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Harnessing the Patient Portal to Build Better Engagement

Evan GrossmanVice President Client Performance

Using the Cloud to Measure Performance

athenahealth’s cloud-based service is uniquely positioned to observe physician and patient trends

Why is the “cloud” significant?• Every encounter (financial, clinical) is captured in a single,

secure database • Every patient portal interaction is also captured

athenaNet contains data on:• 62,000 providers• >100 million annual patient visits• $15billion in collections• 5 million patient portal users

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3

Agenda

The Strategic Case for Patient Engagement• Forces driving increased practice <-> patient engagement• Meaningful Use

Portal Adoption Benchmarks• Age / Insurance type• Level of penetration• Medical specialty

Six Steps for Maximizing Portal Adoption

Strategic Case for Patient Engagement

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Forces driving Patient Engagement

Mounting evidence that engagement improves health outcomes.

Growing service competition in primary care

Meaningful Use incentives tied to engagement outside the physician’s office

Reimbursement for remote chronic care management

Transition to risk-based payment models

Ongoing imperative to restrain operational costs

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3

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Top Failure Points for MU Stage 2

Unmet Core Measuresathenahealth Providers Pursuing MU Stage 2, Q3 2014 with 1 measure to go

32% Secure Messaging

32% Preventive Care Reminders

12%

25% All Other Measures

Electronic Health Data Access

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Patients are Willing to Switch Providers

http://newsroom.accenture.com/news/more-than-40-percent-of-us-consumers-willing-to-switch-physicians-to-gain-online-access-to-electronic-medical-records-according-to-accenture-survey.htm

63%

100

%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

37%

41%

No or limited access to medical records

Willing to switch providers to obtain access

Nearly two-thirds of patients lack full access toelectronic medical records

4 in 10 patients without access to electronic health records

would switch to providers who offer it

59%

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Portals can help reduce operating costs

Cost Savings Achievable Through Patient PortalsIllustrative 10 physician practice

Source Savingsper unit

AnnualVolume

AnnualSavings

Electronic delivery of lab results

$.63 20,000 $25,000

Self-scheduled visits $7.00 5,000 $35,000

Online billing inquiries

$17.00 1,000 $17,000

Patient Engagement Framework

Stage

Description Benefits

I Basic digital connectivity. Required for Meaningful Use payments Lays groundwork for more meaningful activities

II Administrative functions - pay bills, view chart summaries, access lab results, self-schedule visits online.

Lower administrative costs More competitive care offerings for patients seeking

digital access Potentially faster, more complete payments

III Secure messaging. Care team members respond to patient concerns via electronic messages.

Greater responsiveness Ability to deflect unnecessary visits More convenient communication, with no missed

phone calls

IV Population health campaigns; send care reminders and schedule in-office appointments.

Greater compliance with pay-for-performance programs

Increased practice volumes in the short run Better long-term performance under value-based

contracts

V Disease management. Improve outcomes for at-risk patients Greater success under pay-for-performance and

risk-based contracts

Portal Adoption Benchmarks

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Demography is not destiny

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

7% 7%

14%

17% 18% 18% 18%

12%

6%

0.2

0.3

1.1 1.1 1.1 1.1 1.1

0.8

0.5

Penetration Logins per Visit

Pe

netr

ati

on

Log

ins p

er

Vis

it

12

Blue Commercial Other Medicaid Medicare Self-Pay0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

16% 17%

9%

5%

11% 11%

Higher penetration with commercial patients than Medicare, Medicaid

Adoption across athena’s client base

13 n = 1,149 practices

Stragglers30%

Beginners40%

Aspiring22%

Committed8%

0% 6% 12% 18% 24% 30% 36% 42% 48% 54% 60% 66% 72% 78% 84% 90% 96%0

10

20

30

40

50

60

Nu

mb

er

of

Pra

cti

ce

s

Number of Practice at each Portal Adoption Rate

Stages differ in more than adoption rates

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n = 1,612 practices

Stragglers(0-10%

Penetration)

Beginners(10-30%

Penetration)

Aspiring(30-60%

Penetration)

Committed(60-100%

Penetration)

Proportion of Practices 30% 40% 22% 8%

Portal Penetration Rate 5% 18% 43% 75%

E-mail Collection Rate 21% 39% 63% 86%

E-mail Conversion Rate 24% 46% 68% 87%

Average # of Providers 64 41 15 8.5

Tenure (Months Live) 31 34 35 36

Logins / Visit 0.54 0.80 1.03 1.81

Patient Msgs Sent / Visit 0.15 0.18 0.21 0.38

Provider Resp.s Sent / Visit 0.05 0.09 0.13 0.25

Lab, Chart, & Billing Views / Visit 0.01 0.03 0.05 0.08

% of Appointments via Portal 0.7% 0.6% 0.8% 1.6%

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Adoption for select specialties

81%5%

9% 58%

2% 44%

4% 55%

3% 41%

3% 54%

3% 48%

3% 48%

4% 43%

2% 33%

2%37%

32%

34%

8% 47%

2%

2% 27%

Specialty Adoption RatesMedian, Top and Bottom Quartiles, and Top and Bottom Deciles

Psychiatry

Ophthalmology

Urology

General Surgery

Cardiology

Gastroenterology

Pediatric Medicine

Neurology

Internal Medicine

Orthopedic Surgery

Family Medicine

Dermatology

Phys. Med. & Rehab.

Endocrinology

OB/GYN

0% 10% 20% 30% 40% 50% 60% 70% 80%

29%

26%

23%

22%

22%

21%

20%

18%

17%

15%

13%

12%

10%

5%

41%

Maximizing Portal Adoption

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Portal adoption can happen quickly

Catego

ry 1

Catego

ry 3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

55%

85%

40%

66%

34%

57%

91%

Months Since Introducing Portal

Ad

op

tion

, P

ast

30

Days

6 12 18 24 30 36 42

10-physician OB/GYN practice 60-physician multispecialty group

8-physician OB/GYN practice 15-physician family practice

30-physician orthopedic group 300-physician pediatric network

60-physician multispecialty group

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Start by reviewing the practice commitment to using the portal

Developing a Compelling Portal Experience

Lab Results Delivery

Service Required Practice Activity

• Develop policy for pushing normal/abnormal results to patients through portal

• Ensure that providers routinely provide appropriate lab results to patients

Secure Messaging

• Encourage patients to send secure messages

• Respond to secure messages in a timely fashion

General Support

• Dedicate knowledgeable front office staff person to answer routine and complex questions about the portal

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Doctors should not be afraid of opening up communications via a portal

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Most Secure Messages Addressable by Midlevel Providers

All incoming messages

General inquiries handled by medical assistant

40%

RN responds to prescription refill requests

40%

Physician addresses remaining questions

20%

Phone follow-up as required

If patients are not sending messages via the portal, they’d be calling the practice or

looking elsewhere:

“Take good care of your patients, or

someone else will”

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Six Steps for Maximizing Portal Adoption

Portal adoption policy

Online-only lab results delivery

Streamlined portal training program

Consistent and compelling marketing message

In-office registration

On-premises support expert

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6

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1. Portal Policy

Consciously articulate a strategy for adoption, moving from opt-in to opt-out

Portal Adoption Policy

DescriptionAdoption

Target

Default to Portal Registration

Portal use is assumed by default: at the time of service, registrars send a portal registration email to users, explain the value of the portal, and ask them to register in the office by smartphone or in-office kiosks. The practice will see patients without portal accounts.

70%

Tying Portal Use to Care Plan Adherence

Clinicians incorporate use of a portal a central part of a patient’s care plan. Patients who choose not to use the portal must discuss that decision with a clinician, and doing so is considered a failure to adhere to clinical recommendations.

80%

Strict Portal-Only Policy

Patients are required to register for portal accounts except in a limited number of cases (e.g., lack of internet access). Practices may choose not to accept new patients who decline to use the portal and may charge for mail delivery of lab results.

90%

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Greater Portal Adoption Reduces Burden of Offline Lab Delivery

Available with Increasing Portal Adoption

2. Lab result delivery

Concurrent Offline Mailing

With low portal adoption, practices offer

concurrent online delivery of lab results

via the portal and paper mailing of results.

1 Batched Offline Results Delivery

Medical assistants or clinicians schedule

period blocks to mail lab results or call patients

without portal accounts.

2 Offline Delivery Only By Request

Patients must call to receive lab results by

phone or mail, sometimes with a

processing charge for delivery by mail.

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For most practices, switching to online-only lab results will likely drive adoption more than any other strategy (and it saves staff time & resources)

• Redouble efforts to collect email addresses

• Encourage clinicians to push lab results electronically when appropriate

• Communicate value of electronic lab results delivery to patients

• Set up a system to cater to patients who resist electronic results delivery

2. Lab result delivery

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3. Training

Providers & Staff• How to use portal

• Why to use portal

• Lab results & patient messaging policies

• How to promote portal usage

Patients• Onsite expertise (see step 6)

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Portal Adoption by Registrar: Variation within a single practice2014; % Patients seen in 2014 registering for the portal within 30 days of a visit;

Each dot represents one provider with at least 100 annual opportunities1

1. A patient is considered to be an opportunity if she does not have a portal account prior to a visit. One opportunity per patient per year, regardless of how many visits that patient has

3. Training

Reducing variation:1. Establish clear expectations for providers and staff.2. Create standardized scripting for front-office and clinical

staff.3. Report on (and review) activity by provider and staff.

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Craft a compelling portal marketing message

• Tailor benefits to patient population

• Distill the major benefits, and ensure all staff can talk to them

• Develop benefits-driven portal marketing collateral

4. Marketing Message

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po

In-Office Registration Methods Have Vastly Higher Yield

Automated/At-Home Registration Methods

In-Office Registration Methods

513 4,877 1,058 36,899 22,683 7,088Number of

Registrations (11/2014)

5. Registration

57% 53%

23%12%

4% 0.4%

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• Ensure adequate physical space for in-office registration

• Consider kiosk and/or ‘concierge’ approach

• Provide space for 1 on 1 patient consultations / coaching

5. Registration

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On premise portal experts for more complicated questions and reluctant patients

• Can demonstrate portal use while patients are in-office

• Provide limited phone support to patients

• Serve as trainer / portal evangelist to staff

• Eventually, they need to work themselves out of a fulltime job (as adoption reaches critical mass)

6. Expert on-site

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Six Steps for Maximizing Portal Adoption

Portal adoption policy

Online-only lab results delivery

Streamlined portal training program

Consistent and compelling marketing message

In-office registration

On-premises support expert

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4

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In summary

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Greater engagement starts Monday

• Forces driving the need for increased patient engagement are here to stay

• All practices can take advantage of an opt-out (vs. opt-in) portal strategy, regardless of patient demographics

• Expect high engagement and follow the 6 steps

athenahealth today

• 62,000+ providers on athenaNet®

• Clients ranging from 1 to 5,000+ providers

• 50 states and 112 medical specialties

• $13 billion in client collections per year

• Acquired Epocrates March, 2013

33“2014 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com

#1 Practice Mgmt System

(1-10 physicians)

#1 Practice

Mgmt System

(11-75 physicians)

#2 Practice

Mgmt System (Over 75 physicians)

#2 Ambulatory EMR

(Over 75 Physicians)

#2 Patient Portal

#2 Overall Physician Practice Vendor

2014 Best in KLAS

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