7 communication strategies to address gaps in care


Gaps in care cost patient lives and health systems close to 500 billion dollars a year.

A gap in care is the discrepancy between recommended best practices and the care that is actually provided — essentially, when patients don’t get the care they need.

For example, poor treatment adherence is a well-established gap in care. And medication non-adherence accounts for approximately 125,000 deaths in the U.S. per year.

Innovative verbal and digital communication practices can help health systems bridge this and other gaps in care.

1. Frame risk communications

The information patients receive about their health impacts the decisions they make — such as whether to take their medication as prescribed or attend a routine screening. Hence, deliberate communication around risk can help reduce gaps in care.

Dr. John Paling, founder of The Risk Communication Institute, suggests the following approaches for framing risk communications:

  • Statistics are better than vague terms. Instead of telling a patient they are at a “high risk for liver disease,” say, “Roughly half of men who drink more than 8 ounces of alcohol a day for 20 years develop cirrhosis.”
  • Present data with visual aides. Sometimes it’s easier for a patient to visualize their risk of developing a condition if they see a line graph showing a steady risk increase associated with their behavior.
  • Be consistent when comparing. For example, don’t mix fractions and percentages, and use absolute numbers.
  • Give both sides of a statistic, such as chances of survival and chances of death.

2. Incentivize good health with patient-centric communication

Patient-centric communication touches on a patient’s personal values beyond their health, such as family, self-esteem, and personal growth.

A patient-centric communication style may involve motivational interviewing strategies. Use the OARS acronym: Open-ended questions, Affirmations, Reflective listening, and Summarizing. This helps nurture potentially straying patients by fostering more empathetic patient-provider interactions.

This style of communication can help close gaps in care. In patients whose providers received patient-centric communication training, odds of adherence increased by more than 150 percent.

Consider a patient who takes medication for a heart problem. They may say, “I can never remember to take my pills.” The doctor can then affirm the patient is capable of taking control of their health, engage in reflective listening, and suggest a routine that easily fits into their lifestyle.

3. Use texting to reduce gaps in care

Text messages can help healthcare organizations bridge gaps in care in two ways. First, texting patients can improve treatment adherence. For example, research on patients with coronary heart disease showed daily text reminders increased medication adherence by almost 3x and improved blood pressure outcomes. Second, text message campaigns can be sent to specific patient population groups. The messages can prompt them to enroll in risk-based programs or provide patient education specific to their condition.

4. Improve patient communication with technology

Health systems miss more than 30 percent of all phone calls. And it’s estimated less than 20 percent of those callers leave a voicemail. This leads to information gaps, no-shows, and negative phone experiences. In the short term, it may cause patients to reevaluate where they get their health care. There are two consequences to this: The health system loses a patient. And the patient experiences a gap in care as they look for a new provider and wait for an appointment or potentially neglect care altogether.

Reduce hold times and improve show rates by implementing a conversational text messaging patient communication platform. Four out of five smartphone owners want their healthcare providers to text them, and 90 percent of texts are read within three minutes. Texting patients — and making sure they can text you back — eliminates the frustration and missed calls of relying on the phone.

5. Guide the conversation

More and more patients are doing online research prior to doctors appointments. While online information is a great source of patient empowerment, it can also cause tension and disagreements with providers when it comes to concluding a diagnosis or treatment plan.

Steer patients in the right direction by sending patient education by text message. Patients will feel at ease openly discussing the topics at hand, and not blindside providers with questions or concerns.

6. Reduce no-shows to reduce gaps in care

Numerous studies have shown that some form of appointment reminder, especially text messages, helps close gaps in care caused by appointment non-adherence.  In a 2016 study including 186 pediatric clinic patients or parents, those who received a single text reminder were 15 percent more likely to attend their appointment. WELL clients have seen even greater improvements with customized cadence of appointment reminders. For example, Eisenhower Health reduced its no-show rate by 71 percent.

A customizable appointment reminder system can help your patients get in the door while also preparing them with relevant pre-appointment instructions.

7. Coordinate care with unified communication

On a single day, a patient with a chronic condition may have an appointment with a specialist, get a scan, have blood work done, pick up a prescription, and receive a patient survey. They could receive multiple calls and messages from different numbers about these services. The result is confusion and “message fatigue” — contributing to gaps in care.

Instead, ensure patients receive all correspondence in a single text thread. Send from a secure, trusted source — a number from within your health system. Not only does this build trust — patients know who’s texting them — but also it allows you to combine messages into a single text. The better patients understand their care, the easier it is for them to follow through. ♥

WELL Referrals Management reduces patient leakage


As many as 50 percent of patient referrals are never completed.

Sometimes it’s due to a communication breakdown between doctors and patients. Sometimes patients simply forget to schedule or keep a referral appointment.

The result is that patients don’t get the care they need. And they are more likely to be readmitted to the hospital and have worse outcomes than patients who attend specialist appointments.

When patients fail to complete their referral appointments, hospitals suffer too. For nearly half of health systems, patient leakage results in more than 10 percent of annual revenue losses. Moreover, incomplete referrals mean slots go unused in specialists’ schedules. Analysts predict that by the year 2023, there will be a shortage of more than 65,000 specialists. Leaving unused time in their day wastes valuable resources.

We launched WELL Referrals Management to improve the referral workflow and reduce patient leakage. Our platform helps office staff schedule appointments and helps patients keep them. Coupled with WELL’s powerful automation engine and appointment reminders, it creates a concierge patient experience.

Improving patient referral workflow

WELL created its new Referrals Management system to automate the referral communication process. Here’s how it works:

  • After a provider places a referral order in the EHR, the patient receives an invitation to book an appointment. WELL sends it through the patient’s desired communication method (text, phone, or email) from the referred specialist.
  • If a patient responds yes, the specialists’ office can continue the conversation via text, call, or email to set up the appointment.
  • If a patient gives no response, the message can be repeated. This is where WELL’s powerful automation engine really shines. You can configure messaging to be sent out at custom intervals depending on the needs of your practice.
  • If a patient says no or doesn’t respond to the final message, WELL will send this response back to the EMR, closing the referral. From there, staff can personally reach out to the patient to schedule the appointment. As few as five percent of patients actually respond no.

Powerful automation engine

After patients schedule their appointment, WELL sends automated appointment reminders at custom intervals. The value of completely configurable messaging cannot be overstated. Your staff doesn’t need to lift a finger to keep patients engaged in their care and more likely to show up for their appointment. No batch uploads. And no waiting for your patient communication vendor to answer your support ticket.

Additionally, because WELL offers conversational texting, patients can respond with questions. Chatbots answer common questions, such as “Where are you located?” When patients have more in-depth questions, staff can easily enter the conversation as needed.

Benefits of improved patient referral workflow

WELL Referrals Management can reduce staff workload significantly. Staff spend countless hours on the phone trying to reach patients to schedule their referral appointments, sometimes calling multiple times for a single appointment. WELL Referrals Management eliminates these calls, reducing staff workload significantly.

Our messages have a 99.9 percent delivery rate. They’re never waylaid by a patient not picking up the phone or being on vacation. Even when patients miss a call, WELL reaches out multiple times to ensure a patient receives the message. The improved consistency makes your patient referral workflow even more effective.

Appointment reminders have the potential to reduce no-shows by more than 50 percent. For example, Mountain View Medical Center in Oregon reduced no-shows by 54 percent after implementing WELL. Eisenhower Health in Southern California saw similar reductions in no-shows.

Automating the initial outreach allows your staff to focus on the most critical patients and quickly close the referrals that don’t require followup. WELL Referrals Management helps stop patient leakage and frees up your providers and staff to do what they do best — care for patients. ♥

[pt_view id=”e4495297l9″]

Breast cancer patients find healing in empathetic communication


Seven years ago on a cool December morning, Jamie Kastelic woke up with an overwhelming sense of anxiety.

She begged her husband to stay home from work with her and their two children. The young mom had recently finished breastfeeding her second son when she noticed a small lump in her right breast. The nurse practitioner at her OBGYN’s office encouraged her not to worry — she was young and healthy. Nevertheless, she ordered an ultrasound and then a biopsy.

A few days later, her doctor called. “I have really bad news,” he said. “You have cancer.”

“The first thing I thought was, ‘I have two little boys,’” Kastelic recalls. “It was terrifying.”

In a tailspin of terminology

At her first oncology appointment, Kastelic received a binder with names of doctors and volumes of reading material explaining stages of the disease, tumor grades, and treatment options.

“I had a ton of questions,” she says. “Cancer wasn’t on my radar. Until you’re diagnosed, you don’t know a lot about it. You’re bombarded with information. Even the language, you’re not used to all of the terms.”

She remembers explaining her diagnosis to a family friend who is a doctor. She told him it was “oncl carcinoma.” He had never heard of it. He asked if she meant “ductal carcinoma.”

“No, that isn’t it. Maybe it’s so bad that you’ve never even heard of it!” she recalls saying. “The terminology, it’s a crash course — you’re in a tailspin.”

According to research published in the journal The Breast in 2013, one in three patients could not define the terms “benign” and “malignant“. A later study found that the majority of patients receiving chemotherapy said even the word “chemotherapy” was confusing. So too were port, adjuvant, and neuropathy, among a myriad others.

These might seem like basic terms to a provider who uses them every day. But to a newly diagnosed cancer patient, they’re yet another scary unknown.

“Education must be incorporated as a routine part of the consultation to enhance the patient experience and ensure they can actively participate in making informed decisions about their care,” authors of The Breast study said.

Compassion goes a long way

For Dena Taylor, finding a provider with a good bedside manner was non-negotiable. Diagnosed with breast cancer a month before her fortieth birthday, Taylor underwent a bilateral mastectomy, six rounds of chemotherapy, and five years on tamoxifen.

“I needed to know they cared. Some patients say they don’t care about bedside manner, as long as the results are good — ‘just get that thing out of me!’” she says. “I say, you deserve both. You have cancer, for god’s sake.”

Researchers in the Journal of Oncology Practice observed that compassionate care and empathy improve patient outcomes. They identified six types of kindness in cancer care:

  • Deep listening, whereby clinicians take the time to truly understand the needs and concerns of patients and their families
  • Empathy for the patient with cancer, expressed by both individual clinicians and the care culture, that seeks to prevent avoidable suffering
  • Generous acts that go beyond what patients and families expect
  • Timely care that is delivered by using a variety of tools and systems that reduce stress and anxiety.
  • Gentle honesty, whereby the truth is conveyed directly in well-chosen, guiding words
  • Support for family caregivers, whose physical and mental well-being are vital components of the care their loved ones receive.

These constitute “a powerful and practical way to temper the emotional turmoil of cancer for patients, their families, and clinicians themselves,” the researchers concluded.

Having an empathetic oncologist had a lasting effect on Taylor.

“I really liked him the moment I met him,” she says. “He was/is human. He made me feel more confident in my choices.”

Taylor writes about him in her recently released book, I Don’t Wanna Be Pink, where she explores her cancer journey with humor and bracing realness.

Navigating a complex system

The Marie Yeager Cancer Center in Michigan, where Kastelic received treatment, assigned her a nurse navigator, a specially-trained registered nurse available for education, support, and help navigating treatment.

“A nurse navigator is the best thing you could ever have,” Kastelic says. “She went above and beyond anything she actually needed to do. She talked to me after hours, provided insight, and broke down barriers, which is especially helpful if you can’t get in touch with your doctor.”

In a 2014 study published in the Journal of Clinical Oncology, researchers observed that patients who were assigned to a nurse navigator reported significantly higher scores on the PACIC. They also reported significantly fewer problems with care, especially psychosocial care, care coordination, and information.

“A navigator has the opportunity to be there, to be still, to listen, and to ensure they understand that there is someone there to help them,” says cancer nurse navigator Bernadette Lucas-Burch at Salinas Valley Memorial Hospital. “There’s a person to call. Mapping out those next steps.”

Communicate in a way that works for your patients

When Taylor’s oncologist said she could communicate with him by email between appointments, she was pleasantly surprised.

“That blew my mind. I had never emailed with any provider before,” she says. “You call a doctor’s office and leave a message with the staff. Then they call you end of day when you’re commuting and you can’t take the call. It’s maddening.”

There’s a limit though — technology shouldn’t replace human connection. Early in her treatment, one of her friends was also diagnosed with breast cancer. She was referred to a well-regarded surgeon. Taylor attended one appointment with her friend. “Her doctor was so aloof,” Taylor recalls. “She left her diagnosis on her voicemail.”

While Taylor acknowledges that her friend may have indicated that it was okay to leave a voicemail, a cancer diagnosis seemed like a weighty exception.

Empathy and validation matters

For Kastelic, aggressive treatment was the only option. She opted for a bilateral mastectomy followed by chemotherapy and an oophorectomy.

“When you have kids, you say, ‘I will do anything to watch these kids grow up,’” she says.

When she presented her questions and concerns to her doctor, she felt like he validated her perspective without adding to her fears. “He doesn’t minimize what I say,” she says. “If I tell him something, he doesn’t make me freak out either. There’s a good balance.”

She encourages providers to take patients’ worries seriously — even when they seem unfounded. “This is an emotional thing,” she says.

Taylor also found empathy and validation from her doctors. She recalls telling her reconstructive surgeon about her upcoming mammogram — her first since finishing chemo. Sensing her apprehension, her surgeon said, “I can see you’re nervous about another test. You can come in here and talk to me anytime you want.”

Healing in your own way

For many people diagnosed with cancer, joining the breast cancer movement brings inspiration and a sense of belonging. It’s also a way to give back.

For Kastelic, now more than six years cancer free, involvement in breast cancer causes is an important part of her journey. She has volunteered with numerous nonprofit groups, including Living Beyond Breast Cancer and the Susan G. Komen Foundation, and spoken at many events. She also started a line of non-toxic personal care products.

Taylor has a different approach. She forgoes the cancer walks and the pink ribbon campaigns and looks for alternative ways to give back, including supporting others who are touched by cancer.

“I don’t want to be defined by the diagnosis. I don’t want it to be the first thing I tell people. I just don’t want it to dominate my life,” she says. “Right or wrong, it’s just my comfort level with it.”

Nevertheless, she says of the movement, “If it works for someone else, if it brings them joy, confidence, and comfort, how dare anyone steal that?”

Every patient is different

Overall, both women appreciated the empathetic communication their providers displayed.

Taylor remembers a particularly poignant moment during her treatment. A team of nurses attended to her and several other patients receiving infusions. They were packed into a crowded room. She marveled at the nurses’ ability to care for each person — each with unique needs, each with a different prognosis, each with different side effects and reactions to their treatment.

“They’re doing it all day. It can’t be the easiest job,” she says.

To her, it was a well-choreographed dance — a fitting metaphor. ♥

Can your doctor appointment reminder system do that?


Does your doctor appointment reminder system measure up?

Many progressive hospitals and private practices already invest in a doctor appointment reminder service. A phone or text reminder can reduce no-shows, improve patient scheduling, and ultimately ensure patients get the care they need.

However, most patient reminder systems don’t offer the flexibility, accuracy, and bidirectionality that they claim to have. Here are the important points to consider when you choose doctor appointment reminder software:

Can you customize patient reminders?

Medical appointment reminder software should allow you to customize more than just the appointment time and date. You should be able to use patient first names and tailor your messaging to the type of communication that resonates with your patients.

It should also let you text medical pre-appointment instructions — such as reminding a patient to fast before their visit.

Here is an appointment confirmation text sample that works for WELL customers:

“Hello, Maria, Dr. Driscoll is looking forward to seeing you tomorrow at 04/13/2019 12PM at Santa Barbara Oncology, 12 E CARRILLO, SANTA BARBARA, CA. Please arrive at 11:45AM.”

Is texting HIPAA compliant?

Whether or not texting is HIPAA compliant depends on multiple factors — patient health information may or may not be present in your patient reminders. In the previous appointment confirmation text sample, the message includes enough information to deduce a diagnosis, which is protected PHI and should be sent securely.

Ultimately, it’s up your organization and compliance department to determine what content to send via texting and what to send via Secure Messaging. One of the advantages of WELL is that healthcare organizations can configure messaging exactly to match their compliance requirements.

Does the appointment reminder service speak 19 languages?

WELL offers support for 19 different languages. Whatever language your patient speaks, as indicated in the EMR, you can configure messaging to be sent in that language. It seems obvious, right? — speak to people in a way they understand.

Can you schedule and send patient reminders in real time?

With most patient reminder systems, you have to upload your data in batches once a day and then wait for hours before reminders begin sending, irrespective of the actual appointment time or cadence you want.

With WELL, when an appointment is scheduled in the EMR, a confirmation message goes out to the patient immediately. Subsequent messages are stored in WELL’s database and go out at the cadence you choose — no batch uploads, no batch sending.

Is it easy for patients to confirm and cancel appointments?

You don’t talk to your patients in single digits or letters, so why does your appointment reminder system ask them to talk to you that way? When patients only have the option to text “1 to confirm, or 2 to cancel” they’re more likely to make mistakes and accidentally cancel when they mean to confirm. This results in missed appointments and frustrated patients.

With WELL, patients can respond the way they would respond to a friend — “Yes, I’ll be there!” or “No, can’t make it.” WELL’s sophisticated platform understands and processes these responses and sends them back to the EMR. Even better, you can set up keyword-based automations to respond to patient questions such as “Where are you located?” to better serve your patients without additional lift from your staff.

WELL’s truly bidirectional functionality allows patients to also ask specific or clinical questions and receive responses directly from your staff. Ultimately, we want to make going to the doctor as easy as meeting up with a friend.♥

9 reasons to focus on patient experience in 2020


When Colleen Prescott woke up, she noticed that the muscles on the left side of her face were weak and drooped.

A week earlier, she had undergone major abdominal surgery and was still heavily sedated with pain medications. She didn’t want to spend half an hour on hold trying to reach her doctor. She needed an answer and fast.

Her provider had recently implemented WELL, allowing her to easily text the office. Moments later, a nurse responded and urged her to go to the emergency room because her symptoms mirrored those of a stroke.

“I wouldn’t have called my doctor and sat on hold for half an hour — I probably would have just ignored it,” Prescott* says. “Texting allowed me to reach out quickly and get an answer right away.”

Patient experience begins before the appointment

Patient experience begins before an appointment even occurs — for Prescott, it happened while she was still at home in bed.

A 2017 study conducted by the University of Utah found that patients value the ability to schedule a timely appointment, convenient access to their provider, and a reasonable wait time significantly more than actual time spent with their provider, the availability of specific treatments, and the actual quality of care (e.g. absence of medical errors).

“In focus groups and in survey feedback, patients told us they don’t necessarily want to spend more time with their provider — they want to be heard,” the study’s focus group observed.

Nevertheless, according to research published by Sage Growth Partners, a Baltimore-based healthcare consultancy, only 39 percent of health system C-suite execs report using text messaging to improve patient experience. Even fewer are texting patients with truly conversational bidirectional messaging, so patients can actually text you back.

Better patient experiences lead to better outcomes

Research consistently confirms that positive patient experience correlates with better health outcomes. A study published in the journal Circulation in 2010 found that patient satisfaction was positively correlated with 13 of 14 measures of success for treatment of heart attacks. Additionally, for every 25 percent increase in patient satisfaction scores, there was an equivalent 25 percent change in predicted survival.

The researchers concluded that patients are good discriminators of the type of care they receive — when they don’t have a good experience, they don’t fare as well.

Results are similar for patients with chronic conditions. For example, diabetic patients who report better communication and overall experience with their providers also have better blood sugar control and fewer functional limitations, according to a study published in the Journal of General Internal Medicine.

Better patient communication yields better experiences

When Prescott landed in the ER, she was quickly diagnosed with bell’s palsy, or idiopathic facial paralysis. It’s not as serious as a stroke but not something to ignore either — in some cases it can result in permanent contraction of the facial muscles. The sooner it’s treated, the better the prognosis.

“If I hadn’t texted my doctor and received treatment immediately, I could have a permanent nerve damage and a lifelong facial deformity,” she says. “Being able to reach my doctor quickly made all the difference.”

Patient experience is good for business

Cultivating positive experiences makes sense for patients and for providers. Here’s why:

  • Patients are five times more likely to select a practice where they had a positive experience than one with a strong consumer marketing presence, according to a 2018 Press Ganey report.
  • Hospitals with better patient experience ratings tend to have 50% higher profit margins than average hospitals, Accenture research found.
  • Similarly, a 2016 Deloitte study found that hospitals with excellent HCAHPS scores had an average net margin of 4.7%. Hospitals with low scores had average margins of just 1.8%.
  • A Vanguard Communications survey found that 96% of online patient complaints center around customer servicenot quality of care.
  • 72% of patients use online reviews to guide them to a new doctor, a Software Advice report states.
  • 51% of patients would switch healthcare providers if it meant they’d receive great customer service, according to an Accenture report.
  • Good patient experience is associated with lower medical malpractice risk. On a scale of one to five, with one being “very poor” to five being “very good”, every point increase in score reduces the risk of malpractice by 21.7 percent.
  • Efforts to improve patient experience also improve employee satisfaction and reduce turnover. Northwestern Memorial Hospital in Chicago launched a patient satisfaction program that resulted in improved staff satisfaction, productivity, internal and external recognition, and a 4.7 percent decrease in employee turnover.
  • Positive experiences contribute to increased patient retention. Happy patients are three times more likely to remain in your practice than patients who have the poorest quality relationships with their providers.

For Prescott, being able to quickly and easily reach her provider not only resulted in a better health outcome but also yielded fierce patient loyalty.

“The experience was so positive — just what they were able to do for me without me really lifting more than a finger to reach out — I’ll be loyal to them forever,” Prescott says.

*name changed to protect patient identity

Could the crackdown on robocalls block messages to your patients?


“Congratulations, you have won a free vacation to Riviera Maya! Press one to speak to one of our agents.”

Ugh — robocalls. They’re intrusive. They’re annoying. Now, they’ve become downright dangerous.

On April 30, 2019, Tufts Medical Center received 4,500 phone calls in just two hours. Like other robocalls, these urged recipients to act quickly. They were delivered in Mandarin and threatened deportation if the listener didn’t provide personal information, the Washington Post reported.

Not only did the calls cause headaches for hospital staff, they also jammed the system’s phone lines, preventing real patients from getting through.

Tufts is not alone. Other healthcare systems have been inundated with spam calls, disrupting hospital operations and challenging their ability to handle their already high call volume.

Calling it quits on robocalls

On June 25, 2019, the Federal Trade Commission announced a crackdown on robocalls called “Operation Call it Quits” targeting the bad actors behind more than a billion spam calls.

“We’re all fed up with the tens of billions of illegal robocalls we get every year,” said Andrew Smith, Director of the FTC’s Bureau of Consumer Protection. “Today’s joint effort shows that combatting this scourge remains a top priority for law enforcement agencies around the nation.”

Flipping the appointment reminder script

Ironically, for years it has been patients who complained about receiving robocalls from healthcare systems.

The phone rings. A robotic voice recites an appointment reminder script: “Hello, This is Central Hospital calling with an urgent message for Mr. Bob Smith. To listen to this message, press one.”

The calls are legitimate, but they are annoying. Plus, they aren’t exactly how patients want to communicate with their doctors.

Neither are the one-way text messages sent via Televox and other doctor appointment reminder services. The so-called “smart text message” lets the patient reply — but only if their response is Y or N.

Not so smart.

Developing a better option for patient communication

We’ve been the patient, received the robocalls, waited on hold, and endured the seemingly endless notifications from different vendors.

We developed WELL’s patient engagement software as an alternative. With WELL, you can communicate with patients in the way that works for them: phone, email, live chat, or secure text messaging. Our communication is truly bidirectional — meaning patients can respond to messages and interact with their providers.

Staying above the law

As both commercial and government agencies crack down on robocalls, legitimate organizations need to ensure their messages are still getting through to patients.

WELL works directly with large carriers, including AT&T, T-Mobile, and Verizon, to ensure SMS message deliverability. We also provide a set of monitoring tools and fallback mechanisms to identify deliverability issues and retry messages through multiple channels.

You’re not sending spam. So make sure it doesn’t look like it.

Schedule a call with one of our business development representatives today to implement a successful patient communication strategy. ♥

5 Reasons Patients Miss Telehealth Appointments


Telemedicine was supposed to reduce no-shows because there’s no barrier to seeing a doctor by video, right?

Not exactly.

More than 70 percent of consumers are open to telehealth, and there is little difference between the quality of care versus in-person appointments. Nevertheless, no show rates for telehealth are often 30 percent or more, twice as much as for in-person visits.

How can that be?

There’s more to the story than just the stats
According to Brandon M. Welch, PhD, Assistant Professor at Medical University of South Carolina and founder of telemedicine provider Doxy.me, it may not be due to the nature of the visit — by video instead of in person — but rather how the visit is promoted, scheduled, and implemented by the healthcare organization.

For example, many enterprise health systems offer telehealth visits with a pool of qualified physicians who may or may not be the patient’s primary care doctor. This variable alone could account for an apparent increase in no-show rates.

“So you’re not really comparing telemedicine to in-person because there is more than one variable,” Dr. Welch said. “To determine if no-show rates are really higher among telemedicine appointments, other variables (such as the provider-patient relationship) must be controlled.”

So why aren’t patients showing up?
That said, the no-shows in telemedicine are real. They still present a hurdle to ensuring quality care for patients and create a financial and administrative burden for healthcare systems.

Patients miss their virtual visits for a variety of reasons. Here are the top five:

#5 Technical challenges
Technical challenges are one obvious barrier. If patients don’t understand how to use the technology, they’re less likely to follow through with their appointment. Needing to download an app or log in to a patient portal both present opportunities to abandon the appointment. Passwords are forgotten. And sometimes, new tech is just confusing. Research indicates that usability issues at the initiation phase of the appointment account for the greatest patient frustration.

#4 When it’s not seen a real appointment
Patients may think there’s no harm in not showing up for their appointment — like they’re not hurting a real person or wasting real time. This is especially true when patients are seeing someone other than their primary care physician.

Welch views telemedicine as complementary to the traditional in-person care model, rather than a replacement for it.

“The movement to replace in-person appointments with telemedicine will fail, along with quality and satisfaction of care, if it severs the patient-provider relationship,” he said. “Doctors need to adopt and add telemedicine as an option to their practice, rather than organizations trying to replace that traditional in-person relationship.”

#3 Thinking “I can just book another appointment!”
When there’s no consequence to the patient not showing up — no bill and no long wait time to reschedule another appointment — patients may be less motivated to keep their appointments.

One solution to reducing patient no-shows is to implement a policy that penalizes patients with a straight fee or a “three-strikes-you’re out” policy. However, the first approach can scare off patients and discourage them from seeking care with you. The second can actually contribute to patient attrition — not what you’re looking for.

#2 No Good Reason
One of the toughest reasons to address may be the one that doesn’t exist. Sometimes human behavior is inexplicable and people have no good reason for doing or not doing something.

#1 I just forgot
It’s easy to forget an appointment, especially when you’re dealing with an illness or injury. Digital amnesia, forgetting information stored on a digital device, amplifies that tendency. When a patient makes an appointment online, they are more likely to need frequent reminders to keep it.

Engaging patient communication and delightful virtual experiences offer promising solutions to many of the reasons for virtual care no-shows. WELL partners with enterprise health systems offering virtual care and uses its bidirectional text messaging to reach patients where they already are — on their phones.

WELL clients have seen telehealth no-show rates cut in half — especially for the patients who simply forgot to attend. Before the appointment, a series of conversational messages help the patient log in to the portal and check in to the appointment. Because the text appointment reminders are bidirectional, office staff can chime in when needed to help a patient get their appointment started.♥

WELL partners with Binary Fountain (and introduces Sentiment Analysis)


Patient messages are an invaluable source of feedback—if only we could only track them all.

Thanks to an integrated partnership and a brand-new feature, we’ve found a way to make it happen.

WELL already gives you a way to connect to patients in the way that’s easiest for them, keeping you close to their journey and opening up the conversation. Now, you’ll be able to keep careful tabs on what your patients have to say—and jump in when necessary to resolve their concerns.

Binary Fountain

Working with Binary Fountain, a reputation management platform, we’ve made it easy to keep tabs on patient comments, identify trends and recurring issues, and perform fast service recovery when necessary.

  • We send comments and conversations—with patient health information removed—to Binary Fountain in real time. Binary Fountain monitors patient messages in WELL—along with online reviews, satisfaction surveys, and similar data sources—using sentiment analysis software.
  • The system scores each comment for positive vs. negative content and categorizes the patient’s message based on its content (whether that’s “quality of procedure” or “parking”).
  • A feedback dashboard identifies trends among comments and gives you an overall picture. You’ll be able to isolate results for specific clinics, hospitals, or providers within your enterprise, so you can celebrate successes and identify ways to improve.
  • A negative comment indicates that a patient needs attention. Now, you’ll have essential new opportunities to perform service recovery—engaging your patients and improving overall satisfaction.

Sentiment Analysis

  • WELL’s new Sentiment Analysis uses a machine-learning algorithm to read through patient messages. You’ll be able to perform immediate service recovery, triage when necessary, and track feedback trends.
  • When the algorithm detects negative content—whether it’s from a dissatisfied patient or someone experiencing an emergency—it turns the patient channel red and sets it to “open.” That way, you’ll know immediately when a patient needs your attention.
  • Sentiment Analysis also gives you a broader perspective on patient satisfaction. The feature assigns a positivity score to every incoming message. That means you can track patient sentiment across your enterprise—or isolate results for a particular clinic, department, or provider—using WELL Analytics.

And this isn’t the last word on Sentiment Analysis. The new feature has the potential to work with more of WELL’s existing capabilities—like Keyword Actions.

Looking ahead

Look out for more from us in the near future! We’re always working to improve WELL with new features and integrated partnerships. Don’t hesitate to call us if you have any questions. ♥

Uber and WELL: Improving access to healthcare


When we think of access to medical care, we usually think about costs: Does this patient have insurance? Can they afford the bill at the end of the line? What’s the price of that medication?

But sometimes, the hardest part about going to the doctor’s office is just getting there in the first place.

According to the American Hospital Association, an estimated 3.6 million people in the United States miss out on medical care every year because of transportation issues. Likewise, studies have found that transportation problems are responsible for as much as 28 percent of no-shows.

When we talk about transportation, we’re covering a wide berth, from lack of access to a car to long travel times and lack of basic infrastructure. And while providing a ride to a stranded patient won’t address every disparity, it can make a huge difference.

Access through Uber

That’s why WELL has created a way for health systems to send an Uber ride to patients who need one—automatically, with no staff time or input needed. It’s designed to lessen those disparities and get patients in for vital care.

But providing an Uber does more than that. It’s a great way to show patients how important they are—and provide an amazing, concierge-level experience for a minimal cost.

The Uber workflow can be launched with a keyword trigger, and is coordinated by a conversational chatbot that can schedule a ride by itself. Here’s how it happens:

1. Keywords Kick It Off

Automatically respond to messages from patients that include words like “car” or “ride” using WELL’s Keyword Actions. Once a patient has scheduled an appointment, our system will look for trigger keywords and ask patients if they need a ride to the clinic.

2. A Chatbot Gets It Going

If your patient needs transportation, a chatbot will coordinate all the details—including getting the right address, calculating travel times, and automatically ordering an Uber. Everything is taken care of behind the scenes through the WELL API.

3. An Open Channel Alerts You

Although the chatbot can handle the whole interaction from beginning to end, your staff will be alerted if the patient needs help. A staff member can hop in to answer any questions, then guide the patient back to the automated conversation. (If all goes smoothly, the automation skips this step.)

4. Your Patients Are Delighted

Stranded patients are unhappy patients. But virtually without effort, you’ve reduced no-shows, shown your patients they matter, and helped to level the field for underserved patients. That’s a lot of goodwill for the price of a ride.♥

Seniors are texting. Everyone else should text back.


When Alexis Kuerbis applied for a grant to study older adults and text messaging, she was shocked by reviewers’ reactions.

“Basically, I ran into a bunch of ageist and out-of-date attitudes,” said Kuerbis, a professor of social work at Hunter College. “They were saying ‘Older adults don’t use mobile phones. You’re never going to get them to engage in any technology.’”

But that wasn’t Kuerbis’s experience. At the time, she was participating in a study that involved using text messaging as an intervention for problem drinking, and older adults were among the study participants. “I was seeing people who were older and very tech-savvy, and able to engage in an intense assessment via smartphone,” she said.

What the science says

The scientific literature backed her up. Researchers have successfully used text messaging to engage older adults in everything from appointment reminders to medication management.

According to the Pew Research Center, 80 percent of Americans over age 65 own a cell phone. AARP research found that 86 percent of Americans over age 50 communicate with text messaging. For those ages 50-69, texting has actually surpassed email as their preferred method of communication.

“We think of texting as a millennial thing, but people of all ages engage in it,” said Aaron Hagedorn, a gerontology professor at USC and widely-respected expert on older populations. “Every person is the same, regardless of age: We all want to engage socially.”

“In general, older adults are pretty open to using technology,” said William Chopik, a psychology professor at Michigan State University. In 2016, Chopik studied about 600 older adults with a median age of 68 to find out more about their use of social technologies like SMS messaging, emails, video conferencing, and Facebook.

The seniors in the study didn’t just have positive feelings toward the social technologies used; they were positively impacted by them. “It makes them feel less lonely, and, as a result, makes them happier and healthier,” Chopik explained.

“In every study I’ve ever seen about technology being applied to older adults and seniors for healthcare, across the board, they tend to like it. Separately, they also tend to get excited about it, because it feels fun and new,” said Kuerbis.

An outmoded perception

But we’ve all heard the stereotype: Older people and technology don’t mix. Where does it come from?

For one thing, Kuerbis says, it actually was true a generation ago, when older generations went their entire professional lives without using digital technology. Times have changed. “If you think about it, the generations that have aged in the past 30 years aged at a time when the world was being forced to engage in technology in new ways,” she explained.

Kuerbis’s father, for example, began using computers for work in the 1980s, but his parents never did. “There just isn’t the same level of digital divide.”

In addition, Hagedorn said, non-seniors often think of old age in the most dramatic possible terms: “We tend to think about the most disabled older people, and people tend to think that the design that works for them needs to address the most extreme circumstances in terms of color or size or demands on dexterity.”

But that’s not an accurate picture. For one thing, when we talk about older adults, we’re actually talking about everyone over the age of 50. That’s a huge and highly diverse population—one that covers people at the height of their careers as well as those who have been retired for decades.

And even among true seniors—those 65 and older—technology use comes pretty naturally, Hagedorn said: “I would say that among the population of people 65 and up, 80 percent of them would have no problem using a standard app. Another 10 percent of them could handle it with some assistance from others or on a tablet. The ones who can’t manage it are in a real minority.”

Engaging older adults in texting

“Text messaging is the least invasive and the most accessible [technology] across age groups. It takes the least amount of effort for older adults to use,” Kuerbis explained.

That’s not to say that those older adults use texting in precisely the same way younger populations do. For one thing, Hagedorn said, it’s much better if there’s a human on the other end. Older adults are “very people oriented, not technology oriented,” he explained.

How to reassure them that there’s a real person on the other end? “Ask them to reply back,” Hagedorn suggested. “The engagement of having to reply is a stronger reminder and forms a relationship.”

When it comes to appointment reminders, more is better, Hagedorn said. A one-time reminder will be less effective for a senior population than two or three spread out over a few days.

And Kuerbis’s research shows that older adults have some clear preferences about message content: Single punctuation was better received than multiple punctuation marks; messages without emoticons tested better than messages with a smiley face; and older people preferred “you” statements to “we” statements.

Finally, Hagedorn’s research suggests that trying to replace in-person relationships with technology isn’t likely to work well. When he conducted research that involved providing telehealth counseling to older adults, literally 100% of them said they would have preferred an in-person appointment. By contrast, “young people like telehealth counseling better. They feel more comfortable in their own homes, and they may actually reveal more.”

Instead, technology is more likely to engage seniors “if it strengthens a relationship that’s important to them, particularly if it’s related to an in-person experience”—precisely like a doctor’s appointment.

And despite the stereotypes, “older adults have a lot of concerns about staying connected,” Chopik said. “Technology is one of the ways they can increase their communication with the outside world.” ♥

Get Started

Find out how WELL’s enterprise communication hub can make it easy to engage patients for world-class clinical and administrative experience.