1. ! YOUR AUDIENCE IS EVERYWHERE, SHOULDNT UBI? ! UNDER
PRESSURE Hospitals today are under tremendous pressure to improve
patient outcomes and, at the same time, reduce costs. One of the
best ways to achieve this goal is to make patients and their
families part of their own care team. In a systematic review of
research on the links between patient experience and clinic safety
and effectiveness, British researchers noted positive associations
between the quality of clinician-patient communications and
adherence to medical treatment in 125 of 127 studies analyzed
[which] showed the odds of patient adherence was 1.62 times higher
where physicians had communication training. They also observed
evidence of impacts on resource use of primary and secondary care,
such as hospitalizations, readmissions and primary care visits.1 To
this end, electronic communications via email, social media and the
hospitals website can effectively augment and reinforce in-person
communication to improve patient education, compliance and
outcomes. The ideal approach is to be in regular contact with the
patient (and a family member or caretaker when appropriate)
beginning as early in the process as possible. One-to-one channels
of electronic communication are ideal for this purpose. Even the
majority of the senior population (age 65+) is online and more than
90% of adults ages 1849 use the internet.2 Internet users already
go online when they have health concerns: 72% have conducted a
health-related search, according to the Pew Research Center.3 Email
communication provides the most efficient means in terms of time,
effort and costof sustained connection with patients to educate and
encourage adherence to hospital recommendations. However, as noted
by Betsy Weaver, Ed.D., CEO of e- communications solutions provider
UbiCare, to stand out in the queue of emails in the patients inbox,
messages must be concise, of high value, contain reliable content
and be precisely timed to coincide with what is happening in the
recipients healthcare life at the time of delivery. And the message
must be worth taking action onnow!4 Hospitals are finally finding
ways to routinely collect patients email addresses. For example,
classes educating prospective patients about an elective surgical
procedure represent an opportunity to obtain email addressesfrom
the prospective patient as well as family members. These contacts
should be entered in a database, labeled as class attendees, and
uploaded into a software platform with customer relationship
management (CRM) capabilities. This enables the hospital to stay in
touch The result is patients who are more educated about the whys
behind their care instructions and are therefore more compliant.
This, of course, fosters better outcomes and increased patient
satisfaction.
2. ! 2!YOUR AUDIENCE IS EVERYWHERE, SHOULDNT UBI? ! with this
target population on a regular basis, sending out additional
information and positioning the hospital as the expert health
resource in the community. Once a prospective patient schedules a
surgery, the hospital has an opportunity to begin sending regular
email messages related to the surgery dateand the multiple benefits
and cost savings of timeline-specific email messaging begin to
accrue. Each message walks the patient through important steps from
pre-op through the procedure itself and then the stages of post-op
rehab. By including FAQs, information on selected diagnoses and the
hospitals resources, as well as links to additional details, these
email messages reinforce the in-person communications between
healthcare providers and patients. The result is patients who are
more educated about the whys behind their care instructions and
are, therefore, more compliant. This fosters better outcomes and
increased patient satisfaction, which (measured by HCAHPS) has been
shown to be more highly associated than any clinical measure with
reduced avoidable readmissions.5 And that is money in the bank.
SELLING IT TO THE C SUITE This sounds like the right thing to do
for patients, but how can the need for this be best explained to
hospital executives in charge of a clinical departments budget? In
order to determine the return on investment (ROI) of implementing
targeted patient messaging, it is helpful to look at avoidable
readmissions. Last year (2012) was the first year for Medicare
hospital readmission penalties with a maximum penalty of 1% of
Medicare payments to the hospital. In 2013 the maximum penalty goes
up to 2% (and again in 2014 to 3%). Furthermore, additional
measures including hip and knee replacement surgeryhave been
announced for 2013. Here are a few thoughts about ROI that may
prove helpful when discussing the financial benefits of
implementing a new process at the hospital. ! Preventing Blood
Clots Blood clots are normally not a problem after spine surgery,
but when they do occur they can be serious. So we take special
precautions to prevent them, which may include prescribing
blood-thinning medication. In the hospital, you will be fitted with
special elastic stockings while you are in the holding room prior
to surgery. Before being put to sleep in the OR, you will be fitted
with plastic boots that surround your lower legs with air and
inflate and deflate to aid circulation. After surgery, we will
teach you leg exercises that will keep your blood circulating,
prevent blood clots and strengthen your back. Sample support
section from UbiCare's Spine Surgery email!
3. ! 3!YOUR AUDIENCE IS EVERYWHERE, SHOULDNT UBI? ! ROI can be
divided into hard dollars and soft dollars. Hard dollars are direct
cost savings, while soft dollars are generally time savings (which
free up staff to do other tasks) or improvements in patient and/or
employee satisfaction leading to recommendations (bringing in new
patients), reduced staff turnover (savings in hiring/training
costs) and improved perception of the hospital as a great place to
work (thus attracting the best applicants for positions). Whenever
possible, try to assign some dollar value to the soft dollar ROI
items to obtain a more accurate picture of the true value of adding
a new process. This is often not done, making the up-front cost of
a new process look too expensive. Implementing change is a
challenge for everyone, so the ROI needs to be demonstrated to be
worthwhile and have a positive effect on as many departments as
possible. Here are examples of ROI for an email patient education
and engagement product for hip and knee replacement patients at a
hospital with an annual operating revenue of $200 million and an
annual Emergency Department capacity of 20,000 patients): Annual
license fee for an effective e-communication product = $19,000
Medicare reimbursement penalty avoided = $31,250 (1/4 of $125,000
CMS average penalty for 2012)6 Increased bed capacity = $500
(assuming operating at or near capacity, with $1,000 per admitted
patient vs. $500 per discharged patient)7 Additional patients able
to be admitted from ED = $40,0007 (4% of 20,000 patients leave ER
without being seen = 800 patients x 10% admitted = 80 x $500 per
patient) Hospital operating revenue at risk based upon transitions
of care measures = $20,000 (0.1% of $200 million)7 d"
Patient"Education"and"Engagement"
Increased)patient)education)has)been)shown)to:) !
Reduce)healthcare)providers)costs)due)to)fewer)
readmissions)(these)are)direct)savings)for)ACOs).) !
Avoid)or)reduce)Medicare)reimbursement)penalties)
(due)to)reduced)readmissions).) !
Increase)hospital)bed)capacity)(beds)that)were)being)
used)for)readmitted)patients)could)be)used)for)more)
profitable)patients)and)for)timely)transfers)from)the)
Emergency)Department).) !
Reduce)Emergency)Department)wait)times)(avoiding)
patients)leaving)without)being)seen).) !
Improve)patientDsatisfaction)ratings.) !
Improve)patient)careDquality)measures)(due)to)
improved)compliance).) !
Reduce)adverse)events)(due)to)improved)compliance).) !
Improve)hospital)ratings)(attract)new)patients)and)staff)
applicant)pool).) ! Reduce)medical)malpractice)costs.) !
Increase)payDforDperformance)reimbursements.) !
Increase)staff)satisfaction)(and)reduce)turnover).) !
4. ! 4!YOUR AUDIENCE IS EVERYWHERE, SHOULDNT UBI? ! Cost per
readmitted patient = $2,0006 up to $60,0008 (applicable for ACOs
and bundled payments) In addition to the financial benefit to the
hospital, consider the improvements in patient perception and
willingness to recommend the facility. These perceptions are likely
to be reflected in improved HCAHPS scores. Higher HCAHPS scores not
only improve hospital ranking in various Best Hospital reports, but
represent 30% of the performance scores for incentive payments (CMS
Value Based Purchasing Program). STAFF-PATIENT CONNECTIONS: TWO-WAY
IMPACT Standardized, automated patient education and communications
resulting in knowledgeable, compliant patients reduces stress on
staff. This, too, can impact patient satisfaction. As noted in
Healthcare HR and the Bottom Line, a 2012 white paper from
Healthcare Source, happy employees help make patients happy.
Therefore, when institutions provide a satisfying and supportive
workplace for employees, patients are more likely to have a
positive in-hospital experience. In other words, happy employees
result in happy patients and HCAHPS scores go up.9 DEMONSTRABLE
VALUE Hip and knee joint replacement procedures are ideal occasions
for implementation of a measureable education and communication
initiative. Provision of a unique, hospital-branded, compelling and
time- relevant education tool to patients having an elective
procedure can be used to demonstrate the value of this approach.
Patient satisfaction scores should rise, outcomes should improve
and, ultimately, the volume of patients choosing the hospital
should increase. For example, New England Baptist Hospital (NEBH)
learned from an ongoing survey of post-op hip and knee replacement
patients (1,381 respondents) that 86% found the hospitals email
education so valuable that it would be a factor in recommending
NEBH to friends and family.10 Need more convincing? Consider these
quotes from joint-replacement patients who have received email
education in addition to attending pre-surgical classes: Being a
nurse anesthetist, I have seen many knee replacements; therefore, I
felt I had a good understanding of what to expect from the surgery
standpoint. The emails kept me informed of post-op progress and I
found them to be very helpful. I found the pre-op classes were
good. ... I found several of the PT's tips on how to get around
during early recovery very beneficial, especially since I had
bilateral TKR. I am fortunate to have a medical background, but I
still found that I didn't know everything and was glad to receive a
lot of good information. I have recommended St. Vincent [Health
System] to several friends who have had the same surgery.
5. ! 5!YOUR AUDIENCE IS EVERYWHERE, SHOULDNT UBI? ! The emails
came just as I had questions about the next step. The emails were
very useful to me and I have recommended New England Baptist
Hospital to others. 11 Suzanne Nylander, O.D., B.S. is the director
of business development and sales for UbiCare. Suzanne has worked
with numerous health plans providing healthcare survey research
focused on quality improvement. She has a Six Sigma Green Belt
certificate in Healthcare and a Lean Six Sigma certificate. Her
prior experience includes professional relations/education for
medical device manufacturers, technical articles in ophthalmic
publications and clinical practice. Betsy Weaver, Ed.D., is the
CEO, President and Co-Founder of TPR Media (d.b.a. UbiCare) and is
a nationally recognized innovator in patient education and
healthcare communication. With the formation of TPR in 2002, Weaver
created the first email services designed to enhance hospitals care
connections with patients and streamline processes for staff.
Building on this success, in 2010 Weaver created the first hub
platform for healthcare, incorporating email, social media, text
messaging and web services. UbiCare is an award-winning
e-communications solutions company whose proprietary software
creates connections that impact behaviors to change outcomes.
UbiCares evidence-based customizable, timely and targeted products
feature automated, mobile-optimized email newsletters, campaigns,
surveys, microsites, text messaging and social media. Management
tools and real-time reports make it easy to track ROI and make
iterative changes as needs evolve. UbiCares unique technology
enables its healthcare, education and nonprofit clients to build
and sustain strong relationships with target populations. Achieving
57% open and 84% interaction rates, UbiCares solutions educate and
engage while building brand loyalty. Contact UbiCare at
[email protected] or 617-524-8861 to learn how we can help you! Foot
Notes: 1.) Doyle et al., A systematic review of evidence on the
links between patient experience and clinical safety and
effectiveness, BMJ Open 2013, e001570, p.4,
http://bmjopen.bmj.com/content/3/1/e001570.full 2.) Pew Internet
& American Life Project Surveys, Demographics of Internet
Users, Post Election Survey, Nov. 14 Dec. 9 2012,
http://www.pewinternet.org/Static-Pages/Trend-Data-%28Adults%29/Whos-Online.aspx
3.) Fox, S. and Duggan, M. Health Online 2013, Pew Internet &
American Life, http://www.pewinternet.org/Reports/2013/Health-
online/Summary-of-Findings.aspx 4.) Weaver, B., Care Connections,
2012: What Will Todays Trends Mean Tomorrow? UbiCare white paper,
2012, https://social.ubicare.com/whitepapers 5.) Press Ganey
Performance Insights white paper, The Relationship Between HCAHPS
Performance and Readmission Rates, 2012,
http://healthblawg.typepad.com/files/performanceinsights_readmissions-12-12-2012.pdf
6.) Laderman, M. et al, The Effects of Medicare Readmission
Penalties on Hospitals Efforts to Reduce Readmissions: Perspectives
From the Field, The Commonwealth Fund Blog, Feb. 26, 2013,
http://www.commonwealthfund.org/Blog/2013/Feb/The-Effect-of-Medicare-
Readmissions-Penalties-on-Hospitals.aspx 7.) Project Boost: A
Return on Investment Analysis, Society of Hospital Medicine, 2010,
http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/PDFs/BOOST_ROI_Paper.final.pdf
8.) Donovan, P., Payment Bundling Requires Suspension of FFS State
of Mind, Healthcare Intelligence Network, March 25, 2013,
http://hin.com/blog/2013/03/25/payment-bundling-requires-migration-from-ffs-state-of-mind/
9.) Healthcare HR and the Bottom Line: 5 Focus Areas for Improving
HCAHPS Scores, Healthcare Source white paper, 2012, p. 5,
http://bit.ly/17iXhav 10.) How Email Communication Impacts Patient
Satisfaction, results of survey of 1,381 New England Baptist
Hospital patients receiving UbiCares Joint Replacement Support
Emails, June 2011 April 2013. 11.) Satisfaction surveys to
recipients of UbiCares Joint Replacement Support Emails, June 2011
and June 2012. Contact Us | Meet the UbiCrew | Case Studies | Learn
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