage of organizations providing care mostly virtually but with some in-person aspect remains relatively stable, standing at 22.17% in 2023 compared to 22% the previous year. Lastly, 8.60% of organizations in 2023 provide care entirely in person, showing a noticeable increase from the 4% in 2022.

State of CareOps Report 2023 - Care delivery model

When comparing these statistics to 2022, there seems to be a slight shift towards virtual care methods. While the percentage of organizations providing care only virtually has increased, the percentage of organizations leaning towards in-person care has decreased.

Services provided

In 2023, approximately 23.32% of respondents indicated that their organizations provide care specific to one or a few medical conditions. This is a significant decrease from the 45% observed in 2022. Meanwhile, around 39.91% of organizations in 2023 are focused on broad care across various conditions, representing an increase from the 34% reported in the previous year. Additionally, the percentage of organizations dedicated to specialty care has grown to 32.74%.

State of CareOps Report 2023 - Services provided

When juxtaposing these statistics with the 2022 figures, it's evident that the inclination towards broad care has grown, while the number of organizations targeting care for specific medical conditions has lessened. The prevalence of specialty care providers has also witnessed an uptick.

For those organizations providing specialty or condition specific care, this is the detail:

State of CareOps Report 2023 - Medical specialty

Monthly Active Patients

The percentage of organizations with 0 - 1,000 MAPs witnessed a rise from 34% in 2022 to 46% (n=103) in 2023. Conversely, the percentage of organizations with 1,001 - 10,000 MAPs declined from 17% in 2022 to 13% (n=30) in 2023. Organizations with 10,001 - 100,000 MAPs also experienced a decrease, moving from 16% in 2022 to 9% (n=19) in 2023. The proportion of organizations with over 100,000 MAPs remained relatively unchanged at 1% (n=3). Noteworthy is the surge in respondents uncertain about their number of MAPs, jumping from 15% in 2022 to 35% (n=79) in 2023.

State of CareOps Report 2023 - Monthly Active Patients


In 2023, smaller organizations, specifically those with 1-10 members, dipped to 7% (n=14) from 12% in 2022. Meanwhile, mid-sized entities with 51-200 members experienced a growth to 28% (n=57), up from the prior year's 23%. Those within the 201-1,000 bracket made significant gains, reaching 34% (n=69) in contrast to 15% in 2022. Larger organizations with 1,001-5,000 staff saw a decline to 8% (n=16) from 17% the previous year.

State of CareOps Report 2023 - Employees

Provider workforce

In 2023, organizations with 11 to 50 members in direct contact with patients rose to 26% (n=49) from 17% in 2022. Likewise, those with 51 to 100 members increased to 22% (n=41) from the previous year's 15%. However, smaller entities, with 1 to 10 members, declined from 23% in 2022 to 19% (n=35) in 2023. Larger organizations remained relatively stable, while the smallest and largest categories saw reductions.

State of CareOps Report 2023 - Staff in direct contact with patients

Wait - what about AI?

As you can read in our methodology, we already bowed to our AI overlords. At least for the analysis of the CareOps survey. We also anticipate the post-conferences word graveyard to see a significant influx of the vowels A and I over the coming months.

Jokes aside, it’s clear that large language models (LLMs) and their applications are already impacting healthcare. Any aspect of care delivery processes that is directly language related such as visit transcription, note taking and medical coding is rapidly coming into focus to get automated. 

This already has and will continue to have an obvious impact on care flows. We look forward to updating the CareOps framework to take the use of these applications into account and include the use of AI in the CareOps practice into next year’s survey. 

We evaluated doing this already in this year’s survey but ultimately decided to let the peak of inflated expectations run its course and double down on this aspect next year. In the meantime let us know what you’re curious about and which questions you’d like to see answered.


The State of CareOps Survey 2023 was developed by Awell and Health Tech Nerds in collaboration with healthcare operators at Amazon, Foodsmart, Juno Medical, Paloma Health, Oshi Health and Wellinks.

The survey was distributed in July and August 2023 via several platforms, including the HealthTechNerds newsletter, LinkedIn, Twitter and personal outreach.

In total [Rik] professionals involved in clinical operations (clinical operations staff, clinicians, product managers, software engineers…) at virtual-first, traditional and hybrid care providers were surveyed. Given the confidential nature of many questions, we allowed respondents to complete the survey anonymously.

We asked a qualifying question of whether the respondent works at an organization that provides care. Those who answered “no” were excluded from the results for analysis purposes. After some further cleaning of the data, the remaining total is 235 responses. When we refer to “all survey respondents” in the analysis, we mean 235.

None of the questions were mandatory which means some respondents didn’t provide an answer to all questions. In the analysis, where relevant we zoom in on the number of people who provided a response to the question. In that case the total number of respondents is made explicit.

Given the channels we used to distribute the survey, the data is skewed towards people active in digital health/health tech and as consequence is not necessarily representative for the healthcare industry as a whole. We anticipate that over the coming years, the number of respondents on the State of CareOps survey will grow and the data will become more representative of the healthcare industry. This report contains the analysis done at the closure of the survey.

Last year, the analysis took considerable time and effort. Because CareOps is no one's fulltime job today, we opted to get some help this year in the form of ChatGPT Code Interpreter for the analyses.

We had lengthy discussions with our new AI analyst overlord to explore different angles of analysis and drill deeper into the data. As is common in data exploration, many of these "conversations" ended up taking dead end paths because there was not much interesting to see. The insights that ended up in this report are the worthy to surface from these explorations. 

We made sure to use proper prompts when instructing Code Interpreter and to strictly stick to the source data provided. We regularly performed spot checks with a manual count of the data to make sure the results generated are correct. There is however a limitation to making our methodology public - the way ChatGPT Code Interpreter works is that charts and data sets are lost when a session is ended, this means sharing a Code Interpreter conversation post hoc is quite limited in value for the reader. Therefore, these chats are not made accessible by default. In case you do want to read up on our lengthy discussions, feel free to reach out and we’ll share them with you.

As a final remark, CareOps as a field is still young and the team behind the survey and analysis is small. In the spirit of continuous improvement, we can always learn and get better at this. Contact rik@awellhealth.com for any questions, remarks or if you'd like to contribute in the future.


The State of CareOps 2023 report was made possible with the help of other passionate healthcare innovators. The authors would like to thank all of these people for their input and guidance on the report this year. In their organization's alphabetical order:

  • Revathi Anilkumar (Amazon)
  • Olivier De Troyer (Awell)
  • Kate Schlag (Foodsmart)
  • Ryan Russel (HTN)
  • Kevin O’Leary (HTN)
  • Kevin Stephens (Juno Medical)
  • Marina Tarasova (Paloma Health)
  • Markita Billups (Oshi Health)
  • Rob Calvey (Wellinks)

Additionally we’d like to thank our knowledge partner Health Tech Nerds for this fruitful collaboration. 


Thomas Vande Casteele 

Thomas Vande Casteele is the Co-Founder & CEO of Awell. Prior to founding Awell in 2018, Thomas was an entrepreneur in e-commerce and digital marketing where he spent 8 years improving customer journeys for companies like Samsung, Audi and Nestlé before becoming obsessed with value-based healthcare principles. He is passionate about how software can help people perform at the very best of their abilities.

Linkedin / Email

Rik Renard

Rik Renard is a nurse practitioner turned into a startup operator. He is currently Partnership Lead at Awell. For the past three years, he implemented +25 care flows at +15 care organizations ranging from oncology to musculoskeletal to cardiovascular diseases leading to improved patient outcomes and time gained for care teams. He obtained his M.Sc in Health Care Management and Policy from Ghent University. In addition to his passion for streamlining care processes, he is also a passionate dog lover/owner.

Linkedin / Twitter / Email

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State of CareOps 2022

Welcome to the very first State of CareOps report. The survey and report are driven by Awell in collaboration with Health Tech Nerds and a group of individual contributors.

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