Carolina Health Specialists is a multispecialty practice that serves Horry County, S.C., including the resort city of Myrtle Beach. The practice has 50 FTEs – 35 physicians and 15 mid-level providers – who serve approximately 36,000 patients, the majority of whom are retirees.
The practice’s payer mix includes just over 60% Medicare, most of which is traditional but with an increasing amount of Medicare Advantage plans. For the past few years, the practice has almost exclusively focused on outpatient care in nine specialties, including endocrinology, family medicine, interventional pain management, nephrology, pulmonology and rheumatology.
Carolina Health Specialists was an early patient portal adopter and wanted to leverage it to improve communication and engagement with patients and ultimately drive clinical and patient outcomes. Through this gateway, patients could make appointments, manage their bills, review their medical records, obtain lab results and gain access to secure messaging, preventive reminders and educational materials, among other uses.
Between 2016 and 2017, Myrtle Beach was the second-fastest-growing metropolitan area in the United States. With this steady influx of new patients, particularly retirees, the practice knew it had to address the need for physician appointments. “It’s really challenging on the medical side for this whole area to accommodate the inflow of these new patients looking to take over their care,” Kari Vereen, CMPE, business services director, Carolina Health Specialists, says. “We’re constantly looking at ways we can service these patients. We have to meet the demands in the area to keep succeeding.”
“Luckily our practice management system/vendor was on top of it and was able to get something out early on,” Vereen notes regarding the practice’s desire to meet patient demand. “They are still tweaking and it’s evolving, but patients are consumers of their own healthcare and they have a very demanding need for access when they want it.”
“With the portal technology you can be much more efficient with replying and taking care of actions with the patient … there’s greater satisfaction when the patient can take it on themselves and take action,” Vereen says. “The goal was to get secure summaries for lab results and answer any clinical questions as well, because patients will wake up in the middle of the night with a question.”
That said, face-to-face encounters are an integral part of Carolina Health Specialists’ collaboration with patients, particularly when physicians’ services and skills are better provided in person.
Another key objective for the practice was to create a framework for patient engagement and accountability. By doing so, the practice felt that it could improve the health outcomes of its patients, while also reducing its no-show rate. As Vereen relays, not only do no-shows cost a practice money, but they disrupt the workflow for the entire office.
Finally, as patient portal adoption increased, Carolina Health Specialists saw its portal as a means to close gaps in care, which according to Vereen, was the practice’s most important objective.
Once the staff was on board, the practice needed to address potential pushback from patients. The staff made sure there was abundant signage throughout the office and asked patients to contact the practice’s call center if they had questions about logging in or other technological questions related to the portal.
The front desk staff also sent out emails with a link to the portal, asking patients to create an account. If they did not, the front desk staff was notified ahead of when patients checked in for an appointment, which prompted a conversation about the portal. According to Vereen, “It was those repeated reminders throughout their encounter, from front to back office and then back out front again on the importance of that communication tool we were utilizing.”
The practice also made sure its offices were well-staffed the days the portal was made available to patients. “We had several people in the offices as we rolled it out one office at a time to help register patients through the iPad in the offices,” Vereen recollects.
In addition, the practice’s vendor helped immensely during the transition: “The vendor we used had a good protocol in place for how to maneuver through the system and do the setup,” Vereen says. “It was working with the call center to encourage patients — to make sure it was in their communication when a new patient called for an appointment that they were going to be invited to use the portal.”
Throughout the roll-out process, the practice emphasized the portal’s convenience. For example, they reminded patients that requesting refills was more efficient when done online. The “electronic method is a much faster return than making a phone call and putting the request in,” Vereen maintains. “The pharmacy can ping us and see if the refills are approved and send it back. And it’s all done without the old paper trail.”
According to Vereen, “It’s a two-way street: the doctor provides the care and the patient has to act on that care and take their medicine compliantly.” Because patients rate doctors based on the outcomes of their experience, Vereen says “it’s key to make sure patients are comfortable with their provider and it’s the right relationship where they can work together to achieve the goals they set out to improve their chronic care and illnesses.”
With the promotion of patient responsibility comes patient accountability, which also comes down to communication between provider and patient. Vereen says it’s important that the practice makes it clear to the patient what their co-pay is, what their deductible is, why something isn’t covered by their insurance, why they may need a certain procedure, etc.
“If they understand what they are paying for, we have a much better chance at getting that money,” Vereen asserts. “We feel the accountability both from following doctor’s orders, so to speak, and understanding their co-pay and their deductible and taking action to pay their bill — it’s for their own good for a better health outcome. If we can correlate the two and go down the path together — good quality care and a good financial relationship — everyone wins.”
Patient accountability carries over to making sure patients show up for their scheduled appointments. As such, Carolina Health Specialists charges its patients a $35 no-show fee for missed appointments and lab appointments.
As Vereen notes, the practice understands if there’s an emergency that prompts a cancellation, but it’s the repeat offenders whom they’ve tried to address. “We can almost guarantee based on their history that they are going to no-show,” she says. “So that patient will call back and get rescheduled and get back on the books and we go through that cycle all over again.”
However, with compliant patients, the no-show fee has made an impression; once they pay the bill for not showing up, they tend not to do it again. This has resulted in a reduction of the practice’s no-show rate from 8% to 3%, which is well below the national average of 18%.
Thanks to Carolina Health Specialists’ focus and promotion on its patient portal, it was able to increase its portal adoption rate over the past several years. According to Vereen, “there’s greater satisfaction when the patient can take it on themselves and take action.” This is reflected in improved efficiency, as the practice’s portal adoption rate now stands at 70%.
As Vereen points out, the biggest surprise has been the number of elderly patients who have enrolled in the patient portal, more than any other demographic. It’s higher for good reason: “They have plenty of time and they have a lot of health issues, so they want to be able to communicate with their doctor,” Vereen says.
Ultimately, Carolina Health Specialists was able to close gaps in care by conducting effective patient outreach campaigns, such as for flu vaccinations and breast cancer screenings, which may be the biggest benefit they’ve reaped from the patient portal.
“When the patient sees a collaborative effort by the doctor and the office for their health care … they have a better vested interest that they feel the doctor is wanting for them as far as getting quality care,” Vereen contends. “So they are going to be more loyal because we are reaching out to them.”
As such, some of Carolina Health Specialists’ key preventive care and screening rates include:
Going forward, she would like to continue to improve the practice’s patient portal adoption rate and use more technological resources to enhance the patient experience; for example, coming up with a good way to fill slots when cancellations occur within 24 hours of an appointment. As Vereen says, “It’s all driven by accessibility, whether it’s talking to your doctor, making an appointment, looking at your records or paying your bills.”
The practice’s payer mix includes just over 60% Medicare, most of which is traditional but with an increasing amount of Medicare Advantage plans. For the past few years, the practice has almost exclusively focused on outpatient care in nine specialties, including endocrinology, family medicine, interventional pain management, nephrology, pulmonology and rheumatology.
Carolina Health Specialists was an early patient portal adopter and wanted to leverage it to improve communication and engagement with patients and ultimately drive clinical and patient outcomes. Through this gateway, patients could make appointments, manage their bills, review their medical records, obtain lab results and gain access to secure messaging, preventive reminders and educational materials, among other uses.
Between 2016 and 2017, Myrtle Beach was the second-fastest-growing metropolitan area in the United States. With this steady influx of new patients, particularly retirees, the practice knew it had to address the need for physician appointments. “It’s really challenging on the medical side for this whole area to accommodate the inflow of these new patients looking to take over their care,” Kari Vereen, CMPE, business services director, Carolina Health Specialists, says. “We’re constantly looking at ways we can service these patients. We have to meet the demands in the area to keep succeeding.”
Changes made
Carolina Health Specialists recognized a growing need for patients to have easy and secure access to their health information and for patients to be better engaged in their care. Fortunately, the practice’s adoption of its patient portal coincided with the addition of its EHR in 2011.“Luckily our practice management system/vendor was on top of it and was able to get something out early on,” Vereen notes regarding the practice’s desire to meet patient demand. “They are still tweaking and it’s evolving, but patients are consumers of their own healthcare and they have a very demanding need for access when they want it.”
Objectives
As Carolina Health Specialists rolled out its patient portal, one of its key objectives was to utilize all its capabilities. In doing so, the practice wanted to communicate with as many patients as possible through its portal, with the goal of increasing its adoption rate. By stressing that the practice and physicians would predominantly communicate with patients through its portal, the intent was to become more streamlined with patient care and improve patient retention.“With the portal technology you can be much more efficient with replying and taking care of actions with the patient … there’s greater satisfaction when the patient can take it on themselves and take action,” Vereen says. “The goal was to get secure summaries for lab results and answer any clinical questions as well, because patients will wake up in the middle of the night with a question.”
That said, face-to-face encounters are an integral part of Carolina Health Specialists’ collaboration with patients, particularly when physicians’ services and skills are better provided in person.
Another key objective for the practice was to create a framework for patient engagement and accountability. By doing so, the practice felt that it could improve the health outcomes of its patients, while also reducing its no-show rate. As Vereen relays, not only do no-shows cost a practice money, but they disrupt the workflow for the entire office.
Finally, as patient portal adoption increased, Carolina Health Specialists saw its portal as a means to close gaps in care, which according to Vereen, was the practice’s most important objective.
Challenges
For Carolina Health Specialists, the first challenge was to make sure the staff was on board with the patient portal, which would ensure that they were on the same page when promoting it to patients. As Vereen recalls, “That’s where we brought in regularly scheduled meetings with the management team and getting feedback to see what we needed to do differently.”Once the staff was on board, the practice needed to address potential pushback from patients. The staff made sure there was abundant signage throughout the office and asked patients to contact the practice’s call center if they had questions about logging in or other technological questions related to the portal.
The front desk staff also sent out emails with a link to the portal, asking patients to create an account. If they did not, the front desk staff was notified ahead of when patients checked in for an appointment, which prompted a conversation about the portal. According to Vereen, “It was those repeated reminders throughout their encounter, from front to back office and then back out front again on the importance of that communication tool we were utilizing.”
The practice also made sure its offices were well-staffed the days the portal was made available to patients. “We had several people in the offices as we rolled it out one office at a time to help register patients through the iPad in the offices,” Vereen recollects.
In addition, the practice’s vendor helped immensely during the transition: “The vendor we used had a good protocol in place for how to maneuver through the system and do the setup,” Vereen says. “It was working with the call center to encourage patients — to make sure it was in their communication when a new patient called for an appointment that they were going to be invited to use the portal.”
Throughout the roll-out process, the practice emphasized the portal’s convenience. For example, they reminded patients that requesting refills was more efficient when done online. The “electronic method is a much faster return than making a phone call and putting the request in,” Vereen maintains. “The pharmacy can ping us and see if the refills are approved and send it back. And it’s all done without the old paper trail.”
Results
Quality care goes hand in hand with patient retention, which is reflected in Carolina Health Specialists’ stellar patient retention rate of 82%. The practice works hard to ensure patients have a good rapport with their providers and that the lines of communication are always open.According to Vereen, “It’s a two-way street: the doctor provides the care and the patient has to act on that care and take their medicine compliantly.” Because patients rate doctors based on the outcomes of their experience, Vereen says “it’s key to make sure patients are comfortable with their provider and it’s the right relationship where they can work together to achieve the goals they set out to improve their chronic care and illnesses.”
With the promotion of patient responsibility comes patient accountability, which also comes down to communication between provider and patient. Vereen says it’s important that the practice makes it clear to the patient what their co-pay is, what their deductible is, why something isn’t covered by their insurance, why they may need a certain procedure, etc.
“If they understand what they are paying for, we have a much better chance at getting that money,” Vereen asserts. “We feel the accountability both from following doctor’s orders, so to speak, and understanding their co-pay and their deductible and taking action to pay their bill — it’s for their own good for a better health outcome. If we can correlate the two and go down the path together — good quality care and a good financial relationship — everyone wins.”
Patient accountability carries over to making sure patients show up for their scheduled appointments. As such, Carolina Health Specialists charges its patients a $35 no-show fee for missed appointments and lab appointments.
As Vereen notes, the practice understands if there’s an emergency that prompts a cancellation, but it’s the repeat offenders whom they’ve tried to address. “We can almost guarantee based on their history that they are going to no-show,” she says. “So that patient will call back and get rescheduled and get back on the books and we go through that cycle all over again.”
However, with compliant patients, the no-show fee has made an impression; once they pay the bill for not showing up, they tend not to do it again. This has resulted in a reduction of the practice’s no-show rate from 8% to 3%, which is well below the national average of 18%.
Thanks to Carolina Health Specialists’ focus and promotion on its patient portal, it was able to increase its portal adoption rate over the past several years. According to Vereen, “there’s greater satisfaction when the patient can take it on themselves and take action.” This is reflected in improved efficiency, as the practice’s portal adoption rate now stands at 70%.
As Vereen points out, the biggest surprise has been the number of elderly patients who have enrolled in the patient portal, more than any other demographic. It’s higher for good reason: “They have plenty of time and they have a lot of health issues, so they want to be able to communicate with their doctor,” Vereen says.
Ultimately, Carolina Health Specialists was able to close gaps in care by conducting effective patient outreach campaigns, such as for flu vaccinations and breast cancer screenings, which may be the biggest benefit they’ve reaped from the patient portal.
“When the patient sees a collaborative effort by the doctor and the office for their health care … they have a better vested interest that they feel the doctor is wanting for them as far as getting quality care,” Vereen contends. “So they are going to be more loyal because we are reaching out to them.”
As such, some of Carolina Health Specialists’ key preventive care and screening rates include:
- HbA1c Control: 77th percentile
- Overall clinical quality: 70th percentile
- Hypertension control (60+): 72nd percentile
- Colorectal cancer screening rate: 65th percentile
- Mammogram rate: 64th percentile
Next steps
Vereen is extremely satisfied with how well Carolina Health Specialists’ patients have taken to the practice’s patient portal. “From my perspective, hovering around 3% is well below the industry standard we’ve seen in benchmarking, so I’m thrilled to have that,” Vereen expresses.Going forward, she would like to continue to improve the practice’s patient portal adoption rate and use more technological resources to enhance the patient experience; for example, coming up with a good way to fill slots when cancellations occur within 24 hours of an appointment. As Vereen says, “It’s all driven by accessibility, whether it’s talking to your doctor, making an appointment, looking at your records or paying your bills.”
