Computer Telephony Solution Reduces No-Shows - US West's system for Denver Health - Company Operations

Health Management Technology, Sept, 1999 by Andrew Steele

Cost-effective IVR technology saves staff time while it improves customer satisfaction.

For more than 135 years, Denver Health has served the special health needs of the Rocky Mountain region with services such as a nationally known Level I trauma center and the Rocky Mountain Poison Center. It also has served the needs of special Denver citizens such as those without health insurance.

But Denver Health's ability to render the best, most effective care can be impacted by a problem faced by nearly every healthcare provider in the nation--no-shows.

Healthcare organizations must constantly contend with patients who don't appear for scheduled appointments and fail to notify their doctors of the cancellations, which creates additional pressure on medical, administrative and financial resources. No-shows can even put the lives of other patients at risk.

Failing to show up for a scheduled medical visit keeps our doctors from providing necessary preventive care and delays treatment and management of chronic diseases such as diabetes. No-shows also reduce the time we can spend with other patients who need care.

To illustrate the cost of no-shows, consider the following figures: Denver Health scheduled 250,000 billable visits at its community health centers in 1997. The organization had an average no-show rate of 28 percent--meaning about 70,000 patients did not keep their appointments. The Maricopa clinic's no-show rate was approximately 31 percent prior to implementing the solution. Those no-shows represented nearly $11.7 million in potential 1997 revenues for the organization.

But even more important are the potential health problems that went untreated for those patients who missed their visits, a situation that could affect the entire community's overall health and vitality.

Gentle Reminders

To reduce its no-show rates, Denver Health explored ways to cost-effectively remind patients of upcoming appointments and give them a chance to reschedule or cancel. That way, Denver Health's medical staff could ensure patients were properly treated and the health centers could maximize their efficiency.

Using staff to make individual reminder calls was not an appealing option. A system of personal reminder calls stole time from clinic employees who were needed for more critical work or required Denver Health to beef up staff levels. Also, such a system proved time-consuming and often required several calls for each patient. Often, patients were away or unable to answer, while some patients didn't have answering machines or voice mail service, which made leaving messages impossible.

So Denver Health took an other tack--an automated solution. The organization turned to US WEST for an integrated voice response (IVR) system that automatically calls scheduled patients, reminds them of the time and place of their appointment and gives them the option to cancel or reschedule. Because many Denver Health patients are Spanish speaking, the system is configured to deliver the messages in either English or Spanish, based on each patient's choice.

"Our system lets Denver Health start small, but it also will let it grow to whatever size they need in the future," says Greg Ellenoff, US WEST senior market manager-healthcare. "We focused on their particular problem today--no-show rates--with an eye toward what the IVR system can do down the road."

During February and March of 1999, the no-show rate at the Maricopa clinic dropped to 24 percent using the IVR solution.

Showing Strong Results

The solution is CTI-based (computer-telephony integration) and offers powerful capabilities. Each patient's appointment information is coded and stored on a server. The system retrieves the coded data and automatically initiates calls beginning 72 hours prior to each patient's appointment.

If the patient answers, the computer informs them of the time, date and provider for their medical visit. If the system reaches voice mail or an answering machine, a message is left. And if there is no answer, the system simply puts the call back in queue, ultimately making a maximum of five reminder attempts. Patients who need to cancel or reschedule can be directly connected to the Denver Health scheduling desk.

The new system already is proving itself. Denver Health recently conducted a post-implementation survey of patients and found promising results:

* 83 percent of patients received the automated message;

* 46 percent received the message personally;

* 37 percent had a message left on their answering machine or voice mail service;

* only 17 percent could not be contacted at all;

* 13 percent did not answer any of the five attempts;

* four percent were wrong numbers.

Of those patients who received the message personally, 55 percent chose to receive the message in English, and 45 percent chose Spanish. The latter figure was surprising. Surveys of our patient population led us to believe that about 25 percent choose Spanish as their first language.

It seems that a majority of Denver Health patients enjoy the benefits of the new system. An early concern that low-income patients would not benefit from the automated reminder system because they don't have answering machines, voice mail or even telephone service turned out not to be true.