The success of behavioral economics in improving patient retention within an intensive primary care practice

Phillip Groden; Alexandra Capellini; Erica Levine; Ania Wajnberg; Maria Duenas; Sire Sow; Bernard Ortega; Nia Medder; Sandeep Kishore

doi:10.1186/s12875-021-01593-8

The success of behavioral economics in improving patient retention within an intensive primary care practice

BMC Fam Pract. 2021 Dec 22;22(1):253. doi: 10.1186/s12875-021-01593-8.

Authors

Phillip Groden¹, Alexandra Capellini², Erica Levine³, Ania Wajnberg⁴, Maria Duenas⁴, Sire Sow⁴, Bernard Ortega⁴, Nia Medder⁴, Sandeep Kishore⁵

Affiliations

¹ Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levey Place, Box 1199, New York, NY, 10029, USA. phillip.groden@mountsinai.org.
² Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levey Place, Box 1199, New York, NY, 10029, USA.
³ Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 5th Avenue, Box 1199, New York, NY, 10029, USA.
⁴ Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
⁵ School of Medicine, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, USA.

Abstract

Background: A minority of the U.S. population comprises a majority of health care expenses. Health system interventions for high-cost populations aim to improve patient outcomes while reducing costly over-utilization. Missed and inconsistent appointments are associated with poor patient outcomes and increased health care utilization. PEAK Health- Mount Sinai's intensive primary care clinic for high-cost patients- employed a novel behavioral economics-based intervention to reduce the rate of missed appointments at the practice. Behavioral economics has accomplished numerous successes across the health care field; the effect of a clinic-based behavioral economics intervention on reducing missed appointments has yet to be assessed.

Methods: This was a single-arm, pre-post trial conducted over 1 year involving all active patients at PEAK Health. The intervention consisted of: a) clinic signage, and b) appointment reminder cards containing behavioral economics messaging designed to increase the likelihood patients would complete their subsequent visit; appointment cards (t1) were transitioned to an identical EMR template (t2) at 6 months to boost provider utilization. The primary objective, the success of scheduled appointments, was assessed with visit adherence: the proportion of successful over all scheduled appointments, excluding those cancelled or rescheduled. The secondary objective, the consistency of appointments, was assessed with a 2-month visit constancy rate: the percentage of patients with at least one successful visit every 2 months for 1 year. Both metrics were assessed via a χ² analysis and together define patient retention.

Results: The visit adherence rate increased from 74.7% at baseline to 76.5% (p = .22) during t1 and 78.0% (p = .03) during t2. The 2-month visit constancy rate increased from 59.5% at baseline to 74.3% (p = .01) post-intervention.

Conclusions: A low-resource, clinic-based behavioral economics intervention was capable of improving patient retention within a traditionally high-cost population. A renewed focus on patient retention- employing the metrics described here- could bolster chronic care efforts and significantly improve the outcomes of high-cost programs by reducing the deleterious effects of missed and inconsistent appointments.

Keywords: Behavioral economics; Chronic care; High-cost populations; Patient retention.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Ambulatory Care Facilities
Appointments and Schedules*
Economics, Behavioral*
Humans
Patient Compliance
Primary Health Care
Reminder Systems