Schedule more of YOUR patients. chinmay@simplifimed.com

Value-Based Care = Direct Primary Care (focused on keeping patients happy & healthy) In membership based practice, these things immediately became my top goal Happy patients = High patient satisfaction Communication Healthy patients = Outcomes

<1% patients respond, when nudged to schedule preventive care appointments.

The Problem Nudges require patients to call the clinic or use portal/app. Busy patients forget to call back. Patients hang up due to long wait. Patients don’t download the app & forget password. Booking next preventive care visit, at the time of checkout, results in no shows.

Chatbot is a computer program designed to simulate conversation with human users, especially over the internet*. I realized that a chatbot was an excellent solution to provide VBC, so I began to work with a company that provides a chatbot solution for healthcare. A chatbot in this case allows a patient to text with an automated system and receive text responses * Oxford Dictionary

Engaging Patients with a Chatbot Phase 1/3

Patient-initiated communication to make/cancel/reschedule an appointment or refill a med. Patients received a text, informing them availability of the BOT to secure services: Acquired consent for our modified HIPAA policy and added language describing use of SMS. Being conservative with the new technology, engaged patients in batches of 200/day The entire process took nearly 2 weeks Patient’s were given option to opt out: <1% patients opted out Majority of patients opting out were residing in other cities (e.g. Snowbirds) * The bot was not integrated with the EHR.

Lesson Learned: behavior change is hard. Usage of the new system was low Most of the patients continued to call the clinic, instead of using the BOT: Patients are in the habit of calling the clinic

Engaging Patients with a Chatbot Phase 2/3 How did your doctor remind you to get a flu shot this year? 1) Postcard/Call/Email 2) Patient portal 3) Other 4) My doctor didn't remind

Clinic-initiated communication to nudge patients for preventive care. Patients received a text, nudging them to book an appointment to have the vaccination: Patient could decline the service. Patient could schedule an appointment for the vaccination. * The bot was not integrated with the EHR.

Lesson Learned: 1 in 3 patients responded. An overwhelming majority of the patients responded within the first 60 seconds of getting the first text. Almost all of the the patients who decided to get care, scheduled the appointment within 5 minutes of getting the first text. A tiny fraction (<5%) responded significantly later but the same day. 1 patient responded after 15+ days.

Engaging Patients with a Chatbot Phase 3/3

Clinic-initiated communication for preventive care rescheduling & appointment reminders. The system is expected to run in the background without requiring any manual input from clinic staff. * The bot is integrated with the EHR.

Lesson Learned: 1 in 2 patients* responded. * Several hundred patients contacted for Shingrix Vaccine.

Future Directions All preventative care and chronic care guidelines available for implementation Custom follow up based on procedure or condition Completing medical record/history Payments

Actionable Takeaways Regulatory: Ensure that your HIPAA policy covers SMS/texting. EHR: EHR should have Single Sign On (SSO) capability EHR should have extensive set of APIs for two-way data exchange with the chatbot. HL-7 interface is insufficient. Operations: Start with approximately 500 patients/MD Proactively complete “OK to text” field in the PM suite.

Value-Based Care Benefits of automating routine communications Higher revenue, under Value-Based Care model Higher margin from established patients Labor cost savings

Chinmay Singh | (510) 410.0244 | chinmay@simplifimed.com