12 Dec Improving Well Visit Rates: People, Processes & Technology
By Dr. Sue Kressly
Many of you have read my prior blogs about the importance of well visits to pediatrics. I’ll say it again: as many “simple sick” visits are leaving the office for urgent care, telehealth and other competitive entities, it is crucial that the pediatric medical home owns preventive care. It is where we have the best opportunity to identify conditions or concerns early in their course, and where we can promote the value of the family relationship with the medical home.
It is not good enough to wait for our patients to call our office to schedule a well visit when they need a form completed. We need to be proactive about identifying our patients who are coming due, overdue or currently due for a well visit. But that’s not enough. We must proactively reach out to them in a way that they will respond, be engaged, and schedule an appointment. We must iteratively continue that process until the visit is completed. Why? Because it’s good care and vital for our financial survival.
So what does it take to be really successful in getting your patients up to date on well visits, according to Bright Futures? It takes people, processes and technology. You need all three to do this well.
Let’s start with the technology. Having the ability to identify patients (and siblings!) who are overdue for well visits is key. First, you need to have the technology to identify groups of people who are due for well visits. Then, you need to use the technology to proactively reach out to them in a cost-effective way. This is the only way that you capture all patients, not just those whose chart you touch because they happen to be in the office or on the phone.
Even with visual highlighting to identify overdue patients, it requires people to see and act on the information. Reminding and reorienting the entire practice team to visually scan and attend to the information for patients who are in front of you requires continued efforts. It’s amazing how people can look at a screen everyday and not see and act on information right in front of them. Additionally, it takes people to run reports and recalls and reach out to families. You need to identify a person or team in your practice who owns this project and has protected time to make it happen. This work is never done…as there will always be a new group of kids who are due or overdue for well visits.
Which brings me to the processes. Keeping well visits up to date needs to have an accepted process in the practice that is adjusted, refined, and improved over time. It should include a new recall report, run at least monthly. Then, there needs to be a process for outreach. Technology can help with automated requests to contact the office, but you are not done! Some of those patients will not contact the office based on your outreach. What’s the next step in your process? Perhaps your recall coordinator re-runs that report two weeks later, prints out the report, then keeps looping back with portal messages, texts, phone calls and email, and continues to follow up until the appointment is made. The process must include how to follow up on no shows…and then, by the time you are done, it’s time to do it all over again!
Why is this worth the effort? First, it provides great care for your patients. Second, preventive visits pay well without cost-sharing to families! Lastly, many payers have well visit rates as a pay-for-performance program. If you perform well, you can pay your recall coordinator to keep doing this work and make a profit! If you are looking for an example of how to use continuous quality improvement to make this happen for your practice, and to show demonstrable return on investment, check out this presentation from Kressly Pediatrics.