The 2021 Guide to Fully Integrating Telehealth and Eliminating No-Shows

The 2021 Guide to Fully
Integrating Telehealth and
Eliminating No-Shows
Telehealth is here to stay! Easily integrate it with your practice
+ reduce administrative overhead and patient no-shows

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2 | The 2021 Guide to Fully Integrating Telehealth and Eliminating No-Shows
Table of Contents
Why Telehealth?
Pre-Pandemic Now Show Rates
What is Telehealth? 3
Why Do Patients No-Show 7
Motivational Issues
Forgetting Appointments
Childcare
Employment Conflicts
Distance From Home and Access to Transit or Mobility
Transportation - Patients & Providers
Extended Wait Times and Urgent Visits
20th Century Scheduling and Load Balancing
Lack of Family Intervention
Analyze Your No-Shows 19
Frequent Flyers
Technology is Key
No Shows are an Opportunity

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What is Telehealth?
Prior to any discussion of the benefits of digital patient engagement, it is essential to address
the concept of telehealth as a whole. The Health Resources Services Administration defines
telehealth as the use of electronic information and telecommunications technologies to
support long-distance health care.1
This broad definition allows for flexibility of interpretation,
and encompasses a wide variety of communication tools and strategies beyond video
conferencing, which opens the door to addressing systemic issues, such as chronic no-
shows and the effect they have on practice revenue.
Why Telehealth?
Healthcare access and delivery are both vitally important, and frequently fraught with simple
and complex barriers across regions and populations.
From affordability and scalability to accessibility and equitable care, telehealth is more than
a means to an end during times of disruption: it is a strategic supplement to in person care
that increases patient engagement, improves satisfaction, and drives revenue for
your organization.
Robust telehealth platforms offer more than just a secure space to virtually conduct clinical
visits. Comprehensive solutions offer automated appointment notifications, provide tools
for streamlining workflows across staff and providers, and create opportunities to increase
capacity through increasing accessibility for patients and improving efficiency
with scheduling.
1 “What is telehealth? How is telehealth different from telemedicine?” HealthIT.gov. 17 Oct. 2019. url:https://www.healthit.gov/faq/what-
telehealth-how-telehealth-different-telemedicine.

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The best platforms offer opportunities to integrate with existing practice management and
patient record systems as well as offer strategic and technical support to staff, providers and
patients alike to ensure long-term success.
Accessibility
Increasing access to care is a goal in most health treatment settings. Underserved
populations need easy-to-access treatment, but it isn’t as simple as opening more
appointments or hiring additional staff. The National Conference of State Legislatures
acknowledges that “by improving access to lower-cost primary and specialty care,
telehealth can provide timely, accessible care in lower-cost environments and help reduce
expensive emergency room (ER) visits...Telehealth also allows for consultation between
providers, which can build capacity among practitioners in rural areas, where recruiting and
retaining providers remains challenging.” 2
As the ability to conduct non-emergency visits in person became increasingly hazardous in
early 2020, telehealth ensured that critical care could continue to be provided uninterrupted
to patients. The pandemic has served as a catalyst for wider spread telehealth adoption as
well as prompting legislators to revisit policy and regulation pertaining to telehealth visits,
such as licensures and reimbursements. Current events have clearly demonstrated that
telehealth solutions are a supplement in steadier times, and a lynchpin in times of disruption
during a public health crisis.3
2 “Increasing Access to Healthcare.” National Conference of State Legislatures, 30 May 2019. url:https://www.ncsl.org/Portals/1/
Documents/Health/Healthcare-Access_Telehealth_v07_33750.pdf.
3 Using Telehealth Services. Centers for Disease Control and Prevention, 20 June 2020. url:https://www.cdc.gov/coronavirus/2019-
ncov/hcp/telehealth.html.

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While the surge in telehealth has been
driven by the immediate goal to avoid
exposure to COVID-19, with more than 70
percent of in-person visits cancelled,1
76
percent of survey respondents indicated
How has COVID-19 changed the outlook for telehealth?
11%
use of telehealth
in 2019
50-175x 57% 64%
more telehealth visits pre-COVID
are being reported.4
Health Systems,
Independent practices, behavioral
health providers, and others rapidly
scaled telehealth offerings to fill the
gap between need and cancelled
in-person care.
76%
now interested in
using telehealth
going forward
of providers view telehealth
more favorably than they did
before COVID-19
of people are more
comfortable using
telehealth5
1.
Consumer
2.
Provider
3.
Regulatory
Types of services available for telehealth have greatly expanded,
with the Center for Medicare & Medicaid Services (CMS). Lifting
restrictions on originating site allows Medicare Advantage plans
to conduct risk assessments via telehealth, and adding other
regulatory flexibilities to increase access to virtual care.6
80
new
services
1 McKinsey COVID-19 Consumer Survey, April 27, 2020.
2 McKinsey COVID-19 Consumer Survey, May 20, 2020.
3 McKinsey COVID-19 Consumer Survey, April 13, 2020.
4 Ibid
5 McKinsey COVID-19 Physician Survey, May 2020.
6 Medicare telemedicine health care provider fact sheet, March 17, 2020,cms.gov.
Before
they were highly or moderately likely
to use telehealth going forward,2
and
74 persent of telehealth users reported
high satisfaction.3
After

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Pre-Pandemic No-Show Rates
As we adjust to the “new normal,” we must reflect on our understanding of patient needs
and challenges from pre-pandemic times, and apply them to the new barriers to care we
have begun to encounter.
In 2018, across geographic regions and healthcare
specialties, as many as 23 percent of scheduled
appointments were not completed.4
In order to address no-show rates, healthcare
organizations must understand and address
the reasons that patients don’t present for
scheduled appointments.
By identifying the most common barriers, clinics and practices can employ solutions that
change the entry point to care and improve administrative processes to reach more patients.
According to a study by Todd Molfenter, strategies such as streamlining processes,
reducing wait times, and introducing automated appointment reminders reduce no-show
rates considerably.5
By reducing initial
wait times from 13
days to 0, no-show
rates dropped from 52
percent to 18 percent.
4 Dantas, Leila, et al. “No-shows in appointment scheduling - a systematic literature review.” Health Policy vol. 122, no. 4, 2018, pp. 412-
421. NCBI, doi:10.1016/j.healthpol.2018.02.002.
5 Molfenter, Todd. “Reducing Appointment No-Shows: Going from Theory to Practice.” Substance Use & Misuse, vol. 48, no. 9, 2013, pp. 743-749.
NCBI, doi:10.3109/10826084.2013.787098.

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Why Do Patients No-Show?
Missed appointments can happen in any population, and the reasons vary widely. After
examining demographics across the spectrum, Zivin, et al6
in the American Journal of
Managed Care identified specific populations who are most likely to miss appointments.
“Research demonstrates that ‘no-show’ patients are more likely to be younger, male, and
unmarried.” Their study also identified young adults with children and those with less
experience in mental health treatment to have a higher likelihood of no-shows.
While these populations may be more likely to miss an appointment, they are also most
likely to be accessible via technology. These patients need a better way to access care, and
a more comprehensive tool to help overcome psychological, motivational and/or physical
barriers. By working with enhanced tools that introduce engagement via technology, these
populations are able to receive care and interact with their care teams in ways that are
familiar and simple for them.
Access to technology can also be a barrier for some populations, and thus makes receiving
care virtually challenging. Some social determinants of health could remain as barriers for
vulnerable communities, such as digital literacy and access, lack of medical insurance and
limited financial resources. Recent studies estimate that at least 1 in every 4 Americans may
not have digital literacy skills or access to Internet-enabled digital devices to engage in
video visits.7
Improving access and affordability of healthcare is feasible through telehealth, but other
advancements will also be required to reduce these inequities. As noted by Nouri et al.,
6 Zivin, Kara, et al. “‘No-Shows’: Who Fails to Follow Up With Initial Behavioral Health Treatment?” American Journal of Managed Care, vol. 15, no.
2, Feb. 2009, pp. 105-112. url:www.ajmc.com/journals/issue/2009/2009-02-vol15-n2/feb09-3915p105-112.
7 Nouri, Sara et al. “Addressing Equity in Telemedicine for Chronic Disease Management During the Covid-19 Pandemic.” NEJM Catalyst
Innovations in Care Delivery, 4 May 2020. url:https:/
/catalyst.nejm.org/doi/full/10.1056/CAT.20.0123.

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“Now that telemedicine is the default for delivery of primary care — and is likely to
remain so for the near future — it is imperative that we proactively evaluate and address
disparities in access to telemedicine to limit the already worsening health outcomes and
health disparities.”
In July 2020, local lawmakers from Baltimore, Philadelphia and Detroit introduced resolutions
urging Comcast to improve broadband strength and expand public hotspot access swiftly
and equitably in support of virtual learning for students across those communities.8
In
June, a bipartisan coalition of United States Governors submitted a letter urging federal
support for digital infrastructure developments, stating, “This investment will unlock the
potential of a new generation of technologies for healthcare advancement, ensure that
school children across America have access to the best educational tools, foster new ways
of doing business... and give states and communities the opportunities to capitalize on
smart infrastructure deployment.”9
These efforts and similar public/private partnerships —
prompted further by the COVID-19 pandemic — could dually benefit access to technology
and internet connectivity critical for modern-day healthcare delivery.
Motivational Issues
Beyond post-covid apprehension about in-person meetings, behavioral and chronic
illnesses often impair motivation, making it difficult for patients to follow through with
available help. Patients who are struggling with anxiety, depression, bipolar disease, PTSD,
etc. may not be motivated to leave the house, even if the end goal is the treatment that will
help them overcome this. Further, the stigma associated with behavioral health treatment
can be independently anxiety-inducing.
8 McLeod, Ethan. “Students, City Lawmakers Call on Comcast to Expand Free Wi-Fi, Hotspot Access.” Baltimore Business Journal. 20 July 2020.
url:https:/
/www.bizjournals.com/baltimore/news/2020/07/20/students-cities-ask-comcast-address-digital-divide
9 Burgum, Doug et al. “Dear Mr. President and Congressional Leaders…” 25 June 2020. url:https:/
/www.governor.pa.gov/wp-content/
uploads/2020/06/20200625-TWW-Governors-Congressional-Letter-on-Broadband.pdf.

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Solution: Telehealth
The right HIPAA compliant telehealth software can instantly
connect patients with their providers in a secure video
conference with just the tap of a link and date of birth.
Research shows that in some diagnoses and instances,
treatment via telehealth is as effective or more effective
than in-person care.10
By increasing diversity in the range
of providers available, telehealth makes it easier to match
patients with an appropriate specialist.11
Additionally, telehealth
has been shown to bridge cultural and linguistic gaps.12
On the top-rated platforms, telehealth visits consistently
average single digit no-show rates without requiring the
patient to download software to connect.
Ask vendors about their connectivity rates and find out if instant support is available if a
patient or provider ever has trouble connecting. The right telehealth solution will ensure
your staff and providers do not need to assume the role of a help desk.
Forgetting Appointments
In a time when people are inundated with information, it can be easy to miss a scheduled
appointment without reminders and contact from the practice. Many of us operate in a
digital and notification based world, where a single reminder isn’t sufficient. Most patients
Infographic - CMS
Finalized Telehealth
Changes to the CY
201914
View PDF
CMS 2019 CMS
Telehealth
FACT Sheet13
View PDF
10 Hilty, Donald M., et al. “The Effectiveness of Telemental Health: A 2013 Review.” Telemedicine and e-Health, vol. 19, no. 6, 2013. doi:10.1089/
tmj.2013.0075.
11 Jiali Ye, Ruth Shim, Tim Lukaszewski, Karen Yun, Soo Hyun Kim, and George Rust. “Telepsychiatry Services for Korean Immigrants.”
Telemedicine and e-Health, vol. 18, no. 10, 2012. doi:10.1089/tmj.2012.0041.
12 Hilty, Donald M., et al. “The Effectiveness of Telemental Health: A 2013 Review.” Telemedicine and e-Health, vol. 19, no. 6, 2013. doi:10.1089/
tmj.2013.0075.
13 “Medicare Learning Network: Telehealth Services.” Centers for Medicare and Medicaid Services, March 2020. url:https:/
/www.cms.gov/
Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf.
14 “CMS Finalized Health Changes to Physician Fee Schedule CY 2019.” Center for Connected Health Policy. url:https:/
/www.cchpca.org/sites/
default/files/2018-11/Finalized%20PFS%202019%20Infographic%20Final%20V.%204.pdf.

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need multiple reminders at specific intervals to ensure that they make the appointment.
Data also shows that only 30% of patients will actually confirm their appointment, so relying
on confirmations may not be effective.13
Solution: Automated Appointment Reminders
The average no-show rate is 23% across the globe.16
For a 10 provider practice, that equates
to at least $857,808 in lost revenue annually. If the average revenue per visit is $74, a 10
provider group loses $186,480 per month or $2,237,760 annually.
The medium matters: 90% of text messages are read within 3 minutes.17
Mend’s innovative,
automated text, email, and phone reminders can significantly reduce no-show rates by
eliminating the possibility of patients forgetting appointments.18
Reminder sequences positively impact outcomes,19
and the information they contain is
important. Calendar invitations with the appointment confirmation are an excellent start,
followed by text messages and emails set at 1 week prior, 2 days prior, and 1 hour prior to the
appointment. Patients should also have the opportunity to confirm or reschedule digitally in
the event of a conflict. This decreases the likelihood of the patient missing the appointment
entirely. Sending a notice one hour in advance can provide the patient with the address so
they arrive at the correct location.
15 Lassiter, Brandon. “Confirmation Data Analysis.” Mend VIP, Inc., Oct. 2018. Internal data analysis.
16 Dantas, Leila, et al. “No-shows in appointment scheduling - a systematic literature review.” Health Policy vol. 122, no. 4, 2018, pp. 412-421. NCBI,
doi:10.1016/j.healthpol.2018.02.002.
17 “Conversational Advertising.” MobileSQUARED, June 2010. pdf file.
18 Fischer, Henry H, et al. “Appointment Reminders by Text Message in a Safety Net Health Care System: a Pragmatic Investigation.” eGEMS, vol.
5, no. 1, Sept. 2017, p. 20. doi:10.5334/egems.215.
19 Fischer, Henry H, et al. “Appointment Reminders by Text Message in a Safety Net Health Care System: a Pragmatic Investigation.” eGEMS, vol.
5, no. 1, Sept. 2017, p. 20. doi:10.5334/egems.215.

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Childcare
Childcare can be a considerable burden, especially for those who are using treatment-
related transportation. While the patient may be able to travel to their appointment
using these services, children and family are often precluded. Young parents are
disproportionately unable to get the assistance they need with children, and bringing
children to sessions is often not an option.
Solution: Extended Hours Using Telemedicine
Innovative groups have leveraged telehealth and digital workflow technologies to offer
services from 8 a.m. to 8 p.m. This flexibility is especially important for young parents, who
can now connect with providers after their children are in bed and when they can focus
completely on their own care.
Many providers are also seeking flexibility to manage their own personal and professional
schedules and enjoy what patients are now offered with technology. In a virtual setting,
brick-and-mortar and support staff are not always necessary to create extended hours of
operations, resulting in increased revenue, greater patient and provider satisfaction, and a
reduction in no-shows.
Employment Conflicts
Offices that operate on regular business hours can present a challenge for patients to get
out of work in time for appointments. Unless the office is close to the patient’s workplace,
getting in and out during a lunch break is highly unlikely. Patients are often forced to take
already-limited time off work to get to the office, and for those who don’t have schedule
flexibility, this can be a barrier to treatment.

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Solution: Automated Appointment Rescheduling
In addition to offering extended hours of operation,
self-rescheduling processes can encourage
patients to take ownership of their appointments
and reduce the administrative burden of managing
the schedule. With the right platform, patients can
access the schedule no matter the hour. If a last-
minute meeting comes
up, the patient is able to log in and notify the
practice with a reschedule request in real time.
This opens the spot up to be backfilled with
another appointment or to pull someone from
the waiting list.
Integrated, simple rescheduling solutions can reduce no-shows because they make it easier
for the patient to communicate conflicts. Most solutions on the market don’t offer a fully
integrated option. In most cases, the tools available are notification messages that go to an
inbox for review by a staff member.
Review with potential vendors to see if they offer a full rescheduling solution that is
integrated with the EMR or Practice Management system.
Distance From Home and Access to Transit or Mobility
Studies have determined that patients are more likely to present to sessions if the office is
close to the patient’s home base, and that patients who have to travel even 20 miles are
less likely to present to their session.21
This could be related to access to public or private
transportation, difficulty navigating traffic, general discomfort or frustration with traveling
outside of their neighborhood and more.
77% of patients
surveyed want online
patient appointment
self-scheduling.20
20 Accenture. “Accenture Consumer Survey on Patient Engagement. Research Recap: United States.” Accenture, Sept. 2013. pdf file.
21 Butterfield, Stacey. “Research Reveals Reasons Underlying Patient No-Shows.” ACP Internist, Feb. 2009, acpinternist.org/archives/2009/02/
no-shows.htm.

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Solution: Virtual Care on a Trusted Telehealth Platform
Distance is a nonissue with telehealth. As long as the provider is licensed in the state where
the patient is located, patients can connect without any travel at all. Travel and transportation
represent huge barriers to treatment, and while some in-person treatment may still be
required, regular visits become as far away as the patient’s mobile phone or computer. With
the advent of low-cost broadband as well as the proliferation of mobile devices throughout
most demographics, travel for treatment is not always a requirement.
Transportation - Patients & Providers
Patients without adequate transportation represent a large portion of no-shows. Patients
often lack access to personal vehicles, and when treatment transportation is available,
they are unable to access it unless they are traveling alone. For parents without childcare,
this transportation is frequently not an option. When individuals have to choose between
the high cost of transportation to treatment and not attending, they often don’t attend. Other
populations, like those who reside in shelters and nursing homes, present a
high-cost burden to the facilities for transportation that could be easily eliminated with
the correct tools.
Provider travel to homes or different facilities is also costly. Time spent traveling does
not generate revenue, and it can be expensive for the facility in compensation and lost
work hours. Virtual solutions capitalize on the value of provider travel while reducing the
significant expenditure.
Solution: Virtually Connect to Homes & Facilities
A robust telehealth solution can accommodate site-to-site visits and excels at connecting
to patients in their homes. It must also handle other important workflows like paperwork,
clinical assessments, treatment plans, co-payments, appointment reminders, and instant
technical support to ensure that visits happen.
Imagine extending a practice into group homes, shelters, nursing homes, hospitals, primary
care offices or any other facility. Virtual telehealth kiosk solutions allow practices to put
providers in any facility utilizing the equipment that is already available.

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When you meet the patient where they are, whether that be in a home or designated facility,
no-show rates remain extremely low. When done digitally, overhead is reduced and more
provider time is available to help more patients. Most importantly, accessibility for patients to
receive the critical care they need effectively, efficiently and on time increases significantly
with a strong telehealth strategy.
Extended Wait Times and Urgent Visits
Acute patients are the individuals who are most impacted by extended wait times. Patients
who are in need of immediate treatment are the most likely to no-show if their appointment
was booked weeks or months in advance. There is a correlation between functional
impairment and missed appointments22
for both initial and follow up appointments, and
reducing the gap between contact and care is vital. In addition to wait times, the ability to
schedule and conduct urgent visits on short notice, when possible on the provider’s end, is
faster and simpler through telehealth with the right tools.
Solution: Introduce Telehealth to Reduce Wait Times or
Connect Immediately
Facilities across the country have been able to reduce wait times from weeks to days
(and sometimes hours) by integrating telehealth solutions for crisis care and follow ups.
Telehealth reduces geographic restrictions and introduces novel scheduling methods that
can match patients with providers who are licensed in the patient location. By reducing
the requirements for brick and mortar, transportation and in-person evaluation, schedules
become more malleable. The largest telehealth organization in Florida was able to reduce
wait times to 24 hours.23
The availability of introductory care has increased patient retention,
encouraged regular follow up, and reduced overall medication utilization by patients.
Patients with acute complaints receive service without leaving their homes. Patients with
cultural preferences for care are able to link up with providers who meet those needs. The
innovative scheduling tools also increase treatment hours beyond the normal 9-5. Patients
22 Gajwani, Prashant. “Can What We Learned about Reducing No-Shows in Our Clinic Work for You?” Current Psychiatry, vol. 13, no. 9, Sept. 2014,
pp. 13-15, 22-14. url:https:/
/www.mdedge.com/psychiatry/article/86564/practice-management/can-what-we-learned-about-rReducing-no-
shows-our-clinic.
23 Erlich, Lauren. “Telemedicine In Behavioral Health: How Virtual Care Produced Real Outcomes for One

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can meet with providers on a schedule that is quick, efficient, and easily accessible despite
other limitations.
At times, patients and providers need to urgently connect in moments of duress. Mend
offers tools for quickly scheduling visits for an immediate connection via the “Instant Virtual
Exam Room” feature. All a staff member or provider needs is an email or mobile phone
number to send a link to a patient for an immediate connection, keeping the process easy
even in times of emergency. This feature also eliminates the step of adding a patient to the
system first, and allows the patient to do that directly, saving staff time.
20th Century Scheduling and Load Balancing
Restricting appointments to regular business hours means that care is only available 24
percent of the week. Further, traditional scheduling solutions like in-person and phone calls
make it difficult to coordinate schedules or find time during the day to catch an overworked
staff member when he or she is available. A review of scheduling access by a team of
psychologists showed that patients were only able to get an appointment with a psychiatrist
when calling by phone 12 percent of the time. This same study found that when participants
requested a call back, they received returns on their inquiries 23 percent of the time.24
These
difficulties and delays also lead to missed appointments when scheduled patients are
unable to get through to reschedule.
Solution: Patient Self-Scheduling, Self-Rescheduling & Effective
Provider Utilization Modeling
Self-scheduling tools keep overhead low while introducing 21st century mechanisms into
any organization. Internet-connected solutions keep your practice open 24 hours per day
while still providing the control and oversight that the team needs. Self-scheduling, self-
rescheduling, and cancellations can have a dramatic impact on no-show rates.
When patients can self-schedule, they are 50% less likely to no-show.25
Patient self-
rescheduling can move no-show rates even lower. In a 2013 study, 77% of patients surveyed
reported that they want online patient appointment self-scheduling.26
Self-scheduling and
24 Boyd, J. Wesley. “Why Is It So Hard to See a Psychiatrist?” Psychology Today, Nov. 2014, www.psychologytoday.com/us/blog/almost-

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self-rescheduling allow flexibility for conflicts, transportation, and other issues resulting
in no-shows.
Self-scheduling solutions don’t automatically mean that patients have full control over
appointment booking. Most scheduling solutions give staff the option of appointment
approvals, which allow patients to request a time but require approval for actual scheduling.
Many health practices are hesitant to allow patients to autonomously schedule their own
appointments, but they are happy to replace phone calls with online appointment requests
that get reviewed at regular intervals. The experience is intuitive and simple for both the
patient and the practice, and it can be integrated with most EMRs.
In addition to streamlining scheduling, the nature of telehealth allows for greater balance
and flexibility for load balancing for individual providers and across the health system
broadly. It can increase efficiency in different ways, in turn making providers more accessible
to more patients. The Harvard Business Review identified six contributing factors to
shortcomings in care availability and delivery, two of which - uneven distribution and
inefficient use of physician labor - uniquely addressed by telehealth solutions.27
Telehealth eliminates geographic barriers by allowing providers licensed in multiple states
to practice in them no matter their primary location. This can be extremely beneficial for
reaching patients in rural or more remote areas that may have fewer physical clinical offices
in their area. “Virtual care allows providers from different parts of the country to virtually
connect with residents in locations where their skills may be in short supply or where the
local team simply needs ‘reinforcements.’”28
During the current coronavirus pandemic, telehealth has become a vehicle for mobilizing
providers nationwide to serve patients in areas that were at or near capacity, such as New
York City. Additionally, physicians who were potentially exposed to the virus could still
provide services via telehealth while quarantined, freeing up other physicians for in person
addicted/201411/why-is-it-so-hard-see-psychiatrist.
25 Lassiter, Brandon. “Confirmation Data Analysis.” Mend VIP, Inc., Oct. 2018. Internal data analysis.
26 Accenture. “Accenture Consumer Survey on Patient Engagement. Research Recap: United States.” Accenture, Sept. 2013. pdf file.
27 Kerns, Christopher and Willis, Dave. “The Problem With U.S. Health Care Isn’t a Shortage of Doctors.” Harvard Business Review, 16 March 2020.
url: https:/
/hbr.org/2020/03/the-problem-with-u-s-health-care-isnt-a-shortage-of-doctors.
28 Poth, Jenny. “Virtual Care’s Ability to Expand Provider Bandwidth.” Web blog post. American Telemed Association, 13 July 2020.
url:https:/
/www.americantelemed.org/blog/virtual-cares-ability-to-expand-provider-bandwidth/.

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care who were not exposed. As the American Telemed Association notes: “Whether it is a
question of specialty, skill level, or licensure, virtual care workflows can rapidly collect and
analyze data to intelligently match patients and providers for optimized experiences and
outcomes.”29
Telehealth circumvents the limitations of place-based care models not only
as a stop gap when in-person care is disrupted in extraordinary circumstances, but at any
time. It provides solutions on an ongoing basis to make not only accessing a provider, but
accessing the right provider, more intuitive and equitable.
Lack of Family Intervention
The highest risk patients often need the most intervention from their support system in
order to improve treatment outcomes.30
This intervention can be difficult to secure when
the support system is expected to take time off work or travel extended distances to be
involved in treatment. According to the SAMHSA Tip 39 on family intervention in substance
use treatment, family treatment, “...is positively associated with increased rates of entry into
treatment, decreased dropout rates during treatment, and better long
-term outcomes.”31
Though this intervention can be vital, it is not always easily facilitated.
Solution: Group Therapy Using Telemedicine
HIPAA compliant video conferencing can be effortless for patients and providers. Patients
click a link, input their date of birth, and instantly connect to a video session. Bandwidth
requirements are minimal for all connected parties on the top-rated platforms.
Groups operate differently in healthcare through unique workflows. Robust virtual group
platforms allow organizations to create recurring or single group events and add or
remove patients to the groups as needed. Once groups have been established, these
systems automatically handle text message, email, and phone reminders. Patients will also
29 Poth, Jenny. “Virtual Care’s Ability to Expand Provider Bandwidth.” Web blog post. American Telemed Association, 13 July 2020. url:https:/
/
www.americantelemed.org/blog/virtual-cares-ability-to-expand-provider-bandwidth/.
30 Gajwani, Prashant. “Can What We Learned about Reducing No-Shows in Our Clinic Work for You?” Current Psychiatry, vol. 13, no. 9, Sept. 2014,
pp. 13-15, 22-14.
url:https:/
/www.mdedge.com/psychiatry/article/86564/practice-management/can-what-we-learned-about-reducing-no-shows-our-clinic.
31 Substance Abuse and Mental Health Services Administration. “Quick Guide for Clinicians Based on TIP 39 Substance Abuse Treatment and
Family Therapy.” SAMHSA, 2005.
url:https:/
/store.samhsa.gov/system/files/sma15-4032.pdf.

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receive appointment confirmations and calendar invites. Digital forms can also be sent out
automatically. The convenience is valuable for patients, and staff benefit from the reduced
manual labor of automatic EMR input.
Until recently, good solutions for group telehealth did not exist. Tools for group video
conferencing are designed for webinars and meetings, not confidential sessions with
transmission of PHI. Further, the scheduling tools required for a complex visit are absent
from traditional video conferencing solutions.
It can be difficult for working professionals to commit to group sessions. Offering virtual
solutions adds flexibility to certain populations so that they complete their therapy
successfully instead of dropping out. As outcomes and alumni increase, so will your referrals
from those participants.

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Analyze Your No-Shows
Practice management, reporting and data warehouse systems are excellent tools to analyze
metrics and identify high no-show rates. Practices can review this information that is readily
available to develop specific plans of action to prevent them. Working with IT teams or
consultants is another option to search your data for opportunity areas..
An analysis of the data may identify appointment types that have the highest no-show
rates. It could also reveal the patient populations that are most likely to miss
appointments. Conversely, the data may pinpoint providers or teams that have higher
success rates so you can duplicate those processes. This information can easily inform
actions to optimize services.
Frequent Flyers
A thorough review of appointment data can reveal a significant amount about how to
best reduce no-shows. Administrators can find patterns over entire populations. In many
cases, 30 to 50 percent of patients who will no-show have previously no-showed for an
appointment. Mental health care, in particular, is a high follow-up specialty, so those that
miss appointments are frequently repeat offenders. By identifying those patients, practices
and clinics can find alternative notification and treatment solutions.

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Data points to consider when developing a no-show analysis, listed in order of importance:32
• Patient historical no-show rates
• Appointment type
• Type of insurance
• Provider no-show rates
• Appointment lead time in days
• Time of day
• Individual location no-show rates
• Patient scheduled appointment vs. staff scheduled
• Cost
• Gender
• Race
• Ethnicity
• Day of the week
• Marital status
• Source of referral (some EMRs track this)
• Diagnosis
• Education level
• Language
• Symptoms
• Transportation
• Days since last appointment
• Provider to patient gender
Technology is Key
Every other industry adopted smartphones and personal devices to reimagine the
end-user experience. The COVID-19 pandemic provided a jumping off point for the
healthcare industry to finally move in that direction as well.
32 Leila F. Dantas, Julia L. Fleck , Fernando L. Cyrino Oliveira, Silvio Hamacher. “No-shows in appointment scheduling - a systematic literature
review.” Health Policy vol. 122, no. 4, 2018, pp. 412-421. NCBI, doi:10.1016/j.healthpol.2018.02.002.

MendFamily.com
Technology introduces simple-to-use, robust solutions to fill gaps in capacity and access,
address no-shows, and increase flexibility.
Even before the pandemic, one large healthcare organization has been able to harness
the power of technology to complete 4,000-6,000 health visits per month with huge
improvements in appointment completion, medication utilization, provider satisfaction
and more.33
• Reduced no-shows from 60% to 10% or less
• Limited new patient wait times to less than 48 hours
• Improved treatment compliance
• Ended provider shortages and established a wait list of psychiatrists
• Eliminated reliance on transportation
• Eradicated paper forms
• Reduced the need for brick-and-mortar operations
• Increased treatment areas from cities and counties to the entire state and beyond
No Shows are an Opportunity
By partnering with a dynamic and flexible technological solution, organizations can reduce
no shows while limiting administrative overhead. New software does not have to mean
new staff to manage that software. The right solution will be lightweight, easy to use, and
integrate with existing tools. By delivering care, support and information through text
message, email, phone calls and patient access platforms, organizations can impact no
shows and increase access to care and overcome social barriers to care, no matter what the
“new normal” looks like.
33 Erlich, Lauren. “Telemedicine In Behavioral Health: How Virtual Care Produced Real Outcomes for One Community Mental Health Center.”

The Leading Telemedicine & Digital
Patient Intake Platform
Achieve single digit no-show rates and 90+% patient engagement
Mend is a telehealth company. We offer a customized platform including telemedicine,
appointment reminders, patient scheduling, and digital patient intake forms to take existing
workflows and processes to the Web. Simply put, Mend can increase patient volume, close
gaps in care, and automate your workflow while enabling you to increase revenue, reduce
overhead, and save time.
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Engagement Platform
Eliminate no-shows, reduce overhead and increase revenue
Mend is the leading simple, secure, integrated telehealth and patient engagement platform
for modern practices. Our platform spans both virtual and in-person solutions, including
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effortlessly integrates with your existing workflows and enables you to focus on patient care,
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