Why Your Patients Won't See You

Healthcare organizations need to remove access barriers, help patients address financial challenges, and promote care coordination.

When it comes to patient experience hurdles, one of the most vexing challenges for healthcare organizations is when patients struggle to see their providers.

Patients encounter difficulty when trying to schedule timely appointments, run into barriers paying for their care, and face predicaments in care coordination. All these problems detract from the patient experience.

When we think about why it is so difficult for patients to see their providers, it is often because healthcare organizations have made the process difficult, says Laura Pickett, vice president and chief patient and family engagement officer at IU Health. "Patients have been clear with us about what they want. They want us to listen, they want us to partner with them, and they want us to connect with them. But the way we have grown up in the industry does not allow for those things to happen," she says.

So what can healthcare organizations do to help patients?

The primary barriers that make it hard for patients to follow through on seeing their providers are access gaps and long wait times, Pickett says. "With long wait times and trying to be everything to everyone, it is causing a headache in the industry. We need to think about how we can get patients in more expeditiously, which is on the mind of every patient experience officer across the nation," she says.

The long wait times have been accelerated by the COVID-19 pandemic because there are many patients who put off care during that time, and healthcare organizations are trying to catch up with them, Pickett says. The solution is to get back to a proactive state of health rather than a reactionary state. Healthcare organizations need to focus on reaching out to their patients to fill care gaps, she says.

Access is working against healthcare organizations in getting to see their patients. When access is a barrier for patients, they have options for seeking care such as going to an urgent care center outside of their established healthcare organization. "If a patient has to wait a long time to see their established provider, they can select a different option that is in the market," Pickett says.

Healthcare organizations should leverage the voices of patients and families to identify the actions where they would assign value in addressing access gaps and long wait times, she says.

"From that research, we should then act. At IU Health, we are researching this now, so our strategy is built from patient insights and we're addressing the areas within access that have high perceived value to those we serve. Anticipating the research findings, a hypothesis might be: We expand or co-design methods of care delivery (can a patient appointment occur virtually or by phone?) to mitigate access gaps, or for wait times, we can better manage expectations transparently and focus the patient and family on our next step together and what to expect so the patient feels progress. Excellent service and quality delivery can mitigate the stress of a wait time," Pickett says.

Another issue that keeps patients from keeping their follow-up appointments is patients live dynamic lives that change, she says.

"Our industry as a whole does not have mechanisms to react and support change in the moment. For example, if a patient has waited for six months for a follow-up appointment with a dermatologist, and on the day of the appointment the patient wakes up with a sick child in the house, the patient needs to stay home with their child. The patient may not be able to interact with their provider and get another appointment quickly. The provider is not in a position to respond to the life changes their patient may have happen outside of their healthcare needs," Pickett says.

Healthcare organizations can better serve the dynamic lives of their patients and families by considering Plan B and Plan C for them in the event of a shift and offering those options to steep care in patient-centered flexibility, she says. "In essence, we must become less static and more empathetic in acknowledgement of the holistic patient life, not simply the appointment that day.

In the case of the example of a sick child on the day of an appointment, it would be important to engage the patient, Pickett says. "Envision an engagement where a response could be: 'We were looking forward to caring for you. You're important to us and we understand life changes in unforeseen ways for our patients. May I offer you rescheduling options so you can be focused on your sick child? Is there anything we can do to support you in your child's care given she isn't feeling well?'"

Addressing financial barriers

A major reason why patients do not see their healthcare providers is financial considerations, Pickett says. "Cost is a major factor. We have a lot of patients and families in communities across the country who are making difficult choices. Do they get the medicines they need, or do they feed their family? Those decisions can determine whether they can utilize a healthcare provider or not utilize a healthcare provider," she says.

Healthcare organizations can help their patients clear financial hurdles, Pickett says. "At IU Health, we want to ensure that we are competitive from a cost standpoint. Secondarily, you have to consider whether you truly know your patients and whether you know what their barriers might be. There are financial assistance programs, and our access program works closely with patients and families to find a plan that might work well for them financially," she says.

A specific way that healthcare organizations can help their patients navigate troubled financial waters is to assist with understanding government payer programs, Pickett says. "Some of our government payer plans have preventative services that are included in the payer plans. So, it is important to have proactive outreach when patients may consider choosing us to let them know that services may have low or no cost. For example, with Medicaid, we can help with education that can enhance a patient's ability to access us," she says.

Improving care coordination

The primary challenge for patients within care coordination is that healthcare providers are fragmented, Pickett says. "Communication among and between even team members employed by one organization does not always make the care coordination process seamless for the patient or the family. The challenge is even larger if a patient receives care across several organizations," she says.

The solution is to put processes in place that improve communication between team members. Case managers, care navigators, and nursing staff can play a key role in these efforts.