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    A DALL-E-generated image of a patient picking an appointment from a massive calendar.The delicate balance between staffing your practice amid a tight labor market and the increasing demand for care from patients was disrupted countless times since the start of the COVID-19 pandemic, and it remains a major focus of healthcare administrators heading into 2023.

    To better understand how to meet patient demands for a consumer-centric experience in healthcare, MGMA and Relatient produced the 2022 Patient Engagement Report — a research effort to:

    • Understand the approaches and tools used in patient scheduling;
    • Identify the top challenges in scheduling;
    • Assess common strategies in patient communication methods;
    • Understand challenges in administrative staffing; and
    • Identify the top external threats to scheduling and communications.

    In a recent webinar presentation on the findings, Relatient’s David Dyke, chief product officer, and Emily Tyson, MBA, chief operating officer, provided an overview of how organizations are rethinking patient engagement, “whether it’s to address shifts in value or to address operating performance and patient satisfaction,” as Dyke noted.

    The access landscape

    Patient access’ “new normal” has rapidly evolved since the height of the pandemic, with impacts from inflationary economics and “massive volatility” in labor markets and ongoing shifts in patient expectations for their healthcare experience, Dyke said.

    “Patients still continue to report trouble finding the right type of provider; trouble making an appointment, whether that’s technically or operationally; to having significant wait times associated with appointments,” Dyke said, noting that many of these factors are not new but are being felt more intensely because of the speed at which they are changing post-COVID-19.

    “On the provider side, it’s increasingly a competitive landscape, [with] new players entering the market … low-acuity environments setting up and taking care away from primary care networks,” Dyke added. “These [shifts] are happening faster, but they’ve really been happening for a long time across healthcare.”


    As Tyson noted, the study found that almost half (47%) of respondents indicated that patient scheduling was the patient experience function most important to their success, ahead of:

    • Digital patient registration and intake (15%)
    • Patient payments (15%)
    • Appointment reminders/messaging (12%)
    • Health maintenance campaigns (4%)
    • Online chatbots/artificial intelligence (1%)
    • Something else (7%).

    Figure 1. Patient scheduling is the most important patient experience function for success. Figure 2. Economic pressures have the biggest impact on patient scheduling and communicationsWithin that area of patient scheduling, call center experience, online scheduling and patient self-service were the most important to respondents, Tyson noted. But another way to consider this increasingly important area is the quality of scheduling as it impacts overall patient experience.

    “This might seem like an obvious perspective — you want to deliver a high-quality experience … [but] what is the definition of quality?” Tyson said, noting that the concept of quality could include appointment availability, scheduling without a phone call, the length of time needed to schedule, and the wait time until the scheduled appointment.

    Patients, administrators and physicians all have different definitions of quality when it comes to scheduling.

    Medical group and health system leaders also must balance the expectations of patients around scheduling with their providers, who could be frustrated if the scheduling workflows send them the wrong patients, not enough patients, patients scheduled for an inappropriate amount of time for their care needs, or just individual preferences (e.g., doing specific procedures on certain weekdays).

    The study revealed provider preferences (31%) and patient preferences (21%) accounted for more than half of the biggest factors impacting scheduling complexity, outpacing staff turnover (15%), managing waitlists and unfilled appointment slots (11%), patient-to-provider matching (9%), referral management (9%), and something else (4%).

    How it gets done

    As the factors impacting patient satisfaction have evolved and intensified, provider groups increasingly have more than one channel for patient scheduling, but the front desk or receptionist (84%) remains the most common channel for scheduling to occur, per the study, followed by:

    • Call center (58%)
    • Online, request to book (48%)
    • Online, self-booking (30%)
    • Text/SMS (11%)
    • Other (8%)
    • Chatbot (5%).

    “There have been real strides in the industry to try to enable patients to do this themselves, outside of usual business hours [with] an easy process to get the appointment confirmation and know that I am booked,” Tyson said, “but it’s still only 30%.”
    Figure 3. Managing provider and patient preferences are the biggest factors impacting scheduling complexity. Figure 4. Staff knowledge and manual/offline management are dominant in provider/patient scheduling preferences

    Appointment-related communications

    Dyke noted that the study found that more than half of respondents reported a no-show rate above 6%, and the methods used by provider groups to remind patients about appointments varied widely:

    • About three out of four respondents noted using text messages to confirm and/or remind patients of appointments.
    • A little more than half of respondents use email to confirm appointments (51%) or remind patients about appointments (55%).
    • About half of respondents still rely on a manual, human phone call to confirm appointments (52%) or remind patients about appointments (48%), while a higher percentage uses automated calls for confirmations (63%) and reminders (52%).

    Most organizations allow cancelling and rescheduling via reminder communications.“The human phone call is still a very manual, expensive modality as opposed to automated calls with dynamic scripts, or emails or texts that can be automated,” Dyke said. The benefits of some of the automated and digital channels are found in combining cancellation and rescheduling functions into the patient alerts and reminders: Nearly two in three provider groups that have patient alert/reminder systems also allow patients to cancel or reschedule care from the appointment reminder communication.

    However, Dyke noted there remains misalignment in that nearly three out of four (73%) patient appointment cancellations or rescheduling occur during a human call rather than a prompt from an automated call, text, email or other modality. This typically is due to a lack of online schedule management to patients, patients being unaware of self-service scheduling, patients finding the system to not be easy to use, or systems being set up to trigger manual outreach to the patient following a rescheduling or cancellation request.

    “Nearly a quarter of us are offering online schedule management, but the patients are finding that it’s too complicated,” Dyke said. In many situations, “the barriers to entry are a little high.”

    Proactive outreach

    Many organizations use "broadcast" style outreach.
    The proliferation and types of outreach used by provider groups measured in the study varied quite a bit: 60% of groups use some type of “broadcast”-style mass communications (e.g., office alerts, wellness reminders, marketing/promotions, educational content).

    A slightly smaller share of respondents (52%) are engaging in targeted communications, of which the most common were:

    • Preventative care screening information (68%)
    • Population health/chronic disease management (60%)
    • Vaccination reminders (52%)
    • General wellness (48%)
    • Marketing/promotions (42%).

    Almost half of organizations do not use specifically targeted communications for patients
    These findings show that, while general appointment reminders to improve no-show rates are important, there is room to grow in using patient data to get more granular. “There really seems to be a significant opportunity for ... more targeted, personalized messages,” Dyke said. “The ultimate consumer experience for many of us is to be reminded by those companies that we trust about something that’s more relatable to me, as opposed to a generic message that was designed for the whole world.”

    Looking ahead

    Figure 5. Priorities to improve schedulingThe MGMA-Relatient study saw a fairly even distribution around the top priorities among provider organizations to improve scheduling:

    1. Offering/improving online, self-service patient scheduling (22%)
    2. Improving the ability to fill appointment slots (21%)
    3. Reducing no-show and cancellation rates (20%)
    4. Reducing manual workflows with managing rules/preferences (17%)
    5. Decreasing call center or front-desk wait times (16%)
    6. Something else (5%).

    As Tyson noted, most of those areas need to be balanced to support the organization’s primary goals (e.g., new patient acquisition, improving patient satisfaction scores, minimizing administrative burdens), and understanding how the different pieces connect as part of the broader patient access workflow.

    “Just getting the patient booked is not the whole journey,” Tyson noted.

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