By Ed Curtis and Steve Schelhammer
Hattiesburg Clinic, the largest nonacademic multispecialty clinic in Mississippi with 250 providers and 40 locations, was looking for a way to automate population health management.
The clinic was using a manual process to identify and reach out to patients who were not getting in to see their physicians-for recommended care. A receptionist or nurse would go through the individual patient records to find those patients who weren't meeting the minimum requirements for their chronic care follow-ups and preventive visits. It was a monstrous undertaking for a clinic of that size.
Hattiesburg Clinic wanted to ensure that it was providing proper preventive and chronic care. In 2009, the clinic implemented a patient outreach solution that uses an electronic registry of the clinic's entire patient population. Patients in the registry are notified through an automated phone messaging system when they are due for recommended care. The system also handles appointment reminders.
In the past two years, the outreach solution has generated 50,000 new appointments and nearly $4 million in additional revenue for the clinic. At the same time, more patients are getting recommended care, including mammograms and follow-up visits for hypertension.
The patient outreach system that Hattiesburg Clinic adopted includes three primary components.
Clinical protocols. The system incorporates evidence-based, specialty-specific protocols-or recommended care guidelines-for chronic and preventive care. Among the chronic conditions on the menu are asthma, hypertension, high cholesterol, and diabetes. Preventive services included screening colonoscopies, mammograms, annual obstetrics/gynecology visits, and prostate-specific antigen tests for prostate cancer. These protocols are based on guidelines from such organizations as the National Quality Forum, U.S. Preventive Services Task Force, and the National Committee for Quality Assurance.
The physicians in each of Hattiesburg Clinic's 40 practices chose which guidelines they wanted to use. The application's protocols can also be customized, but the physicians made few changes to them.
A patient registry. The patient registry was created by the vendor, and it included all the demographic and medical record information the clinic collected in its electronic medical record since going live in 2002, as well as information from its interfaced practice management system.
The registry combs the clinic's electronic health record, lab, radiology, and practice management systems so it can receive a constant stream of patient data, including visit dates, diagnoses, referrals, lab results, and medications.
An automated phone system. The outreach system automatically compares patient records in the registry against the recommended care protocols to identify patients who are due for preventive screenings and follow-up care for chronic diseases. These patients are then contacted via the automated phone messaging system.
For example, the system includes a protocol for diabetic patients that indicates they should receive blood glucose tests two to four times a year. When a patient with diabetes has gone more than six months without this test, the system automatically tags that patient and reaches out to him or her via a phone message. The message reminds the patient that it's time to make an appointment to see his or her physician.
Since June 2009, the patient outreach solution has generated 300,000 outreach events and 800,000 appointment reminders for Hattiesburg Clinic. These calls led to roughly 50,000 new appointments made within 60 days of the outreach events, generating approximately $4 million in additional revenue at an average of $80 per visit.
While there is no exact method of knowing how many of these appointments were made as a result of the reminder calls, it was determined that between 55 percent and 60 percent of appointments are booked within five days of a patient being contacted. Based on the response pattern, it seems logical that most of the visits booked within 60 days are related to the outreach calls.
Based on this assumption, it was estimated that Hattiesburg Clinic breaks even on its program costs by the sixth day of every month. Including all of the clinic's spending in the patient outreach solution since implementation, the clinic has achieved a 16:1 ROI.
The patient outreach solution has also improved the quality of care for many of the clinic's patients. For example, in the first year, the system's hypertension protocol resulted in more than 14,000 visits. These were patients diagnosed with hypertension who had not had a chronic-related visit in the previous six months and did not have a visit scheduled in the next four months.
Another example: More women are getting needed mammograms. The breast center at Hattiesburg Clinic is the first in the state to be recognized as a Breast Imaging Center of Excellence.
However, when the system ran a report on patients who were more than a year overdue for a mammogram, it discovered about 7,000 women in need of an appointment. By using some of the system's protocols, it began making three calls per day, per physician-and 1,500 of the women contacted made appointments for mammograms. In addition, the system's obstetrics/gynecology protocol resulted in more than 10,000 appointments for annual visits.
The system has also helped the clinic reap an unanticipated benefit in community relations. CEO Tommy Thornton says he had people tapping him on the shoulder and saying, "I'm thrilled to death that you guys care about me, that you called me, and told me I'm over a year past due."
Hattiesburg Clinic implemented the appointment reminder part of the system at all of its 40 locations right away. But the clinic took a more tempered approach to calling patients about getting recommended preventive and chronic care.
Management did not want to overburden the physician practices with new appointments generated by the system. To prevent this, the clinic decided to target just primary care and obstetrics/gynecology providers.
In the past two years, no more than 70 of the clinic's physicians have used the outreach solution at any given time.
The first physicians to adopt the new system were those who had available slots in their schedules. This was particularly true with new physicians who needed to grow their respective practices, as well as established physicians who wanted to expand their practices. This was the perfect tool with a proven track record of producing results.
Hattiesburg Clinic employs other methods to ensure physicians aren't overburdened by system-generated visits. For instance, the clinic is constantly surveying patients to find out how long they wait to get an appointment and how long it takes to be seen when they arrive. The survey is used to measure the impact of the automated phone messaging system. The clinic is very cautious not to make too many outbound calls.
Even with its cautious approach, the clinic ran into a few situations where a physician's schedule had become stressed-the open slots moved from this week to 30-plus days out. This caused both the administrator and the physician to re-evaluate the number of outbound calls that were being made.
The patient outreach solution has enabled Hattiesburg Clinic to provide better health care to thousands and thousands of people. Because of the visits that the clinic gets as a result of this system, it has also been a good business decision.
Ed Curtis is assistant COO, Hattiesburg Clinic, Hattiesburg, Miss. (firstname.lastname@example.org).
Steve Schelhammer is CEO, Phytel, Inc., Dallas (email@example.com).
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