A very warm Hello to our curious readers who are looking to get some more insights into how the AppointmentNotify Platform can boost efficiencies and improve the bottom line for fairly large healthcare providers (Health Systems) comprising of many physician practices, a significant socioeconomically challenged higher-risk patient population with a high appointment no-shows rate. This particular blog post will highlights the efforts undertaken at the Einstein Healthcare Network, a not-for-profit academic, urban health system founded in 1865, which operates facilities and outpatient centers in Philadelphia, PA. The article specifically highlights the extent of the problem at the health system, the solution they implemented, the results sought and gives a fair indication of how the health provider might be able to gain additional savings and increased sustainable revenues by supplementing their efforts with AppointmentNotify if they wish to engage us.

Einstein Healthcare Network logo
Courtesy: Einstein Healthcare Network

NOTE: The AppointmentNotify Platform is agnostic to the size of the organization using it as it allows organizations large or small to use it the same way. It can be used by a one-doctor family practice to a medical group with dozens of physicians to a large hospital with several in-patient and out-patient facilities. Additionally, it allows different medical businesses to “connect” with each other so that they can manage appointments for medical businesses from within the same AppointmentNotify Platform Provider account without having to have separate accounts for each. This versatility allows appointment information to be visible to other entities and extremely beneficial to a larger health systems who wants to view this information for its sub-entities.


Our blog post is a commentary on a July 16, 2018 article by the Advisory Board titled: “How Einstein Healthcare addressed their no-show problem—and drove 40K additional visits per year“. This well-written article narrates the successful approach taken by Einstein Healthcare Network back in 2017 to reduce their high number of patient no-shows. The article describes reflections from Barry Freedman, CEO of Einstein, and members of Advisory Board’s Patient Access Consulting team who worked with Einstein on that effort.

Here is a quick snapshot of Einstein Healthcare Network’s problems and employed solution as outlined in the article:

PROBLEM

  • High no-show rates of 20-30% at several physician practices,
  • 160,000 missed visits annually out of a base of almost 1 million annual visits,
  • Long wait times for new patients as well as repeat patients to see their physicians,
  • Even physician practices employing tools like patient reminders, strong policies and workflows were also facing high no-show rates; meaning the otherwise useful tools and processes were ineffective,

SOLUTION

  • Analyse and understand root causes triggering no-show behaviors for specific patient subsets to evaluate 20-25 different data attributes that could help predict no-show rates meaningfully.
  • Develop and deploy a complementary tool that makes use of the attributes to understand specific factors (including Social Determinents of HealthSDOH) to reduce the chance of a particular patient becoming a no-show.
  • Use the tool to strategically overbook based on no-show probability for each patient to avoid wasted capacity.

RESULTS

  • 75% accuracy predicting patients who didn’t show up at Einstein as being highly likely to no-show,
  • Only 5% had been flagged as likely no-shows when in fact, those patients did show-up indicating the margin of error being low for the tool,
  • Reduction in no-show rates from 19.4% to 16.5%; a ~ 4% more visits yearly (~ 40,000),
  • Potential to reduce total overall patient no-shows by up to 30% if utilizing recommended overbooking strategies,
  • Improvements in patient satisfaction due to better access,
  • Improvements in staff morale due to workflow efficiency gains.

The article quoted Einstein’s CEO, Freedman:

I think that tools that allow you to predict the risk of patient no shows and the ability to create patient risk profiles are incredibly valuable. I think everybody that is experiencing a problem with no-show rates needs to consider applying tools like this to achieve better efficiency.

The above points highlight how a large Healthcare Provider was able to work with a prominent consulting group to dig deeper into a rich set of data to analyze the root causes of why patients end-up as no-shows and to reclaim efficiencies by deploying a self-learning tool that let’s them predict patient behavior using statistical methods. The end goal is to improve access for patients (especially high-risk patients) and help them change their behavior that could result in better health outcomes all the while improving the bottom line by reaping efficiencies for the health provider.

Let’s now turn our attention as to how we at AppointmentNotify could be of help to Einstein and other health systems who are facing similar challenges. It is important to note that our solution is not restricted to solving the no-show problem only. We have a much wider set of features that we offer to engage both the Provider (Physicians as well as the Front-desk Staff at Physician Practices) as well as the Patient!

How can AppointmentNotify supplement curbing no-shows?

If we have to ask a simple question about healthcare then what do you think it would be?

Say we ask:

Who is the most important stakeholder in healthcare?

The answer could vary depending on who you ask, however, as Patients, we @AppointmentNotify felt a need to raise our voice loud and clear, and answer it:

“Patient” is the most important stakeholder in healthcare!

Do you (the reader) have a difference of opinion?

Regardless, as Patients we have been seeking advice, counsel, care and help from Providers and all the other healthcare stakeholders since the get-go. In this age and time, we feel we need everyone else to know the Patient perspective and “demand” something that we would like to have as opposed to all others “choosing” what is best for us.

That is the essence of what is different in the AppointmentNotify Platform which is including the most important entity that others normally do not tend to include directly in their tools and workflows which is: the Patient!

The tool that Einstein implemented is definitely a great achievement, however, it “only works from the Provider-end” so to speak and uses “historical (appointment) data” combined with demographics and perhaps other patient information to “predict” future outcome. What it is still missing is “active real-time engagement and input/actions by Patients themselves” that could help Providers “interact” directly with the Patients and get their preferences in real-time. That could be one simple way to avoid a lot of challenges faced by Providers as well as Patients both before seeking an appointment as well as while waiting to see the Physician in the waiting room.

AppointmentNotify is plugging the missing piece (the Patient) in this puzzle by giving patients access to a Platform that can allow them to interact with their Providers directly and with other Patients indirectly. We believe this simple change in workflow for managing appointments can keep the Patient as well as the Provider happy allowing them to gain value as well as better experience than is typically offered by other tools which were specifically designed to address this problem from the Provider-end!

Let’s try to quantify our suggestion above by sharing research metrics from MGMA:

MGMA-2017-Report
Courtesy: MGMA Research & Analysis Report, August 2017

As can be seen above, patient no-shows (and cancellations, for that matter) are directly related to appointment lead times. The longer the lead time, the higher the chance that the patient will be a no-show or will cancel the appointment. So while tools like that implemented at Einstein are good in predicting no-shows, they really do not give assurance that patients will:

  1. have a dedicated appointment slot,
  2. the ability to allow patients to specify their schedule preferences, and
  3. find direct value that the patient could see, experience and make use of (that is, find value in it) other than the indirect benefit of seeking an appointment the same way they have been used to (that is based primarily on Provider’s own availability and not Patient’s schedule preferences!)

This last point above is perhaps the most important for patients if one expects them to change their behavior over long term.

That is:
Until and unless you provide something of value to patients which offers them a unique experience of being part of the engagement, it is highly less likely they will engage!

And that is visible in the use and adoption rate of Patient Portals to-date which is dismal at best!

Roughly 90 percent of providers offer patient portal access, however, it is no surprise that less than one-third of patients are accessing their own health information via such portals, according to this 2017 article by PatientEngagementHIT. Now this is interesting since a typical Patient Portal offers a lot of things of value (PHI – Protected Health Information) to patients like: appointments, messaging, test results, medications, care notes etc. That is on-top of patients getting to have access to their own account (the Patient Portal account)! Additionally, Patient Portal mobile apps complement adoption as it offers quick and easier access. Despite that Patients are not adopting Patient Portals across the board.

What could a patient possibly ask for more in a Patient Portal which renders their adoption?

Well, as patients ourselves, we at AppointmentNotify tried to answer that in a simple way below:

[Patient]:  Thanks for giving us access to Patient Portals, however, no thanks for the below:

  • There are dozens of portals of all sorts, all with weird login id requirements. How am I supposed to use different portals offered by different providers to get a consolidated view of my health. It is cumbersome to remember so many account credentials which adds to my already degrading health pressures!
  • The appointment feature of typical Patient Portals is useless as you are told to wait a day or two before your appointment is confirmed. Some of the worst portals tell you that someone will give you a call to confirm your appointment!
  • Messaging: Ah, the holy grail of Patient-Provider Engagement. It is still plain old email-based messaging as opposed to real-time chat. Worst yet, not all Physicians respond and respond in time. What good it is is to get an answer after I no longer require it?
  • My test results do not show up in my Patient Portal account, even after I tell my provider. They tell me to stop by and pick up a paper print out or they could fax it to a fax machine. Hello! “I no longer use a fax machine!”
  • My medications are not up-to-date either and there is little ability to have multiple physicians from the same medical practice know about all my medications prescribed by different physicians!

The bottom line is that the use of Patient Portals by Patients is not as valuable as has been perceived and offered by Providers and their vendors. The healthcare industry has pretty much not been able to understand what value Patients seek from a tool like Patient Portal which is meant to engage them better.

We close this post by summarizing what we wanted to communicate to our readers. AppointmentNotify is supplementing to fill the gap that others have not been able to fill, which is to include Patients voice to engage them so that they can participate in making choices that could help them change their behavior for positive health outcomes. This engagement has long term benefits for patients as well as providers as it is a strategic solution to solve challenges that our healthcare system as a whole has been facing since a long time. This is opposed to short-term fixes which only solve such problems from one end (the end across from the Patient!). We have seen the efficacy of in-house tools, like the one implemented at Einstein as well as those available widely to Patients (Patient Portals). It is time healthcare organizations look at simple yet innovative solutions like AppointmentNotify to gain adoption as well as greater efficiencies for improved patient health outcomes and a healthier bottom line!

AppointmentNotify can help the Patient, the Provider and the Healthcare System as a whole.

Feel free to engage us if you think we can add value to your existing process. We offer an add-on platform that does not require any change on the provider-end which is a great way to try out a pilot and see if your patients, physicians and front-desk staff gain benefit from its use. In the case of Einstein Healthcare Network, the new tool they implemented was able to reclaim 40,000 no-shows with double-booking strategies based on data set on “existing patients” including the historical appointment activity. The network typically faced 160,000 missed appointments annually which means a 25% benefit. One can expect that with time the self-learning tool realizes more gains and we hope it reaches a much higher figure some day.

Now imagine, AppointmentNotify requiring no change for Einstein to try it out, requires no double-booking, very little involvement from the Front-desk staff, gets patients (both existing as well as new) to engage in real-time with their providers. This Platform could potentially sort out both the longer lead time issue as well as the no-show and cancellation issues faced by the network in the simplest possible manner.

Sounds surreal, right?

All we have to say is try it out. You have nothing to loose and everything to gain. There can’t be anything better than that! 🙂

NOTE: This blog post is our own depiction of publicly available online information of the sources mentioned.