Patient Engagement and the Primary Care Physician

Primary Care Physicians are critical to the ongoing health of their patients. However, the effectiveness of this relationship depends on the frequency and quality of encounters and an open and ongoing dialogue.

The Shape of the Encounter

The most typical form of communication with the PCP is via telephony. The phone call is still the primary method used to schedule appointments, inquire about billing, communicate about referrals, and more. However, call handling often leads to patient frustration and poor customer service. Abandoned calls are a common occurrence. And while the number of abandoned calls to a practice is not a direct indication of quality of service and responsiveness, it is a useful gauge and quality metric worth tracking.

Abandon rates are a result of several factors ranging from staffing, average handle time, purpose of the call, alternative communication options, time of day, and more. Addressing abandon rates is, therefore, part art and part science. While more and more patients have become familiar with (and in many cases welcome) such features as callbacks, and even AI self-service bots, not all patients are willing to lose the personal touch of the one-on-one interaction. Striking a balance between these capabilities is fast becoming a critical component to overall patient satisfaction and practice efficiencies. 

The period a patient remains on hold is directly correlated to their overall satisfaction of an interaction. Not surprisingly, a patient who remains on hold for more than 5 minutes decreases their overall satisfaction and continues to escalate as time on hold increases. This is in fact truer at key times of the day, and correlates closely to call abandon rates.  In a recent study, we determined that over 50% of all daily abandoned calls occur between 8 and 9am, and between 12 and 1:30pm. While this correlates to the time limits of the patient (beginning of the day, and lunch hours), it is among the most easily addressed challenges from a staffing perspective. But staffing can only go so far. Alternative options must still be deployed to minimize the average handle time of each interaction.

This data also suggest that patients are looking to engage with their doctor’s office during times they are not working, thus highlighting the need for off-hours methods of interaction. In an online survey, we learned that 85% of respondents have attempted to contact their healthcare team outside of regular office hours, and that 73% were not satisfied with their doctor’s office availability, responsiveness, and accuracy.    

A hand stacks wooden blocks with icons that correspond with several elements of healthcare.

Speed to Handle - Speed to Resolution

The average handle time (AHT) can be reduced by more than 25% by capturing patient profile data prior to the engagement of a contact. While it is not uncommon for an agent to need access to a third-party solution (i.e. EHR), this is expedited by identifying the patient prior to the direct interaction. Adding a call “Agenda” can provide further benefits, and serve as reminders to next steps, and/or outstanding care needs. The Agenda concept allows for the most productive interaction, and can be driven by AI and rule-based logic to ensure the most efficient engagement, each and every time. So, while average handle times may decline, there is a valid argument that longer AHT can in fact represent more efficient communications, and better overall service management and more long-term encounter and billing effectiveness. Upcoming prescription refills? Outstanding screenings? Outdated History? All these items can be highlighted in a call Agenda, if the patient is identified early in the process.      

Priority of call is perhaps the most important component of a call center solution. Some calls are more important than others. While this may not be a message projected to patients, the reality is that calls from other Dr. offices, or calls related to time-sensitive urgent and transitional care are in fact more critical than billing questions, and prescription refill requests that have alternative options to fulfill (i.e., pharmacy refill requests). Priority of calls and queues, therefore, can see dramatic benefits to providing access to care for the most critical encounters.  In a recent implementation. We were able to lower abandoned calls by roughly 80% overall, and over 90% for Urgent calls through prioritization of targeted queues, as well and workload-based contact flows that encourage self- service and callback queues during heavy call volumes. As a result of these efforts, we are seeing a higher rate of timely appointment scheduling for the patient in Transitional Care Management (TCM), leading to higher compliance, patient satisfaction, and ultimately increased reimbursements.

In addition, we understand that patient access to a practice may be limited by the office hours of the practice. Unfortunately, the office hours of the typical practice are largely the same as those of the average patient. Meaning the time the average patient is at work is the same as the practice is open and available. As such, patients are often confined in opportunities to engage with their PCP. Enabling features that can capture appointment requests and other communications outside of office hours can extend patient satisfaction. These additional engagement channels are often delivered via a patient portal, but often go largely unused due to the static and unresponsive nature of the engagement.  As a result, more interactive methods are being used to actively engage with the patient. While not yet commonplace, AI self-service bots provide a more immersive communication channel, and one that can mirror the same experience via telephony or chat. Ultimately, combining these technologies with the call center queue priorities and escalation, the practice can further enhance the engagement in the most efficient and critical manner.

Engagement is a 2-way relationship

While this article focuses on the benefits derived from the inbound side of patient engagement, it is important to recognize the outbound as well. Developing an outbound strategy to the individual patient journey is key to addressing the frequency and quality of patient engagement that furthers the critical dialogue between provider and patient. A closed-loop strategy is helpful in addressing each interaction from inception, to engagement, to follow-up. But the patient journey goes well beyond a single interaction. While such events as the annual wellness visit may be the most compelling reminder or follow-up, the truth is that practices can benefit greatly by a targeted outreach strategy that engages patients based on their individual health needs and social determinants. While the typical EHR provides tools for recalls and clinical reminders, it typically does not provide an approach to prescheduled and event-based engagement across channels. Programmatic patient journeys can leverage a common view of both the inbound and outbound engagement with each patient, to ensure the ideal engagement for each individual. But more on this in a future article.

Patient Engagement

Conclusion

The patient relationship is often limited due to various engagement and interaction constraints. While overall health of the individual is often dependent on their Primary Care Physician, the relationship with each patient may suffer if impacted by an infrequent and/or incomplete and ongoing dialogue. While this ongoing dialogue consists of both inbound and outbound communications, it is often the inbound that impacts the relationship the most. And, more often than not, the first interaction is inbound, and sets the tone for the ongoing relationship.

Addressing the inbound challenges faced by most patients can improve patient satisfaction dramatically and can also improve overall practice efficiencies. Small changes to handling the inbound process can pay significant dividends in practice efficiency and patient satisfaction.