Patient Engagement: The Key to Population Health Success

Part one: Where Patient Engagement is Making a Difference

Recently, Oliver Wyman published an article titled Patient Engagement Will Be Healthcare’s Next Breakthrough where they state ‘As the cost of care climbs and clinical performance stalls, patient centricity, particularly patient engagement, can no longer be treated as a soft metric or downstream benefit.”  The time is now. This blog highlights specific interventions that already deliver Healthcare’s next breakthrough to progressive organizations. Part two provides guidelines and lessons learned to help organizations shifting from limited use to population level, enterprise use. 

My hope is that sharing examples and results will inspire more people to act. This is particularly important for organizations with value-based care as these programs require organizations to demonstrate value for an entire population, regardless of whether the patient schedules an appointment with the provider. Success with value-based care requires organizations be proactive reaching out to engage patients.

This blog builds on Oliver Wyman’s six domains of patient excellence adding examples and practical examples how it is being done by QliqSOFT clients.  

1. Adhering to treatment plans

Patient nonadherence is frequently cited as the reason for poor outcomes and increased utilization. Using medications as an example, patients don’t take their medications as prescribed half the time. Common reasons for this include fear, side effects, costs, lack of understanding, and lack of symptoms. Between 20-40% of hospital readmissions are medication related. 

Staffing challenges 

• limit organization’s ability to follow up with all patients who are discharged and 
• pressure staff to quickly review instructions to get through as many patients as possible that they need to call.

Combine this with all the paperwork provided at discharge and the opportunity for confusion and nonadherence is understandable.

Technology is critical to find specific patients who need staff help. QliqSOFT clients use technology to provide simple, proactive screening. Clients personalize post discharge digital conversational assistants (chatbots). All patients discharged in the last 24 hours are included in digital outreach which screens for common reasons for readmission such as has the patient filled and are taking their medications, have they made a follow up appointment with their physician, etc. An affirmative response can be celebrated, and negative responses can transfer the patient to a digital agent or alert staff to call the patient to determine why, for example, medications were not filled or taken and then take appropriate action before it becomes a problem.

2. Self-management and monitoring

Individuals who monitor and manage their health utilize more lower acuity options and cost less to care for than others with similar conditions. 

Since 2024, home health agencies are held accountable for hospitalizations incurred by patients under the care of the home health agency. Organizations can reduce readmissions by providing automated outreach to check in on home health patients between visits. Some organizations have turned to remote patient monitoring devices. Many of the ten common reasons for home health patients to be hospitalized are not detected by a monitoring device but can be identified by sending automated digital check ins to reinforce key instructions, screen for readmission risk and then escalate those patients reporting issues such as social determinants, missed appointments, infection, and more to staff to manage.

Patient no-shows cost the healthcare industry $150 billion a year. No-shows and late cancellations can have a greater impact on gastroenterology practices than in other medical specialties due to the prep time required for endoscopic procedures.

According to research, 29% of patients with gastrointestinal (GI) symptoms missed their scheduled outpatient procedures and are considered “no-shows.” Other patients either show up unprepared or cancel at the last moment, leaving little to no time for care administrators to fill vacancies with other patients. 

Organizations are increasingly adopting best practices providing pre and post procedure guidance digitally to ensure that patients are prepared for their procedures and to screen for post-procedure issues that require intervention.

These best practices can be applied to any procedure. Results specifically for colonoscopies which require complex prep timed to the procedure have resulted in a 36% decrease in no shows. Considering the average charge for a colonoscopy is $2,412, the revenue gains can be significant. 

3. Engaging in preventive care

As much as 75% of healthcare is reactive. This is consistent with wellness visits where data shows that only 10-25% of patients schedule an annual wellness visit.  Physicians use wellness visits to address most gaps in care, so managing only patient-initiated visits is unlikely to achieve performance targets.

45% of US deaths have been attributed to modifiable risk factors. Routine health screening is key to reducing healthcare burdens. To prioritize preventive health, Medicare has incentivized practices to incorporate the AWV. This provides opportunities for accountable care organizations (ACOs) to increase revenue while providing this service to patients.

Despite the importance, only 8% of people obtain all recommended screenings, per the  National Institutes of Health.

Proactive digital outreach is ideal to increase Annual Wellness Visits (AWVs). Technology is important yet how you introduce and manage it determines your level of success Here are things we have learned using digital patient engagement to increase AWVs.

4. Becoming informed and educated

Digital patient engagement can improve health and health equity by addressing barriers to healthcare access and empowering individuals to take control of their health. Addressing health literacy is key.

The National Assessment of Adult Literacy (NAAL) study revealed sobering findings:

This same study shows that current health information is too difficult for average Americans to use to make health decisions.  Even people with strong literacy skills can face health literacy challenges, such as when:

• They are not familiar with medical terms or how their bodies work.
• They must interpret numbers or risks to make a health care decision.
• They are diagnosed with a serious illness and are scared or confused.
•  They have complex conditions that require complicated self-care.

Alliance Chicago aimed to reduce disparities in well-child and immunization completion in vulnerable communities via bi-directional, patient-centered communication using QliqSOFT’s AI chatbots.

This digital outreach reminded families of upcoming well-child visits and immunizations, provided anticipatory guidance materials, and facilitated easy appointment scheduling. Their efforts resulted in a 27% increase in well child visits and immunizations at a time when immunization rates nationally were falling.

5. Actively communicating with providers

In the evolving landscape of healthcare communication, secure patient texting has emerged as a vital tool for healthcare contact centers. With chronic staffing shortages, the average call center hold time is roughly 13 minutes; most people are willing to wait 2-3 minutes on hold before getting upset.

Organizations are also increasingly using patient lists and analytics to trigger automated, digital outreach to patients. This results in increased volume of patients contacting the organization. 

Implementing secure patient texting in healthcare contact centers leads to significant improvements in operational efficiency. For example, QliqSOFT clients use automated digital outreach to close gaps in care. Patients receiving the chatbots are encouraged to contact the organization to schedule their preventive testing. These same patients are also prompted to provide personal information via a form to reduce the data capture burden on the contact center staff. This reduces both wait time for the patient and call duration for the staff.

Other clients offer a fully digital patient contact center texting option to eliminate hold time entirely, which also reduces the chance that the patient will abandon the call.

6. Participating in care coordination

Oliver Wyman states “True progress requires shifting the orientation from care coordination on behalf of patients to care coordination with patients.”

We are seeing that happen with specialty medications. Specialty medication use is growing, especially in the practice of neurology. Specialty drugs are vastly more expensive than their traditional drug counterparts, costing upward of $100,000 to half a million dollars and more for a year’s worth of treatment. They have complex authorization and distribution methods. They also offer copay assistance programs, reducing patient out of pocket costs for those who know how to navigate the system. The specialty medication process is complex and not well understood by most people.

Staff help patients navigate this process. It is understandable when staff have an abundance of patients who need education and are short on time and tools to do it, that something like this can happen. The result is low comprehension and high patient non-adherence. There is a better way.

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Thanks to HCT Digital Care for use of this video

To relieve their growing monthly volume of patient conversations concerning specialty medications, our client created an educational chatbot to educate the patient about specialty medications. The staff assigned the chatbot to the patient and then reached out once they could see that the education was completed. The result, they:

• Enrolled 10,000 patients in copay assistance programs, a 60% to 88% increase 
• Reduced staff burden by eliminating 30 minutes of phone time per patient

In conclusion

These real-world examples demonstrate that patient engagement is no longer a theoretical ideal—it’s a practical, proven approach that delivers measurable results across the care continuum. From improving adherence and reducing no-shows to empowering patients with information and streamlining care coordination, digital engagement strategies are helping organizations achieve better outcomes for both patients and providers. 

As value-based care continues to shape the future of healthcare, those who embrace proactive, technology-enabled patient engagement will be best positioned to deliver on the promise of higher quality, more efficient, and truly patient-centered care. The time to act is now—let these success stories inspire your next breakthrough.

Watch for our next blog in this series, where we will explore keys to success and lessons learned for organizations just starting their patient engagement journey.

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