Engaging your patient population is an ongoing challenge for most healthcare organizations. Patients are juggling the complexities of a busy life, and working parents may be more likely to stop in at a local urgent care for an annual physical or sick care.

How do you keep them connected to your practice, receiving the more comprehensive care they deserve?

Some patients are managing lifetime chronic disease or are slipping into the category of rising risk on their way to receiving a chronic diagnosis. They require ongoing support and education from our healthcare systems. Factor in the internal challenges that clinical and operations staff encounter daily, and it becomes nearly impossible to perform consistent patient outreach—let alone engaging in risk stratification to determine which population of patients require it.

Since most of managing a person’s individual healthcare happens outside of the four walls of the exam room, how does engaging patients outside of the office visit impact the health outcomes? Below are six key areas to explore within your organization to design and develop a successful population health outreach program.


1. What are your organizations clinical quality goals?

Many healthcare organizations are bound by regulatory bodies and value-based contracts when defining clinical qualities goals. While these goals are multifactorial, defining your organization’s priorities are an important first step in designing a population health outreach strategy. To determine your quality goals, ask yourself the following questions:

  • What patient populations demonstrate the most need?
  • What populations represent high risk or rising risk categories that require additional attention or support?
  • Are you supporting initiatives related to chronic disease management and prevention, or does prevention fall to the bottom rung?


2. What barriers are your patient’s facing?

When developing a population health strategy and the populations that represent your areas of focused priority, you also must evaluate potential barriers that patients are facing. Often the social determinants of health (SDOH), or the conditions in which individuals live, work and play are relevant factors in answering this question.

Mitigating the SDOH that are most common to your patient populations should be considered in developing an effective population health outreach strategy. Are your patients non-adherent to their plan of care? Or, is it more likely that transportation is a barrier to keeping appointments? Perhaps the challenge is that affordable medications are not accessible.

Raising your awareness of the common barriers your patients are faced with can help assist them in overcoming them. For example, patients needing prescription assistance can use available resources such as 340b programs. (340b eligibility limited to specific settings. Click here for eligibility information).


3. What potential incentives are available through value-based contracting?

Is your organization engaged in value-based care contracts? Does your approach to population health outreach support you in meeting the established goals? If not, you may want to determine the areas of focus outlined in your value-based contracts as an opportunity to improve your approach to population health outreach to existing patients, as well as those assigned to your practice rosters who have yet to establish care.

Creating a strategic approach to outreach by using technology to automate population health outreach is a method to increase engagement across these varied populations. Focused outreach increases patient engagement in their own care while increasing the likelihood of reaching outcome-based goals and boosting revenue by being awarded the available incentives.

4. What have you already tried?

When revising your population health outreach strategies, it is important to include what approaches have already been attempted and had the greatest impact. Perhaps patients were responsive to telephonic outreach, but it became more difficult to scale these efforts to all target groups. Using an automated solution to scale outreach to a broad population is a method to increase efficiency while driving results. Developing a population health outreach strategy using technology allows a practice to engage more patients at a high level, while reserving limited resources to have more meaningful, focused individual conversations.


5. What are your competing priorities?

In every organization, leaders have to continually define and redefine current priorities to optimize limited resources. When scaling population health, these efforts become even more hazy. Does it make sense to have staff reach out to patients directly to re-engage them in care or provide reminders when care is coming due? Or it is more efficacious to utilize automated outreach as a population health strategy and reserve your clinical care team for individualized patient education?


6. What is your organization currently spending in time and money doing outreach manually?

Have you considered the costs associated with “old-fashioned outreach” that you may be currently performing? Consider these other questions regarding your current approach to population health outreach.

Are you doing telephonic outreach, having to open each chart manually and hoping the patient answers? If your agents leave a voicemail, you are now initiating a game of phone tag if the patient calls back, assuming they can actually reach the person that performed the initial outreach call.

Are you using mailers to remind patients of upcoming screenings they are due/coming due? What are your costs of paper consumption and postage? How many of those result in returned mail?

In addition to the hard costs mentioned above, the staff resource to perform these functions adds up quickly. Are you able to demonstrate ROI for your efforts? Using a technology solution for automated population health outreach can dramatically improve these efficiencies, engage more patients, and improve staff and patient satisfaction.



As you consider the answers to the questions posed above, are you able to more clearly determine your next steps in developing population health outreach?

Adding another responsibility to the long list of a busy medical practice may not be the best answer. Using technology to scale outreach efforts addresses the goal without managing the function manually, allowing many more patients to become engaged in the process. Using technology to automate population health outreach has become more accepted, and even desired, among consumers—even your senior population. According to Pew Research Center in 2017, the rates “of adults ages 65 and up who own smartphones has risen 24 percentage points (from 18% to 42%) since 2013” and this number continues to rise.

Providertech has amassed clinical and technology experts to support you in developing a collaborative population health outreach strategy. Contact us today to learn more!