Driving patient engagement – straight to the bottom line

By Kari Vereen | September 26, 2018


As an industry, the days of patient engagement as a simple nice-to-have are long behind us.

Today, we need to ask ourselves if we're taking patient engagement seriously enough – in our health systems, in our mobile applications, and in our daily scheduling workflows.

According to the Center for Studying Health System Change, patients who aren't engaged are twice as likely to defer care and three times as likely to have healthcare needs that aren't being addressed. With numbers like that, it's clear that patient engagement is a key driver of both clinical and financial outcomes for patients and practices alike.

At Carolina Health Specialists, we find that patient engagement affects many different facets of our business, from scheduling preventive care to collecting payments. In all cases, when patients better understand the expectation, whether it's their care plan, their bill, or their explanation of benefits, we get a better result, because they understand it – education is the real patient engagement.

We've experienced incredible success in building a framework for patient engagement within our organization. Read on for three real-world approaches to cultivating active collaboration between patients and providers, with clarity and accountability on both sides. Then tell us what's worked for your organization in the comments section below, or tweet us @athenahealth.

Get patients on the portal

We have a 65 percent portal adoption rate – but it didn't happen overnight. In the beginning, we literally had people in the lobby stopping patients and signing them up for the portal. Now, our centralized call center gets the email address of every patient scheduled and immediately sends an invitation to join our portal.

Our millennial patients simply expect 24/7 access, and are quick to change practices when they don't get it. At the other end, our 65 and older patients were the biggest portal adopters. They spend a lot of time thinking about their healthcare, and 91 percent of Medicare patients use the internet – it's how they communicate with their grandchildren.

Today, our patients use the portal to schedule appointments, including plenty of same-day and after-hours options. They receive all their preventive care reminders via the portal. And they can review health information and care plans, and view lab results.

Patients even get billing notifications and can pay their bill straight from their phone – we have been shocked by the number of patients who are taking advantage of this to pay their bills before we even put them in the mail – and we've seen our patient-pay-yield improve significantly.

We see this kind of patient-centered portal access as a real differentiator, a way to drive patient loyalty which, for us, stands at 82 percent, which is much higher than the average of 75 percent.

Reach out to close care gaps

At Carolina Health Specialists, we use the portal, group campaign calls, and any other means to reach out to patients with general wellness reminders, appointment reminders, and prompts to schedule screenings or other required preventive care.

The patient response has been overwhelming. In fact, we learned the hard way that we need extra staff in the call center before pushing out something like a flu vaccine reminder, because within 15 minutes, our phones are blowing up. That's how quickly they respond. It's a measure of our patients' engagement in their healthcare, their trust in our sincere commitment to keep them healthy long-term.

Patients also receive a health questionnaire before each appointment. It includes contact information, medical history, and a depression screening. All the information is reviewed by the intake team before the patient is seen. It has really improved our clinical workflow and made sure that we don't have any backup in appointments.

Our results have been remarkable. We screen 75 percent of eligible patients for colorectal cancer and have a depression screening rate of 63 percent. Our hypertension patients are 76 percent under control, and 72 percent of our high-risk cardiovascular patients are on statins.

Reduce no-shows

Our last strategy to increase patient engagement is to focus on reducing no-shows – because an open or missed appointment, in the clinic or the lab, is costly for everybody. We follow up with every person who misses an appointment to find out why they didn't make it, and we track that in the EHR. Did they have an emergency? Or did they just forget? What can we do better next time to remind them?

And, in the interest of joint accountability, we instituted a no-show fee – $35 for any missed appointment. We gave everyone a 6-months heads up, letting them know they would be fined if they didn't give us 24-hour notice of cancellation (the fee is waived if there are unavoidable extenuating circumstances). The fee is noted in the online reminder sent 10 days before the appointment. We remind them that these physicians have waiting lists, ask them to reserve time for their physician as their physician has for them, and urge them to take their responsibility seriously.

The proof is in the pudding: Over the past three years, we have seen a 50 percent reduction in no-shows. Our no-show rate is now holding steady at 3 percent – the average across healthcare is 18.8 percent. We aren't looking to make money off of no-shows – we'd much rather have a patient in that slot – so it wasn't about the dollars, but more about the common courtesy.

Preserving the partnership

All of this goes back to the idea that healthcare needs to be a partnership between patient and providers. At the end of the day, I don't think our portal adoption or no-show rates are the real measure of success at Carolina Health Specialists. These are proxies that say we are succeeding in designing the care experience around the patient – making providers available, engaging in shared decision-making, focusing on preventive care, and delivering the best outcomes.

Kari Vereen is business services director at Carolina Health Specialists in Myrtle Beach, South Carolina.

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