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Shifting the Paradigm of Appointment Scheduling
By Matthew M. Walsh, COO, Clinical Enterprise & Joan E. Topper, Vice President, Clinical Access Management, Geisinger
Patient expectations are changing regarding how they choose to access healthcare and transact the associated appointment scheduling process. Industries over time have centralized processes to create value and then found a path to replicate and distribute functions based on consumer behavior.
For example, let’s look at the computing industry. Behemoth mainframes that once occupied floors of their own or even entire buildings shifted to distributed computing, desktops and ultimately smart phones and devices in our pockets or on our wrists. With the drive to healthcare consumerism, our patients expect their doctors to keep pace with their expectations to interact according to their preferred communication channels. The healthcare industry typically gravitates to centralized models for scheduling, relying on large-scale call centers to meet the needs of patients in a complex environment.
At Geisinger the pendulum has swung towards the personalization of the patient contact experience across multiple communication channels and includes a more distributed access strategy to empower multiple scheduling pathways.
At Geisinger we aim to leverage the strength of a large distributed network while still achieving the benefits that centralization has to offer. Through a multipronged approach we are working to achieve this balance by optimizing point-of-care appointment scheduling, engaging with patients directly through self-service and leveraging text-based communications differently.
Point of Care Scheduling
Point-of-care scheduling seems simple enough –schedule a patient’s future appointments before he or sheleavesthe clinic, and the job is done. The concept seems straight forward at first glance but requires a significant process alignment and investment in technology to make complex scheduling simple enough to be done without in-depth scheduler knowledge of the designated specialty.
To accomplish point-of-care scheduling, a different paradigm is required than a typical specialty practice model. Historically a small group of schedulers know and have documentation of very specific preferences of a practice or provider and schedule appointments accordingly. In the point-of-care scheduling process, over 1,000 patient access representatives from across our health network have been empowered to schedule into other specialty practices. The patient leaves with the appointment in hand and has peace of mind that the next step of their care plan is scheduled. The reliance on both standardization of protocols and technical development of guided scheduling is the only way to make scheduling possible to scale across a large network. Provider schedules are released far enough in advance to accommodate a patient’s return visit, e.g., one year for a routine annual check-up, vs a more frequent follow-up for management of an acute or chronic condition.
The reliance on both standardization of protocols and technical development of guided scheduling is the only way to make scheduling possible to scale across a large network
Geisinger has invested in building guided scheduling tools in the EHR to support scheduling into specialties from any clinic front desk in the organization. The patient access representative at checkout will ask up to five questions to collect information and input into a questionnaire. When combined with pertinent clinical information from the referring provider, the scheduler is guided to offer the appropriate providers and appointment. The guided scheduling is also offered to our patients to directly schedule appointments in the patient portal.
Because of focused efforts, in the past year we have scheduled one million patient return appointments and 34,000 specialty visits at point of care. Guided scheduling has also reduced our call center agent on boarding time and facilitated increased agent cross-coverage of incoming calls.
Patients are increasingly tech savvy and are looking for ways to manage tasks themselves. From hailing a cab to ordering dinner via mobile devices, healthcare can ride this wave of adoption to further empower patients for self-service.
Geisinger has invested in building the guided scheduling for patients in our my Geisinger patient portal resulting in an average of 6,000 appointments per month scheduled without staff intervention. Self-scheduling has been of particular value for primary care, though we are beginning to see growth in self-scheduled specialty appointments. By better leveraging data and technology to streamline workflow and promote accurate scheduling, we strive to make the right workflow the easy thing to do.
Leveraging Text Differently
Like many organizations, Geisinger uses text to remind patients of upcoming appointments, sending over 20,000 reminders per day. Patients can easily confirm, cancel or indicate they need to reschedule the appointment. We recognize the tremendous opportunity to further partner with patients using text as their preferred method of communication. Our strategy includes leveraging text across the patient care continuum starting with access-related functions of scheduling, preparing for the visit, communicating when onsite and post-visit follow-up. The asynchronous nature of text allows the patient to interact with the scheduler at their convenience.
The plan includes an initial outreach to the patient to let them know we’ve received the referring provider request for a specialty appointment. Patient preference drives whether the scheduling is completed solely via text and provides the option to “click to call us” when preferred, thereby converting an outbound contact into an inbound contact. In essence, the patient is deciding when it is convenient for them to schedule with us.
Shifting the Paradigm
The days of a one-size-fits-all, centralized scheduling strategy are over. Similarly, to how Amazon allows decentralized retail and Uber enables self-service rides instead of taxi dispatch stations, we must find the balance in bringing the process closer to the patient while leveraging our central scheduling services strategically. Finding this balance may mean challenging long-established practices, procedures and structures to make scheduling more patient centered, but it will be well worth the effort. Simply put, it’s time to shift the paradigm.