Customer improves patient hold time from 18 mins to less than 30 seconds
Our customer’s front desk typically had to handle 300+ calls per day (during business hours). They did not know how many calls they received after business hours as no one attended them anyway. They received more than 20 voicemails per day. They also had no idea how long of a wait time their patients had on the phone. They knew that it was high because most patients complained directly to the doctors during their visit about the hold times. The front desk staff also took incoming calls while the patients were in the waiting area. This, as expected, led to patients in office having to wait to be serviced. While their non clinical staff didn’t say anything about this, the patients went on to complain to the doctors about the front desk issues.
Patients had left very few reviews on google or facebook. However, the reviews that were left on Facebook or Google were mainly negative. Another point to note is that even in the negative patient reviews, there were positive mentions of the doctors themselves. Most of the complaints were about the front desk, the wait times in the office and the hold times on the phone. Patients and their pharmacies also called the front desk with various questions about medications. The front desk staff would typically route the calls to the technicians that were already busy tending to patients inside the office. More often than not, this led to the pharmacies leaving a voicemail and the patient standing at the pharmacy not being serviced. That led to even further friction and reduced patient satisfaction with our customer’s practice.
This became worse when any kind of marketing push was made. With each marketing push, more inbound calls would occur – as expected. And with more patient appointments would occur as well. This led to more patient hold times and wait times in the office.
Our customer’s management recognized that there was a problem but didn’t actually know how to resolve the challenge.
With our first analysis of the customer’s call logs, we found that patient hold times were more than 15 mins per patient. These were worse in the mornings and earlier during the week (Mon-Wednesday).
We didn’t really have to analyze much about this situation because we are already of the opinion that the front desk should not be tasked with taking inbound calls. They are there to service the patients in the office and to manage the patient flow in the offices.
Our recommendations included:
- Creating a centralized patient contact center team
- Having the patient contact center team handle both inbound and outbound calls
- Outsourcing the patient contact center
- Migrating the call center software to Amazon Connect Contact center
- Using NisosHealthCRM and PatientEngage software
We deployed our patient contact center team to handle all inbound and outbound calls within a matter of 5 days. We “right-staffed” the patient contact center team using the Erlang-C model. This reduced the patient call hold times to less than 60 seconds.
We migrated the call center software to Amazon Connect within 5 days. The entire IVR was transferred over. It took about 10 days for Amazon Connect to port the existing phone numbers of our customer over to Amazon.
We utilized our software to engage patients via text messaging, voicemail drops, voice calls. In addition to these channels, we also added new channels – facebook messenger and Google my business messaging.
At the end of each day, all reports and KPIs / metrics were available for our customer in our healthcare CRM.
The original goal of reducing patient wait times was achieved (with flying colors) and patient satisfaction grew tremendously.
Healthcare customer increases reviews from 22 to 650+ in 8 months
Our customer was not getting enough new patient appointments from their website. While the customer got a lot of new patient appointments from their referring partners, their inbound appointment request channel was pretty scant and dry. They had a website in place and had spent a decent amount on creating their website. However, they were not getting much incoming calls or appointment request submissions from their website. A point to note that in the past they had never really paid attention to getting reviews from their patients. A reputation management program was simply not in place.
When we started our engagement with this group, they had 12 providers and only 22 reviews to show for the last 4 years of operation. While their website did show up in search results, it didn’t provide any confidence to prospective patients about the quality of care they might receive. All the medical SEO work that our customer’s medical marketing agency kept doing, was going to waste as patients chose higher reviewed doctors (competitors).
Since most patient reviews software charge per provider and come bundled with other software that we did not really need, we recommended that our client use our free Patient Reviews software. Each day, patients were sent review requests via SMS. For patients that had provided our customer with landline numbers, our patient contact center team called and asked for their feedback. Then, our patient contact center team would send these patients a text message with the review request.
Within 8 months, our customer had 650+ reviews across all three locations.
A key point to note is that our customer started seeing a much higher inbound appointment request volume as well.
Ophthalmology group practice adds new patients with community outreach
Most specialist practices depend heavily on referrals from primary care physicians or other specialists. Our ophthalmology provider group client was no different. They had ridden the physician referrals boat for 4 years. A large part of their patient referrals were from FQHCs (federally qualified health centers). The greatest thing about tying up with FQHCs is that their referred patient volume is extremely high.
However, disaster struck as one day, our client found out that their top referring FQHC was no longer referring patients to them. This, in effect, had dried up 20% of their daily incoming referrals. That was a large hit and was prominent enough for management to take note.
As expected, the practice was scrambling to fill in the lost new patient appointment channel. They started investing in digital marketing and the physician liaisons ramped up their door to door marketing activities.
When we engaged with this ophthalmology group, one of our suggestions included community outreach. This, in our experience, would allow the provider group to start establishing themselves in the communities they served, in addition to being able to stand up a new patient acquisition source as well. Our analysis showed that 90%+ revenues depended on referring partners. This, according to our practice management best practices was unacceptable.
While we did recommend starting with community outreach, our customer’s staff was not trained in community outreach. In addition to that, no one on staff had any interest in cold calling the neighborhoods. The customer’s staff was OK with taking inbound appointment requests but were not willing to make 100s of outbound calls per day to their neighborhoods, in order to introduce their employer.
We put together a community outreach team with our patient contact center expertise. To get started, we identified zip codes around our customer’s locations. Then, we reached out to InfoUSA and purchased “people data” (aka consumer lists) for those zip codes. We limited our customer audience to age 40+ (ophthalmology patients are, of course, on the older side). Since a large part of our customer’s patient population had Medicare/Medicaid, we targeted the customer audience at a predetermined income range as well. There was no point in calling homes wherein patients were younger and at work all day. This gave us about 30,000+ patients to introduce our customer’s eye care clinics to.
We tracked all our efforts by using NisosHealthCRM and made dials using our Patient Engage software. Keep in mind that these patients are all “consumer list” / “leads” only and none of these patients were in the customer’s EMR. We started with 1 person calling the list of 30K patients.
Net results – our customer started adding an average of 40 new patients per month
Provider group reduces lost patient leads to less than 10 percent
One of our ophthalmology partners was having trouble understanding the efficacy of their marketing. They were investing time and money on marketing to referring providers. They used physician liaisons for marketing to referring partners. They had also invested time and money into print and media marketing (direct to patients). In addition, they were spending their budget on digital marketing as well (Google ads, primarily).
Our client didn’t know the efficacy of their B2B marketing, B2C marketing and had trouble justifying their marketing spend. They wanted to know how many new patients they were receiving per channel (e.g. referring partner referrals, print/media advertisements etc). They also wanted to know whether these patient appointment requests were actually being tended to or not. Our client wanted to understand the cost of patient acquisition per channel as well. It was important for them to understand the quality of patient “leads” per channel.
We engaged with our customer and tried to analyse the total patients generated per marketing channel. In the initial days, we had the front desk ask each patient “How did you hear about us” and capture this information in a Google Sheet. We also tried to understand the conversion rates of each channel as well. For this, we simply asked the same front desk staff to update the Google Sheet by the end of each day. We ran this analysis process for almost 4 weeks and gathered data.
We deployed our patient contact center team and NisosHealthCRM software. We also moved the inbound calls to Amazon Connect Contact Center. This way, we were able to track each and every incoming call and were able to record the same in the NisosHealthCRM. For patients that came in through print and media campaigns, we ensured that each day’s new patients were captured with the marketing “source” information.
There were several instances where the front desk still did not capture the patient’s marketing source. For those patients, our patient contact center team called the patients and ensured that they obtained this information. As for the social channels of new patients (google my business and facebook), the same process of entering all that information in the NisosHealthCRM was followed.
This allowed us to surface 100% visibility into all the new patient appointment requests. As soon as there was visibility and everything was being measured, the cracks in the new appointment booking process surfaced. Over the next quarter, we plugged all those cracks one by one.
Net results? Our customer reduced “lost” patient leads to less than 10%.
Specialist provider group eradicates referrals leakage, increases revenues
Our customer reached out to us when they started getting angry calls from various referral partners. According to our customers’ referring partners, they were not getting patient notes back on time (or ever). Our customer had received complaints from referring partners that they had no idea whether their patients were being seen or not. They were missing out on their own HEDIS reporting measures / timelines.
These complaints were from referring partners that already had a good relationship with our client. In other words, these referring partners had at least bothered to let the management team know their issue. Our customer had no idea how many referring partners had never bothered to complain, slowed down their referrals nor did they know how many referring partners they had lost.
We partnered with our client to understand the issue better. Our initial analytics showed us that:
- There was no process around closed loop referral management.
- The referral coordinators handled multiple referral sources. These sources were – fax, email, phone calls, 3rd party referral websites. However, there was no consolidation of incoming referrals. Hence, there was no visibility into referring partner volumes.
- There was no process around patient satisfaction or referring partner satisfaction engagement.
- There was no way to monitor conversion of referrals
- Intuition based referring partner relationship management
We proposed to solve this issue with changes to :
We have always advocated the importance of closed loop referral management to increase revenues and at the same time, increase referring partner satisfaction. We believe that a high performing referral network not only benefits patients but also adds tremendous value to increase patient volumes.
We consolidated from the 3 dedicated referral coordinators into one dedicated referral coordinator (outsourced to our patient contact center team).
As a next step, we started using healthcare referral management software to start logging all incoming referrals from all the different sources. We knew that we would not be able to change the way our client’s referring partners sent referrals. So, instead, we decided to change the way we “manage” referrals. This alone gave us the visibility we needed across all incoming referral channels. This is akin to managing all incoming referrals in a spreadsheet (which is messy).
We put SLAs around incoming referrals.
- Respond to each referral to within 1-2 hours of receiving the referral.
- At the end of each day, generate a report to gauge incoming referrals vs referrals tended to.
- Provide each patient appointment update within 24 hours. This included updating the partner with visit notes as well.
- Call each referred patient at least and up to 3 times. After this, send the referral back to the referral sender.
- Give each referred patient an appointment within a maximum of 2 weeks.
- Each week, send a consolidated referral status update to both the referring partner and the manager.
- Each month, ask every referring partner “how we are doing”.
Just by making these people, process and technology changes, our customer was able to reduce referral leakage to less than 2% with a proportionate increase in patient visit volumes and monthly revenues.
Eye care group avoids no-shows revenue drain
One of our eye care provider group customers was facing a high no show rates within its patient population. While they didn’t really have their no show taste pinned down, they were already aware of the challenges they were facing with their no show rates.
To combat their challenge with no show patients, the practice personnel had started to overbook patients. This is very much in line with what other practices were doing as well. It’s considered an industry practice. However, the approach typically leads to a “feast or famine” patient flow. Many a time, overbooked patients actually did show up. This led to extreme crowding in the waiting rooms. This in itself had patients extremely unhappy with the long wait times.
Unhappy patients invariably led to them misbehaving with the practice staff. Unhappy patients also led to no reviews. In some cases, this led to the practice getting bad google reviews as well.
Finally, practice management was also having trouble forecasting revenues due to the variances in patient visit volumes.
When we first engage with this eye care customer, we ran some analytics on their appointments over a period of 12 months. We discovered:
- no show rates were at 35%. Out of 10 patients, about 3.5 didn’t show up
- Overbooking was done at approximately 50% (higher than needed)
- No shows were primarily in the mid day timeframe
- Appointment reminders were sent automatically from the EMR but no one tally monitored the patient responses, not took any additional steps to ensure that the patient was truly engaged and did actually show up
It’s an established fact that half the patients in most EMRs are landline numbers. EMRs send appointment reminders via text messaging. These don’t reach the patient’s landline.
Nisos Health patient contact center team instituted “appt reminders” that were multi-touch points and multi-channel. We sent reminders on a cadence of 7 days before the appointment, 3 days before and finally, on the day of the appointment.
We ended up using our customer engagement solution to send patients text confirmations, reminders. For landlines, we dialed them automatically and still allowed the patients to press 1 to speak with someone from the patient contact center team immediately.
This alone reduced the no shows to < 20% (50% reduction)
Ophthalmology group doubles appointments
At one of our ophthalmology group clients, the group practice seems busier than ever, but they felt that somehow, they were not making more money. The leaders wanted to address this situation.
Upon engaging with them, we ran our analytics as a first step (always our first step).
After a brief analysis, it turned out that while the practice “seemed” busier than ever, in reality, they had the following issues:
- Low provider utilization
- Low equipment utilization
- Underutilized production capacity across offices
- Subpar return on investments compared to high monthly expenses (salaries, G&A etc)
Problem – Low provider utilization
The problem with low provider utilization existed because there weren’t enough appointments in a day. As a commercial practice that typically books patients for 15 min appointments, each optometrist was supposed to see 25-30 patients per day. However, there were never 25-30 appointments per provider per day. Average utilization was not even 60%.
On top of this, their patient population also had a pretty high no-show rate. No one had measured the no-show rate of the practice. We did a quick analysis of the no-show rates based on trailing 12 months. The practice was averaging 35% no-show rates.
This meant that for their ophthalmologists or optometrists to see and bill for 30 patients a day, they would have to book 45+ patients per day.
The solution was simple – our client needed more appointments booked per day.
Problem – Low equipment utilization
Our client also had several ophthalmic testing equipment in their eye care locations. We looked at the investments in all ophthalmic equipment that our client had made for testing purposes. Based on our analysis, those equipment never crossed a utilization rate of 25%. In other words, the return on equipment investment was sub-par.
There was no dedicated effort to book tests per day or per week. The equipment went underutilized. Meanwhile, the providers would direct their patients randomly during the day to get tests done (based on medical necessity). While testing patients for medical necessity isn’t an issue per se, it did require breaking the predefined workflow for the day. The ophthalmic technician would have to make the next patient wait while conducting the ordered tests on the current patient. This, in turn, delayed all future appointments of the day.
Net-net, there wasn’t really a system in place. We posited that instead of testing patients ad-hoc or on-demand, if the patients were scheduled on a separate day, this would improve the utilization of the equipment and at the same time, would also not delay the remainder of the patients.
Problem – Underutilized production capacity across offices
Our client had 3 office locations that were operational 9-3:30 PM 5 days a week. While that worked fine for some of the optometrists and ophthalmologists, the reality was that the real estate was being utilized for only 5-6 hrs per day. Meanwhile, a majority of the patients were not able to get appointments based on their preferences – after working hours. This was evidenced even further by the fact that early morning appointments were the highest in demand. Their front desk always got requests for late afternoon / after work appointments.
Looking at it from a real estate utilization point of view, our client would have been better served by keeping offices open beyond normal business hours. That way, they could have captured a lot of patients that wanted late afternoon appointments that did not force them to take time off of work.
All patients know that eye care appointments tend to be on the longer side – especially if your eyes are dilated. This, added to the facts mentioned above compounded the situation.
We proposed that as an immediate first step, the number of appointments per day be increased by at least 50%. This would at least address the provider underutilization issues. Nisos Health ran a “not seen in 6 campaign” and added 5,200+ recalled patients in 2 months (118% increase).
We started by attaching our NisosHealthCRM to our client’s EMR. This allowed us to define segments of patients that were “not seen in 6 months” very easily. Once we had that defined, we divided our patient segments further. This allowed us to separate the patient mobile numbers from the landline numbers. After this, we created campaigns in our NisosHealthCRM software and executed them via web texting and calls from our patient contact center.
We assigned all those patients to our patient contact center agents using NisosHealthCRM. The first step that our patient contact center agents took was using our Patient Engagement software. They sent automated, yet personalized SMS blast and left automated personalized voicemails. In addition to this, they called each patient as well.
Overall, the strategy was executed such that each patient was contacted 4 times per month – either via SMS, automated voicemail or a call.
Results? Our client saw a 118% increase in appointments within 2 months
Skilled nursing facilities extend patient access leveraging telehealth
Skilled nursing facilities face a severe shortage of workers. As it is there is a documented shortage of primary care physicians and the gap keeps getting wider.
On top of it, SNFs have been known to have a shortage of direct care workers. Add to this, the primary care shortage – makes matters even worse.
The fact that a majority of baby boomers are above 65 and will soon be entering into the purview of skilled nursing facilities, this acute shortage needs to be addressed.
One way to deal with this is to provide primary care providers on call. This is exactly what one telemedicine company wanted to do – they had a roster of USA licensed physicians that were ready to provide on-call services.
This is not a new business model per se, as primary care providers have been provided on an on-call basis for a while. However, in this particular case, the telemedicine company wanted to provide video and voice calling facilities to the skilled nursing facilities.
The basic idea was that when the SNFs would face a volume of patients without having enough primary care providers on site, they would immediately book an appointment with these on-call doctors. Each provider would have VPN access to the EMR of the skilled nursing facility hence would have the ability to look at patient records as well as update with diagnosis and treatment/care plans.
The idea was executed quite simply – the nurse would create appointments on available providers’ calendar. The provider being on call, would always have their calendar up to date. At the time of the call, the provider would read the nurse’s note for the upcoming patient video call, login to the SNF’s EMR, read the patient chart and thereafter, start the video call.
While on a video call with the patient, the provider would take as many notes as needed and as part of the after-call-work (ACW), they would update the patient’s record on the SNF EMR to reflect these notes.
At all times, these recordings needed to be available for audit and security reasons, stored on a HIPAA secure infrastructure.
Hopefully this gives you an idea of how to deploy a telehealth strategy at your practice.
Ophthalmology group uses telehealth
An ophthalmology group hat deals with a large diabetic population wanted to offer teleretinal screening services to their referring partners. This not only assisted in medical marketing for them but at the same time extended patient compliance in addition to assisting the primary care providers to meet their yearly CDC screening goals.
Diabetic retinopathy is the leading cause of blindness in the USA (mostly for adults 20-74 yrs of age). About 30 million Americans and 414 million people worldwide have diabetic retinopathy. With early detection, vision loss is preventable in up to 95% of the cases.
AAO, NCA and NQF recommend annual retinal exams for diabetic patients – however, only 20-50% really comply. Here are some reasons for this:
- Lack of patient awareness and education
- Lack of access to healthcare and even more so, specialists.
- Patient logistics are usually the biggest factor.
NCQA HEDIS and CMS STAR rating include retinal exams. CMS ACO diabetes management scores also includes retinal exams.
Regardless, DRE compliance increases incentives under HEDIS/STAR ratings, compliance has been poor.
Fort Drum Regional Health planning organization had started a telemedicine based diabetic retinopathy screening program where 95 % of the target population live in a health profession shortage area (HPSA) across various sites (see here). In less than a year after launch, they reported pretty promising results here.
As reported numerous times, the main challenges of patient logistics are due to the current workflow (as below)
- A patient visits their PCP for a check up (not necessarily related to diabetic retinopathy)
- The PCP office is supposed to do yearly retinal exams. However, many PCP offices are not equipped with this clinical decision support system.
- The PCP office refers the patient to a specialist office (ophthalmologist). They typically do so by handing the patient a note or a referral pad referral.
- The patient leaves the office – there’s no further follow up.
- A minority of those patients call the ophthalmologist offices. Since they are a high demand specialty – usually, they are already backed up.
- The patient faces barriers in setting up an appointment with the specialist office
- Finally, and when the patient does get an appointment with the specialist office, they may or may not show up.
- Even when the patient does actually show up for the visit, the encounter/visit notes may or may not be sent back to the PCP office.. Therefore leaving an open care loop.
The options already out in the market include the likes of retinalscreenings, Welch allyn RetinaVue network etc.
An ophthalmology group in NYC that deals with a large diabetic population wanted to offer teleretinal screening services to their referring partners.
This not only assisted in medical marketing for them but at the same time extended patient compliance in addition to assisting the primary care providers to meet their yearly CDC screening goals.
Solution – how it helped
In this particular case, the PCP office was responsible for patient acquisition, identification for retinal screening cases and therefore the ophthalmology group depended on the PCP offices.
The PCP office would create the patient as a new screening case to be diagnosed. They would then upload their images (right and left eye) to the web portal. This would send the alert to the retinal specialists on staff at our ophthalmology group and the specialists would immediately diagnose the images.
More often than not, while the patient was still at the PCP office, the PCP would get a report back. The system would generate a report with all information and notes necessary for billing purposes as well.
For patients that were diagnosed with NPDR, the PCP office could immediately send an electronic referral to the ophthalmology group so the patient compliance was already expected to be higher.
While WelchAllyn and retinalscreenings offer a slew of retina specialists that grade images, this does not help individual ophthalmology practices generate new patient business. Using those existing services is like listing themselves on ZocDoc – you cannot predict the amount of business you can generate, because every retina specialist is already on those networks.
Since the patient referral was generated immediately and the patient got an appointment before leaving the PCP office, the problem of patients forgetting to follow up with the specialist office was entirely eradicated.
Occupational therapy practice uses telehealth to gain new patients
Here’s how an Ergonomist and Occupational Therapist uses telehealth solution (app) to acquire, serve and retain patients for life. Workpose (Ergolution) staff are working in the field of injury prevention for hi-tech, insurance and healthcare enterprises.
Much like any service based business, Ergolution understood that the only way to grow revenues was to add more staff / increase headcount. The more headcount they added, the more the overheads – in other words, profit margins kept getting smaller. Increased headcount also led to higher revenue & cash flow requirements… all the problems that you know very well.
- Acquire – Generate more patient leads with a “foot in the door” offer, at a low cost of acquisition
- Convert – Provide tangible value to these new patients with this low priced offer. This is serviced with minimal effort from our client’s side.
- Nurture – Be in regular contact with these new patients, provide tangible value and aim for the larger business – being introduced to the companies these customers work for.
- Up-sell – Present these initial customers with a slightly higher priced service offering that isn’t a big ask from these new leads. For this, only two pictures were required from the customer. Again, this was also serviced with minimal effort from our client’s team.
How it was executed
Our customer launched a simple mobile app that allows their providers to achieve all of the above (telehealth doesn’t necessarily need to be a mobile app).
The mobile app presents 4 paths to help someone with aches/pains (patient)
- Self assessment – the patient is asked a series of questions to help them with their aches and pains
- Solutions for body discomfort – wherein the patient can click on various body parts to identify self care and ergonomic tips.
- Help videos – helps the patient make immediate changes to their posture with self help videos
- Ergonomic equipment recommendation – helps the patient choose from various products to ease their aches and pains.
Facebook was a perfect venue for advertising the app. Considering the segment that the app was going to help, this would have been a very large audience.
The app was advertised on Facebook with a small ad spend of $5/day (of course, proper audience creation, segmentation etc was done to identify the right kind of audience and show the app to only these users).
In fact, the audience was limited to California as well since it provided more than enough ROI.
Mobile app downloads were achieved at a very low cost per acquisition.
The “foot in the door” offer was for patients to immediately see value in an ergonomic consultation.
Approximately 80% of people that downloaded the app used both the self assessment.
Approximately 20% of these users also used the various solutions the app provides for body discomfort.
About 35% of these users that downloaded the app also signed up to hear more directly from the practice
About 20% of the users that answered various assessment questions, also signed up as a lead to hear more from the practice
To service this “foot in the door” offer, the practice owner and their team didn’t have to spend a single minute. These assessment questions and the solutions for various body discomfort were all canned responses.
In other words, the initial “foot in the door” offer was a raging success !
Nurture – Be in regular contact with these new patients.
All leads that were signing up to hear more from the practice are constantly nurtured via various methods.
Push notifications – there are several ways that the practice is staying in touch with their patients. Push notifications is one of them.
As an example, when a patient is seen using the app within the past hour (i.e. they are actually active), a push notification is sent to remind the patient to take a 2 min break and stretch every 30 mins of sitting at their desk. This has a dual purpose. First, for people that are really using the app, it keeps them engaged and helps them achieve their goals. On the other hand, if someone hasn’t opened the app in the last hour, it doesn’t bother them at all.
Does that mean that the practice is not going after these “inactive” patients? Nope !
Campaigns are set up and regular push notifications are sent to patients that have downloaded the app but are not using it actively. The practice also monitors the conversion rates of these mobile users.
For patients that have already provided their email address or phone number, they are nurtured via email/ SMS providing various occupational hazards and tips on how to avoid them.
Up-sell to existing patients
The idea was to present these initial customers with a slightly higher priced service offering that isn’t a big “ask” from these new patients.
Once we saw that people were interacting with the app and using the various self help and self assessment areas of the app, it was now time to up-sell these customers to a personalized recommendation. We called this “Ask an expert”.
Of course, for their regular practice, this would require an in-person visit from the patient or if this was being done at a contracted enterprise, the team would have to make in person visits to their offices.
Instead, this up-sell, again, required minimal inputs from both the patient and the practice team.
The patient was asked for a single picture from the side of them sitting at their desk (capturing the computer, keyboard and their feet). This allowed the practitioner to “virtually” see the patient and immediately recommend posture changes, recommend any changes to various equipment in use in addition to recommending any alternate desk/chair options.
This was a very easy up-sell as the patient had just undergone self diagnosis, already obtained a lot of tangible value from the get-go.