Overview:
Founded in 2001, the Rhode Island Quality Institute (RIQI) “is a non-profit and collaboration of leaders in the Rhode Island community including CEOs of hospitals, health insurers, and businesses, along with leaders of consumer groups, academia, and government.”[i] RIQI operates and manages CurrentCare, the state’s Health Information Exchange (HIE). The success of a state’s HIE hinges on its ability to reach consumers and convince them to allow providers and other caregivers to share and access their health information. Over the past 5 years, RIQI has successfully enrolled about half the population of Rhode Island into CurrentCare.[ii] All health care professionals have a stake in delivering the safest, highest quality care, and the sooner patients enroll in an HIE, the sooner they and health care professionals can appreciate its benefits. This success story highlights RIQI’s achievements with patient outreach and engagement and some strategies moving forward.
The Challenge: For an HIE to demonstrate benefit to providers, patient information must be available to view and share across provider organizations. Patients must provide their consent in order for their information to be shared outside of their physician’s practice. Rhode Island’s consent policy requires that patients “opt-in” or provide affirmative consent to share their information. RIQI’s challenge was to identify ways to get a significant percentage of the state’s patients to consent to share their health information.
Outcome:
The Strategy: Enrolling one patient at a time would be a long and protracted process. To enroll as many people as quickly as possible into the HIE, RIQI started working with some of the largest health organizations within Rhode Island. RIQI built a foundation by convincing stakeholders — including the state, payers, and large health care groups’ leadership — of CurrentCare enrollment benefits. With buy-in from these important stakeholders, including leadership sponsorship and support, RIQI focused on enrollment at large hospital networks (i.e., hospitals with the largest number of beds) and large provider groups with greater than 50 clinicians. RIQI also worked with the state of Rhode Island to ensure enrollment in the HIE was part of stipulations in state-agreed contracts: when a hospital is bought or sold within Rhode Island, there is a stipulation in the contract that requires participation in the HIE. The state also helped RIQI by offering providers and hospitals a subsidy for every new enrollment. By focusing on large health care providers, RIQI was able to enroll ~480,000 into CurrentCare in 5 years.
While RIQI targeted both patients and providers in its marketing campaign, it focused more on providers since they have direct access to patients and can help highlight participation benefits. RIQI used a “boots-on-ground” effort, where RIQI staff joined payers during visits to large provider sites and worked in the provider’s office for a few hours so they would have direct access to patients. In addition to these visits, RIQI created double-sided posters (see Image 1) with meaningful reasons to join CurrentCare. These posters targeted both the patient and the provider and were available in practices. RIQI also started an e-mail enrollment campaign that provided practices with messaging to send to their patients.
The e-mails highlighted the importance of CurrentCare enrollment and benefits for both the patient and
the provider.
During the initial enrollment phase, point-of-care enrollment hit a plateau of 91 percent. Looking to further increase enrollment, RIQI focused on patients who infrequently accessed the health care system and started to contact partners that provided health services outside the traditional health care system. RIQI worked with the YMCA, health clubs, alternative providers (e.g., chiropractors, optometrists), and other ancillary health service providers where non-enrolled consumers would visit to encourage them to enroll. For example, a 25-year-old male may not visit a practice or hospital but might visit a gym where he could be educated about CurrentCare benefits and enroll.
RIQI asked practices with high enrollments for their secrets to success as well as copies of messages and scripts that were most effective in enrolling patients. RIQI also met with payers who work with the Medicaid population to review the messaging and received feedback that the original messaging needed simplification. Patients do not want to read long, text-heavy documents about HIEs. Patients want quick, easy-to-read, and easy-to-understand information. To be successful with an outreach campaign, RIQI needed to ensure they were addressing their audience’s concerns and their message was in a format that patients found appealing. Most patients in Rhode Island are concerned about their health data and how it is being used, so RIQI ensured that its marketing materials included information about the security of patient information and benefits of HIE enrollments upfront.
Lessons Learned:
Since its inception 5 years ago, RIQI has enrolled about 50 percent of Rhode Islanders in CurrentCare. A large part of this success is due to RIQI’s top-down strategy with buy-in from large hospitals/practices and the targeted marketing efforts used. Key lessons learned include:
- Work with leadership from the top-down to obtain their sponsorship and support to allow for easier point-of-care enrollment.
- Approach the larger health care organizations in the market and engage them to accelerate enrollment early on.
- Understand and tailor messaging for Rhode Island consumers and what resonates with them.
- Time the delivery and format of messages so they deliver the greatest impact. (For example, An important lesson learned from the e-mail enrollment was that sending this type of e-mail on a Friday at 4:30 p.m. with 5,000 words had very little impact on enrollment.)
- Make the enrollment process as easy as possible.
- Work with non-traditional health service providers to gain access to consumers who do not regularly access the health care system.
- Focus on the benefits to the patient, not just the benefits to the providers, such as:
- Offers a more complete picture of a patient’s health for all providers.
- Provides a comprehensive record that will include lab test results, medications, and doctor or hospital visits.
- Doctors, hospitals, pharmacies, and labs work together so their approach is consistent, cohesive, and coordinated.
- Avoids unnecessary and expensive duplicate procedures for patients.
Next-Steps/Future Vision:
RIQI considers 2016 to be a learning year in direct-to-consumer outreach. They will continue their enrollment strategy through non-consumer-based channels; however, they plan to shift focus to consumers as well. In the next enrollment phase, RIQI plans to partner with Medicaid Rhode Island. Every year, eligible Rhode Island Medicaid participants must either enroll or re-enroll. This enrollment ioccurs automatically through Healthsource RI, the official health insurance exchange for the state of Rhode Island. While this still needs to be agreed upon by Medicaid Rhode Island, RIQI believes that doing this will increase HIE enrollment significantly because every Medicaid participant will be provided an option to enroll in CurrentCare.
As part of their consumer engagement next steps, RIQI plans these activities:
- Simplify the enrollment process to make it easier for consumers, providing them with mobile enrollment capability.
- Continue to address health literacy to assure that messaging meets the needs of their consumers.
- Reaching to consumers and convene focus groups to better understand the patient perspective.
- Provide patients with access to their health information through patient portals and mobile applications.
[i] http://www.riqi.org/matriarch/default.html
[ii] http://riqi.org/matriarch/documents/CurrentCare%20Reaches%20400K%20Enrolled-July%2031%202014.pdf