Across the athenahealth network and beyond, healthcare organizations are designing and implementing simple interventions with outsized impact on outcomes, satisfaction, and success. Here's another.

The problem

A low no-show rate is vital to the success of any practice, but for Treasure Valley Family Medicine no-show patients have an even more profound impact on the bottom line. The Idaho-based direct primary care practice’s standard appointment duration is 30 minutes. That’s double the average primary care non-wellness appointment. This means an enhanced negative financial impact for every patient who doesn’t show up at Treasure Valley. Dr. Brian Crownover and his two physician assistants have the opportunity to get a more in-depth perspective into the holistic health of their patients and reduce the number of outbound referrals thanks to their comprehensive primary care model with longer appointment times. But to serve both the population’s physical and emotional needs, Treasure Valley needed an easy way to communicate with 3,000 patients.

The solution

As a former Air Force doctor, Crownover previously received four to 10 calls a night after-hours. After starting his own practice in 2014 and “training” both himself and patients to regularly use athenahealth’s patient portal, he gets an average of just two after-hours calls a week. Eighty percent of his patients have adopted the tool, and automatic reminders of upcoming appointments greatly reduce no-show rates. He says using a portal for communication—instead of going back and forth with phone messages—contributes to healthcare grounded in “personal relationships.”

“It’s really about trust—if they can depend on me to get back to them, patients are willing to communicate asynchronously. For me, the patient portal is an excellent tool. I really push our patients to use the portal because one, it means I don’t have to mail out lab results, for instance,” he said. “I’m expected 365 days a year to have my cell phone at my side, but if you’re getting calls every night, you don’t have much of a personal life—and the time spent on calls isn’t reimbursed.”

Crownover says having the flexibility to respond to messages when he wants versus being interrupted in the middle of family events has made his homelife “tremendously better” and decreased factors that contribute to burnout.

Besides reducing his stress level, the portal supports his practice’s profitability, Crownover said. Across the athenahealth network, 2020 data show a 5 percent increase in patient yield among practices that increase portal adoption by at least 20 percent. Treasure Valley Family Medicine has quadrupled that with their 80 percent adoption rate; Crownover can go beyond discussing medical issues or delivering lab results and is also able to direct messages to his office staff to follow up on billing questions using one streamlined tool. “What I was really looking for from the outset and what I really like about my EHR is centralized functionality,” he explains. “I can have a patient record and my tool also supports a HIPAA compliant communication portal, as well as quality metric reporting and financial accounting … [Everything] under one roof is very helpful.”

Communication through the portal has also been key during the COVID-19 pandemic. Treasure Valley Family Medicine has been able to send push notifications with virus warning signs to patients scheduled for visits. By proactively requesting that those with symptoms don’t physically visit the clinic, they’ve been able to avoid exposure for staff and other patients.

Financial stability is vital to maintain access for the local community, which has a large at-risk population. Thanks to the portal’s options to connect patients’ caregivers with providers, Treasure Valley has been able to serve the complicated mental and physical needs of developmentally disabled adults, and juvenile patients in foster care. The local hospitals have restricted availability for Medicaid psychiatric medication management appointments, meaning new-patient intakes can take anywhere from six to 10 months, Crownover says. By scheduling these new patients within a week, he can have an ongoing dialogue with caregivers or adoptive parents earlier during in-person visits and portal communications – vital during a child’s rapidly changing developmental stages.

The outcome

Crownover is among the body of doctors anticipating a potential uptick in requests for mental health services due to the stress of the COVID-19 pandemic, making after-hours communication essential.

So far, he says the better he can connect with patients without burdensome, unanticipated phone calls, the more fulfilled and less stressed he is. “For me to be able to work with these folks – especially on their mental health concerns — and see their gratitude as to how their lives have changed is really just so gratifying,” Crownover said. “It may not be as dramatic as going to the OR and replacing a hip, but the difference you can make in a family’s life can be as big or greater versus doing some of these high-ticket surgeries.”