Community heath centers (CHCs), and all facilities that serve/support the underserved, provide valuable, mission-driven public health services to their communities. These patient populations are diverse, complex and require focused attention to ensure patients receive timely and effective care. It is critical for community health centers to engage, re-engage, and empower patients around their healthcare.
CHCs provide comprehensive care across the continuum of needs these complex patients require. Some patient populations include chronic care patients with HIV; school-based adolescent care; LGBTQ specified healthcare needs. This requires a level of care and focus by CHC staff to ensure the patient receives timely care, and all members of the care team are on the same page with the patients’ needs.
CHC staff that support these community health clinics post-COVID are already burdened and burned out. CHCs struggle with not only staff shortage, but the many manual and administrative tasks placed on their workload. This places an unrealistic expectation on staff to juggle prioritizing patient care needs against manual tasks that, if automated, could lift their burden, improving their satisfaction, therefore increasing staff retention and work-life balance.
Texting is the most effective way to engage patients. There is sometimes a misconception that low-income patients will not engage with texting. 92 percent of adults earning less than $30,000 have cell phones, and 67 percent have smartphones. The response rate for texts is 209 percent higher than it is for phone calls, and most text messages are read within 15 minutes.
HIMSS (Health Information Management Systems Society) discussed how automated and actionable messaging can truly engage patients. Secure texting and conversational chatbots can lower CHC costs by increasing efficiencies in the clinic by reducing call center volume; increase revenue by reducing no-shows and closing referrals by engaging patients with chatbots who can assist with multiple patient needs; and empowering patients to get back to the clinic and close gaps in care with actionable messaging, ensuring they reengage with their CHC care team.
CHCs are constantly reimagining how to engage their patients. They want to ensure continuity of care, the ability to assist with complex patients, and to ensure patients are satisfied so they return to the clinic for follow-up care. Patient portals are no longer enough. Patients need real-time actionable messaging, to respond at their convenience, to meet them where they are. Patient portals innately are not meant to support two-way communication let alone conversational chatbots. By leveraging a digital platform, patients feel that sense of connection, attention, and reassurance that someone is looking out for them. With the ability to customize these messages to the patient’s preferred language, their demographics, literacy level, and specific healthcare needs, patients are more likely to engage and be called to action.
In this article, we will explore how CHCs can deploy chatbot-based digital automation to successfully engage and empower patients in their health. It also can reduce staff burden spanning primary care, behavioral health, and more.
We will review the Top 10 burdens/needs for CHCs, and how chatbot-based digital automation can help to alleviate these burdens, allowing care teams to truly focus on their patients.
CHC patients require customizable patient engagement tactics, specific to each health center’s patient populations. This includes accurate and timely collection of patients’ social determinants of health (SDoH) such as transportation and housing needs, as well as required demographics such as sexual orientation/gender identity which can be sensitive to ask patients while in the busy clinic waiting room.
The amount of data required for CHCs to collect only increases each year with federal requirements. Chatbots allow automated conversational outreach to patients to ensure they will be present and prepared for a planned on-site visit or reschedule. One health care organization’s adoption of chatbots realized reductions in intake time as high as 30%.
As evidenced by CMS’s “ACO REACH” initiative, the focus is moving away from fee-for-service and more towards health equity and SDoH patient needs.
An ongoing focus for CHCs is on better patient outcomes as well as reducing gaps in care e.g., due for vaccines, mammogram, etc. For many CHCs, this places burden not only on providers, but ultimately care team members including nurses, care coordinators, and referral coordinators to call the patient to remind them of these gaps. Conversational chatbots can help relay the exact gaps they are due/overdue for and prompt them to act.
This then alleviates the burden on staff for manual intervention. Additionally with federal requirements such as HEDIS and UDS, this provides the ability to meet these measures, equating in funding for CHCs.
Digital engagement assists with patient access to care with adult and pediatric wellness visits, behavioral health visits, etc. (reducing no shows), while also decreasing hospital and ER visits. In turn this increases CHC revenue by getting patients into the clinic.
Chatbots allow for automated reminders for patients to ensure they are receiving appropriate care, while reducing CHC staff manual interventions, allowing them to focus on patient priorities.
CHCs are striving for a more holistic approach to patient care and a prioritization of more integrated/continuum of care e.g., between primary care and behavioral health.
Secure bidirectional patient texting allows for timely secure communication with patients to focus on holistic patient engagement, education, and care coordination around patient needs.
Chatbots and secure texting allow for engagement with patients including patient timely education and outreach pre/post visits – Examples: prepping a patient ahead of a visit to bring their insurance cards, medications, and to complete lab work; Chronic care managers can assist in timely education for a diabetic to gather blood sugar results pre-visit and provide education and medication reminders post visit. This level of patient engagement goes past a patient portal.
Patient portals require the patient to remember their credentials to log in and to hunt/peck for health details. Automated reminders take out the guessing game. The call to action is driven from the digital platform, and the patient can then take the next steps at their convenience. Given patient reluctance to download apps and challenges remembering passwords, consider an app-less approach. Send your patient an SMS text with a link to a secure, app-less communication. Patients are 60% more likely to respond to texts than emails, says Becker’s. Removing the barrier of downloading an app and/or remembering a password, further reduces barriers to completing the interaction.
According to ONC Data Brief #57 from Sept 2021, only 38% of individuals nationwide reported that they accessed their portal at least once in 2020. When asked, patients who do not use their patient portal prefer to communicate with the medical practice or hospital directly and do not want to view their records online.
Virtual visits (even post COVID pandemic) continue in areas of care including but not limited to behavioral health, non-billable visits for hypertension and diabetes to also collect patient home monitoring (blood pressure, blood glucose, weight, etc.). Chatbots assist patients in getting prepared for their telehealth visit (sign forms, capture information) and to send results, etc.
Telehealth call and video visits are here to stay! New federal and state policies have led to increased utilization, expanding access to care via virtual visits. The digital platform allows for these visits to occur, along with the collection of any pre-visit information from the patient.
Behavioral health telehealth has only increased post-COVID. Digital platforms allow this to be integrated in the same platform the provider can also bidirectionally message their patients. Staff and patients are all on the same platform, cutting back on the confusion of other telehealth vendors.
Telehealth visits in-between visits can also cut down on ER and hospital admissions by allowing patients access to their care team to troubleshoot non-urgent issues.
By collecting pre-visit prep information, this allows for less time within the four walls of the waiting room. This also increases accuracy of data collection from patients by having the patient complete the intake at their convenience, without relying on staff.
This then allows providers and clinicians to see more patients, driving up clinic revenue along with patient satisfaction.
Optimizing health center workflows and increasing staff retention/satisfaction with automation tools for multiple staff: care coordinators, referral managers, front desk staff, nurses, and providers as more patients can be reached without manual workflows.
Automated messaging allows for less administration tasks and phone calls, allowing staff to truly focus on priority patient needs. In turn this allows staff to get home on time. They can focus on closing outstanding billable items and visit documentation versus having to call back multiple patients at the end of their shift.
CHCs are always striving to improve patient satisfaction. This ensures patients want to return to their care, and also allows CHCs to improve their business, their processes, their care. CHCs can leverage chatbots to deploy patient satisfaction surveys. Surveys on the market can feel bothersome, cumbersome, therefore having patients not take the time to fill them out. Most are sent via email, so can often be ignored, or sent to spam. By automating patient surveys to follow the last visit for the patient or at a time convenient to the patient via text, CHCs are more than likely to get that engagement.
The concept of asynchronous engagement will allow patients to respond to messages at their convenience, while CHC staff can follow up based on priority and when it makes sense to. Automated communication via secure text has shown to help patients navigate their multitude of needs, from scheduling their next visit to ensuring they get their lab work completed.
CHC staff are already stretched with a variety of tasks. Those supporting the EHR are tasked with not only maintaining and managing the EHR, but also ensuring proper credentialing for clinical staff, such as providers and nurses.
In addition to the benefits of staff to patient messaging, chatbots can also be used to automate messaging to staff to gather information e.g., DEA updated expiration dates; changes to NPI licensure; nurse credentialing details, etc.
In this article we have explored the variety of ways CHCs can benefit from a digital platform, allowing for bidirectional messaging with patients, automated patient messages/reminders, and conversational chatbots. All these benefits increase patient and staff satisfaction. A digital platform approach takes the burden of work off staff by automating tasks that previously would have relied on manual action such as phone calls. It also reduces the burden on patients, so they do not have to guess what is next on their health journey. Customized conversational chatbots will take out that guesswork.
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Ms. Bubb joined QliqSOFT in 2023. Jaimie previously worked at AllianceChicago, where she supported and guided health centers around any new products, implementations and optimization efforts. She also strategized with health center leadership to advise around activities surrounding HCCN, CIN and other healthcare related changes. Ms. Bubb is a Registered Nurse with experience in burn care, intensive care, general telemetry, and medical surgical nursing. In addition to clinical experience, she also has three years of experience in disability and disease management. Ms. Bubb received her master’s degree in Medical Informatics from Northwestern University and has a B.S.N. from University of Otterbein.
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