Community Memorial Health System, based in Ventura, California, had a legacy appointment reminder system that only delivered messages in English, which was a problem for many of its Spanish-speaking patients.
Also, the system provided patients limited responses by pressing 1 or 2. As a result, many patients either did not respond or simply cancelled.
So staff carved out time each day to manually call patients to remind them of their appointments, and to reschedule cancellations for necessary follow-up visits. Sometimes they got through and sometimes they left a message. It was time- and resource-heavy, and the no-show rate was quite high.
“Then, in December 2017, the largest wildfire in California history to date swept through our community,” recalled Lori Hooks, director of quality and practice systems, ambulatory medicine, at Community Memorial Health System. “Some of our sites had to close without notice. Providers could not work, or quickly moved to other locations temporarily.”
"Simply reducing no-shows will not do it. You have to fill those slots in a timely manner to see the benefit."
Lori Hooks, Community Memorial Health System
The health system had to reach out by telephone to every patient on the schedule with no advance notice. But then, even the call center had to move to another location to escape the smoke and power outages. That meant the core phone team could not make or answer calls until the organization scrambled to physically set up an alternate phone system. The organization got it done, but it was challenging. Staff knew they needed a faster, more nimble plan.
“Community Memorial Health System clearly needed a communication platform with the flexibility to handle each location’s unique needs while addressing the high no-show rate and with the ability to reach patients quickly in the event of an emergency,” Hooks said.
That is when Community Memorial Health System turned to health IT vendor Well Health.
“The team at Well listened to our issues and offered solutions that we felt were going to be effective,” Hooks remembered. “Things that our old system could not offer were suddenly all available: messages in multiple languages, the ability to customize on the fly without opening a formal support ticket, and the ability to customize the system for each of our specialty providers.”
As for emergency preparedness planning needs, the web-based nature of the new technology also made it possible for staff to log on from alternative locations and to launch emergency messages anytime, day or night. The health system also could send messages in batches by clinic or provider schedule. This was ideal for provider call outs and schedule changes.
There is a variety of patient engagement and text messaging systems on the health IT market today. Some of the vendors of these technologies include Casetabs, Demandforce, Medici, OhMD, Patient Trak, PerfectServe, Revenue Well Systems and Solutionreach.
MEETING THE CHALLENGE
At first, Community Memorial Health System piloted the Well system at one of its busy clinics. Scheduling agents noticed that most patients adopted the texting immediately. It was a familiar and convenient thing.
Staff customized the English and Spanish texts to strike a friendly tone, as staff would in any normal conversation. Patients responded well, even sending emojis back. If patients have landlines, or opt out of text, the Well app can still send a voice message, so it is set per customer preference.
“The pilot site noticed an immediate improvement in the no-show rate, and we also saw increased cancellations, allowing us to rebook many of those slots we had previously not been able to recapture,” Hooks explained. “One provider who had been counting on the ample downtime in clinic to do paperwork even commented that we were making him work harder all day. His schedule was suddenly full.”
Community Memorial Health System immediately decided to roll the new system out across all clinic sites. The subsequent results have been similar across the board, though different specialties have required some extra customization.
“Our scheduling agents can text-chat with patients and reschedule appointments,” Hooks said. “There is no need to play phone tag in order to recapture the visit. Also, our referral coordinators are able to notify patients of their specialty appointments, clinic staff can notify patients that paperwork is ready to pick up, answer simple questions, even send HIPAA-compliant messages at the patient’s request.”
To date, the provider organization has achieved full integration with its Allscripts practice management system, and it is working to integrate Well with its referral software. It also is coordinating efforts with the software QueueDr, a system that helps automatically fill cancellations that Well helps to create. The Well system continues to evolve as Community Memorial Health System works to customize it.
Results put simply: A 29% reduction in no-shows and a $1 million increase in annual revenue.
“And we have used the emergency messaging several times,” Hooks commented. “Unfortunately, we have had to activate this option for other fires, but also local incidents such as a building flooding, or a provider calling in sick and cancelling clinic at the last minute. Now we can reach the whole schedule of patients immediately via text or phone message, and notify them before they arrive for a cancelled appointment.”
Now Community Memorial Health System is setting new goals and looking at utilization patterns to move the numbers even more.
“Well provides monthly analytics to help us along,” Hooks noted. “We have estimated more than $1 million in revenue due to our decreased no-shows and increased utilization due to Well’s ability to enhance communication with our patients so we can maximize our clinic schedules. Simply reducing no-shows will not do it. You have to fill those slots in a timely manner to see the benefit.”
ADVICE FOR OTHERS
“Vendors always want to generate an interest in having you buy what their product can do, but you need to keep the conversation focused on your organization’s needs,” Hooks advised. “Do not stop looking until you get the answers you are seeking. Lots of products are good at one or two functions, but don’t give up on getting more. Today’s solutions need to offer customers flexibility to innovate, excellent support, and interoperability with a light touch.”
As Community Memorial Health System strives to meet the requirements of the ever-changing value-based payment systems, its dollars need to go further, she added.
“We need all the help we can get,” she concluded. “Health systems really need to build a team of vendors that can drive meaningful change and efficiencies and offer good analytics to prove the business case for their products. Do not be afraid of making a change if you are not getting what you need. It is a lot of work, but it will help serve your providers and patients better in the end.”