Engaging with patients to keep them happy and healthy

No, it's not a text from a paramour.

Instead, it's the opening line from one of Healthgrades' chatbots.

They conduct automated conversations with patients, checking in about their health in between physician appointments.

The average patient goes to the doctor two or three times a year, said Healthgrades' chief medical officer, Dr. Brad Bowman. “That leaves a whole lot of time between visits when there's little or no ongoing follow-up,” he said. “We use these bots to help people between their doctor's visits and to create a sense of interactivity.”

Healthgrades' CareChats is one of the platforms providers are using to maintain communication before and after the actual point of care. They're partnering with the makers of these platforms to help patients stay engaged, healthier, satisfied and trusting. That, in turn, benefits providers, who can keep a closer eye on patients who need follow-up.

“There's a limit to how far the system can extend using humans and telephones,” Bowman said. “There really isn't any more capacity—the humans can't do it anymore.”

Enter the bots. Healthgrades offers many of them, each one with a different personality. They can be used for various purposes, from post-operative check-ins to lifestyle coaching. The bots adjust depending on how the conversation evolves, but they tend towards “story arcs” created by people who are both physicians and screenplay writers or novelists. If, during a story arc, a bot senses a problem, it can send a message to a care coordinator for immediate action.

“You can almost think of these as care coordinators responsible for a population,” Bowman said. “The key benefit for providers is certainly the data,” he said. “They are able to head things off while they're still small problems, and their patients rate their experiences much better in terms of patient satisfaction.”

A number of technology companies have entered the market for automated patient interaction. These systems go beyond patient portals such as Epic System Corp.'s MyChart and into more proactive communication with their patients. Patients want this kind of communication: A 2015 Surescripts survey found that 51% of patients would communicate with their doctors if they could do so via email or text, and 46% would feel more comfortable asking questions over those media.

But the market is still small, with most providers still relying on the patient communication tools embedded in EHRs. Accenture estimates that in 2016 there was $600 million invested in digital health startups focused on virtual and care-coordination technologies. Dr. Bob Kocher, an analyst with Venrock, estimates that the market for independent patient-provider communication is less than $1 billion.

That doesn't mean patients aren't interested in communicating with their providers and vice versa. “All providers today acknowledge there's utility in communicating with patients through email and text,” Kocher said. “And patients do very much value these communications.”

Like CareChats, HealthLoop is automated, linking patients to their providers before and after they receive care. Patients get preparation instructions before they're admitted; after the procedure, they answer check-in questions (after surgery, for example, “Did you notice any new redness around your incision?”) from their providers. An algorithm tracks the answers and alerts providers of potential problems so they can intervene before poor follow-up results in a readmission.

And because the HealthLoop system actually captures the data it receives, it's a closed loop that can be used to improve the very algorithm that drives the loop. “It turns out patients really want to engage with their providers, particularly if they've just had an acute event,” said Todd Johnson, CEO of HealthLoop.

The company's hospital clients, including a unit of Memorial Sloan Kettering Cancer Center in New York, have already logged over a half-million monthly assessments of patients.

“This notion that after you're discharged from the hospital your doctor is keeping tabs on you is powerful,” Johnson said. “We're giving the patient an outstanding experience.”

Unlike HealthLoop and CareChats, other platforms give patients a way to text providers directly, getting real-life (rather than automated) responses. OhMD, for instance, integrates with EHRs and is a secure texting platform for both patient-provider and provider-provider communication. “We view texting as far and away the preferred platform for communication these days,” said Amelia Coleman, vice president of business development for OhMD. “This is going to become second nature for providers across the board.”

In addition to serving as a platform for provider-patient texting, Medici, another secure communication app, allows providers to electronically prescribe medications from within the app. “It's the most consumer-friendly experience you can imagine,” said Clint Phillips, Medici's CEO. By July, Medici will have 5,500 providers using the platform.

Not only is Medici more convenient than phone calls, which can lead to endless games of phone tag, it's also reimbursable by high-deductible health plans. Providers set their own rates, usually below the cost of an in-person consultation—which appeals to patients who are now more aware of cost, given the rise of high-deductible health plans.

“There's a real window in healthcare at the moment” for platforms such as Medici, Phillips said, since people are comfortable with technology. “There's also this consumer-driven movement that's getting people to ask the question, 'How much does this cost?' ”

But the real payoff for hospitals and physician practices adopting automated outreach systems is the improvement in patient access to physicians and urgent-care clinics, and the follow-up text messages they enable. Those contacts can save a lot of money, since it can prevent readmissions or the need for follow-up appointments.

“We know that 75% of disease is preventable, and we're not going to be preventing it in the emergency department,” said Margaret Sabin, CEO of Penrose-St. Francis Health Services, which uses CareChats for digital health coaching. “This is where we really do make a difference.”