L.A. health center reduces no-shows, fills empty slots via text messaging
Universal Community Health Center in South L.A. was experiencing a terrible lack of consistency with patient reminder calls.
The center has four operators who take care of all of the patient reminders for the provider team. The center was finding that the operators were overwhelmed by call volume; with the large number of calls that were coming in, they were simply not able to make all of the reminder calls on their lists.
Additionally, front office staff – who also would help with reminder calls – already had a lot of work they needed to do, so if someone was out sick or unavailable, patients would end up not getting reminder calls for their appointments.
This led to a high number of missed appointments – upwards of 50% – and unhappy patients. On the business side, that meant a lot of empty slots.
“In addition to volume, we had a problem with two-way communication,” said Dr. Edgar Chavez, CEO of Universal Community Health Center. “Operators would say they left a message, but we had no confirmation from the patient that they received it. It became a vicious cycle of no communications; we wouldn’t be able to get the patient, and they wouldn’t be able to get us.”
The center’s eClinicalWorks EHR does have a reminder system, but it does not allow for two-way communication with the patient; it would simply allow for one reminder to be sent, without the ability for patients to opt for alternative appointment slots, he explained.
The center turned to patient relationship management IT vendor Luma Health, which promised that with its texting platform, the center would be able to have two-way communication with patients.
“We would be able to alert them ahead of time when their appointment was, and do so within a schedule we set,” Chavez explained. “In addition, the platform would interface with our EHR, whereby it would update the visit type within the system to alert us that, yes, the patient has confirmed, saving us the time of having to switch over and enter that into another system.”
By enabling two-way communication, Luma Health said the center would be able to decrease the number of no-shows and fill empty appointment slots.
There are a variety of patient relationship management tools on the health IT market today. Some of the vendors of these tools include Luma Health, RevenueWell, Salesforce, Solutionreach, Weave, WebPT and WELL.
MEETING THE CHALLENGE
Chavez said he looks for vendors that will work with his EHR – within the EHR. He does not like to have platforms outside of eClinicalWorks because he said it makes it difficult for the data to come back; things get murky.
“We deployed the Luma Health system pretty quickly since this was such a big problem for us,” he recalled. “We wanted the operators trained on how to manage the reminder messages, so that was what we focused on first. Once it was implemented, we rolled it out to patients – a timeframe of about 2-3 weeks.
“It went smoothly,” he added. “People liked being able to communicate in compliance with HIPAA with patients and then having those responses go back to the EHR as a telephone encounter. It was great to have a record that we texted and/or called the patient.”
On the patient side, one consequence of the rollout of the new system was that once they started receiving texts about their appointments, they wanted the ability to text about other things.
For example, they wanted their referral paperwork sent via text; they didn’t want to have to pick it up or have it mailed. So, soon after the text program, the center implemented document exchange through the referral coordinator program with Luma Health.
With the new reminder texts in place, the Universal Community Health Center had a drop in no-shows between 5-7% within the first three months. It also saw a decrease in empty slots of about 10%. Many more patients were being reminded to come in for their appointments and empty slots were being used up passively.
“Before, we were seeing about 6-7 patients each day,” Chavez said. “With the platform in place, we were able to add 1-2 patients to get to the sweet spot of eight patients. For us, the passive scheduling made a big difference – allowing patients to choose an appointment time that works for them seamlessly via text message. We were able to fill some of those empty slots that previously would have gone unused.”
The center had implemented the text reminders about 3-4 months before COVID-19 struck, so by the time it hit, the center had gotten really good at communicating with patients via text.
“Therefore, when we had to switch over to telehealth – which we did over a weekend – we already had a built-in way of communicating with them,” Chavez explained.
“For patients with appointments on that Monday, we sent a text message on Thursday telling them to not come in for their appointments; rather, they could confirm that they wanted to do a tele-visit. Because we had already been communicating with our patients via text, they were used to that form of engagement and we were able to maintain pretty much the same level of appointments that first month of the pandemic.”
ADVICE FOR OTHERS
“Evaluate what the biggest challenge is for you and your patient community,” Chavez advised. “Ask yourself: What is the thing preventing patients from coming in based on my scheduling scheme? How are you reminding patients to come in? Is it efficient? Are you allowing them to efficiently reschedule – in a way that fits into their existing lifestyle?”
For the center, it realized the system it had in place was no longer efficient. One patient could be taking 30 minutes of an operator’s time because they had so many questions. The process in place wasn’t allowing for staff to connect with all patients, making it largely inefficient and ineffective, he added.
“We have identified three phases of patient communication: Snail mail, texting and social media, like portals,” Chavez concluded. “A lot of people, especially the elderly, are not ready for the portal, but they are really good at texting. I decided that’s where I wanted to meet my patients, at texting. Once they get savvy with that, we can move onto getting them comfortable with the portal. I wanted to make sure we have a solution that would allow us to grow into something in the future.”