I had this question come up a few weeks ago and now that I some down time I can work on this. Can effective outreach programs move HEDIS scores? The answer is of course yes it can. Does a doctor talking to a patient affect that person's health? Is that an outreach program, of course it is. Is a nurse talking to a member about their health an outreach program, yes it is also. So with that settled a health professional engaging with a patient is an outreach program. Does the patient remember to do what their health professional asks them to do is a whole other matter.
Once a patient walks out the door of the practice they are now on their own to make whatever decisions they feel like doing. This is where your organizations outreach programs can make a huge difference. The plain truth is that most HMO's and practice's don't have the experience or the expertise in doing effective outreach. There are organizations out there that do this. These outreach program's typical have telephonic and mail operations along with analytics to identify members for outreach based on criteria set by the plan or practice. NCQA's and URAC's disease management program's are examples of good outreach programs in theory. The unfortunate part is that a plan can play lip service to these program's, pass the accreditation, and still not have a robust program.
A plan/practice must have a way to identify and stratify its patients through its analytics with those who have a need for outreach. You need solid data from your reporting systems to be effective. This means getting lab and pharmacy data along with normal reported billing data. This also means you need to be vigilant when getting data from 3rd parties. It has to be accurate and timely. For health plans this isn't too hard but at the practice level this might be harder. If you think about it there is some logic behind pushing for state level health information exchanges.
Next is can you actually contact the member? Might sound a bit silly but its a real issue for many outreach plans. If you are planning telephonic campaigns just assume that 10% of the phone numbers are invalid(This is being generous). Many people have cell phones now and less have landlines. People often change their numbers. This is a struggle for a lot of places. There are companies that acquire valid numbers for members(though their results can be dubious). Does the person have a mail address? Is it valid? Do they even read the mail? What about email? Will your outreach get through a spam filter? How about HIPAA concerns with email? See how this gets a bit more difficult? Really the best way for outreach is to talk to a person one on one. You really need trained clinicians on a phone talking to patients at times when they are available and about topics they are concerned with.
Then do you have the infrastructure to support outreach? Do you have a system in place that can show a patient's information, schedule followups, appointments, send out health literature? Seems like a lot doesn't it? Well it is and its a big pitfall for many companies. Just don't assume you can do this and do it well. Plus just having anyone on the phone isn't going to work either. You have someone dialing the phone and making initial contact but then have to hand it off quickly. That work's sometimes.... You'll have dropped calls and annoyed patients. It might be cheaper but you get what you pay for.
Now that you have them on the phone you need to engage them about the clinical gaps you've identified. Hopefully you have the correct data so the member don't think you are barking up the wrong tree. You need a thoughtful and knowledge clinician on the phone that can help with appointment scheduling, health coaching, health materials and have ability to do follow up calls. That's an ideal system it's also tough to setup and maintain. Have a 24x7 service is really essential just doing the 9-5 outreach doesn't really work anymore.
