REACHing Success: How Digital Nudges Improve Patient Care

Value-Based Care

May 30, 2024
A black family checking on their child's health during a CHEC-Up visit. The family sits on one side of the table with their doctor facing them on the other side of the wooden desk.

With the ongoing shift from Fee For Service (FFS) Care to Value-based Care, the need to proactively reach out to patients has gone from nice to have to critical to the financial success of the practice.  

Routine care is essential to detect, prevent, and treat illness, yet data shows that only 10% to 25% of patients schedule a needed visit. Since providers rely on these visits to detect and address gaps in care, and manage chronic conditions, managing only patient-initiated visits is unlikely to achieve either Value-based Care or health targets.

Patient Portals are Not Enough

Patient portals, which have become increasingly popular in recent years, are secure websites through which patients access personal health information. Patients can:  

  • review their health data,  
  • securely message their providers, and
  • complete administrative tasks such as self-scheduling visits and bill pay from any location using a computer or smartphone.  

But even with the convenience and ease of these tools, many adults are not using portal services. About 3 in 5 individuals nationwide reported they were offered and accessed their online medical record or patient portal in 2022. This is an improvement since 2020, yet the most common reason to access the portal is to access their medical record and test results, which is most likely to be AFTER an interaction with their provider. Black and Hispanic individuals were offered and accessed patient portals at significantly lower rates than White individuals.  

Proactively Nudging Patients Influences Behavior

A nudge is an attempt to influence user behavior by presenting options to them. Nudges help individuals make wiser choices by subtly altering the environments in which those individuals make decisions. Importantly, to qualify as “nudges,” these “choice architecture” strategies do not mandate or forbid options, and they do not meaningfully change the financial incentives associated with various options. Rather, nudges tap into the psychology of decision-making and gently guide individuals to different outcomes. Nudges are perfect for improving participation and commitment to a cause of action. In the two examples below, recipients were encouraged to make an active choice to be seen and then provided a simple way to execute that decision.

A doctor checking the heartbeat of a baby. The baby is being held in their mothers arms while the doctor closely listens in with her stethoscope.

Example 1 – Well-child Visits and Immunizations

AllianceChicago noticed a concerning decline in preventive health visits for children and adolescents. To address this finding, AllianceChicago’s healthcare providers and staff implemented an innovative mechanism to use AI chatbots to engage caregivers in evidence-based preventive care for children. They provided access to Quincy’s conversational chatbots to in-network parents and guardians who are 82 percent racial and ethnic minorities of approximately 10,500 children.  

The human-centered digital outreach, which did not require an app, reminded families in their preferred language of upcoming well-child visits and immunizations, provided anticipatory guidance materials from the CDC before the visit to enrich the dialogue, and facilitated easy appointment scheduling of babies and children for well-child visits and vaccination visits.  

Their results demonstrate how chatbots can be used innovatively to improve health disparities in a patient-centered manner:  

Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group who engaged with the chatbot.  Well-child visits and immunizations in the intervention group demonstrated an absolute increase of 13% compared to the usual care group.  Survey results, patient, and clinician interviews indicated a high level of satisfaction using the chatbot. In addition to experiencing a favorable perception of the chatbots, patients also identified future use cases for chatbots to improve health and well-being.

Example 2 – Capture SDoH and Increase Participation in Adult Wellness Activities

Next, AllianceChicago partnered with Settlement Health and QliqSOFT, to improve personal, community, and public health through innovative collaboration, successfully executed through the RE-imagining Primary Care using Artificial Intelligence and Chatbots (REACH) project. REACH closes adult gaps in care and engages with patients who are overdue on preventive screenings and primary care services. The REACH project’s four objectives include:

  1. Identify patients due for preventive services or care gaps and implement a timely, effective, efficient, and patient-centered approach to engage them in primary care services.  
  1. Achieve innovative bi-directional outreach in English and Spanish using artificial intelligence (AI) enabled chatbots to increase patients’ knowledge of gaps in care and address unique needs.
  1. Promote education and dialogue on evidence-based preventive services for which patients are due to promote safety through early action and to understand patient concerns.
  1. Leverage chatbots to promote equity, screen for social determinants of health (SDoH), and intervene in a manner respecting the sensitive nature of the content and patient privacy.

Multiple clinics have experienced challenges with systematizing SDoH screening within their workflow. Screening for SDoH at the point-of-care has presented barriers such as physical space, sensitivity of questions, and time and staffing needed to successfully screen and address needs. The REACH initiative demonstrated that chatbots could be successfully used to identify needs and redirect those needs to resources that could help address them. Their results are summarized below:

A close-up of a medical report - viewing metrics from before and after chatbot use

Additional Benefits of Proactive Patient Outreach

In addition to improvements in preventive care and capture of SDoH, proactive patient outreach provides the following benefits:

  1. Improved Patient Outcomes: Proactive communication can lead to better health outcomes by ensuring patients understand and follow through with their treatment plans, attend follow-up appointments, and adhere to medication orders. Regular check-ups and preventive screening catch issues early before they become serious.
  1. Enhanced Doctor-Patient Relationship: Engaged patients are more likely to take an active role in managing their health. Proactive outreach can make patients feel valued and supported, which increases their involvement in their own care and encourages healthier behaviors.
  1. Chronic Disease Management: For patients with chronic conditions, consistent follow-up is critical. Proactive communication helps in managing chronic diseases more effectively by monitoring symptoms, adjusting treatments as needed, and providing ongoing education and support.
  1. Patient Trust and Loyalty: When providers actively reach out, patients often feel a stronger connection to their healthcare team. This can lead to higher satisfaction levels and loyalty, which are crucial in an increasingly competitive healthcare market.
  1. Reduction in Hospital Readmissions: By maintaining regular contact post-discharge, providers can identify and address issues that could lead to hospital readmissions. This not only improves patient health but also helps in reducing costs associated with readmissions.
  1. Following Treatment Plans: Patients may not always understand their care plans or the importance of following them. Proactive outreach can clarify instructions, answer questions, and provide reminders, thus improving compliance.

Chatbots are the ideal vehicle to engage patients outside of the walls of the clinic and nudge them to take proactive action to improve their health. QliqSOFT can help. Click here for a complimentary consultation to help you design and implement your patient outreach strategy.

The Author
Bobbi Weber

Bobbi is a lifelong learner who is passionate about enabling healthcare transformation. She has 20+ years of healthcare experience in care delivery, consulting, healthcare IT, and market strategy.

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