Before the arrival of value-based care, the consistent scheduling of follow up appointments in Primary Care varied widely. In most of the scenarios, physician concern for co-pay affordability left the onus of scheduling follow up appointments with the patient.

Below are some of the observed challenges:

• Long list of patients at end of year with many care gaps and had not been seen in the past one year.
• Significant number of patients with uncontrolled Diabetes/Hypertension who had not visited their physician within the past six months.
• Increased hospital and Emergency Room utilization driven by patients.
• The patients not keeping a clinically appropriate visit with their physician.

Once the importance of consistent follow ups had been established, we set to work utilizing AaNine’s Analytical tools to establish root cause. The data revealed that on average, 30% of patients were leaving the primary care clinic with a follow up appointment scheduled. Root cause analysis revealed a lack of consistent workflows regarding the scheduling of follow up appointments.

Many physicians relied on the patient to stop at the front office on their way out of the clinic to schedule. Faced with a long line, many patients would simply leave the clinic with the thought of calling later to re-schedule. Those who did stop, were often met with confusion from front office staff due to unclear follow up timelines, or differences in physician preference on how this information was entered into the EMR.

In discussing these findings with physician leadership, the futuristic idea of scheduling follow-up appointments in the exam room was proposed. Initial reaction was mixed at best. Staffing challenges, time constraints, and appropriate use of clinical staff were all frequently voiced concerns. To promote adoption of the new workflow, physician champions were chosen. Initial progress was fast and promising. With our newly developed AaNine’s analytics tool, we were able to analyze which patients had been scheduled for a follow up appointment before leaving the exam room. Results showed that many of the physicians were already achieving 75% + of their patients having a follow up appointment scheduled compared to the baseline of 30%.

The physicians reported increased patient compliance and improved outcomes. The long list of patients needing an appointment was growing shorter. Soon, the more key members of the team began to take note and adoption rates increased. Also, scheduling of follow up appointments from the exam room allowed physicians and front office more control over their schedule which increased satisfaction and engagement in the process.

Many physicians prefer to schedule patients themselves, while others prefer the front office to address. From a workflow point of view, many physicians have decided that the follow up appointment should be scheduled at the start of the visit. Information obtained during pre-charting ideally gives a good indication of necessary visit frequency – HbA1C, Blood Pressure, etc., A less common workflow is scheduling the follow up visit at the end of the appointment. Front Office and physician logistics make this workflow less than ideal and decreased compliance is widely noted.

Success in value-based care often requires a forward and futuristic mindsets and workflows. This blog highlights one out-of-the-box workflows that had a great impact.