Reaching the Unreached: How AI Is Rewriting Who Gets a Seat at the Table in Clinical Research

My Father Taught Me What Inclusion Actually Costs 

My father was the first African American from the state of Wisconsin to earn a master’s degree from the Air Force Academy. He didn’t stop there. He went on to hold a position leading the Pentagon’s Equal Opportunity Commission where he championed some of the most contested inclusion policies of his era advocating for women, minorities, and LGBTQ+ service members to serve safely and with dignity in our armed forces. These were not popular positions. They required him to stand in rooms where he wasn’t entirely welcome and make the case, over and over again, that the institution was stronger when it reflected the people it served. 

I grew up watching my mother do the same thing differently as a singer, entrepreneur, and civil servant who mentored young women and built deep community roots everywhere we lived, receiving rewards for her impact and local contributions. Together, they showed that advocacy isn’t a department or a job title. It’s a decision you make every day about whose needs you center and whose voice you amplify. 

That legacy is what brought me to clinical research. And it is what drives me, now, to make them proud and make the case that the patients’ medicine has historically been designed around  rather than for deserves to be at the center of what we build next. 

The System Wasn’t Built for Everyone 

Clinical research has a structural problem that the industry has spent decades softening with careful language. The truth, stated plainly, is this: the trials developing tomorrow’s treatments have largely been built around a narrow slice of the population while the people carrying the heaviest burden of disease have been systematically left out of the conversation. 

More than 80% of clinical trials still miss their enrollment goals. More than half of study terminations are linked to recruitment failures. And despite a tenfold increase in the number of trials over the past two decades, the field continues to draw from the same 4 to 5 percent of the population. The people waiting longest for cures patients navigating language barriers, geographic distance, limited access to specialty care, and deep-seated distrust born from generations of medical harm, minorities and marginalized groups are still, far too often, not in the room. 

This is not a pipeline problem. It is a design problem. And AI, when deployed with intention, is one of the most powerful tools we have to redesign it. 

What AI Actually Does That Conventional Recruitment Cannot 

When most people think about AI in clinical trials, they imagine genomics or drug discovery. But some of the most consequential work AI can do is far less glamorous: finding the patients who should be in a study but have never been asked, and then actually engaging them in a way that earns their trust. 

Areti Health was built specifically for this. Areti’s platform uses multi-agent large language model (LLM) workflows and EMR integrations connecting to data covering more than 33 million patient records  to identify eligible patients based on real-world clinical profiles, geography, and social determinants of health. Rather than waiting for patients to find trials through academic medical centers or social advertisements, the system surfaces them proactively to research teams. The difference between reactive and proactive recruitment is often the difference between a dataset that reflects only who showed up and one that reflects who actually lives with this disease. 

Through partnerships across Hispanic network organizations, Black doctor organizations, and others that understand, at a community level, why patients haven’t shown up before we establish a unique well thought strategies. As an example Tea Leaf Health is one of those partners. Built on a mission to close the trust gap in healthcare, Tea Leaf combines AI with human intelligence  going beyond traditional claims data to surface patients from rare disease and historically overlooked communities that commercial tools are simply not designed to find. Their deep roots in community-based networks mean that when Areti identifies a patient, Tea Leaf has often already done the relationship work that makes engagement possible. Together, the two platforms represent what the next generation of recruitment looks like: technology that is precise, proactive, and grounded in the communities it is trying to reach. 

Engagement That Meets People Where They Are — Not Where It’s Convenient 

Identifying a patient and engaging them are two entirely different challenges. For patients who have spent their lives interacting with a healthcare system that was not designed with them in mind, an outreach message from a clinical trial isn’t automatically welcome. It takes more than a mailer or a phone call. It takes consistency, patience, and the willingness to communicate on someone else’s terms, timelines, and modalities. 

Areti’s AI Coordinator operates 24 hours a day, seven days a week, in more than 50 languages, across text, email, phone, and chat. It doesn’t just push information it responds to questions in real time. We’ve learned that roughly 25 percent of patients have two to three questions that, when answered promptly, determine whether they take the next step. For a patient who has never participated in a study and is weighing the decision after putting their kids to bed, that real-time responsiveness can be the difference between a yes and a missed opportunity. 

This matters especially for communities that have historically been told, implicitly or explicitly, that their time is less valuable. When someone receives an immediate, thoughtful response in their own language, on their own schedule, that is not just good technology. That is a signal that they matter. 

Busting the Assumptions That Have Held the Field Back 

Two assumptions have quietly shaped recruitment strategy for years, and both are incorrect. 

The first is that older adults don’t engage with digital technology or AI-assisted outreach. In two pre-clinical Alzheimer’s studies alone, Areti’s platform scheduled 302 participants between the ages of 60 and 80 for screening visits. These are people the industry has historically written off as unreachable through digital channels and they showed up. 

The second is that AI-assisted recruitment skews toward white, tech-comfortable demographics. Areti’s recruitment data tells a different story: our participant balance consistently reflects a 55 percent minority and 45 percent white split across studies. And 66 percent of our fastest-response engagement patients who act without delay comes from women. These numbers don’t happen by accident. They happen because the platform was built to reach broadly, communicate inclusively, and remove the friction that has historically kept entire groups of people from participating. 

These are a few examples of what it looks like when technology is designed for the full population.  

The Infrastructure That Makes Equity Possible at Scale 

None of this works without the underlying plumbing. Coordinators who are manually cross-referencing an EMR, a CTMS, a recruitment CRM, and a spreadsheet are coordinators who are going to miss patients not because they don’t care, but because the system is working against them. 

Areti’s CTMS connectors and EMR integrations allow sites to identify eligible patients directly within their existing clinical workflows. This reduces administrative burden, accelerates site activation, and ensures that patients who have been systematically overlooked surface through the same data pipeline as any other eligible participant. The PRIME platform further compresses timelines by automating intelligent, branching prescreening questionnaires that patients can complete digitally with the ability to ask clarifying questions like “what is BMI?” in real time, without waiting days for a callback. Eligible patients are escalated to coordinators immediately. Those who don’t qualify receive respectful follow-up that keeps the door open. 

The results across more than 150 studies and 20 therapeutic areas: dramatically shortened prescreen-to-referral timelines, more than 100,000 hours of staff time saved, and a 60 percent conversion rate from contact to scheduled visit. 

Health Equity Is an Engineering Decision 

Earlier this year, Areti Health was named a finalist in the Health Equity Congress Start-Up Showcase, recognizing startups making meaningful strides toward advancing health equity in healthcare. Standing on that stage, I thought about my father  about what it cost him to walk into rooms and insist that institutions were stronger when they made room for everyone. I thought about what it means to carry that work into an industry that still, too often, treats equity as a checkbox rather than a design principle. 

The FDA’s 2023 guidance on diversity action plans makes clear that post-hoc demographic reporting is no longer sufficient. Sponsors must demonstrate proactive, data-driven strategies for inclusive enrollment. That is not a burden it is an invitation to finally build the research enterprise that patients who have been left out of the conversation have always deserved. 

The tools exist. The data is clear. What’s required now is the willingness to treat equitable access not as a problem to be managed at the margins, but as something you engineer from the start. 

The Future Belongs to the Patients We Haven’t Reached Yet 

My parents taught me that barriers aren’t permanent, they are invitations to innovate. At Areti Health, that is the work we show up to every day: not just making trials faster or cheaper, but making them genuinely open to the people medicine was not originally designed for. 

For those of us who have spent our careers at the intersection of community trust and clinical science, the progress is real and it is not enough. We keep going because the patients with the most to gain have waited long enough to be invited in. 

Niambi Blodgett is Senior Director of Customer Advocacy at Areti Health, a Silicon Valley backed AI-driven patient engagement platform committed to accelerating clinical trial recruitment and building a more inclusive research ecosystem.