Harnessing the Patient Portal in Healthcare
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Transcript of Harnessing the Patient Portal in Healthcare
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Harnessing the Patient Portal to Build Better Engagement
Evan GrossmanVice President Client Performance
Using the Cloud to Measure Performance
athenahealth’s cloud-based service is uniquely positioned to observe physician and patient trends
Why is the “cloud” significant?• Every encounter (financial, clinical) is captured in a single,
secure database • Every patient portal interaction is also captured
athenaNet contains data on:• 62,000 providers• >100 million annual patient visits• $15billion in collections• 5 million patient portal users
2
3
Agenda
The Strategic Case for Patient Engagement• Forces driving increased practice <-> patient engagement• Meaningful Use
Portal Adoption Benchmarks• Age / Insurance type• Level of penetration• Medical specialty
Six Steps for Maximizing Portal Adoption
Strategic Case for Patient Engagement
5
Forces driving Patient Engagement
Mounting evidence that engagement improves health outcomes.
Growing service competition in primary care
Meaningful Use incentives tied to engagement outside the physician’s office
Reimbursement for remote chronic care management
Transition to risk-based payment models
Ongoing imperative to restrain operational costs
1
2
3
4
5
6
6
Top Failure Points for MU Stage 2
Unmet Core Measuresathenahealth Providers Pursuing MU Stage 2, Q3 2014 with 1 measure to go
32% Secure Messaging
32% Preventive Care Reminders
12%
25% All Other Measures
Electronic Health Data Access
7
Patients are Willing to Switch Providers
http://newsroom.accenture.com/news/more-than-40-percent-of-us-consumers-willing-to-switch-physicians-to-gain-online-access-to-electronic-medical-records-according-to-accenture-survey.htm
63%
100
%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
37%
41%
No or limited access to medical records
Willing to switch providers to obtain access
Nearly two-thirds of patients lack full access toelectronic medical records
4 in 10 patients without access to electronic health records
would switch to providers who offer it
59%
8
Portals can help reduce operating costs
Cost Savings Achievable Through Patient PortalsIllustrative 10 physician practice
Source Savingsper unit
AnnualVolume
AnnualSavings
Electronic delivery of lab results
$.63 20,000 $25,000
Self-scheduled visits $7.00 5,000 $35,000
Online billing inquiries
$17.00 1,000 $17,000
Patient Engagement Framework
Stage
Description Benefits
I Basic digital connectivity. Required for Meaningful Use payments Lays groundwork for more meaningful activities
II Administrative functions - pay bills, view chart summaries, access lab results, self-schedule visits online.
Lower administrative costs More competitive care offerings for patients seeking
digital access Potentially faster, more complete payments
III Secure messaging. Care team members respond to patient concerns via electronic messages.
Greater responsiveness Ability to deflect unnecessary visits More convenient communication, with no missed
phone calls
IV Population health campaigns; send care reminders and schedule in-office appointments.
Greater compliance with pay-for-performance programs
Increased practice volumes in the short run Better long-term performance under value-based
contracts
V Disease management. Improve outcomes for at-risk patients Greater success under pay-for-performance and
risk-based contracts
Portal Adoption Benchmarks
11
Demography is not destiny
0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
7% 7%
14%
17% 18% 18% 18%
12%
6%
0.2
0.3
1.1 1.1 1.1 1.1 1.1
0.8
0.5
Penetration Logins per Visit
Pe
netr
ati
on
Log
ins p
er
Vis
it
12
Blue Commercial Other Medicaid Medicare Self-Pay0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
16% 17%
9%
5%
11% 11%
Higher penetration with commercial patients than Medicare, Medicaid
Adoption across athena’s client base
13 n = 1,149 practices
Stragglers30%
Beginners40%
Aspiring22%
Committed8%
0% 6% 12% 18% 24% 30% 36% 42% 48% 54% 60% 66% 72% 78% 84% 90% 96%0
10
20
30
40
50
60
Nu
mb
er
of
Pra
cti
ce
s
Number of Practice at each Portal Adoption Rate
Stages differ in more than adoption rates
14
n = 1,612 practices
Stragglers(0-10%
Penetration)
Beginners(10-30%
Penetration)
Aspiring(30-60%
Penetration)
Committed(60-100%
Penetration)
Proportion of Practices 30% 40% 22% 8%
Portal Penetration Rate 5% 18% 43% 75%
E-mail Collection Rate 21% 39% 63% 86%
E-mail Conversion Rate 24% 46% 68% 87%
Average # of Providers 64 41 15 8.5
Tenure (Months Live) 31 34 35 36
Logins / Visit 0.54 0.80 1.03 1.81
Patient Msgs Sent / Visit 0.15 0.18 0.21 0.38
Provider Resp.s Sent / Visit 0.05 0.09 0.13 0.25
Lab, Chart, & Billing Views / Visit 0.01 0.03 0.05 0.08
% of Appointments via Portal 0.7% 0.6% 0.8% 1.6%
15
Adoption for select specialties
81%5%
9% 58%
2% 44%
4% 55%
3% 41%
3% 54%
3% 48%
3% 48%
4% 43%
2% 33%
2%37%
32%
34%
8% 47%
2%
2% 27%
Specialty Adoption RatesMedian, Top and Bottom Quartiles, and Top and Bottom Deciles
Psychiatry
Ophthalmology
Urology
General Surgery
Cardiology
Gastroenterology
Pediatric Medicine
Neurology
Internal Medicine
Orthopedic Surgery
Family Medicine
Dermatology
Phys. Med. & Rehab.
Endocrinology
OB/GYN
0% 10% 20% 30% 40% 50% 60% 70% 80%
29%
26%
23%
22%
22%
21%
20%
18%
17%
15%
13%
12%
10%
5%
41%
Maximizing Portal Adoption
17
Portal adoption can happen quickly
Catego
ry 1
Catego
ry 3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
55%
85%
40%
66%
34%
57%
91%
Months Since Introducing Portal
Ad
op
tion
, P
ast
30
Days
6 12 18 24 30 36 42
10-physician OB/GYN practice 60-physician multispecialty group
8-physician OB/GYN practice 15-physician family practice
30-physician orthopedic group 300-physician pediatric network
60-physician multispecialty group
18
Start by reviewing the practice commitment to using the portal
Developing a Compelling Portal Experience
Lab Results Delivery
Service Required Practice Activity
• Develop policy for pushing normal/abnormal results to patients through portal
• Ensure that providers routinely provide appropriate lab results to patients
Secure Messaging
• Encourage patients to send secure messages
• Respond to secure messages in a timely fashion
General Support
• Dedicate knowledgeable front office staff person to answer routine and complex questions about the portal
1
2
3
Doctors should not be afraid of opening up communications via a portal
19
Most Secure Messages Addressable by Midlevel Providers
All incoming messages
General inquiries handled by medical assistant
40%
RN responds to prescription refill requests
40%
Physician addresses remaining questions
20%
Phone follow-up as required
If patients are not sending messages via the portal, they’d be calling the practice or
looking elsewhere:
“Take good care of your patients, or
someone else will”
20
Six Steps for Maximizing Portal Adoption
Portal adoption policy
Online-only lab results delivery
Streamlined portal training program
Consistent and compelling marketing message
In-office registration
On-premises support expert
1
2
3
4
5
6
21
1. Portal Policy
Consciously articulate a strategy for adoption, moving from opt-in to opt-out
Portal Adoption Policy
DescriptionAdoption
Target
Default to Portal Registration
Portal use is assumed by default: at the time of service, registrars send a portal registration email to users, explain the value of the portal, and ask them to register in the office by smartphone or in-office kiosks. The practice will see patients without portal accounts.
70%
Tying Portal Use to Care Plan Adherence
Clinicians incorporate use of a portal a central part of a patient’s care plan. Patients who choose not to use the portal must discuss that decision with a clinician, and doing so is considered a failure to adhere to clinical recommendations.
80%
Strict Portal-Only Policy
Patients are required to register for portal accounts except in a limited number of cases (e.g., lack of internet access). Practices may choose not to accept new patients who decline to use the portal and may charge for mail delivery of lab results.
90%
22
Greater Portal Adoption Reduces Burden of Offline Lab Delivery
Available with Increasing Portal Adoption
2. Lab result delivery
Concurrent Offline Mailing
With low portal adoption, practices offer
concurrent online delivery of lab results
via the portal and paper mailing of results.
1 Batched Offline Results Delivery
Medical assistants or clinicians schedule
period blocks to mail lab results or call patients
without portal accounts.
2 Offline Delivery Only By Request
Patients must call to receive lab results by
phone or mail, sometimes with a
processing charge for delivery by mail.
3
23
For most practices, switching to online-only lab results will likely drive adoption more than any other strategy (and it saves staff time & resources)
• Redouble efforts to collect email addresses
• Encourage clinicians to push lab results electronically when appropriate
• Communicate value of electronic lab results delivery to patients
• Set up a system to cater to patients who resist electronic results delivery
2. Lab result delivery
24
3. Training
Providers & Staff• How to use portal
• Why to use portal
• Lab results & patient messaging policies
• How to promote portal usage
Patients• Onsite expertise (see step 6)
25
Portal Adoption by Registrar: Variation within a single practice2014; % Patients seen in 2014 registering for the portal within 30 days of a visit;
Each dot represents one provider with at least 100 annual opportunities1
1. A patient is considered to be an opportunity if she does not have a portal account prior to a visit. One opportunity per patient per year, regardless of how many visits that patient has
3. Training
Reducing variation:1. Establish clear expectations for providers and staff.2. Create standardized scripting for front-office and clinical
staff.3. Report on (and review) activity by provider and staff.
26
Craft a compelling portal marketing message
• Tailor benefits to patient population
• Distill the major benefits, and ensure all staff can talk to them
• Develop benefits-driven portal marketing collateral
4. Marketing Message
27
po
In-Office Registration Methods Have Vastly Higher Yield
Automated/At-Home Registration Methods
In-Office Registration Methods
513 4,877 1,058 36,899 22,683 7,088Number of
Registrations (11/2014)
5. Registration
57% 53%
23%12%
4% 0.4%
28
• Ensure adequate physical space for in-office registration
• Consider kiosk and/or ‘concierge’ approach
• Provide space for 1 on 1 patient consultations / coaching
5. Registration
29
On premise portal experts for more complicated questions and reluctant patients
• Can demonstrate portal use while patients are in-office
• Provide limited phone support to patients
• Serve as trainer / portal evangelist to staff
• Eventually, they need to work themselves out of a fulltime job (as adoption reaches critical mass)
6. Expert on-site
30
Six Steps for Maximizing Portal Adoption
Portal adoption policy
Online-only lab results delivery
Streamlined portal training program
Consistent and compelling marketing message
In-office registration
On-premises support expert
1
2
3
4
5
6
In summary
32
Greater engagement starts Monday
• Forces driving the need for increased patient engagement are here to stay
• All practices can take advantage of an opt-out (vs. opt-in) portal strategy, regardless of patient demographics
• Expect high engagement and follow the 6 steps
athenahealth today
• 62,000+ providers on athenaNet®
• Clients ranging from 1 to 5,000+ providers
• 50 states and 112 medical specialties
• $13 billion in client collections per year
• Acquired Epocrates March, 2013
33“2014 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
#1 Practice Mgmt System
(1-10 physicians)
#1 Practice
Mgmt System
(11-75 physicians)
#2 Practice
Mgmt System (Over 75 physicians)
#2 Ambulatory EMR
(Over 75 Physicians)
#2 Patient Portal
#2 Overall Physician Practice Vendor
2014 Best in KLAS
Thank You