Penn Medicine is continually trying to optimize operations and decrease number of patients who do not show up for their appointments. This has included new changes to text message reminders, implemented as usual care. At a baseline, less than 75% of scheduled outpatient appointments are actually completed. This results in longer wait times and decreased access for patients and operational inefficiencies. The goal of the project is to test whether supplementing standard text message appointment reminders with targeted outreach using an automated phone call to patients with increased risk of not showing up for their appointment (>15% per Epic's Risk of Patient No-Show Model) reduces no show rate (the study's primary outcome) and increases patient appointment completion rate (% of appointments that were completed during scheduled appointment time, a secondary outcome). Participants will be randomized in a 1:1 ratio to receive either the standard text message or standard text message plus the automated caller. Eligible patients have already consented to receiving text message reminders from Penn Medicine and must have an in-person appointment scheduled during the study period. The Access Optimization Group at Penn will be monitoring the randomization and outcomes reporting of whether a patient confirmed, cancelled, or no showed at the scheduled appointment. All eligible outpatient appointments over a two week period will be included in this operational evaluation. The Access Optimization Group will then make a decision on which approach to implement as usual care based on the results of this operational evaluation.

Inclusion Criteria:

• in-person appointments
• English or Spanish speakers
• 18 years old or older