There is solid and convincing evidence in numerous well received studies that quantify the occurrence of patients not receiving recommended care between 45% and 55%! Even at the low end of the range it represents a potentially enormous problem in terms of outcomes based health improvement initiatives and evaluation of such based on population health methodology, or looked at another way – an enormous opportunity to reach out and engage patients to book appointments to get the care that has been recommended to them.
In the next four slides, we’ll be reviewing outcomes generated by the Outreach program.There are really two fundamental questions we’re concerned with:Is Outreach driving a patient response?If so, does that response affect our visit volumes for our providers who utilize the Outreach product.To better understand the patient response to Outreach, we used histograms.We analyzed monthly E&M visit volumes to get at the second question.
This is the first of two histogram slides. It measures how quickly patients respond to Outreach calls by scheduling visits that are billed with codes that are directly related to the call reason. For example, if a patient is called because he or she is in need of treatment related to diabetes, the patient has a visit billed with an ICD-9 code for diabetes. If there were no response to the Outreach calls, patients would be as likely to have a visit 90 days after the call than they are at 5 days. Their response would look something like the dotted red line, which is flat over the entire time period. Instead, there’s a large volume of appointments booked right after the Outreach call. This histogram measures patient response over a 90-day period. Within 5 days of the call, 27% of the patients book an appointment. That number jumps to almost 50% at 15 days. This means that of all the patients who scheduled an appointment directly related to the call reason within 90 days of the call, 50% of them did so within 15 days. When you turn on the Outreach product, patients will start calling your office to schedule appointments.
This second histogram measures patient response where the visit is ultimately billed for a code that is different than the call reason. For example, the patient was called for hypertension, but instead had a visit related to some other reason. While the patient response is not as pronounced as it is for visits that are directly related to the call reason, there’s still a downward slope. The act of generating a targeted phone call to a patient population drives a residual response as well as a direct response. The main point of the histogram slides is that Outreach is going to both bring patients back into the office for reasons directly related to the call, and drive a residual effect in which patients are motivated to simply reconnect with their physician.
[Good place for Steve to add insights into how Mankato operationalized the extra hour of office visit time for PCPs]
This slide trends monthly E&M visits between January of 2008 and August of 2010 for Mankato providers who subscribe to Phytel Outreach.The red bar indicates the time when the initiative to add an extra hour of office visit time for Mankato PCPs went live. There is an uptick in office visits from August to September, but the most significant change happens after Outreach went live. The average monthly visits in the period from January to August 2010 is 22% higher than the average from August to December 2009. Notice the big increase in office visits in the spring of 2009. That was the result of the H1N1 pandemic. We actually had to call patients to tell them to stay home. Even with that spike, the average monthly E&M visits in the January to August 2010 time period – the time after Outreach went live – are still 14% higher than the same time period in 2009. And they’re 22% higher than the same time period in 2008. This is to say that from our experience there are two pieces to increasing visit capacity. First, operational processes need to support the goal of seeing more patients – Mankato addressed this through the initiative to add an extra hour of office visit time for PCPs. And next, a program to proactively bring patients in need of care into the office is important to filling that capacity.