Texting works well for healthcare workflows such as scheduling, billing, patient surveys, and day-to-day communication, and applying the technology to much larger challenges such as chronic care management and social determinants of health (SDOH) is promising.
“We spend about $4 trillion a year on healthcare in this country, and the majority of that is related to chronic care,” says Josh Weiner, chief executive officer at SR Health by Solutionreach. “We need to find more effective ways to manage care for these patients.”
Q: We’ve talked in our last two discussions about why healthcare providers need to improve their appointment workflow and the role text messaging can play there. Can these strategies help address bigger issues in healthcare like chronic care management or SDOH?
A: Chronic care management and work on SDOH can definitely benefit from the use of text-based workflows. The technology’s widespread acceptance and the immediacy it brings to patient-provider communication helps improve patient engagement, and provides a platform for messages such as appointment reminders, recall activities, targeted education campaigns, and medication adherence reminders.
A typical chronic care management workflow for stroke patients includes a post-discharge follow-up text and survey one day after the initial care visit, followed by a series of texts over the next few weeks providing links to stroke education materials as well as various reminders to schedule a follow-up appointments with a rehab therapist, primary care physician, and/or neurologist. The key to the workflow’s effectiveness is the way that it is based on the patient’s specific chronic disease or condition and the corresponding provider care strategy to address it.
The approach for SDOH is also based on patient health data and uses text-based workflows, but it takes into account a broader range of attributes such as whether patients have a primary care physician, are high-risk, need help with care coordination, or have other risk factors that require real-time communication. SDOH workflows mirror chronic disease management in many ways, featuring text-based appointment scheduling, reminders, patient education, and healthcare instructions, and all with a focus on eliminating gaps in care.
Q: Can you provide some examples of how you have seen healthcare organizations use text to address these bigger challenges?
A: A good chronic care management example is an initiative that Solutionreach did with Community Medical Center, a 25-bed critical access hospital in Nebraska. The organization was experiencing challenges with high no-show rates (19% overall) and poor patient outcomes for diabetic patients (roughly 50% had an A1C level of 9% or higher) and looked to Solutionreach for some help. Although it had an older system in place for appointment reminders, it wasn’t very effective.
The Solutionreach offering gave patients the option of selecting text, e-mail, or phone reminders, and established a regular cadence of automated communication. The results have been quite positive, with the no-show rate falling from 19% to just over 3%, an 80% decline. Likewise, the numbers for diabetic patients also improved dramatically after Community Medical Center pulled data on patients due for A1C testing and then sent automated appointment reminder texts. The percentage of patients with A1C levels 9% or higher declined from about 50% to 17%–19%.
An example of an SDOH initiative using texting is a project that SR Health did with a Michigan healthcare system that primarily provides care for a very diverse population. During COVID-19, patients weren’t always able to see a provider face-to-face, a problem that was present even during the best of times. With SR Health’s help, the organization created a virtual urgent care program to help patients communicate with a provider about health issues, order a COVID test, or get a prescription for medications. The use of text was so effective they began using it to follow-up with at-risk patients after discharge, including those who had no primary care provider or were particularly isolated to improve care adherence and reduce readmission rates.
Q: Healthcare organizations have been overwhelmed by continuing to treat COVID patients and delivering the vaccine. Why is now the time to be thinking about improving their appointment workflow?
A: COVID-19 exposed challenges that already existed in healthcare, and more work needs to be done to engage patients in their care and move beyond a one-off approach. Many providers were already on their way toward greater use of digital communication to help address these issues, but COVID-19 accelerated the process. There’s no better time than now for providers to build a more dynamic and flexible system of appointment workflows, with text-based solutions at the forefront as they rebuild financially from the pandemic and welcome back the many patients who have postponed care.
Director, Marketing Programs
SR Health by Solutionreach