Patient Engagement

4 Tips for Engaging Hard-to-Reach Patients

May 1, 2019

Over 27 million underserved patients visit Federally Qualified Health Centers across the country every year now, representing 8% of the total U.S. population. These patients are disproportionately impacted by chronic diseases and include many hard-to-reach patient groups, such as homeless populations, who are particularly challenging to care for.

Saban Community Clinic, a Los Angeles-based FQHC, is particularly experienced with caring for transient patients and has recently implemented a successful patient engagement strategy leveraging text messaging to effectively communicate with this population.

As studies have shown, including our own research, text messaging is a medium for communication that has the highest response rates among underserved patients. It can be especially effective in reminding these patients about appointments, filling gaps in care, and providing health education. Here are four lessons from Saban’s patient engagement strategy to apply to your own.

1. Maximize limited staff time to better engage with patients

Because Saban Community Clinic had a limited number of staff members to communicate with patients through their call center and during in-person visits, they focused their efforts in using text messaging to drive operational efficiency and improve outcomes. They asked themselves the following questions:

  • How can we best utilize the staff we have?
  • Are the workflows we have in place the most efficient?
  • Do we have the right technology in place to help us grow and improve our efforts?

With these questions in mind, Saban decided to help their call center staff maximize their time and efficiently connect with patients through using text messagings for appointment confirmations while using phone calls to help with other initiatives. Ana Vazquez Alvarado, EHR Integration Manager at Saban, shared one area of impact on no-show reduction:


“We noticed our amount of call center staff didn't change, but their work shifted [from using CareMessage]. Instead of taking so many calls about cancelling appointments, we started taking more calls about appointments needing to be made.”

No Show Reduction from 35-38% to 17-18%

Sending patients appointment reminders via text message allowed Saban to open up more appointments to patients who were waiting to be seen. They were able to receive confirmations and cancellations from patients, updated in their EMR real-time, decrease their cycle time in clinic as well as save the front desk time to check in patients and keeping providers on schedule.

2. Personalize messages to transient patient needs

Serving underserved populations, particularly low-income and homeless individuals, presents a unique set of challenges to health centers across the United States.

At CareMessage, we’ve found that while sending text messages to underserved patients is the best medium for communication, the content within those messages is crucial to improve response rates and health outcomes. Here are a few tactics Saban Community Clinic used to connect with their hard-to-reach patient population:

  • Make it easy for patients to respond
  • Send messages in a patient’s native language
  • Send messages at an appropriate reading level
  • Send more than appointment reminders

By leveraging CareMessage’s message library, Saban can send texts at a 5th grade reading level, in culturally relevant English or Spanish based on patient preferences in the EMR, and allow for data collection on appointments, flu shots, and other metrics of care. Saban is sending out appointment reminders everyday, while also creating patient groups to send outreach messages to for preventive care such as flu shots and screenings.

3. Implement a technology that scales with you

Saban’s learning from prioritizing their patient engagement strategy started with asking the question: do we have the right technology in place to engage with all of our patients at scale? They shared a few learnings about how to implement a new patient engagement technology in any health center:

  • Involve all stakeholders and get your team involved to ensure long-term buy-in. Have directors think about what type of outreach they would want to do and think about if there are enough staff to manage the patients who will take action.
  • Reinforce the importance of staff confirming patient phone numbers during visits and calls to maintain accurate data to communicate with patients.
  • Ensure your platform supports a bi-directional sync with your EMR to keep patient records up-to-date and accurate. The integration CareMessage provides with EPIC OCHIN for Saban empowers their team to take action every day and enables their health center to run efficiently.

8-10 Hours a Week Saved with Bi-Directional Interface

4. Continuously explore new opportunities for impact

Eager to continue driving even stronger patient engagement, Saban shared a few ideas on how they plan to expand their strategy further:

  • Launch a quarterly preventive messaging calendar.
  • After an appointment, allow providers to indicate patients who could be enrolled in one of CareMessage’s nineteen text-based health education programs.
  • Develop a data collection process and gather metrics to compare how text messaging in comparison with other engagement strategies has impacted their patient population.

To learn more about how to implement a patient engagement strategy, use the below form to connect with the CareMessage team.

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