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How many times have you had the experience of finding that appointment card in your wallet -- two days after your scheduled appointment? It's happened to all of us, at least a time or two. Usually, this just seems like a minor inconvenience, but the consequences of a missed appointment are more serious than one might think.
Missed appointments drive up operational costs in health care. They also clog up office schedules, forcing other patients -- sometimes sick patients -- to endure longer wait times for medical appointments. They're also bad for the person who fails to show up for the doctor's visit: Missed appointments can cause delays in the discovery of life-threatening conditions and the start of new treatments.
Sharp Rees-Stealy Medical Centers, a large health care organization headquartered in San Diego, wanted to find a way to reduce the risks associated with missed appointments. Founded in 1923, Sharp employs more than 400 physicians and 1,800 staff members in 20 locations. Among their employees are about 100 call center agents.
Sharp schedules approximately one million appointments per year. At about $300 in revenue per appointment and a 10% no-show rate, the amount per day in lost revenue would be approximately $100,000. Sharp had previously tried a different automated contact services but wasn't very happy with the results.
"We were really looking for much more robust capabilities, something that would allow us to do more," said Kathy Hutchens, vice president of business development and patient engagement at Sharp. They health care provider's quest for a better way to engage patients ultimately led to Varolii.
Varolii is a customer interaction management firm headquartered in Seattle that focuses on automated customer engagement. It specializes in health care, financial services, utilities, communication, airlines and retail. Its most simple services include automated reminders for such things as medical appointments or upcoming flights, but Varolii also offers interactive programs that allow for a variety of automated contact systems. For example, a company can use Varolii to set up automated fraud-detection programs, order status and delivery notifications, and employee notifications.
Sharp first began using Varolii's services last year, primarily to take advantage of automated patient reminders. The automated service will call the patient at the number they've specified, typically three days in advance, and remind them of the location and time of their appointment, in addition to the name of the physician they will be seeing. If the patient cannot make it to the appointment at the scheduled time, Varolii's database is programed to interact with the customer using voice analytics to reschedule the appointment for another time.
David McCann, CEO of Varolii, explained that his company's software runs on top of an Oracle database and is based on some pretty complex business rules.
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"When you engage with a human in a call center, essentially the [first] human is having a two-way conversation and is always presenting choices. The other human being is selecting a choice. There is always a dialogue with the agent and another set of choices," McCann explained. "We've written all those rules in software, and we conduct them with recorded voices. [We're able] to automate a whole set of dialogues that normally would take a human being."
Sharp's Hutchens said that the greatest concern about the technology has been from medical professionals who are concerned about the doctor-patient bond being disrupted by technology. A benefit of the technology is that it reduces the need for nurses to continually call patients on the phone. As a result, those nurses can spend more time providing personalized health care to patients. While the Varolii system offers callers an option to be connected to a nurse for more detailed information, less than 2% of Sharp's patients who receive automated messages use that function, according to McCann. For automated post-care follow up calls, that number rises to 6%. While some patients do need to have a more in-depth conversation about their care, the vast majority of patients seem to be satisfied with the automated message they've received.
Sharp plans to begin using Varolii to send out automated messages if an appointment needs to be rescheduled due to an emergency on the medical professional's end.
"It's on our plan, I'd say, within the next year," Hutchens said. She added that Sharp has a "big wishlist," and that Varolii offers many features they hope to take advantage of in the future. Other items on Sharp's wish list include reminders well in advance for specialized appointments such as colonoscopies -- which have a very long wait and where special advance preparations may have to be made -- and reminders for general wellness appointments, such as cholesterol screening and immunizations.
For those systems to work, McCann explained that Varolii's systems have to be able to communicate with the back-end systems at the medical center. The only problem is that not all of those systems are compatible with the Varolii system. But with a little hard work from Sharp's IT group, they will be up and running soon.
Sharp's patients have already begun taking advantage of automated reminders via text message rather than phone call, a communication channel that was added last November. So far, 20% of Sharp's patients switched to texts rather than phone calls. The next new channel Sharp intends to add will be email. Other future projects for Varolii include video chat with doctors, iPad integration and remote monitoring of health conditions.