When a Single Letter Is All That Stands Between Your Patients and Cancer
How we designed, built, and scaled a solution that saved money and lives
This AMSURG marketing and innovation executive had a problem. He had figured out a way to improve operations at the 245 ambulatory surgery centers in his company’s network. It was based on a best practice developed by the Cleveland Clinic. It was going to make AMSURG money. It was going to save lives.
Sitting across from him at a restaurant in San Francisco, I listened as he told me about the project. We had run into one another at Dreamforce 2015 and had decided to get lunch. He was at the conference because his project required a technology platform, and he had chosen Salesforce.
In 12 weeks, we built a solution that significantly increased screenings for colorectal cancer.
Eager to please a client the size of AMSURG, Salesforce had set him up with one of its elite implementation partners. He had spent the past six months discussing the project with this partner. According to their initial estimate, the solution AMSURG needed was going to cost the company half a million dollars.
He was excited. He had come up with a great project. He had found a partner who could make it a reality. In his mind, the pilot was already a success.
He had no idea what he was getting into.
“Good luck with that,” I told him.
He paused and looked at me. “What do you mean?”
Not Exactly Persuasive
This leader was trying to improve colonoscopies. People needed them, but they didn’t want to get them. While it was hard to convince a patient to come in for their first colonoscopy, it was even harder to convince them to come back for a follow up.
To address this, gastroenterologists often have administrators send patients a letter reminding them of their follow-up colonoscopy. The administrators usually make a few hundred copies of a form letter, writing a different patient’s name at the top of each copy, and signing the doctor’s name at the bottom.
AMSURG needed a way to increase patient recall rates at all 245 of its ambulatory surgery centers.
While these letters contain important information about the patient’s upcoming appointment, they aren’t exactly persuasive. Attendance rates for follow-up colonoscopies are generally below 20% and sometimes even less than 10%.
He thought he had a solution to this. He had read about a best practice created by the Cleveland Clinic. The clinicians there had designed a Smart Letter system that had been shown to moderately increase attendance rates for follow-up colonoscopies. It had done so by giving patients information about their family history of colorectal cancer as well as their own risk of contracting the disease.
He wanted to use Salesforce to automatically generate smart letters for all of the surgery centers in the AMSURG network. He had already chosen four centers to serve as a pilot group. It was a great idea. There was just one flaw.
“How are you going to keep the doctors from feeling like big brother’s watching them,” I asked him. “How are you going to convince the administrators that they won’t lose their jobs? How are you going to build something they’ll actually use?”
“You’re right,” he said, sitting back in his chair, a troubled look on his face. He had thought of everything except how his project might impact the physicians and administrators it was meant to help. “How did you know that?”
An Easy Fix
Over the next week, I jumped on three calls with the leadership at AMSURG. We didn’t talk about technology once. Instead, we talked about my first job in healthcare as the IT manager of a gastroenterology practice that was partnered with AMSURG.
We talked about how we could build a solution that would fit into existing workflows. We talked about how we could collaborate with AMSURG’s partners to decrease colorectal cancer rates by increasing follow-up colonoscopies.
By the start of the following week, AMSURG had hired us to build a solution for the over 200 gastroenterology practices in its network. Our solution pulled patient data from GIQuIC, a national database that almost 80% of AMSURG’s gastroenterology partners were already using. The solution then generated personalized letters for those patients who needed a follow-up colonoscopy.
But when we rolled out the solution to the first practice in our pilot group, we hit a roadblock. The physicians at the practice refused to use it. I flew to San Antonio, where the practice was located, to find out what had gone wrong. As it turned out, the physicians there had a relatively simple, though firm, objection.
Every gastroenterology practice has its own instructions that it sends patients prior to a colonoscopy. Sometimes even doctors in the same practice will have different instructions. At the San Antonio practice, each gastroenterologist needed their personal instructions sent out in the letters.
We reassured them that we weren’t trying to change how they did things. Then we made it easy for them to include a link to their instructions in the letters. It was an easy fix.
A Single Letter
Soon after this, we rolled out the solution to the other members of the pilot group. We worked closely with the physicians and administrators in those practices to refine it. The letters it generated were delivered by mail or secure email, depending on a patient’s preferences. Each letter was personalized, pertinent, and persuasive.
The results were impressive. Attendance rates for follow-up colonoscopies rocketed to 40% at all four practices. When AMSURG decided to roll out the solution to the rest of its gastroenterology partners, it was a fairly straightforward process. Not only had we designed the solution to scale across AMSURG’s entire network, we had also developed it in collaboration with the regional marketing director in charge of convincing practices to adopt it. She understood the solution inside and out, making it easy for her to promote.
Because the solution we built was flexible enough to be used for procedures of all kinds, AMSURG eventually decided to implement it at all 245 ambulatory surgery centers in its network.
We accomplished this in 12 weeks at a quarter of what AMSURG’s original partner would have charged. We were able to work so efficiently because we know the healthcare industry. My experience as the IT manager of a gastroenterology practice meant we didn’t have to spend months trying to understand the existing workflows. My team’s broad experience in healthcare delivery meant we already knew the nuts and bolts of patient outreach.
“You need someone who knows what needs to be done,” I remember telling our soon-to-be customer in San Francisco. “You need someone who knows what’s at stake.”
Because when a single letter is all that stands between your patients and cancer, you really don’t have time to waste.
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