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The race to improve patient experience: 4 ways SMS can keep you ahead of the curve

A simple technology with big impacts: text messaging can be a quadruple threat—improve patient experience, lower healthcare costs, drive better patient outcomes AND empower clinician engagement. Healthcare is on the cusp of true innovation with SMS impacting nearly every type of patient interaction.

In this video, Bandwidth discusses innovative ways to improve your patient experience through SMS and the regulations and guidelines that shape the messaging industry.

We’ll walk through a real healthcare customer’s SMS journey from basic implementation to supporting the unexpected scale that happened with COVID-19. Read the full story here.

This panel-style experience will help you understand the messaging ecosystem and identify important considerations you may have overlooked, like new carrier fees and more stringent filtering.


Nicole Culver (00:06):

Hey everyone. Thanks for joining me on this webinar to discuss improving patient outcomes with SMS. First, I want to tell you a little about why I’m here talking to you today. Who the heck is Bandwidth anyway? We are a communications platform as a service that powers the applications you use daily, where you live, work, and play. And that includes everything from Google Hangouts to Rover, to even Solutionreach, which powers healthcare application reminders. So I am the Senior Product Marketing Manager for our Communications APIs here at Bandwidth. And I am so jazzed to be joined with MJ today. So with Mary Jane, we call her MJ. MJ, tell me a little bit about your role at Solutionreach.

Mary Jane Isaacs (00:52):

Yeah, thanks, Nicole. So I am the Senior Director of Engineering at Solutionreach. I’ve been there for almost eight years, and it’s been a phenomenal journey. I’ve spent most of my career in healthcare coming to Solutionreach, and being able to help improve healthcare and make a significant impact through communications has been an absolute adventure. It’s one that I’ve learned so much from, and I’m excited to be sharing some of those learnings today with you.

Nicole Culver (01:21):

Awesome. Thanks, MJ. Yeah, I love the healthcare industry and the impacts that such simple changes can have. So let’s dive right in. I’ve got this agenda for you all in the race to improve the patient experience. So what are we going to talk about today? First, we will address the elephant in the room, HIPAA. Then we’re going to talk about SMS in action in healthcare today, and that’s MJ’s specialty. And we’ll touch on how you can improve patient experience and outcomes with SMS.

Nicole Culver (01:59):

That’s it. So let’s get right to it. So I couldn’t help myself. I did a funny little cartoon because I think that HIPAA is a terrifying thing to talk about. You talk about regulations or protected health information; everyone gets ratcheted up. But the reality is that while HIPAA is a regulation, being HIPAA compliant is mainly about preserving that patient health information in the best way for your patients or your business. So if you are using or transmitting patient health information via email, you can do that. The director of the HIPAA enforcement agency said, “Healthcare providers can share PHI (Protected Health Information) with patients’ consent as long as they understand what they’re consenting to so that it’s a non-encrypted form of messaging, right? So email happens day in and day out. You probably also use a messaging platform like MyChart or patient enablement software. But there’s also SMS; we cannot forget about SMS. It’s on your phone; you use it in and out every day. So if you are a business dealing with PHI, do you have to sign a BAA? Well, we can’t tell you that. In a second, I’ll let MJ talk a little about her approach to BAAs. But I do want to say that Bandwidth supports BAAs. We are launching into a BAA program, which I’m very excited about. But ultimately, it has to be the right decision for you and your business. MJ, I would love to hear how you thought through BAAs.

Mary Jane Isaacs (03:49):

Yeah, absolutely. So at Solutionreach, we enter into BAAs with all our customers. Our healthcare provider customers are very much centered on HIPAA and ensuring they’re compliant. So we want to support them in that. We have not proceeded with doing a BAA with Bandwidth yet; we are keeping our eyes on your program as it rolls out and is excited about it. But we’ve been very comfortable with Bandwidth as a conduit to ensure we stay in compliance, but we always keep a pulse on HIPAA and the latest. But I can tell you, Nicole, that having SMS available in healthcare has been immense. And I only see that continuing to the future and any support we can get to make sure people feel like we’re compliant and comfortable, we’re excited about it. So we’re keeping an eye out for your new program. It has not held us back from sending lots and lots of SMS.

Nicole Culver (04:43):

Awesome. That’s what I love to hear. I know that BAAs are very exciting for a lot of our customers. But again, I just want to say that if your patients understand what they are consenting to, it’s their choice to share information in their way. So you might decide that a BAA is the best choice for your business, and we will support that. But you also might choose, as Solutionreach had in the past, that your conduit exception is satisfactory. So definitely consult your legal theme for that. Alright, I am so excited to talk about SMS in action and give Mary Jane the chance to show off Solutionreach. So, MJ, should I pull up the image of the healthcare example screen?

Mary Jane Isaacs (05:31):

I’ll just jump in, so, and give a little bit of a description of what we see here. At Solutionreach, we’ve been sending SMS for many, many years, decades. Several years ago, we started to address a need in the healthcare industry, which is having conversational type of message exchanges. So we have a solution called Conversations, which is an application for the desktop and also for the mobile app. So our customers can easily pick up those conversations with patients. And admittedly, when we first began, we weren’t sure what type of conversations we would see. But as you’ll hear today, SMS and having those conversational-type exchanges have opened the doors to many exciting things. So let’s jump in and talk about some of those ways that SMS is helping us in healthcare.

Nicole Culver (06:32):

Sounds good. So are going to talk about four ways to improve patient outcomes with SMS. That’s what we’re here to talk about today. Let’s start with an overview, which is not just about patient outcomes but also your patient experience, and maybe even financials for your healthcare business. The first one would be scheduling appointments and appointment reminders. The second would be intake and billing. Use SMS to send your patients their intake forms or billing reminders. The third is medication reminders, and we’re going to talk a little about medication adherence, how critical that is, and how SMS help. And finally, there’s a whole world out there of healthcare interventions that I am so excited to talk about. MJ has given me a bit of a preview of some stuff they’re working on to create a more personalized healthcare experience via messaging. So let’s start with what we know about scheduling and appointments. MJ, can you tell me more about something as simple as scheduling and how it affects the providers you work with?

Mary Jane Isaacs (07:49):

Yes, we found with our online scheduling tools, and we have one that is very prevalent in the industry as the audience probably very well knows. We found that patients prefer very much so to be able to schedule online. They enjoy the flexibility to make adjustments to their appointments online and to be able to do that any time of the day. What’s been exciting is that when a patient goes online to schedule an appointment, it is quick and easy to gather additional information around that particular appointment. So whether it’s updated information about their insurance, their healthcare condition, or why they’re coming in, it feeds additional information that’s current and accurate into that appointment.

Mary Jane Isaacs (08:43):

So when those appointment reminders start going out, they can be very timely and relevant to that situation. The office is highly informed about what that patient’s coming in for, and they have the most current information. At Solutionreach, our appointments, and I’m sure almost everyone on this call has probably received an appointment reminder text before. Still, we’ve found that what is most compelling is not one but sending three appointment reminders per appointment, via SMS, preferably. And the reason for that is so many patients just forget, I’ve done it myself, just fail to make it to that appointment. But if you have a reminder to go out a few weeks, before a few days, before a few hours, and before just confirming, it will increase the chances of that patient arriving at that appointment.

Mary Jane Isaacs (09:36):

And again, with online scheduling, it’s an appointment time that the patient could fit into their schedule that increases their ability to show up and has all the information gathered during that process. So it starts to set up this appointment to be more of a perfect appointment. There was maybe a clipboard or a stack of papers handed to them before. But getting that first step of helping patients remember the appointment they’ve scheduled online has made a massive difference for healthcare providers, which just means better healthcare outcomes.

Nicole Culver (10:18):

Oh, totally. I’m a little ashamed to admit that it was only maybe two weeks ago that I missed a doctor’s appointment. They didn’t send me a text message reminder or send me an email reminder. So appointment reminders are so critical, and I felt awful, but I’m just so used to it. All of my other providers send me a text message and an email or, whatever I’ve, picked as my preference. And it’s not just scheduling appointment reminders or sending appointment reminders in the office; it can also be crucial, like scheduling and reminding patients to complete at-home screening tests. That’s one example of how text messaging has improved patient outcomes. One study showed colorectal cancer screening, and it showed that sending patients text messages at home with a series of reminders enhanced the number of return test kits by mail by 18%. That’s a huge thing that doesn’t cost a lot of money. So as we look beyond scheduling and appointments, this is the one MJ I have to admit intake and billing were not top of mind for me. Some providers have sent me a link to fill out my forms before my appointment via text message, but it’s not common. So can you tell me a little more about what you see with intake and billing improvements?

Mary Jane Isaacs (11:49):

Absolutely. So intake digital intake it’s fundamental. We want to replace the paperwork, we want to replace the time in a waiting room, and that time spent in a waiting room with pre-appointment digital work. We do these things to make it much more streamlined and efficient. For example, 98% of all SMS messages are being opened, compared to a much lower rate on email. Providing options like intake that bring such incredible efficiencies to offices has increasingly catapulted people to rely on their phones. I read a study where on average, a person checks their phone 150 times daily.

Mary Jane Isaacs (12:42):

We need this intake information before you come in, or we have a balance that we need you to address—sending that message via SMS and providing a smooth user experience to complete an intake form or make a payment initiated by SMS will result in a much higher completion rate. You’re going to end up with much more patients saying, “Yes, like I want to be able to pay online. I want that is my preference. Yes, I want to be able to fill out an intake form from my phone quickly.” And suppose we’re sending appointment reminders a few hours before an appointment, and maybe that appointment reminder reads slightly differently. In that case, if that intake form hasn’t been completed, they click the link right there and complete the intake form from their phone. So it’s not just the SMS alone, but everything else we’re building and providing to bring these efficiencies. Without SMS, it will never get to the point where it has the impact that we’re seeing it has today.

Nicole Culver (13:57):

Yeah. I don’t want to ignore these stats on the screen. I mean, when I read that 61% of denied insurance claims are from incorrect data entry on paper forms, that blew me away because not only I have had that happen to me, but also I’ve had a provider sit down with me and be like, “You answered this question in this way. Is that what you meant?” They have to kind of like walk me through it. I think that you know, the ability to look at it and get it to the provider ahead of time, so they can walk it over with you. That would be crucial. And like you said, 80% of patients prefer to use digital tools. I think that’s so important. And you said something to me a couple of weeks back, MJ, about how text messaging and even intake and billing can improve patient outcomes. And it had to do with the billing, not being a barrier to their care. Can you walk me through that a little bit?

Mary Jane Isaacs (15:08):

Absolutely. And I think, yeah, going back to that stat, so many patients prefer to pay online, which makes us wonder why we still receive so many paper invoices. When I pull them out, I immediately look for the URL so I can go online cause I’m not going to write a check and mail it in. So I look for that. But I think that experience is very much part of our healthcare journeys. We know that balances are hard to collect, but we have seen that when payment requests go out via SMS, they are paid much quicker than if paid on paper. And what I truly believe is that a paid balance keeps the avenue open for additional care. As soon as there becomes an unpaid balance, is a possibility that a patient is reluctant to come in for their next appointment?

Mary Jane Isaacs (16:04):

Whether because they are financially unable to pay for care or is it that they are a little uncomfortable knowing to have an unpaid balance, any barrier that’s put up between a patient and their healthcare provider is one that we need to knock down. It prevents the best possible healthcare outcomes. I’ve had unpaid healthcare balances simply because I’ve forgotten to pay them. Making it easy to understand my balance and where to go to pay in any available media has made such a big difference. This is because, I think, you know, it’s part of what we’re doing to improve healthcare outcomes. It has a financial piece to it as well. We want to ensure people are comfortable getting the care they need.

Nicole Culver (17:00):

I’m kind of laughing over here because I’m remembering being, I don’t know, in my early twenties, not super great with money yet and having unpaid balances and not wanting to go to the doctor because I don’t want to have the conversation of, I can’t pay that right now. Thank you for hitting on that. I think that’s critical.

Mary Jane Isaacs (17:21):

And Nicole, I’ll just chime into speaking of the early twenties, right. When we’re figuring out the world, you know, but much of it remains true. Is being able to have that connection to your healthcare provider still. And I do think SMS is more of a conversation than an email. Emails are fantastic, but when we look at how the world is shifting and changing in all industries, connecting with a business or a provider via SMS keeps it very personal and friendly. Even if it’s an automated reminder to come to an appointment or a system-generated payment reminder, there is a way to put a personal touch on that. And through an SMS message makes, that connection feels very real. We keep providers connected with the patients and continue to improve and transform healthcare.

Nicole Culver (18:17):

Thank you for touching on that. I completely glossed over what we call the intimacy of your messaging inbox on your phone. You’re right. The ability to not just feel a little bit more of a personal connection to a provider but also the barrier to healthcare because you’re afraid to pay a bill. It’s much easier to text your provider back and say, “I could use a little help with a payment plan .”Like, such giving your patients options rather than getting on the phone. And, you know, I’m sure there’s shame and difficulty with that. And if you have a service with text messaging where you might send out automation that they can reply and ask their provider questions or their provider team, that’s huge. I think that’s a great thing to touch on now that we’ve touched on the critical part of text messaging, which is the intimacy of the inbox, which has, from my perspective as my job, I should have touched on that in the beginning.

Mary Jane Isaacs (19:21):

We’ve got lots of other stuff prepared to talk about that. Especially when it comes to appointment reminders, and that’s just the beginning. I think throughout the industry, every patient has come to expect an appointment reminder. So the SMS experience makes a big difference. Medication reminders, I keep going back to that intimacy, right? Like it’s not just, “Hey, you know, Mary Jane remember to take your medication.” It can be definite with instructions on what to do and the power of that, right? It’s personal instead of a blanket statement or generic information. And again, Nicole, as you talked about HIPAA, if a patient consents to receive SMS healthcare information via SMS, such incredible, powerful things can occur.

Nicole Culver (20:27):

Totally. When I was doing this research, it blew me away from medication adherence. So the impact on a patient’s care and the industry itself is huge for optimum care. The number of patients who needed to take medication was about 80% consistently. But the compliance for medication hovers around 50%. That 50%, just the 30% decrease in compliance, results in: 177 billion in direct and indirect costs for the healthcare industry, from 50% treatment failures per year, 125,000 deaths per year, and 25% greater hospitalizations per year, just from medication non-adherence. That blew my mind. So I think there’s a lot that we don’t consider or talk about. But, you are, you are so right. MJ. I am seeing a demand for that personalized, intimate care channel. Let’s maybe talk about care flows and healthcare interventions. I know that pervasive health issues like diabetes and heart disease require a lot of patient self-management. What kind of impact could that have in your mind, MJ?

Mary Jane Isaacs (22:00):

Yeah, I don’t know the specific, other than huge impact. So the reason why we don’t know, and we can isolate one or two use cases, one or two different conditions, or put together some best practices around messaging, but what we’ve learned, and I hope for the audience, rings true as well, that it is so complex and there is so much variety. It is hard to prescribe a certain communication cadence around a particular condition. Because you can get best practices put in place, the one thing that will always be the variable is the patient and their unique situation, needs, and health conditions. Any piece of their experience, you want to make sure is taken care of. It’s always going to be the variable. So while we have seen very, very compelling use cases to put SMS into play, now we’ve got some ideas listed here on a slide that I think we can all relate with that time when we were handed the packet of paper post-care with an excellent, thorough walkthrough. All that information left our minds as soon as we left the healthcare clinic.

Mary Jane Isaacs (23:14):

And trying to remember when to take a medication, when I need to schedule my next appointment, and what the following action is is hard to do. So if we can imagine SMS, which we’ve already established as an intimate, timely, and effective way of communicating, we can think about what we could do to improve the care flow. So not prescribing is the one thing to do for diabetes or heart disease prevention. These are the three messages you need for the building solutions flexible enough for our healthcare provider to put them to use no matter the condition, no matter the procedure, and no matter the patient. So all of a sudden, we have a tool where we still bring automation efficiency to the healthcare provider because that’s not only going to help do this for them but allow them to dictate, will enable them to design and configure the experience for each patient and do in a way that’s very, very efficient.

Mary Jane Isaacs (24:17):

So at Solutionreach, we focus on building a healthcare system with the messages we’ve been sending for decades and the practices we’ve learned. We can now allow our customers to begin designing their own experiences. Now that we’ve hammered out SMS and email, we know how to get them. We know how to be effective and compliant and design them correctly to deliver them at the right time. Now we need to allow providers to say, “Here is the experience that I’m working hard to provide my patients. How can I do it better with SMS?” And it is inspiring. And just to be able to say, you know, we’ve got experts in messaging and healthcare communications, we have healthcare experts, let’s bring them together and provide tools that allow healthcare experts, providers to do exactly what they need to do and leverage the power of SMS to improve the patient experience. More importantly, it improves outcomes because they can easily adhere to the healthcare expert’s advice.

Nicole Culver (25:24):

You’re so, so right. And I’m so excited for the future of innovation in messaging and communications for healthcare and telehealth. I wanted to let the audience know there is evidence for this. So, I believe diabetes was the seventh leading cause of death in the US in 2017. Over 5 million people are expected to have type one diabetes by 2050. These are big, scary numbers and a good portion of the population. In one study on diabetes, text messaging was found to improve glycemic control, compared with usual care by almost a full percent—so little bits of impact help. I think nearly three-quarters of a million Americans die each year from heart disease, and colorectal cancer is the third leading cause of cancer-related deaths in the US.

Nicole Culver (26:34):

So imagine having an impact on these devastating diseases. For example, text messaging for diabetes where they’re, you know, saying, “Hey, you’re going to have this follow-up. Here’s what you have to do for your sugar levels.” The second one is “Just take a 30-minute walk.” And so there was a study that showed using these automated text messages that were lifestyle focused, you know, a life cycle focused support system. It was rated as 91% effective by all participants. And after six months, they saw that the LCL levels were significantly lower in the participants versus nonparticipants. And there were concurrent reductions in systolic blood pressure, blood pressure, significant increases in physical activity, and a significant reduction in smoking.

Nicole Culver (27:39):

It went from 26% to 44% of people had reduced their smoking. So that’s huge. I just think it’s so important to touch on this, and I couldn’t have said it better in that; in that same diabetes study, she said, “As a low-cost intervention, we believe text messaging has a great potential to improve the management of diabetes, especially among patients who struggle due to employment, transportation, and other barriers to access healthcare services.” The thing about that is you could replace diabetes with just about anything. There are ways to utilize text messaging to improve patient outcomes all across the board. And I’m just so excited to see people taking more and more initiative and innovating those programs. So MJ, you are one of them, and I’m excited to see what Solutionreach does next.

Mary Jane Isaacs (28:35):

Yeah, I’m excited too. I do believe that we can transform healthcare through communication. We’ve discussed how SMS is accessible using these modern solutions to help us accomplish that. And then, of course, keeping it personal. I’m excited for Solutionreach; we’re doing some great things. I’m excited for anyone in this space who’s working hard to have an impact on healthcare. I’m excited as a healthcare consumer at the opportunities for better healthcare. Just by staying in touch, feeling connected with my providers, and ensuring I get timely information. I need to stay healthy for myself and my family. It’s a fantastic industry to be in. It’s an exciting time. The past year has proven to us that we can adapt. We can move quickly. We can innovate and meet needs all over the place. So it’s a great adventure, and I’m excited to see what lies ahead.

Nicole Culver (29:27):

I couldn’t agree more. It’s an excellent time to be in healthcare. It’s a good time to be in text messaging. I think there are fantastic future innovations to look forward to. I wanted to let everybody on the call know I have a list of resources here. I’m not sure if we can attach those links, but if you are interested in the research, please book a meeting with us today. You can use this QR code, scan it, fill out the form, and we will get back to you. But you know, we’re happy to answer your questions. We want to be there for you. Not just from a messaging perspective but also from a healthcare perspective. And I think we can; you can work together to get some of these innovations going. So thank you for taking the time to watch this today. MJ, thank you so much for joining me today.

Mary Jane Isaacs (30:20):

Yeah. And it’s so fun to speak to someone with equal passion for making a difference in healthcare. So thank you, Nicole and Bandwidth, for being excellent partners at Solutionreach. I personally really appreciate everything you do for us.

Nicole Culver (30:35):

Great day, everybody.