Why Removing Humans From Care May Undermine Outcomes

Why It Matters

Retention, not just acquisition, determines whether digital‑health platforms survive; hybrid AI‑human solutions may be the key to sustainable growth.

Key Takeaways

• Avena Health’s fully automated AI cut retention to 2% after three months.
• Hybrid model with human specialists restored 40% long‑term retention.
• Digital‑health apps lose >75% of users within two weeks, per IQVIA 2023.
• Venture‑backed firms focus on acquisition, neglecting retention metrics.
• Alva Health will test hybrid approach in saturated U.S. digital‑health market.

Pulse Analysis

The promise of fully automated digital‑health platforms has attracted billions of venture dollars, driven by the belief that artificial intelligence can replace clinicians, lower costs, and expand access. Yet the experience of Avena Health reveals a stark counterpoint: after replacing human specialists with an end‑to‑end AI workflow, active user retention fell to just two percent after three months, despite the algorithm delivering clinically correct recommendations. This collapse underscores a deeper behavioral issue—patients disengage when the care experience lacks a human touch, a factor that raw clinical outcomes do not capture.

Sandoval’s response was to re‑introduce clinicians at strategic touchpoints while keeping the AI engine handling routine tasks. The hybrid architecture boosted long‑term retention back to roughly forty percent, a figure comparable to the platform’s original performance. Industry data from the IQVIA Institute shows that more than three‑quarters of digital‑health users abandon an app within two weeks, highlighting that acquisition metrics mask a systemic engagement crisis. Companies that double down on gamification and push notifications often improve short‑term usage but fail to sustain the relational trust that human specialists provide.

The lesson for investors and founders is clear: efficiency alone does not guarantee market viability. Platforms that prioritize full automation risk building “empty” products that perform well on paper but lose users at scale. Alva Health, Sandoval’s next venture, will launch the hybrid model in the crowded U.S. market, betting that the combination of algorithmic speed and expert oversight can deliver both cost savings and the retention needed for sustainable growth. If the approach proves successful, it could reshape funding criteria, shifting emphasis toward measurable engagement metrics alongside clinical efficacy.