Every Saturday, you’ll find me serving lunch at Atlanta-based Trinity Community Ministries. Like you, I consider service to the community central to my personal life. When Walter* came up to me this weekend with a small, white-tattered appointment card, I was surprised to discover that I could glean crucial insight to inform my professional world as well.

Walter, a resident at the center, explained that he had missed an important doctor’s appointment that week – one for which he had patiently waited for months. The social worker had been delayed getting to the center for work that morning, and the van was late to transport him to the appointment. He, therefore, missed the appointment. His next shot, he explained as his voice quivered with sadness, was three months from now. He was, therefore - in my world - a “no-show.”

The role of the patient access call center has evolved over the years from a more linear, transactional piece of health care to a now more robust and increasingly valuable part of a health system's approach to optimizing patient access. Tukesha Parks, Director of Ambulatory Access, and Jennifer Hayden, AVP Patient Access, Atrium Health Wake Forest Baptist discussed their access journey and the patterns they have observed with their call center since 2012. Their journey exhibits strategies they have employed and multiple "upgrades" through leadership and staff training to enhance visibility, develop accountability and create greater efficiency.

Parks addressed three "foundational components" that drive the outcome of a patient's experience, including a dedicated staff, a training culture, and measuring success through KPIs (metric reporting and scorecards). Parks relayed, "With a dedicated IAS support in place and a technology roadmap, common issues and understanding where the gaps existed became more visible." For example, cleaning up the work queues, closing the call loop process, and introducing reporting dashboards to track referrals and turnaround times are key areas they have continuously monitored to develop improved patient and provider satisfaction. From 2018-2020, a series of training opportunities for front-line staff leaders were rolled out, as did the "WQ Monitoring Tableau Dashboard" to assist managers with tracking referrals.

The 2023 PAC Benchmarks are ready for primetime! Join us for a deep dive into the nation's best benchmarks for patient access -- and learn about how to access them from the PAC's new reporting platform. 

When:
May 24, 2023
12-1 PM EST

With more than 200 patient access professionals in attendance, representing 72 academic health systems from across the country, with great networking opportunities and fantastic programming, the 2023 Patient Access Collaborative Symposium in East Lansing, Michigan, was a wild success. The conference provided a relaxed, discussion-based forum, which allowed PAC members to connect, learn, and understand the initiatives of each institution.

In Part 1, we discussed the importance of gathering and assessing business intelligence, and in Part 2, we learned how to determine prevention strategies. Now, in Part 3, we'll discuss managing the templates.

Manage the Templates. The scheduling template provides an exceptional tool to manage non-arrivals, as they will exist despite all best efforts to prevent them. The issue of non-arrivals is, at its foundation, one of human behavior. Predictive (or strategic) booking is the final pillar to address non-arrivals. Efforts can simply feature overbooking by the number of slots that are, on average, predictably failing to show. For example, if a clinic with 100 slots per week exhibits a consistent show rate of 90%, an additional 10 slots can be built into the template for a total of 110. This overbooking tactic, driven by the "average" experience, however, often fails to engage constituents in a positive manner. In sum, providers and clinic staff quickly become frustrated with the booking strategy and rebel. The reaction is understandable as human behavior doesn't
align with a strategy tied to an "average."

In Part 1, we discussed the importance of gathering and assessing business intelligence, and we're continuing the conversation with determining prevention strategies.

Determine Prevention Strategies. Many health systems skip over this step, but preventing non-arrivals is an essential part of the discourse. First, incorporating interventions engages all stakeholders. As a health system, the mission is to provide care. If an appointment is granted, it is our duty to serve that patient.  Leading with the discourse about best-practice, patient-centered interventions provides a framework to engage everyone in this important discussion.

Slots that go unfilled are arguably the greatest challenge in patient access. They represent a failure to accommodate a patient despite unrelenting demand; they also equate to a financial loss, a result no health system can afford today. Our providers’ time is our system’s most important asset – and an unfilled slot represents our failure to be good stewards of that precious resource. Considering the importance of unfilled slots, let’s approach the problem of non-arrivals with three key tactics: gather and assess business intelligence, determine prevention strategies, and manage the templates.

Gather and Assess Business Intelligence. This may seem a simple step, but the nuances of identifying booked slots that don’t arrive are often overlooked. Leaders pull data from dashboards about no-shows, cancellations, etc., not realizing that most of the decision-making for the explanation of the non-arrival is a manual one. When a patient calls to cancel, doesn't show up for an appointment, or a provider requests an appointment to be rebooked, the person who is documenting that transaction is the one who selects the reason for it, typically from a selection set that displays as a drop-down menu. These staff positions - receptionists, call center agents, secretaries - suffer from high turnover. The topic of non-arrivals is just one of a multitude of subjects featured during training; for many health systems, it's one slide during a multi-day training session.

We are excited to announce two new industry partners to the Patient Access Collaborative: notifyMD! Read more about them below.

notifyMD

notifyMD is a healthcare technology and live voice service provider, offering a comprehensive suite of HIPAA-compliant communication and patient access tools for healthcare organizations. Through its medical answering service and in-depth mobile app, notifyMD's solutions streamline clinical workflows, strengthen patient and provider communications and improve the patient experience. The mobile app platform includes features such as critical message management, secure chat with staff and colleagues and real-time patient updates. notifyMD is committed to enhancing healthcare delivery and improving the patient experience through professional virtual receptionists and innovative technology solutions, all protected by best in class cyber security solutions. Visit their website.

Calling to schedule a medical appointment can be stressful. Combine the discomfort of talking about a health problem with waiting on hold, and you got yourself 40% of patients preferring to book appointments online, according to an industry report.

“They’re not calling to schedule a Disney Cruise—they’re calling about their health, their lives,” says Amber Townsend, Director of Contact Center Operations at University of South Florida and Tampa General Physicians, about patient calls.

Schedule Density: A Better Way to Measure Good Access

Last week, we determined that good patient access must incorporate the ease of delivering it – a frictionless process, from the patient’s perspective. We also delved into schedule utilization, which may fall short as a value-added metric unless template integrity exists.

Once the hard work of defining clinical expectations, building the schedules, and securing them has been solidified, it then becomes possible to add features to schedule utilization to transform it from an operational metric to one that incorporates the patients’ experience. Combined, these measures offer valuable insight into patient access.

The Patient Access Collaborative is launching a podcast and we asked you to help us name it! We received so many clever and great name ideas and have settled on the winner.

Congratulations to Michael Palko with Duke University Health System for helping us name our new podcast: PAC’s All Access Pass! 

Does a metric answer the question – is our access good?

Good patient access is not easy to define and even harder to measure. It takes a combination of metrics to paint the full picture. This blog series examines one of the most common metrics used by access leaders – schedule utilization.

Terminology

The use of nomenclature in health care has long been problematic for industry stakeholders, let alone patients. Terms like “Otolaryngology” and “Hematology” require studies in ancient languages, and then we have a habit of shortening the terms – like “Gyn-Onc” (pronounced “guy-knee-onc”) to further complicate matters. Even experts stumble upon the vast array of acronyms that pepper the health care landscape – from ACO to MSP to QPP. As we center our efforts on improving access for patients, there may be opportunity to examine how shifts in our communication can prove beneficial.

We are excited to announce two new industry partners to the Patient Access Collaborative: Abax Health and Gozio Health! Read more about them below.

Abax Health

Abax Health’s AI powered clinical analytics and patient engagement platform, Clarity, is dedicated to ensuring every patient receives the care they need, when they need it, and that the health system realizes the revenue related to all of their missed procedures. Clarity uses advanced artificial intelligence and machine learning to identify when a patient has a “missed referral” for a procedure and ensures that the procedure gets scheduled.  The platform analyzes millions of patient records to find missed referrals, quantifies the financial impact of the missed procedures, and then our concierge team of outreach specialists get to work reminding the patient of the procedure, educating the patient on its necessity, and then conducting all of the administrative scheduling and financial clearance steps (Patient Access functions) involved in getting that patient scheduled for the appointment. Visit their website.

Can a tube of toothpaste inform our access improvement journey?

Behavioral science provides evidence that consumers are influenced by their experience and many other factors related to purchasing decisions. Price is often cited as the most influential component of our buying decision, but many other determinants come into play. This fact led researchers to develop a "better" experience to encourage us to brush our teeth. Over the years, various components like fluoride have been introduced by toothpaste manufacturers, but perhaps the greatest innovation was striped toothpaste in 1955 by Leonard Marraffino. According to Aquafresh, the stripes represent concepts - tooth decay prevention and breath freshening, which produced the first two-striped toothpaste based on Marraffino's patent. As consumers, we rarely think about the stripes and certainly don't consider which color fights tooth decay and which freshens our breath. But the novelty propelled an entire era of influential consumer packaging - think about the laundry pods, for example. We can "see" the product at work, something that ridesharing companies like Uber and Lyft took advantage of as well. When we log onto our app to call a car, we are not getting a different product (a taxi serves the purpose just as well), we are getting a different experience. As consumers, we love it. 

By Nkechi Okwu-Lawrence and Elizabeth Woodcock

With medications being such an integral part of population health management, handling prescription refills in an effective manner is vital to success. As access teams become more engaged in efforts to improve refill management, it’s important to identify best practices. The Patient Access Collaborative invited three members to present their approaches to refill management, all of which are proving to be a value-add to their organization.

Laddy Rua, Contact Center Manager, Prescription Line, and Kirsten Peck, Contact Center Supervisor, Prescription Line, from Baystate Health discussed the efforts to improve refill management by focusing on their employees. Medical assistants work in the Patient Access Center, answering inbound calls from pharmacies and patients. They use work pools that are strategically managed to level the workload among the team. Per diems are staffed during non-business hours to further maximize efficiencies. Onboarding protocols for new team members include shadowing, side-by-side mentoring, and weekly one-on-one’s.

USF Tampa General Physicians initiated its call center decades ago; while scheduling is the primary function, there is an inbound patient clinical concern team. The team, as described by Christine Kilfoyl, RN, BSN, and Desiree Thomas, LPN, consists of nurses, medical assistants, and a recently hired pharmacist. Approximately 60% of the daily inbound calls to the clinical concern team are for prescription refills, with the team fully handling 80% of these calls. Kilfoyl notes that department relationships are “very, very important” for their team, in order to share knowledge and maintain currency. “Carve outs will kill you,” is a mantra for the team, which aims to standardize workflows and adhere to institutional policies to successfully manage refills in a centralized manner.

Ami Shumway, Operations Director, Loma Linda University (LLU) Health, details the team’s focus on first call resolution. This goal was a key driver of hiring pharmacy technicians, aiming to improve patient satisfaction and reduce the excess administrative burden being placed on the clinical teams where possible. Shumway and other access leaders engaged the LLU School of Pharmacy, which has aided in the recruitment of the technicians, as well as pharmacists and pharmacy students. A mere six months into the project, Shumway highlights that first-call resolution has increased by a notable 64% for prescription-related calls.

For PAC members, head to Webinars to listen to the panel of experts who presented on August 16, 2022 under the title, “Centralized Refill Management.”

There's nothing more frustrating than to discover an opportunity, only to recognize that too much time has already passed. For many PAC members, that's been the case with patient satisfaction survey results that are often released months after collecting the data from patients. The lack of timeliness combined with low response rates have plagued stakeholders. An alternative that shows promise is on the horizon. To address this issue of timely feedback related to access, post-call surveys are now deployed by many PAC organizations in their ambulatory contact center.

What is a post-call survey? After the caller and the agent have completed the call, the caller is requested to score the conversation. The caller may be automatically prompted to provide feedback - or the collection mechanism may be a follow-on text or email. The results are compiled and reported back to management, allowing for near-immediate feedback at the agent or organization level (and often, an intermediate area such as the specialty or department, as applicable).

Patient Access Collaborative is Seeking Speakers for our 2023 Educational Calendar!

The Patient Access Collaborative is planning our 2023 Educational Calendar which includes webinars, virtual conferences and our annual symposia. If you are interested in speaking and can deliver exciting, innovative information that would be valuable to our members, please submit a Request to Speak form.

By Matthew Shore, CHFP, Project Manager I, Organizational Excellence

I’m sure it’s no secret to Patient Access Collaborative members that employee engagement and morale are very important in our industry. Engaged employees are happier, more loyal, more productive, and more devoted to the organization’s mission. It is for these reasons that I launched a team newsletter for the access center at Montefiore Health System.