Guest Column | January 8, 2019

4 Ways To Address Socioeconomic Factors In Your Practice

By Jim Higgins, Solutionreach

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The United States is a hodgepodge of different income levels, backgrounds, cultures, geographical locations (rural vs. urban), and even languages. These differences impact not only your day-to-day interactions with patients, but also the successful implementation of practice policies, such as cancellation and no-show policies. In order to boost the overall success of your practice’s operations and improve the health outcomes of your patient base, it’s important that you understand and take these differences into account.

How Do Demographics Impact Healthcare?

It’s long been understood that low income levels have a dramatic impact on health outcomes. Research has found that people with a lower socioeconomic status suffer from increased rates of cardiovascular disease, hypertension, arthritis, diabetes, and cancer. They experience a lower life expectancy and receive fewer diagnostic tests and medications than those with higher income levels.

In addition, the location of your patient base can have a big impact on your practice. Rural patients consistently have worse health outcomes. They are more likely to engage in risky health-related behaviors, suffer from more chronic conditions, be uninsured for longer periods of time, and less likely to receive proper care.

But the challenges extend beyond income and geography. Patients with differing religions, culture, and ethnic customs also can struggle to receive the healthcare they need. Without proper training, clinicians may deliver medical advice without understanding how health beliefs and cultural practices influence the way that advice is received.

Ultimately, not addressing the needs of these unique populations can have a direct impact on the success of your practice. Patient cancellations, no-shows, and turnover will rise.

Developing Processes And Policies With Cultural And Socioeconomic Factors In Mind

As a practice, handling those with different backgrounds can be tricky. In order to develop a solid patient base and reduce churn, it is important that you find ways to meet the needs of all of those in your particular area. This requires the implementation of processes and policies that work for your unique patient base. So, it’s critical that your practice has a strong understanding of your patients.

Depending on the situation of your particular clinic, you may see lower income patients, urban patients, a particular cultural or religious segment, or any combination of the above. Take the time to do some research on those in your area. Feel free to ask your patients about their religion, culture, or customs in order to better understand and engage with them. Track the locations your patients live. How far of a drive are patients traveling to reach you? Once you have a better understanding of your patients, work with staff, community members, and the patients themselves to come up with policies and plans that align with your specific patient-base, such as:

  1. Increase communication frequency and accessibility. For those coming from different backgrounds than the typical American, communication is critical. It is important to understand that these patients, more likely than not, have unexpressed needs. You need to take on the role of their advocate. This means opening the lines of communication. This can be done through regular, personal emails, newsletters, or text messages. If you text patients regularly, try to implement two-way texting. This will enable patients to more quickly and easily reach out to you. Look for software that provides content in other languages. Most offer at least Spanish. Adding Spanish was a big help to Galen Healthcare & Aesthetics in South Carolina. “We’re in a market where we treat a lot of different demographics,” explains Eric Holland, the practice manager. “Our non-English speaking patients were getting reminder texts and emails written in English, and we weren’t getting a good response from them.” Since adding Spanish language reminders and recall emails and texts, their no-show rate has gone down, patients show up prepared, and they have added over $4,000 a month in recall revenue.
  2. Develop on-going, automated recall programs. Patients with special cultural, geographical or socioeconomic factors are less likely to come in for regular care—including wellness visits, screenings, and even visits when ill. This means that it is very important that you set up your recall messaging to reach out when these patients are due for appointments. They may need a few more “nudges” to come in for a visit, so this may require sending out more reminders than you might to the typical population. Consider offering some screening events in the community to reach people where they are. If you identify an issue, you can schedule an appointment right then for follow up care.
  3. Use multiple contact channels. Best practices for patient communication include always contacting patients in the method that they personally prefer—whether this is phone, text message, email, or so on. This is true for those with different cultural and socioeconomic circumstances as well. One difference with this population, however, is the need to reach out in multiple ways. This is especially true for those who have financial situations where their phone or internet may not always be working. There is the possibility that one reminder method might not reach these patients so have a backup reminder sent through a different channel go out as well.
  4. Be flexible on your no-show policies. Patients in these groups have higher overall no-show rates than the average patient. Some frustrated practices decide that this means they should buckle down on these patients through strict no-show policies. The opposite is often true, however. Strict no-show policies may just scare them off for good. These patients face difficulties the average patient may not. They may have childcare problems, transportation challenges, or an inability to pay their copay on any given day. While it is very important to create a no-show policy, it is also great to focus on encouraging patients to cancel in advance, rather than focusing all of your efforts on reactions to no-shows. One practice decided that instead of patient termination, after three no-shows, patients would be required to come to the office for an education course before setting up another appointment. During this time, the practice was able to get to know some of the challenges these patients were facing, develop stronger relationships with them, and teach them the importance of regular care.

Understanding the challenges of patients with unique cultural, social, religious, or financial circumstances will help providers better serve their needs. This, in turn, will lead to patients feeling better understood, more loyal, and more likely to show up. It’s a win for everyone!