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. ♥

Aligning health system priorities for innovation


Being responsible for innovation—in a famously slow-moving industry—can feel like an oxymoron.

Somehow, it’s your job to simultaneously resolve individual pain points and develop a long-term vision for the way your health system runs. And getting people on board—either for individual solutions or long-term pain points—isn’t always easy.

At WELL, we’ve worked with a wide range of innovation leaders, and we’re used to helping bring people into alignment as they implement our platform. We’ve seen heads of innovation who were great at getting buy-in across their organization. We have also seen the particular areas where they’ve struggled.

Get an overall picture

Rather than trying to learn the ins and outs of each department from the beginning, start with the CEO or head of your health system. What are their large-scale goals for the organization? How are they being measured? These things vary hugely across organizations.

Once you understand those things, it’s easier to ask individual departments and heads how their objectives align with the larger vision. That way, the solutions you develop will be more strategic and targeted toward your health system’s overall goals, rather than being small-scale fixes for isolated problems.

It also means that you’re more likely to get buy-in. Helping colleagues toward their own strategic goals is the best way to get them on board.

Find pain points

That said, a large part of an innovation leader’s role involves listening. “If you walk into a room and say, ‘This is what we’re going to do,’ you have already lost people,” said John Halamka, the executive director of Beth Israel’s Health Technology Exploration Center.

He makes it a point to ask colleagues, “What are your business problems? What are your pain points? What are the things for which, if there were a technological solution, you really would feel better about your workday?”

Put solutions first

While it’s easy to think primarily in terms of solutions to existing problems, it’s not always that simple. According to Michelle Stanbury, vice president of innovation at Houston Methodist, the invention of a new solution sometimes can bring a hidden problem to light.

“You may not understand the pain point until you understand what’s available in the industry,” she said. Houston Methodist’s group of self-titled DIOPs—that’s “digital innovation-obsessed people”—actually begins by keeping a close eye on new technological developments both in healthcare and elsewhere. When they see an exciting new technology, Stanbury said, the next step is to “wonder if we can bring that back into healthcare.”

Not all organizations are as tightly focused on innovation, and it’s common to encounter some resistance from key figures. At WELL, we’ve had a lot of experience working with people in these roles. Below are some key strategies for getting them in your camp.

Chief Financial Officer

“If you go to a chief financial officer and claim a return on investment on an IT project, most savvy chief financial officers will not believe you,” Halamka said.

It’s counterintuitive. After all, CFOs are focused on financial impact, so it makes sense that you’d want to show a direct relationship between a new innovation and a specific, measurable outcome. But it’s also a CFO’s job to be risk-averse, and no solution is guaranteed to produce a solid return on investment.

However, they do understand the importance of benefiting the organization in other ways, so it can be more effective—and more flexible—to make a case based on potential impact. “Focus on other things: the strategic imperative, the impact factor, the safety and quality, and the compliance and regulatory side,” Halamka said.

In particular, he recommended focusing on patient satisfaction, improving physicians’ and staff members’ work lives, and presenting a cutting-edge image to the world. “The health care system wants to be known as tech savvy,” he explained.

Chief Medical Officer

A CMO is most likely dealing with a burned-out physician group. “Physicians want to get back and spend more time with their patients,” Stanbury said. A savvy CMO will be interested in natural-language processing or AI solutions that can help make that happen.

In addition, CMOs care intensely about clinical outcomes, and metrics are important. Before you bring an idea to your health system’s CMO, spend some time reading studies that support your proposed innovations—and if possible, reach out to the experts who wrote those studies. The expertise and data they provide can go a long way.

According to Halamka, never underestimate a CMO’s role as peacekeeper. “A chief medical officer’s role is to align all of these individual, sometimes strongly opinionated, clinicians to a single path forward,” he said. “If you can, as an innovation officer, go to the chief medical officer and say ‘I have a product or an idea that will standardize work and align clinicians to do things one way.’ The chief medical officer will jump for joy.”

But it’s important to be humble—everywhere, but perhaps especially here. Healthcare is a complicated space, and patient outcomes are hard to measure and prove. You may be persuaded by the first set of metrics you present, but a CMO may not. Enlist the help of experts and re-frame your case.

Head of Marketing

“How is the organization perceived?” is the first question on a marketing officer’s mind, whether they’re thinking about acquiring new patients or just the health system’s brand perception more generally.

This can be a great thing. A new technology may not move the dial for a CMO or CIO who’s focused on results. But a marketing officer is likely to love it, provided that it makes your organization look innovative and forward-thinking.

A marketing officer also differs from other leaders in one important way: Everyone else is more invested in the existing structure and patient population. By contrast, marketing wants to reach out into the world, attracting attention and acquiring new patients.

Innovations designed to attract patients—such as a new technology designed to improve communication, or Houston Methodist’s new app intended to give patients easier access to the health system—are likely to go over well. So are smaller-scale implementations that don’t have an easily measurable payout—like introducing a new live chat designed to capture new patients.

Finally, a marketing officer may be particularly interested in integrations that raise the brand profile. Partnering with a major name (such as Uber Health) will help your health organization appeal to a larger community. If you’d rather not take on the considerable work of partnering, look for vendors that have already developed multiple integrated partnerships, which takes the heavy lifting off your shoulders. ♥

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