What The Pandemic Taught Us About Patient Engagement

Handling the Big Cancellation

When the pandemic hit in the U.S., the combination of lockdowns and fear of the virus set off massive cancellations of in-person medical services. Elective surgeries were postponed. Patients delayed seeing their providers for check-ups, immunizations, and other non-emergent care.

While the loss of immediate revenue was significant, some health systems were better prepared and able to take the initiative to remain in communication and rebook the same or similar services in a virtual setting as quickly as possible. For many others though, the pandemic and mass cancellations exposed and magnified existing weaknesses in patient communication and scheduling.

Rescheduling Hiccups

Roughly half (51%) of patients in the survey report being contacted “fairly quickly” about rescheduling their cancelled appointments. However, for more than one-quarter (27%), it “took a while” for their healthcare providers to contact them to reschedule. Incredibly, another 8% of respondents are still waiting to hear from their providers months after their existing appointments were cancelled.

If any of your existing appointments were cancelled due to lockdown as a result of the pandemic, were you contacted by your healthcare provider’s office to reschedule?

Communications that Get a Response

Meet Patients in Their Preferred Channel

For communication with their primary healthcare providers, the most popular channel (37%) for consumers in the survey is email, followed by phone (30%), and text (28%).

Of those patients that rescheduled, more than half (56%), were prompted by a phone call from the doctor’s office. Almost one-quarter (22%) received no prompt at all but rescheduled on their own. Text message (15%), letter (5%), and email (2%) rounded out the channels providers used to contact their patients to reschedule cancelled appointments

Not surprisingly, age played a role in patient engagement with certain communication channels, with younger age groups (between 25 and 44 years of age) preferring text and those over 35 preferring a phone call. The only patients who reported responding to an email from their provider were between 35 and 44 years of age.

Pivoting to Virtual Alternatives

Most health systems were able to pivot to telemedicine to continue serving their patients while protecting all parties involved from exposure to the virus in a healthcare setting. While some providers and systems were able to move faster than others, our survey confirmed what research and anecdotal reports have also shown: the overall number of telemedicine visits grew during the pandemic.

Telehealth uptick

In our survey, 36% report they’ve accessed care via telemedicine or virtual channels three to four times since COVID-19 began, with nearly one-third (31%) saying they accessed virtual care once or twice. A majority of respondents shared that online consultations have greatly improved access to healthcare services and made healthcare more convenient. Highlighted benefits included lower consultation costs, improved doctor availability, and seamless integration with online prescription fulfillment and delivery platforms.

At the same time, more than one-quarter (29%) did not access care via telemedicine or virtual channels at all. One possible explanation for why so many did not take advantage of telemedicine is that certain types of appointments aren’t as well suited to virtual visits as others. For example, survey respondents preferred in-person visits for more specialized medical care such as urology, ENT (ear, nose, and throat), and pulmonology appointments.

Waiting Somewhere Else

For those patients needing in-person visits (34%) during the pandemic (people with emergencies, urgent cases, or elective procedures), healthcare providers often provided virtual waiting rooms instead of, or alongside, physical waiting areas. Half of respondents (52%) reported using a virtual waiting room during their visits, where they remained in their car, at home, or near the facility until an exam room was ready. The majority (65%) of these consumers said that they had an “excellent,” “good,” or “very good experience” with the virtual waiting room service. Only 17% of patients said they had a “poor” or “very poor” experience.

Have you ever utilized a virtual waiting room, where you stay in your car, at home, or nearby the facility until an exam room is ready? How was your virtual waiting room experience?

While in-person visits are expected to rebound post-pandemic, especially for certain types of visits, virtual waiting rooms and services will remain important to help patients safely and conveniently access the care they need in the right setting.

Eroding Patient Satisfaction

While pivoting to telemedicine helped recoup some revenue from cancelled appointments, many health systems still suffered significant losses in cancelled surgeries, outpatient treatments, and emergency department services. The American Hospital Association estimates a total four-month (March through June 2020) financial impact of $202.6 billion in losses for America’s hospitals and health systems, or an average of $50.7 billion per month as a result of cancelled surgeries and outpatient treatment, and reduced emergency department services.

Late or missing communication

In addition to the immediate financial impact, health systems also experienced a drop in patient satisfaction during the pandemic — which does not bode well for patient loyalty and future revenue. In the survey, patient satisfaction fell 13% for provider communications when tracking those consumers who were “very satisfied” before and since COVID-19. For example, respondents cited a general lack of provider responsiveness to communications from patients. One respondent said their orthopedic surgeon took two to three days to respond to email communications.

Before COVID-19, how satisfied were you with the level of communication received from your primary healthcare provider(s)?

73% Very Satisfied

25% Very Satisfied

2% Very Satisfied

After COVID-19?

60% Very Satisfied

34% Very Satisfied

6% Very Satisfied

Rushed appointments

The disappointment doesn’t end with provider communications. During the appointment itself, more than half of the respondents (54%) say they felt rushed, an increase of 35% compared to pre-COVID experiences. Qualitative statements from respondents shed light on why they felt rushed, with some stating that the provider did not spend adequate time examining them. Others believed that their provider made assumptions about what was wrong and the treatment needed without taking time to better understand.

Limited patience for lack of availability

Another potential area of concern is whether health systems are losing patients because they can’t provide appointments when patients want and need them. Most respondents (82%) are willing to wait up to seven days for non-emergency appointments before they look elsewhere for medical assistance. Anything longer than seven days and health systems risk losing patients to more responsive and available providers.

Communication Channel Strategies May Be Too Limited

When asked whether their providers effectively communicated their COVID-19 policies and procedures prior to attending scheduled appointments, 63% said yes.

The primary communicaiton channel was:

Phone call 35%

Email 27%

Text message 24%

Only 5% received multichannel communications. This represents an opportunity for providers to broaden their communication strategies to more effectively reach patients in their preferred channel.

Increasing Mental Health Needs

The outbreak, ongoing economic uncertainties, and periods of lockdowns are taking their toll on mental health. Our survey shows that amid the pandemic, the number of consumers seeking mental health treatment grew by 10 percentage points, increasing from 16% of consumers pre-COVID-19 seeking mental health treatment to 26% who say they are seeking mental health treatment due to the effects of the pandemic, social inequality, and the U.S. presidential election.

Consumers aged 35 to 54 made up nearly half of all people (47%) in the survey who said they sought out mental health treatment for issues related to the pandemic as well as events associated with social inequality and the election. Prior to the pandemic, older age groups (55 and older) made up the largest percentage (40%) of those seeking mental health treatment.

The impact of missed appointments

More troubling is the finding that nearly one-quarter of consumers (23%) missed their appointments with their healthcare providers due to their mental state. More than one-third (38%) of those who said they missed a healthcare appointment due to their mental health had sought out treatment due to the pandemic, social inequality, and the election.

A study in 2019 showed that patients with mental health conditions who missed more than two appointments per year had a greater than eight-fold increase in risk of all-cause mortality compared with those who missed no appointments.3 For these patients, it’s a life-threatening situation when communication and reminder efforts fail to engage and encourage action.

In the last year, did you miss a scheduled appointment with your provider due to your mental health?

COVID Limits Access to Mental Health Treatment The World Health Organization (WHO) reports that the impact of COVID-19 on healthcare services disrupted access to mental healthcare services. According to the WHO, primary causes were infection and the risk of infection in long-stay facilities such as care homes and psychiatric institutions, barriers to meeting people face-to-face, mental health staff being infected with the virus, and the closing of mental health facilities to convert them into care facilities for people with COVID-19.

What These Findings Mean for Your Health System

Reassure patients and assuage fears of contracting COVID-19 while receiving care by offering contactless experiences, from online self-scheduling to virtual waiting rooms and online check-in.

Create a frictionless telehealth experience with online and live voice scheduling solutions, patient reminders, and technical support for patients who are new to virtual visits.

Improve communication and patient satisfaction with multichannel strategies that combine automated text, email, professional recorded voice, and live agent messages, as well as dedicated hotlines for patient, caregiver, and staff questions.

Drive immediacy for appointments and prevent patients switching to another health system by making scheduling convenient and easy with live voice scheduling and self-scheduling across all care venues, including emergency, urgent care, physicians, specialists, and telehealth.

Help mental health patients adhere to appointments and treatment plans by personalizing and optimizing patient engagement with customized communications that reduce no-show and cancellations.

Execute a successful vaccine program with a HIPAA-compliant solution that supports scheduling, reminders, hotlines, and follow-up.