Text-based technology has improved a California clinic's interaction with patients, while bolstering operational performance and patient satisfaction.
With the ability to instantly exchange information via a mobile device, texting changed the way people communicate with each other. Does it hold the same potential to alter interactions between healthcare providers and their patients?
According to the University of California, San Francisco (UCSF) Health Hub, it might. Luma Health, which offers a suite of products that primarily use text messaging to help providers and clinics manage patient communications and appointments, was selected as the winning EHR Patient Engagement solution in the USCF Digital Health Awards this fall.
To think of this innovation as merely a convenient HIPAA-compliant method to exchange messages is a mistake, says Samantha Guthman, chief operations officer at Alexander Valley Healthcare in Cloverdale, California, which has been using the solution since last year.
The patient engagement platform has "completely transformed how we do business with our patients," she says, adding that the simplicity of the technology is a large part of its appeal. It uses a common feature—texting—on devices patients already use every day, yet through interactions with intelligent chatbots, it accomplishes many of the same tasks performed by mobile apps and patient portals without the need for logins or passwords, Guthman says.
The solution has had a powerful impact on the clinic's operational performance and patient satisfaction, she reports. In 20 months of use, scheduling and wait lists have been automated, relieving staff members of 1,500 calls each month; the clinic now operates close to capacity; patients are seen faster; and the clinic's Google star ratings have improved from 3.5 to 4.9 stars only six months after use. In addition, patients are becoming more involved in their own healthcare with a greater percentage signing up for health screenings.
As part of HealthLeaders' effort to help readers sort through myriad innovations on the market, we take a deeper look at this solution, selected in the USCF Health Hub contest from a field of 500 entries, which were narrowed down to winners in 13 categories. Submissions were open to qualified, mature digital health companies with in-market products that have been used by thousands of patients and have been verified in a validation study or clinical trial.
The Problem: No-Shows and Lack of Patient Engagement
Alexander Valley Healthcare is a federally qualified health center, offering primary care, chronic care case management, behavioral health and substance abuse services, general dentistry, and other patient services. In addition to serving uninsured and low-income patients, the clinic also cares for a large number of privately insured patients and Medicare beneficiaries. It is the only health center in a 20-mile radius and provides care for 5,200 patients, encompassing more than 25,000 patient visits annually.
Due to no-shows, providers at Alexander Valley Healthcare were not working at capacity, Guthman explains. While staff tried to fill vacancies, it was a difficult process to manage manually. In addition, very few patients responded to cold calls or canned texts generated through the EHR urging them to schedule appointments or prevention screenings.
"We were seeking a solution to engage our patients," says Guthman. "We chose Luma Health because of its functionality." It enables the clinic to manage the entire appointment life cycle in a way that improves operational performance and business results. The flexible design also fed into the clinic's existing workflows and offered opportunities to customize messaging, she adds.
The Experience: Fits Into Workflows; Patients Comfortable With Texting
Alexander Valley Healthcare began using the solution in February 2018. The chief operating officer worked with the vendor to personalize the messages that would be delivered to patients, along with an appropriate sequence and cadence.
"They customized the whole setup to our practice," says Guthman. "It's user- and patient-friendly, so training was minimal." The biggest challenge, she says, was getting staff to adapt to the new system simply because it was a different way of doing things.
Another potential issue was overcome once the solution was deployed. "We weren't sure how our patient population was going to [react]," says Guthman. "They adapted really well." Almost 90% of patients now use texts to communicate with the practice, she says.
Results and Impact
The patient engagement platform has become the backbone of the communications system between the practice and its patients and has changed how the clinic conducts business. Guthman reports the following eight ways the tool delivers results and impact:
- Reduces the no-show rate. Before using the system, 14% of patients did not keep clinic appointments. The industry standard, says Guthman, is 10%, "and we're under that now at 8%." The entire process is automated, including reminders, scheduling, developing waiting lists for specific appointments, and filling slots created by cancellations. There is no need for staff intervention, freeing them to focus on other activities.
- Fills providers' schedules. As the no-show rate drops, capacity rates increase, Guthman explains. Before using the technology, the clinic was operating somewhere between 80% to 89% of its capacity. We're now at 95% of our capacity, which is huge," she says. The advantages: providers are more productive, and patients are seen sooner, she says.
- Helps patients become more involved in their own healthcare and increases enrollment in prevention screenings. Before employing the solution, staff members would cold call patients to inform them it was time for preventive services such as a Pap test or colorectal cancer screening. Previously, only 4%–8% of patients signed up for the recommended service. Now that these notices are personalized and automated, 45% of patients receiving these texts register for a screening. A big payoff from this dynamic is that patients are becoming more involved in their own healthcare, says Guthman.
Guthman says that personalizing the message with the patient's name and their doctor's name and testing recommendation helps. The patients can click to set up an appointment or read more about a test or condition provided in a link. These are often set up as a series of messages. "The communication is not canned; it's personalized and relevant to our patients," she says. "It makes the patient feel special, [and conveys] that we care about what's going on in their life."
- Frees staff time. Because the system automatically fills appointments, the clinic eliminated the need for staff to conduct 1,500 calls each month.
- Increases patient access. During evenings or weekends, patients can set future appointments "without having to call or wait for us to come in on Monday morning," says Guthman. "It's completely opened up access for our patients."
- Secures real-time patient feedback. Two hours and 15 minutes after an appointment, each patient receives a text asking how likely they are to recommend the clinic to a family member or friend. In addition to gathering this Net Promoter Score, if the number is low, it links the participant to a survey to provide further feedback. "There are no forms to fill out, and I can address issues the day they happen," says Guthman. "It allows us to be more proactive and allows patients to share their concerns or their gratitude with us on a real-time basis."
- Boosts patient satisfaction. One key measure of patient satisfaction received an immediate bump after installing the solution. "Our overall Google review page went from 3.5 stars to 4.9 stars in six months," says Guthman.
- Organizes data into detailed reports. In addition to aggregate data, the system provides net promoter scores by provider and location. "You can really drill down and see all of your promoters and detractors," she says. "You can also see how many appointments were back-filled and how many were on the wait list. There are a number of data points that you can pull from and it's user-friendly. It's great to have that data when we had nothing before."
Return on Investment
While Guthman and Luma Health declined to disclose costs for implementing the solution, Alexander Valley Healthcare established its return on investment by determining "how many back-filled appointments we needed the system to do to start paying for itself," Guthman says. "We've averaged 65 back-filled appointments a month, exceeding [our goal.]"
“Luma Health has completely transformed how we do business with our patients.”
Samantha Guthman, chief operations officer, Alexander Valley Healthcare
Mandy Roth is the innovations editor at HealthLeaders.
The innovation employs patient-friendly text-based communications to replicate many of the tasks performed by apps and patient portals.
Staff at a California clinic have been freed of scheduling responsibilities and receive patient feedback via text immediately after appointments.
The practice now operates at 95% of its capacity; no-show rates have been reduced from 14% to 8%.
45% of patients sign up for prevention screenings based on text reminders, up from a previous low of 4%.