LCH serves more than 5,700 clients annually with a range of health, behavioral health, and social services. Our clients are predominately Latino, and most are low education workers in fields such as the local mushroom industry, cleaning, and landscaping. This mix of characteristics presents us with challenges in providing high-quality care. Our clients usually do not have access to email, and while they have mobile phones, they cannot take time for phone calls while they are at work. Our challenge is to find reliable, efficient ways to reach our clients to schedule, change or confirm appointments, schedule prescription pickup, share lab results, etc.
At present, our staff spend a lot of time on unproductive telephone follow-up with clients. At the same time, our no-show rate for appointments hovers around 20-30%, due to this communication difficulty. Our proposed project would create the infrastructure to send HIPAA compliant text messages to our clients, using our Centricity database.
Offering high-quality care is just part of the competency we must possess to improve the health of clients. To be fully successful, we must meet them where they are in terms of culture, education, and technology. Doing so is critical to the success of our financial model (which suffers when we have a high rate of no-shows), and our outcomes. For example, we struggle with keeping in touch with clients diagnosed with depression, to ensure they are taking their prescribed medication. Frequently, our providers engage in multiple rounds of “phone tag” and still cannot speak with their client. When that client comes to her next appointment, her provider must start over again with her treatment plan. By reaching out to clients in a simple, easy way they can respond to even when they are working or with family, we can close those gaps in communication and improve both organizational efficiency and client outcomes.
This project will help us improve the behavioral health outcomes of our clients by improving communications and facilitating appointment making. Frequently, our clients want to come to all scheduled appointments, but life gets in the way - their employer will deny them time off, or a family situation will arise. Without these regular appointments, our clients are not receiving the counseling they need, may not be complying with prescription instructions, and are not having their condition monitored regularly by a behavioral health professional. An irregular schedule of care will not generate optimal results for our clients, so we are aiming to imporve outcomes by facilitating easier appointment-making and -changing, and thereby making it easier for clients to receive all of the medication and services they need to improve their mental health.
LCH's efficiency takes a serious hit from no-shows, and our current no-show rate hovers between 20-30%. This means that the client who didn't show up is not getting the care he needs, and also that another person who needs care is not scheduled as early as possible. The inefficiency created by this gap is costly in terms of provider time and resources. Our medical providers and support staff also currently waste a substantial amount of time trying to reach clients by phone to confirm medication compliance, share lab results, reschedule appointments, etc. We believe that text messaging will be a time- and money-saving technology that will be readily received by our clients, and that will ultimately help us both become more efficient, and more effective in meeting our objectives for improved mental health for our clients.
This project is creative in addressing the specific needs and limitatons of the population we serve. This population is very busy with work and family, and frequently employed at workplaces where they cannot take time for personal phone calls. They are often employed as hourly workers, with employers that frequently change their hours, making rescheduling of appointments unavoidable. Our clients have low income and low education, and many do not have access to email. Nearly all of them, however, have mobile phones, and text messaging is a simple, easy way to reach clients quickly using the technology they are most familiar with. Sending a one-sentence text message to LCH is much more practical for clients than taking time for a phone call (or a series of phone calls, as is often the case). A small, one-time investment in technology could make a huge difference to LCH and our clients' health.
Amy Lambert, LCH’s Director of Business Operations and Programs, joined LCH in 2013 as a behavioral health consultant and has since been promoted to oversee all of the site’s operations due to her passion for logistics, problem-solving, and ameliorating health disparities. Ms. Lambert supervises the integrated behavioral health team, including social assistance services such as case management and eligibility/financial counseling, oversees the revenue cycle of the health center, and is charged with risk management and compliance with federal regulations as a federally qualified health center. Ms. Lambert is a licensed clinical social worker in both Delaware and Pennsylvania. She received a BS from the University of Richmond in 2007 and a Masters in Social Work and a Masters of Public Health from the University of Pennsylvania in 2010.
Once the text messaging software is purchased and integrated into our system, and the procedures have been set up and troubleshooted, we expect that the annual cost of maintaining the system will be very low. We feel that the increase in kept appointments will boost our efficiency more than enough to justify the small annual cost of text messaging to clients. We also feel that as the health care system nationally makes a transition to value-based payments, this technological advance will position us well to improve client outcomes in a very low-cost way.
If this project succeeds in helping us to improve communication with clients, increase our kept appointment rate, and improve depression treatment and client outcomes, it will be readily replicable by other organizations. The technology is readily affordable and truly an investment in better efficiency and outcomes. For many safety net health centers like ours, email and telephone are unreliable means with which to communicate with patients. Text messaging offers an affordable, simple way to improve client outcomes and satisfaction.
LCH Centricity, our comprehensive database, tracks all of the information we would collect to measure the success of this project. The measurements we have chosen focus on two specific issues we feel are impacted by the current communication difficulty: a high no-show rate for appointments; and low compliance with depression treatment for our clients diagnosed with depression. Through the implementation of this text messaging program, we expect to:
- Reduce our no-show rate for scheduled appointments from 20-30% to 10%.
- Increase capture of change in depression screening tool (PHQ-9) score for people with diagnosed depression from 50% to 85%.
- Increase % of patients who are taking depression medications prescribed one week after visit where prescription was given from 20% to 60%.