The Challenge
Lack of patient engagement poses a significant challenge for healthcare organizations, undermining the effectiveness of care delivery and overall health outcomes. When patients are not actively involved in their own health management, they are less likely to adhere to treatment plans, attend follow-up appointments, or make necessary lifestyle changes. This disengagement can lead to poorer health outcomes, increased hospital readmissions, and higher healthcare costs. Additionally, it hampers the ability of healthcare providers to gather accurate and comprehensive health data, which is crucial for personalized care and effective treatment planning. As a result, healthcare organizations face difficulties in achieving quality care standards, improving patient satisfaction, and maintaining financial stability. To address these issues, healthcare organizations need to implement comprehensive patient engagement strategies that leverage technology to facilitate continuous communication and access to health information, and empower patients to take an active role in their health.
For Prisma Health, a sense of fear and uncertainty during the pandemic exacerbated the problem of patient disengagement and posed additional challenges for its diverse patient population, keeping them from scheduling care, refilling prescriptions, and undergoing recommended screening studies. To close these emerging care gaps, the healthcare system tasked its staff with conducting patient outreach, but inconsistencies in telephonic outreach yielded minimal results and quickly led to employee burnout. The organization needed to find a more efficient, effective solution to solve their patient engagement issues without burdening staff.
Objectives
Prisma Health’s primary goal was to recall patients with open care gaps to ensure they received necessary care. This objective aimed to proactively deliver preventive services, identify and address barriers to care, and enhance quality scores for value-based care contracts. Given the constraints on resources, Prisma Health required an automated, digital, and omnichannel outreach strategy to effectively engage its diverse patient population across South Carolina. The ultimate goal of the effort was to create a differentiated, personalized experience for patients, providing them with easy access to healthcare and surfacing relevant information when needed. This approach was intended to improve patient engagement, adherence to treatment plans, and overall health outcomes while optimizing operational efficiency and reducing the burden on staff.
Method
To achieve its objectives, Prisma Health sought more than a point solution — the organization wanted a partner that could help them deploy an enterprise-wide platform that would be capable of serving their diverse patient populations; minimizing manual effort for administrative and clinical team members; and accommodating various population health-focused use cases. After reviewing all options, Prisma Health chose to partner with Upfront Healthcare, leveraging their comprehensive platform to integrate digital assets and services within each patient’s personalized microsite. This integration elevated relevant information — educational, navigational, and clinical — in a meaningful and user-friendly manner. Upfront Healthcare configured its platform to incorporate data points from Prisma Health’s EMR, customer relationship management systems, and other sources. This data integration allowed for the creation of a personalized patient experience that extended beyond clinical information management, enhancing the relevance and impact of care provided through Prisma Health. The platform facilitated automated, digital outreach, reducing the need for manual telephonic efforts and thus conserving staff resources.
The method involved several key components:
Automated digital outreach, using Upfront Healthcare’s platform to send personalized communications to patients, encouraging them to schedule preventive screenings and close care gaps;
Data integration, pulling relevant data from the EMR, customer relationship management, and other sources to tailor communications and ensure that patients received information pertinent to their specific health needs;
Personalized microsites, creating individualized microsites for patients where they could access educational materials, schedule appointments, and find navigational assistance;
Omnichannel engagement, to reach patients through multiple channels (e.g., email, text, web portals) to increase engagement and response rates; and
Reduction of manual efforts, by using automated outreach processes to relieve the administrative burden on staff, allowing them to focus on direct patient care.
By integrating these elements into their patient outreach, Prisma Health hoped to improve patient engagement, adherence to treatment, and overall health outcomes while maintaining operational efficiency and reducing staff burnout.
Results
From 2020 through February 2024, Prisma Health’s partnership with Upfront Healthcare resulted in digital outreach to nearly one million patients (over 75% of their patient population) to complete preventive screenings and close care gaps. This resulted in $4.9 million in operating savings generated — the equivalent of 324,000 full-time equivalent (FTE) hours of telephonic outreach. Prisma Health also realized better outcomes because of the 37,000 appointments Upfront Healthcare’s platform scheduled, including activating 50% of patients that were previously off track with medication adherence to refill their prescriptions, or to flag a barrier to care for their care team to address. Over 35,000 patients then engaged in the next steps to complete preventive care, including scheduling care.
The digital outreach program was so successful that Prisma Health extended the relationship with Upfront Healthcare to replicate its performance across its clinically integrated network. They are also implementing outreach solutions for additional care gaps, referral coordination, and direct scheduling integration with their EMR, all in service to their system-wide strategic goals to improve health for the populations they serve.
Discussion
At present, large health systems are facing a new set of challenges. The end of the COVID-19 public health emergency is requiring Medicaid to redetermine its patient population; payers are continuing to push for value-based care (VBC) arrangements; workforce shortages are surging, leading to staff burnout; and patient care preferences are evolving as patients increasingly demand consumer-centric experiences from healthcare. Adding to those operational challenges, recent U.S. Census Bureau data show that there are 55.8 million people aged 65 and older in the country, an age group that is at higher risk for multiple health conditions.(1) And these numbers are projected to grow: by 2034, the number of Americans aged 65 and older is predicted to reach 77 million.(2)
Recent industry data and research highlight these health system pain points that are now pressuring enterprises. For example:
Medicaid eligibility redeterminations have hurt health systems’ financial performance by limiting CMS reimbursement, as more than 20 million enrollees have been dropped from coverage since April 11, 2024.(3) These data prove that systems need a better way to retain and activate patients to necessary care to keep the healthcare dollar flowing.
Clinical workforce shortages continue to weigh heavily on health systems. The country is expected to suffer a shortage of up to 124,000 physicians in the next five years, including a shortage of between 17,800 and 48,000 primary care physicians.(4) By 2025, it is estimated the U.S. may face a shortage of 200,000 to 450,000 nurses available for direct patient care, equating to a 10% to 20% gap.(5)
The growing shortage of physicians puts additional pressure on current care and administrative team members to perform duties outside their job role and take on more patients, further amplifying burnout and expanding patient wait times. While a report found that physicians experience burnout for a variety of reasons, one of the top three identified was “too many hours at work.”(6) Technology should be tapped to better support care teams in guiding patient care journeys and optimizing appropriate treatment.
Meanwhile, payers are continuing to encourage health systems to move toward VBC arrangements. It is predicted that VBC lives will grow from 80 to 100 million in 2022 to 130 to 160 million in 2027, requiring health systems to upgrade their risk-bearing capabilities.(7)
System executives are strapped with juggling VBC financial equations to manage how much risk they should take, while simultaneously working to keep their diverse patient populations healthy. Operational advancements or technology integrations will need to be made to successfully navigate VBC transitions.
Providers want better use of health data to improve care delivery, and the ease of consumer interaction with retailers is forcing health systems to catch up and deliver similar experiences through omnichannel communications, including digital tools for payment and self-scheduling. A survey of medical group leaders unveiled their top technology priorities for the year ahead, finding that 35% of respondents reported electronic health data usability as their top priority, with the second most common answer (26% of respondents) being patient communications and access.(8)
Patient and provider experiences must be improved. Enterprise technology solutions that can address both sides of the care equation for a longitudinal view of care should be considered to limit a system’s operational headwinds.
Conclusion
Prisma Health, serving a 21-county market area covering 50% of South Carolina, is a leader among health systems in evolving its approach to minimizing industry-wide operational pain points and maximizing patient engagement for improved outcomes.
Prisma Health continues to work with Upfront Healthcare to execute a proactive and personalized outreach strategy, combining deep behavior insights with the technology-enabled capabilities of the Upfront Healthcare platform, namely its omnichannel outreach and personalized microsites. Patients can easily access healthcare education and online health system scheduling, further minimizing administrative and care team resource burdens. Additionally, the platform automates recall for preventative screenings and eliminates unnecessary telephonic outreach, driving patients to fulfill their care journeys by addressing open care gaps and adhering to prescribed medical therapies. The program has been extended to four use cases:
Preventive care recall for annual wellness visits;
Medication adherence;
At-home Cologuard kit screenings; and
Open care gap recall for A1C diabetes management, diabetic eye exams, screenings for diabetic kidney disease, screenings for colon and breast cancer, and routine vaccines such as influenza.
To date, the fully integrated Prisma Health and Upfront Healthcare patient engagement program has had an enterprise-wide impact, resulting in the following:
It reached 921,000 unique patients through digital, omnichannel outreach;
It preserved $5.9 million in opportunity savings;
It conserved 392,000 FTE hours;
It ensured 50% of patients adhered to their medication therapy and refilled their prescriptions within 30 days of outreach; and
It garnered a 30% click-through rate across all patient engagement use cases.
These operational changes required zero lift from staff and have been transparent to the whole organization, prompting a leader from the mammography department to ask their ambulatory operations team, “What are you doing differently? We are seeing more women than ever before! It’s amazing!”
References
United States Census Bureau. Older Americans month: May 2022. Census.gov. www.census.gov/newsroom/stories/older-americans-month.html
United States Census Bureau. Older people projected to outnumber children for first time in U.S. history. Census.gov. March 13, 2018. www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html .
Medicaid Enrollment and Unwinding Tracker. KFF.org. May 10, 2024. www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker . Accessed May 20, 2024
Robeznieks A. Doctor shortages are here—and they’ll get worse if we don’t act fast. American Medical Association. April 13, 2022. www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act .
Berlin G, Lapointe M, Murphy M, Wexler J. Assessing the lingering impact of COVID-19 on the nursing workforce. McKinsey. www.mckinsey.com . May 11, 2022. www.mckinsey.com/industries/healthcare/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce .
“I cry but no one cares”: physician burnout and depression report 2023. Medscape. www.medscape.com/slideshow/2023-lifestyle-burnout-6016058?faf=1#6 .
Abou-Atme Z, Alterman R, Khanna G, Levine E. Investing in the new era of value-based care. McKinsey. www.mckinsey.com . Published December 16, 2022. www.mckinsey.com/industries/healthcare/our-insights/investing-in-the-new-era-of-value-based-care
EHR usability, patient communications and billing outrank AI as top tech priorities at some medical groups. www.mgma.com . January 3, 2024. www.mgma.com/mgma-stat/ehr-usability-patient-communications-billing-outrank-ai-as-top-tech-priorities . Accessed May 20, 2024.