Patient Relationship Management
There’s been a lot of talk in the news lately about not enough people in the US having or seeing primary care providers (PCPs). Fair Health’s “Window into Primary Care” has been quoted by about 40 articles recently, and it stated that 29 percent of patients who received medical services between 2016 and 2022 did not visit a primary care provider. Medical Economics wrote in February 2024 that 25% of American adults don’t have a usual source of care. The “Closing the Primary Care Gap” report from the National Association of Community Health Centers has also gotten a lot of press this year, where it said that over 100 million Americans did not even have access to primary care due to physician shortages – nearly 1/3 of the population.
Certainly, we need to train and deploy more PCPs and equip them with tools and workflows to leverage technology that augments relational medicine, thus improving outcomes and allowing docs and providers to do the things they were trained to do – working at the top of their licenses, as we like to say.
But are we doing all we can for the patients who do darken the hallways of PCP practices (real and virtual hallways)? Are we effectively engaging patients in their own care and nurturing patient-PCP relationships that can positively influence health and well-being?
This month’s newsletter focuses on Patient Engagement, both as a foundational piece of value-creating healthcare delivery as well as from an innovative perspective.
Consider your personal relationships. How do things work in a family where one person is sending out all types of unrequested information but never responds to requests or comments from others in the family? Or you only see each other for 15 minutes a couple times a year in a rushed encounter?
Patients need a trusted resource to optimize their health and well-being. Trust must be intentionally cultivated over time.
So, buckle up! We’ll spend this edition of the VBC newsletter looking at basic, just-do-it ways of engaging patients plus some innovative uses of technology to take engagement to the next level – relationship management.
Fair Health (2023). “A Window into Primary Care.” March 15, 2023.
Richard Payerchin (2024). “‘Primary care is in crisis’ – 2024 scorecard outlines just how bad it is, and solutions needed.” Medical Economics, February 28, 2024
Tried & True
Ami Patel, MD
Yuvo Health
Healthcare executive with over 10 years of experience in leading clinical programs that improve the health and well-being of diverse populations.
I had the opportunity to speak with Ami Patel, MD, the Chief Population Health Officer for Yuvo Health which partners with FQHCs to create value in how they deliver care. She gave insight into the challenges faced in meeting patients where they are, methods we should all be employing to improve those relationships, and some examples of how it can be done successfully.
Dr. Patel noted that health literacy rises to the top of the heap as an obstacle to care for the patients they serve. Again, the FQHC environment compresses and compounds a ubiquitous problem. While this is very prevalent in the FQ setting, even patients with advanced degrees and good incomes can struggle with health literacy.
The other big challenges she sees faced daily and in significant proportion are:
Lack of personalization
Communication gaps
Health coaching and support issues
Digital-literacy barriers
The FQs Dr. Patel and Yuvo work with have found the most success engaging patients in their care through a multi-modal approach. She says, “When engaging patients among FQHC populations, we need to consider various factors that may influence the patient’s ability to receive relevant communications. Do they have access to the Internet? Do they have a phone? What is their primary language? As a result, patient engagement needs to comprehensively span the widest range of modalities as possible.”
Their partners successfully employ:
In-person and in-visit communication, with support from translators, when needed
Patient portals, mobile apps and/or wearable devices that provide easy access to personal health records and relevant educational content
Audio recordings
Printed materials
Text messages and phone calls
She gave me three examples of how these methods have been used successfully.
Complex medical information
Challenge: Patients, parents, and partners struggle to comprehend the complex medical terminology and information they’re provided, leading them to disengage from their care.
Action: They developed education materials for FQHCs to use, including plain language, visual aids, language variations based on needed languages and multimedia formats to enhance understanding. They also provided on-site translation.
Limited access to information
Challenge: Patients can have difficulty accessing and understanding their health information and ecosystem. Many patients and caregivers are unaware of all the support and resources available to them, they were entitled to, and/or they needed.
Action: Yuvo helped their FQHC partners implement patient portals, mobile apps and/or wearable devices to provide easy access to personal health records and relevant educational content. They also provided, for patient use, audio recordings outlining the wrap-around services available to patients could listen to that to them.
Cultural and language barriers
Challenge: Diverse cultural and language barriers exist among FQHC patient populations that can restrict their understanding of and access to care, impacting their approach to their care.
Action: With their FQHC partners, Yuvo offered multilingual resources, culturally tailored educational materials and interpreter services to improve communication and understanding. They focused on training the workforce to allow for culture, tradition and language understanding among patients.
So, what kind of results have they seen from their engagement efforts? Dr. Patel shared three shining stars with me from one of their partners, Joseph P. Addabo Family Health Center.
Adolescent immunizations: Increased from 49% to 57%, placing JPA in the 90th percentile for performance.
Child and adolescent well visits: More than doubled from approximately 26% to 54%.
Breast cancer screenings (BCS): Up from 57% to 61% for eligible patients.
For Adolescent immunizations and Well Visits they realized that in person, text, and phone were the best modes of communication and yielded the best results. They provided multi-touch point access via school-based health clinics and free-standing medical clinics. Allowing for flexibility in location, time and at some points taking the medical care to the patient yielded optimal results.
For BCS they used similar methods but added partnering with health fairs and mobile mammography vans to the mix. Like the multiple access points for the kids, these we aimed to bring BCS services to the patient where they are. An added touch, one that goes beyond foundational work, in my opinion, was they offered a walk-through of the mammogram process, describing what it was and why it was needed. They found that this helped inform their patients and gain their buy-in into their own health.
Dr. Patel also shared with me that we need to always remember how much impact relationship can have, not only with our patients and their care, but with their families and the people in the clinic providing the care.
“The barriers were not just in patient care, but also in the patient support system. We worked to create multilingual material for both the patients and the providers, and we also implemented ‘live onsite staff’ at each practice location to assist with patient engagement, enrollment, and questions. With this, we noticed the patients were directly engaged with our on-site staff and, in turn, we were able to provide robust wraparound services.”
If you’ve listened to any of Season 2 of the BoPC Podcasts you’ve heard it repeated that meaningful, trusting, and bidirectional relationships are imperative to the best provision of healthcare and maintenance of well-being. This is foundational work that needs to be done, nurtured, and maintained in order to have the most positive impact on lives.
Effective healthcare delivery is a 2-way street. Patients need physicians and providers to guide them on their journey, and clinicians can’t provide healthcare successfully without engaged, involved, and interested patients. Engaging patients is more than just speaking to them in the office or blasting them a closed-ended text message about flu shots. As you’ll read in this month’s Innovations article, it’s about relationship management.
Think about the meaningful relationships in your life. They are (likely) bidirectional in communication and information flow. Rarely do we feel much connection when the only flow is toward us. That can feel more like ambivalence (at best) or harassment (at worst) rather than a relationship.
Some basic first steps to remember in reaching out to your patients deal with the form of your outreach efforts. Style points are rewarded.
Pay attention to the phone number your calls or texts are originating from – they need to be local to your patients.
Use a practice logo in your messages to instill trust in the source.
Most texting campaigns have shown the biggest impact around the noon hour.
Track your own responses to fine-tune when and how you send.
Reaching out to patients and allowing them to reach out to you is foundational to good PCP practices. Effective communication is even more important in value-based care, where the patient becomes your partner in so many of the processes needed to be successful.
Federally Qualified Health Centers are laboratories for exploring this indispensable component of Primary Care of engagement, where – given that they provide care to predominantly underserved populations, such as homeless or low-income, under-insured, uninsured, and Medicaid populations – the obstacles around patient engagement and relationship management are usually magnified.
Innovation
Patient engagement is foundational. Relationship management is innovative.
A good proportion of the VBC foundational work is doing and paying for things that aren’t billable but have huge positive impact on patient outcomes, like communicating with patients in a bidirectional manner.
As mentioned in this month’s Foundation article, there are a lot of old-school, tried and true ways to do that. Let’s now look at how AI and other tech innovations are augmenting our ability to engage in meaningful communication, building relationship while at the same time allowing for scalability.
Bobbi Weber from QliqSOFT walked me through a texting campaign they did that accounted for a 3-fold increase in patients getting their flu shots compared to previous years. Though this sounds foundational in approach, the innovation for me was that the campaign was directed at rural, lower income, Medicare patients.
This demographic is often considered the wrong one to use SMS and cellular tech on. Bobbi said, “I've been told so many times that ‘The disadvantaged population will not use it. The elderly population will not use it.’ And I got to tell you, Jon, that's baloney*. They, they use it at almost exactly the same rate that the general population does.”
Taking this to the next level, let’s throw AI and chatbots into the SMS outreach mix.
Both Bobbi and Vijay made the point that AI and appropriately positioned chatbots can help solve the staffing and administrative burden issues plaguing PCP practices.
Bobbi said, “I think if you're truly going to be successful in value-based care, you have to engage your population. Whether that's wellness visits, whether that's gaps in care, whether that's post discharge follow up, you need to be proactive and engage this population. With all the staffing shortages that we have, one of the best ways to do it is to leverage these chatbots, because they're conversational, people love them, and they offload work from your staff. I think it's a survival strategy for value-based care.”
Vijay pointed out that a great place to start in a conversation with a patient is a chatbot to determine the true need, asking questions based on responses that lead to the issue at hand for the patient. If the reason for the contact is something that can be handled in a self-service way – non-urgent appointment, routine med refill, etc. – that can be programmed into the system and dealt with without using staff time.
For other interactions, the chatbot can do a better job than a phone tree in discerning exactly who the patient needs to speak to and get them there, with all the pertinent info teed up and ready.
Two key points on this are 1) There can be no dead ends – if the chatbot can’t resolve the contact reason, a human on the practice’s side needs to be engaged, and 2) this safety net needs to be multimodal, as well, allowing for the patient to continue to the human within the channel of communication they chose to start in.
Bobbi echoed this, noting that escalation to a human can be on the phone, in a chat session, or even the initiation of a virtual visit. This was one of the features that helped their flu shot campaign to be so successful.
When setup this way, chatbots can also be great outreach tools for encouraging care measure closure and screening for SDOH. The right people can get notification of their need for, let’s say, a mammogram. They can be directly scheduled for it, they could be linked to getting an appointment with the PCP, or if they have questions not answerable by the bot, they can talk to a human.
Likewise, with SDOH screening, patients can be privately asked the personal questions related to social issues adding risk to their health. Based on their responses, they can be connected to social services or connected to a staff member to get help with their issue(s).
Let me use Vijay’s words to conclude. “It’s about relationship management, right? You can send a push notification. You can send an SMS reminder as an engagement.
But that’s only half of the of the puzzle. The other half is patients have questions of their own and they need channels that work for them 24 7. Right? If you think about how relationships work personally, if one person can reach the other person anytime they want (the PCP Practice to the patient), but the second person can only make a phone call and he'll be put on hold for 30 minutes, it's never going to work.”
But there are not enough people in the practices to meet all the communication needs. That’s where tech steps in, to augment and scale the practice’s ability to communicate and foster relationships.
Always remember these 2 things:
Success in healthcare relies on the appropriate application of technology and relationship, and …
You can't tech your way out of relationship.
*Editor’s Note: I apologize for Bobbi taking the name of a food in vain. ☺
Vijay Verma,
Televox
Seasoned professional with expertise in customer engagement, conversational experiences, and enterprise-scale transformation initiatives.
I like how Vijay Verma from TeleVox summed it up in a conversation I had with him at HIMSS24 in Orlando: “It's not just about the technology. It’s about what problems we are solving, right? And principally, that problem is about relationship management as opposed to an engagement model.”
He went on to say, “In an engagement model, an institution will text, email, and send flyers to patients around taking in specific action. But they don't necessarily close the loop of what happens when the patient has questions of their own as well.”
In addition to using AI chatbots to initiate or receive conversations from patients, other innovations in this arena include reaching out to patient cohorts you wouldn’t normally consider for this type of interaction, building in redundant safety nets to prevent patients from encountering a dead-end or falling through the cracks, and intentionally using AI to help you scale communication efforts while still building relationship.
Focusing on relationship management means treating communication as a multimodal, bi-directional, 2-way street flexible enough to meet a patient’s communication needs at that given time, be it text or phone or portal or website or something else.
Let’s look at some examples of how the ketchup of patient communication can be transformed into special sauce through appropriately applied technology.
I know an organization that deploys a great example of effective communication and relationship building using text messaging. They will monitor ADT feeds from hospitals, looking for patients from their practice who get admitted. Upon notification of the admission, a message is automatically sent from the PCP to the patient’s phone noting their hospitalization and giving information on how to make followup appointments with appropriate links.
This lets the patient know their PCP is aware of their hospitalization, the PCP cares about that, and wants to ensure the best care after discharge. Knowing that someone cares about you builds trust and strengthens a relationship.
Bobbi Weber, MBA
QliqSOFT
High-performing clinician with 20+ years of healthcare product marketing executive, IT product management and consulting expertise focused on payer and provider markets and improving customer experience.
