- As medical practices seek to close gaps in care and reduce patient no-show rates, many may be turning to patient outreach technology to better connect with patients. But in an industry seeing technology emerge at lightning speed, some medical professionals may have concerns with the impact on compassionate, personalized connection.
At Grunberger Diabetes Institute (GDI), patient outreach technology did not need to trump genuine patient-provider connections, according to the practice’s office manager, Lynne Frazier. Instead, these technologies built upon the practice’s longstanding commitment to patient relationships while addressing care access issues.
GDI was specifically seeing issues with patients keeping their appointments, Frazier said in an interview with PatientEngaegmentHIT.com.
“We really had a high number of no-shows and we had no way of tracking that,” Frazier explained. “The EHR we were using only would send e-mails to our patients, but not everybody checks their e-mails on a continual basis, so patients were missing them or they would check it after the appointment actually occurred.”
The diabetes practice was especially seeing issues getting patients back into the office after an appointment cancellation.
“We also had no way of doing recalls,” Frazier noted. “We were losing some of our patients through the cracks because we weren't following up. If they canceled the appointment – you know, their three-month follow-up – they would cancel it, but then somehow things would get lost in the system or they would get lost in their busyness and we wouldn't be able to follow up because we had no way of tracking that.”
GDI tapped Solutionreach, a patient engagement technology that helps connect patients with their practices and manages patient messaging. The tool connected GDI with patients via text message because that was the most effective platform on which the practice could reach its highest risk patients.
When patients received appointment reminders and nudges to schedule doctor’s visits in the right place, Frazier saw an enormous difference in patient retention. Patient no-show rates went down by 66 percent, and Frazier was able to reschedule cancelled appointments for 675 patients.
“If there's nothing in the system scheduled, patients actually get a reminder text and we do see a lot of response from that,” Frazier explained. “We have patients responding very positively to get those appointments scheduled. We needed a much better way of communicating with our patients than by e-mail, so we were looking for a text message solution.”
Of course, there was some technological divide. Although research indicates that most Americans own a smartphone, some of the older patient populations had the potential to fall through the cracks, Frazier acknowledged.
“Some of our older patients don't even have a cellphone or they have a flip phone, something like that. But we knew technology was going to be a minor issue, but we weren't really concerned with that,” she stated.
Older patients weren’t part of the patient population at high risk for no-shows or forgone recall appointments, Frazier explained. Older patients – the ones who might not have a text messaging device – tend to be retired and are usually on top of their care management strategies at GDI.
It is younger and middle-aged patients managing busy personal lives who tend to fall through the cracks.
By connecting with those patients and reducing the occurrence of no-shows, GDI has been able to recover the costs of the outreach technology. Cost was the main point of contention when Frazier first pitched the tool to clinic leader George Grunberger, MD, FACP, FACE.
“The biggest challenge was getting Dr. Grunberger to approve it. That was my biggest challenge because of the cost,” Frazier recalled. “But when we saw what we could be gaining from those recall appointments, it would more than take care of the cost of the program. And it did. In the first year itself we more than covered the cost of the program because of our recalls.”
The patient outreach tool has supported other areas of clinical improvement, Frazier noted. The patient feedback option has garnered 67 online reviews so far, which Frazier and Grunberger look at on a monthly basis. These reviews have influenced some practice changes to better serve their patient populations. They have also served as marketing tools on social media platforms, Frazier explained.
The online review tool has also allowed individual doctors to receive insights into their clinical workflows. When doctors receive a review of four stars or less, Frazier calls the reviewing patient and asks how the clinic can better serve them next time. This is a satisfier for patients, and offers insights into practice improvements.
Those practice improvements translate into some patient engagement reporting measures, Frazier said. Under the Medicaid Access and CHIP Reauthorization Act’s (MACRA’s) Merit-based Incentive Payment System (MIPS), participants must select some performance measures. The patient outreach tool’s patient feedback function gives GDI concrete reporting data for collecting and following up on patient experience and satisfaction data.
“I'm actually able to choose that activity and show our reviews and what we do to improve patient satisfaction at our office,” Frazier stated. “I couldn't do that before unless I used comment cards, but this actually shows CMS numbers and hard data.”
The tool also assists under the continuity of care category for MIPS.
“We can actually pull that measure as well and get credit for our patient outreach efforts,” Frazier continued. “Before, we wouldn't have been able to claim that measure and not get credit for it. But because we're doing recalls and are capturing those patients that are falling through the cracks, we actually get credit for that.”
Despite those reporting benefits, Frazier maintained that the biggest improvement from patient outreach technology was supplementing the practice’s relationships with patients. The tool contacts patients regularly, she pointed out, which is a part of the practice’s mission to always try to contact all patients.
“We know there are always going to be some people who don't respond, but we want to go the extra mile and capture them,” Frazier explained. “We are trying to focus on the personal touch at our office, and we try to stay in touch as much as possible.”
Outreach messages aren’t always clinical. The tool sends a birthday video greeting, newsletters, and holiday updates. The tool also allows the clinic to conduct emergency outreach with patients, such as clinic closure due inclement weather.
There are times where the system sends out more reminder messages than may be necessary, Frazier conceded. However, more messages is better than too few messages.
“We have some thyroid patients that only need to be seen once a year,” Frazier said. “They get the recall messages because if they don't have an appointment on the books in three months, they're going to keep getting those reminder calls. But you know what? It keeps our name there. Patients will say, ‘I think I have an appointment six months from now. Can you check on it? I'm getting this reminder on my phone.’”
When Frazier and staff members explain to patients the purpose of reminder messages, patients tend to understand.
“We tell them that we do that as a precautionary measure and they understand and they're fine with it, and they actually are very appreciative that we've gone that extra step to make sure that they're being cared for,” she noted.
Although GDI’s patient outreach is supported by technology, Frazier maintained that it aligns with the practice’s mission to deliver person-centered care with a personal touch. Healthcare is living in the digital world now, and patient outreach technology helps GDI reconcile personal relationships with technology use.
“Our doctors are very personable and know all of the patients. They know what's going on in their lives and they try to keep in contact with them just so the patient knows that they're there,” Frazier concluded. “The more they hear from us, the stronger the connection and the stronger the relationship they have with our office between physician and patient.”