Turning Gaps into Gold: Revenue Strategies in Rural FFS Primary Care

Why are gaps in care important?

A gap in care is a discrepancy between medical best practice and the care the patient receives. Gaps in care include things like annual physicals, well-child visits and immunization, colorectal cancer screening, blood pressure monitoring, diabetes screening, and more.

45% of US deaths have been attributed to modifiable risk factors. Routine health screening is key to reducing healthcare burdens. Despite this, only 8% of people obtain all recommended screenings, per the National Institutes of Health. Looking at it another way, in 2021:

We are missing a huge opportunity to improve the population’s health and for Rural Health systems to retain patients in their community and generate consistent revenue streams.

What are primary care practices doing today?

Physicians follow these best practices to keep patients healthy. When a patient comes into the office, most EMRs generate alerts that highlight gaps in care for patients in the office to help providers identify and address these gaps.  

These same EMRs and analytic systems create lists of patients who are due for various preventive testing for staff to call. The challenge is what to do with these lists. Today, closing gaps in care is a labor-intensive telephonic and mail-based effort. Given current staffing challenges, staff are only able to contact a small subset of patients who are due for testing. Mailing reminders is expensive.

Compounding these challenges, a recent survey revealed that 75% of people do not answer an unknown phone call. With more patients put on hold due to staffing shortages, this further adds a barrier to gap closure. 60% of patients will hang up after waiting one minute.  

Why shifting responsibility to the patient is not the solution

Patients do not schedule recommended screenings for many reasons, including:

• A lack of awareness  
• Limited understanding of the risks and benefits of preventive health
• Cost concerns
• A lack of time
• Health equity concerns

Most patients do not have the health literacy to track and manage their health needs.  

Per the US Department of Human Services Report, America’s Health Literacy: Why We Need Accessible Health Information “Only 12 percent of U.S. adults had proficient health literacy…Over a third of U.S. adults…would have difficulty with common health tasks, such as…adhering to a childhood immunization schedule using a standard chart. There is an urgent need to address the gap between the health information currently available and the skills people must understand and use this information to make life-altering decisions”

This is an opportunity for Rural Health Systems to support their care teams, generate revenue, and increase community use of their facilities. Campaigns and chatbots can use registries or lists from EMRs or analytic systems to efficiently reach out to more individuals while reducing the need for time-consuming phone calls. Proactive digital outreach enables organizations to use these patient lists to:

1. Automate outreach to all patients overdue to be seen or for preventive screening  

2. Provide targeted education, 5th-grade level to maximize understanding  

3. Screen & address barriers to care

4. Make it easy to schedule needed care by seamlessly transitioning the patient ready to schedule to your call center.

5. Send reminders and visit preparation materials to increase patient follow-through  

Why FFS primary care should invest in digital outreach

In addition to the significant health benefits this provides to your community, there are also compelling reasons clinics reimbursed primarily by FFS should embrace digital outreach:

How does this work?

Let us look at an example of a 50-provider Primary Care practice or Community Health Center.  

The model does not include increases in incentive revenue, which vary significantly by organization. The savings are calculated based on the national prevalence of each population and current levels of outreach.  

The assumptions on response rates, reduction in no-shows, streamlining patient intake, and closing care gaps come from our own clients’ experiences in three different initiatives.  

Implementing chatbots to proactively reach out to engage and then activate this large population of patients provides low-cost, effective outreach. If you would like to discuss how this would look at your organization, please reach out to me at [email protected]. We can apply the model to your practice and together develop a plan for success.