After the Visit Is When the Real Work Begins: Post-Visit Communication, Chronic Care, and the Technology Closing the Gap

This transcript was generated automatically and may contain errors.

Melissa Gilkes-Smith: Your patient just left the building, the visit went well, the provider was thorough, the instructions were clear, the care plan is in the chart. Now what? For most healthcare organizations, the honest answer is not much. A discharge summary goes home in a folder, maybe a reminder call before the next appointment, and in between, silence. For a patient with two chronic conditions trying to follow a care plan they only half understood, that silence is where health outcomes fall apart. Today we’re talking about pillar seven of the nine pillars of patient experience framework, post-visit communication, what it actually takes to extend care beyond the walls of the practice, and what happens to patients and to practices when you do it well.

I’m Melissa Jilk Smith. This is Touch Points, Moments That Matter. Let’s get into it. Today we’re inside Pillar 7, post-visit communication. This is the touch point that begins the moment a patient walks out your door. And for most practices, it is the most underinvested touch point in the entire patient journey. My guest today brings 20 years of healthcare operations, clinical products, and revenue cycle expertise, and a specific focus on where value-based care, chronic care management, and patient engagement intersect. He works with Subflow Health, a platform that automates patient engagement and clinical workflows to help providers deliver structured care between visits without overwhelming their teams.

Larry, welcome to Touch Points.

Larry Estes: Hi, Melissa. Thanks so much for having me. Excited to be here.

Melissa Gilkes-Smith: Excited to have you. So before we get into the substance, tell me how you got here. 20 years in healthcare operations, revenue cycle, chronic care management. What is the thread that runs through all of that and brought you to the work that you’re doing right now?

Larry Estes: That’s a great question. Absolutely have I like to laugh that most of the wrinkles and gray hair that I have is being in healthcare for as long as I have and the challenges it represents. But over the years, the thing that it’s always excited me the most is when I’m able to get closer to the patient, to be able to see the influence of what my company does and how it can impact them and their outcomes directly. And then obviously, not only them, but their families, their work, everything beyond that. And so after a couple of different opportunities, I found Subflow, was able to touch base with them. And the moment I talked with them and what they do, I knew they filled a void. Because one of the biggest challenges is the fact that once the patient, healthcare’s very good at knowing what happens inside the building.

But once the patient leaves, all bets are off. They just don’t know. And that gap, as you so very well describe in your intro, is exactly where things can go sideways. And Subflow has the ability to understand that, so pick up the signals, and very unique in the industry. And as I said, I’ve seen many different software solutions from a medtech perspective. And this is the first one I’ve seen to do what Subflow does. And I couldn’t wait to get started.

Melissa Gilkes-Smith: This isn’t just follow-through. Um, this is and not just a healthcare campaign, but follow through with specifically what they spoke about at the visit, the patient and the provider. This is the ensuring that the patient is able to follow that care plan. Did they follow through with what you spoke about during the visit, during that clinical encounter, you know, when the patient was just kind of like sometimes during the headlights, you know, lots of things are being thrown at me. And I’ve been handed a packet at checkout. And okay, so I’m gonna do all this. And then they get home and they set it down on the counter and they get on with their day. And this is where Subflow steps in, right?

Larry Estes: You’re you’re spot on. Uh you use deer in the headlights. I call it the white coat syndrome. You’re you’re in the room and you’re just nodding. There’s all these terms coming at you, and you’re trying to, as a patient, you’re trying to be um, you know, agreeable, et cetera. But you’re absolutely right. That packet of information, whether it’s from a provider or even from an ED visit, you take it and maybe it makes it to the car. If it makes it to the car, it probably goes in the back seat. If it makes it and if it goes inside, you’re right. It gets sat down, and the rest is history. The challenge with that is there’s no doubt most patients, unless they are in healthcare, perhaps like you and I might, we might have a different approach, but there’s a lot of information in there for them to digest.

And what Subflow can do is actually digitize that information and then by enhancing it, digitizing it, and delivering it in a very patient-centric, bite-sized way, the patient is able to absorb what they just heard, and now they understand how they can participate in their own care going forward.

Melissa Gilkes-Smith: So for a patient with one or two chronic conditions, the time between visits is where their health is actually being managed, or of course, you know, as we just said, not managed. The provider can do everything right in the exam room and still lose the patient to non-adherence, confusion, or simply not knowing what to do next. That’s correct. And so, from your experience across healthcare operations, what are the most common and most costly things that fall apart in that space?

Larry Estes: It could be a variety of things, but there’s a ones that come to mind at the top of the list, and believe it or not, is medication adherence. And obviously, a physician, a provider, a nurse practitioner could write that prescription and say, okay, go get this. This will help with your blood pressure, as an example, or diabetes. Take your pick. Obviously, these are all very important things that, if managed proactively, can have a much better output or outcome at the end as opposed to trying to catch up. And that in between visit adherence, orchestration, communication, managing expectations of the patient is where those improvements can fall. Because now then the patient’s going to actually understand why it’s important to get their medication, why it’s important to take it at the right time, why it’s important to perhaps exercise or whatever it is, because they’re being educated along the way in a way that’s most beneficial to them.

Melissa Gilkes-Smith: So, what is an example of? So we’re talking about medication management, we’re talking about reminders. How does this actually work specifically? Like let’s go through kind of an example with a patient.

Larry Estes: Sure. I mean, it could be as simple as once the patient leaves the office, the automation takes over. So it’s not something that’s going to be added to the staff, but the automation takes place, messages delivered to the patient, and it could be as simple as, hey, did you were you able to pick up the prescription that Dr. Smith sent for you? Yes or no. And then at that point in time, it could actually be one of, it depends upon that answer, if it’s a no, well, then the next step could be, well, can you tell us why? And so instead of just a simple yes or no binary thing, is to actually understand, particularly if it’s not adherent to the scenario at hand. And by doing that, now then we can actually get in front of it, solve that problem, and allow the patient to continue moving forward.

Melissa Gilkes-Smith: Now, these automations, because they’re a computer-generated, probably a lot of AI involved, or logic-based automations, these are mostly transactional. They’re yes or no questions, right? So when does the human element become involved, the relational part of that follow-up?

Larry Estes: Absolutely. So many times that follow-up can be very straightforward. And from a as from a call center perspective, right? You’re going to have some sort of care manager making the call. I may or may not pick up because I don’t recognize the phone number. I don’t have the time. So that goes into voicemail. So if I happen to pick it up, it’s going to be probably pretty perfunctory and just very simple, which means we’re paying somebody to do that. We’re paying somebody to leave a voicemail, we’re paying somebody to ask a pretty simple question. Whereas if you can automate it and have it delivered to the patient in a way that’s most beneficial for them, that’s great. Well, the this is where that differential falls for subflow, is that we know if that patient’s actually reading the information sent to them.

How much of the information is being sent to them? When did they open the text versus when it was sent? How many times was it sent before they opened it? And all these pieces of the puzzle. So every action and inaction is actually a signal on as to the patient’s adherence. And if those signals are sort of pointing towards, you know what, we have a patient that could be at risk. Maybe it’s because they didn’t pick up their medication. Maybe it’s because they didn’t read the text about doing their blood pressure test today. Maybe whatever the case may be, those signals now can say we may have an issue. And now then we the staff can be notified. This is beyond the basic, we need to have a human in the loop to make sure that this patient remains on track.

And that face-to-face or voice-to-voice opportunity is going to be there. And it could be something to the tune of, hey, patient, you know what, your office, Dr. Smith, is going to call you in the next half hour. Look for this number on your phone because we have some more questions for you. And so now then the staff is actually those providers, nurses, doctors, whomever it might be, are going to be able to truly practice at the top of their license, doing what they were trained to do, which is to interact with a patient when there’s an issue, as opposed to simply asking some very basic questions along the way.

Melissa Gilkes-Smith: It doesn’t feel like a checklist. It feels more customized to what the patient needs in their care journey at that moment, instead of just, well, I’m a nurse, I have this checklist here that I have to ask you questions, and well, that’s it, you know, called on.

Larry Estes: You’re exactly right. I mean, one of the things that I’ve seen over the years, and this is what makes this particular solution so exciting in its upflow, is the emergence of consumerism, where healthcare is understanding that patients have choices and patients want to be treated as a customer as opposed to a patient. This kind of solution does exactly that. It’s a customized care plan for them, and it will feel as such because of the interactions that take place and the way that it’s very patient-centric or consumer-centric in how it’s delivered, how the information is provided, how it allows for that two-way communication when the patient wants, as one example, or when it’s necessary to make sure the patient remains on track for their care plan.

Melissa Gilkes-Smith: And this connects directly to something I see in patient experience data consistently. When patients feel like the practice does not follow up after a visit, it reads as indifference, not as operational oversight. It’s more of a lack of care. The patient doesn’t know that you are understaffed or are using, you know, lagging data. They just know nobody called. So, how do you see that patient experience dimension playing into the clinical and financial consequences of the practice?

Larry Estes: That’s a boy, we could very honestly we can go on that one for quite some time, Melissa. Which is probably why you asked the question. In reality, I mean, it’s one of the things that I we’re starting to see the swing a little bit, right, especially relevant to value-based care, even how um payer insurance plans are covered, you know, the high deductible. There’s this obviously this very focused effort to make the patient more participatory in their own care and kind of make their own decisions on how they can improve it, as opposed to always waiting for a doctor to tell them what to do. So if you think about that, this is sort of that this allows them to not only take advantage of the lower costs associated with the care plan, or the insurance plan, I should say, but also kind of feel like they’re in control.

And I would argue that’s probably one of the main things. If you to do to digress just a little bit, the thing about health care is there’s really only you only use health care when things are going wrong. Except for one thing. If you’re gonna have a baby, then yeah, you want your health care, and that’s a good thing. But otherwise, it’s when something is not necessarily going as planned relevant to your health. And if there’s anything that can make someone feel out of control, it’s their health. And that uncertainty and the waiting and the well, what can I do? Questions that go through a patient’s head. By delivering a care plan and resources and videos and things to help them manage their own expectations in between those visits and allowing them to take a nugget of control back mentally, psychologically, is a huge win.

And so now then when they go into the doctor’s office again, particularly for a chronic care scenario, they’re able to say and feel like, okay, I’m doing this, and it’s not, it’s truly a little more of a two-way scenario. And the physician will know, they’ll be able to see the progress or the adherence, if you will, the adherence score, for lack of a better term, of that patient relevant to the chronic care management. And it can it can prompt another conversation. Hey, Larry, these are the kinds of things. Did you, what did you like about the video? What made sense? And so now then that care plan can be customized even further for that patient, making them feel one, it’s about me, not about the doctor.

And two, I feel like I’m a little more in control and I can actually influence my own outcome.

Melissa Gilkes-Smith: And this falls into also this touches on quality care metrics as well for with that follow-up, specifically, you know, not just, of course, outpatient practices, multi-specialty groups, you know, ambulatory surgery centers, but you’re also, you mentioned emergency departments. Mm-hmm.

Larry Estes: Absolutely. So to your point earlier, it was if I kind of had to um smile the packet of the discharge, right? And we it goes out the door. Let’s pick a scenario, and it doesn’t anyone can work, but the usual MO right now is they will get a phone call. Hey, or they simply just hand you out the paper. Here you go. Well, if you could automate those touch points after they leave, and then based upon those patient-reported outcomes, now then you could be, again, much more proactive is wait a minute, you know, his pain score is higher than we would think, or he should be able to breathe better based upon X, Y, Z, something’s still not quite right. And so what invariably would happen is the patient would, because they’re not having that communication, they don’t understand their expectations are not being managed, they go back to the ED or they go back, and now then things are escalated even further, which, from a value-based care perspective or bundle payment, we all know what that means financially.

But if now then, if you can have that conversation with the patient, get in front of those symptoms. Wait a minute, this is a signal that something’s not right because it’s all documented. Let’s bring the patient back into a primary care scenario or whatever the case may be. So that one situation doesn’t actually become a bigger scenario.

Melissa Gilkes-Smith: And this is what separates what Subflow does from a basic reminder system. You’re not just sending messages, you’re chat, uh, you’re tracking whether patients actually act on them.

Larry Estes: That’s correct. The information we capture is actionable. So we know if everything’s status quo, we’re good, or there’s something amiss. And the patient’s behavior is not going to allow this to move the right direction. So we need to get most patients probably are gonna be fine, but let’s face it, you only need one emergency room visit to ruin a day for everybody.

Melissa Gilkes-Smith: And and, you know, let’s of course talk about how, you know, staffing is always an issue in healthcare. And so, you know, fewer practices are actually able to make those follow-up phone calls for all of the patients that they see in a day. I mean, you have practices that see hundreds of patients a day sometimes. And, you know, how many, you know, staff are you actually going to be able to give to that specific task, to assign to that task of calling all of those patients back to find out, you know, did they did they understand, you know, their discharge paperwork? Do they understand what medications to take? Do they understand the instructions and of you know what to do next in their care and what what prescription to pick up, what labs they have to go get, what tests they have to go get, what doctors that they have to, you know, make an appointment with.

And and then all of that tracking the adherence, I mean, that that right there is an algorithm that not many, you know, people could actually manage to track and figure out, oh, what is the trend for this specific patient with their adherence level, right? And so this changes a lot of things and it helps the practice follow up without having to dedicate all of the staff that they don’t have.

Larry Estes: Exactly. I mean, if one of the uh customers we have actually saves six hours a week making phone calls. So kind of go back to your previous statement about what could that nurse navigator do with six hours a week back into her schedule? How would that impact the care of the other patients within the practice? How would and this is where this is where it becomes fun? I have a it’s over here on my left, I have a book um that I love for our kids called If You Give a Mouse a Cookie. Yeah, it’s so much fun. And then and they’re like, well, why do you have that? Because that’s health care. And his is a perfect example. If that nurse navigator can now spend more time with patients at the office face to face, how would that affect their patient satisfaction?

And if that patient satisfaction goes up, how does that impact their own care and what they think and how they want to participate? You know what, Dr. So-and-so’s office, I spoke with this nurse, and boy, that was great. I really felt I really felt like I was their focus. And then it just could feeds on itself. In the meantime, those patient reported outcomes that are coming back in from the subflow platform are giving the the providers that much more insight on how that patient behaves and what’s going to be the best way for them to move forward in the process. And then just even things like that’s uh we go back to the uh a nurse navigator making a phone call. If I do pick up and I’m talking to somebody, I’m gonna try, I’m working as hard as I can to get off the phone, most likely.

I’ve got something else going on. So maybe my answers are as are 100% honest, but they may not be as full as they could be. Whereas if it’s via a text messaging now, then based upon that first answer, I can go even deeper in my responses. Those responses are that much more actionable for the provider and gives them more insight into actually what’s happening. And at this point in time, no staff has gotten involved, except if those answers that the patient’s providing indicate this could be something bigger. And now then they can actually apply their skills where it’s needed, not just because. Perfect. Exactly right. That’s where the that’s where the magic happens, right? I mean, it when it’s all about me in the patient’s mind.

And that’s what they want to see. And when it’s just simply to you, as you mentioned earlier, a checkbox, okay, great. I called Larry, I call Melissa, I called Sam, I called Mary. That’s not it. And the same thing, you know, if you think about what today is, and we all know why, we can talk about that. That’s a whole nother podcast. When the patient goes into the office and the doctor is staring at the screen and putting information into the EHR, days of them really turning around and spending that 20 minutes, half hour with the patient, that just doesn’t happen as much. And so there’s that experience from the patient, the pack of papers, and they’re off the door, as opposed to now, then they’re getting this personalized attention, this personalized communication specific to them, their situation with guidance, education, resources at their level about their situation and when they want to or when it’s necessary.

Now then they get that one-on-one time to make them feel like they are the center of that provider’s universe.

Melissa Gilkes-Smith: And that’s of course how you build, excuse me, loyalty through the relationship. It’s the practice-patient relationship that you’re building that’s that’s what builds the you know loyalty from those patients. Um you had mentioned uh the EHR. So the integration question is one I know that practices always ask before they commit to any new technology. Walk me through what real integration looks like with different um, you know, EHRs.

Larry Estes: Happy to. So SubHub is built with fire um technology, APIs all over the place. So we’ll connect with anybody that will let us. The reason that’s important is let’s say we’re having a conversation, the doctor’s having a conversation, and this patient’s been diagnosed with hypertension. I want that patient to enter into this care plan. We will listen for that signal. In reality, that’s what Subflow does, is we just keep listening for different signals in different places. That signal comes in automatically from the EHR into Subflow, initiate the hypertension program for Larry. And off we go. Now, as those, as that information is captured, as those signals are captured, as their behavior is captured, and what’s taking place downstream, as I mentioned, it’s all actual, that can actually determine the next step in the care plan, number one.

And number two, those data points now then can be sent back upstream to the EHR. So now then there is a single source of truth for what’s happening once the patient leaves the building. Now, the good news is if that EHR does not allow an API integration, Subflow can actually operate independently. It can also be attached, frankly, to a CRM. Any source, any way that you want to initiate that care plan, it is happy to do so. And regardless if that data is going upstream, it is still being captured and kept so that it’s available for use and um analysis later.

Melissa Gilkes-Smith: So does this also connect with your um with the practices patient portal as well? So that can the patient communicate within the patient portal also with Subflow?

Larry Estes: That’s a very good question. And actually, one of the huge benefits that a lot of our clients like is the fact that we don’t have a portal. Theoretically, we could put it into the portal, but there’s no passwords, there’s no need for a desktop, there’s no need for any of that. It’s very patient-centric. So, and it’s designed to be mobile friendly, it’s designed to be simple, it’s designed to be intuitive. All these pieces of the puzzle are going to allow for better patient participation one way or the other. And so that I you and I both know healthcare, obviously, Melissa. I call I sign in some portals, and but uh I know what I should be looking for, I know what I want to find, I know the language, but this is so far more confusing and challenging that it should be.

Whereas Subflow does allow, well, I’ve been very into it, but it does allow for two-way texting. It allows for the communication to go back. There’s a there’s there’s a way to just simply press the button and call the office. So, in other words, the patient’s always one step away from having that interaction. And because what happens also is once these signals are received, that’s that perhaps that patient’s at risk and the escalation has occurred, that task basically will now fall onto somebody’s staff’s desktop. They will be notified that this patient needs to be contacted or this patient has a question. So, in other words, it’s a lot easier and there’s it’s a notification as opposed to hoping that the they sign on to the portal and the EHR and the EHR tells them what’s going on.

Melissa Gilkes-Smith: So it’s one less thing for the patient to lock into because you know you you go see, you know, depending on certain patients, I mean chronic care management patients, they’re probably seeing a good amount of doctors. And every single you know practice has a different portal to lock into, a different EHR system. And so they’re trying to figure out how to navigate those portals, but everybody, just about everybody, has a phone that they’re texting on.

Larry Estes: You’re exactly correct. And you can design it that way. And and so in also if you even think about, I mean, it chronic care, as we know, uh addresses so many different demographics. But um, if I’m slightly older, let’s put it this way, I would much rather use my phone at a certain age than trying to navigate on a desktop and patient portal. It’s gonna be much simpler for me to understand what’s happening because you know there’s a qu there’s a question about, well, is it good for the elderly? Well, actually, it gets more and more useful for elderly all the time. There’s still an acceptance phrase of, I think, in the mid-90s, no matter what the age is. Now, absolutely. There are some that probably will be not as comfortable.

Subflow actually is agnostic. We can do phones, we can do other opportunities, we can do email. So we have other ways. We probably lean most on texting because it is so universally accepted. And as you just pointed out, everyone has a phone. Uh and it’s it’s much easier to do it that way and to get to drive action is really what we’re trying to do. We’re trying to drive action, drive adherence. And if not, if we’re not seeing that, then also allow the provider, because as we started off this whole conversation, they walk out the building, what’s going on? Well, now then we’re subflow allows the provider to see what might be taking place in between. And one thing I’ll mention here just simply because it kind of came to my mind, is as remote patient monitoring devices continue gaining popularity, um, Subflow can actually integrate with that.

So let’s use our hypertension as an example. I do, I take my blood pressure every day. I don’t, I probably should, but I don’t. Let’s say I take my blood pressure every day with a remote device. Subflow can actually integrate with that. And that signal then can say things are in our nominal, we’re good, or wait a minute, it’s falling out of range. Now then this needs to be escalated and can move forward from there.

Melissa Gilkes-Smith: So I love the product. I I truly do. And for practice administrator or patient experience leader who is listening right now, who knows their post-visit communication is insufficient, but does not know where to start, what is the first thing that they need to do?

Larry Estes: The first thing they one, let’s have a conversation. Um, invariably, one of the things that we want to do as an organization is we want to really understand what is the gap that you’re seeing? What are your, what are the things that you would want to change? If you had like three priorities relevant to this very issue, what are they and why are they their priorities? And then that allows us to kind of sit down and put together a customized uh approach, most likely one of, you know what, let’s walk before we run. Let’s pick a condition, let’s pick a type of patient that you would really want to impact the most. What’s the one that, gosh, if only and he kind of, if only I could fix X. Okay, what’s X?

And let’s start there and let you see how this works, how it can offload the time from your staff, how it can impact the patient satisfaction. And obviously, at the end of the day, you know, this is where it gets to be really fun. Um, as more and more data will be collected, whether for your practice or for whomever, you’ll be able to see what are the, let’s look at our adherent patients, the ones that are in the green, if you will, what are the ones that are in the yellow, and what are the ones in the red? But then let’s look at the claims data attached to that. How often are the ones in red visiting your office versus the ones in green? Well, right there, you’re looking at a huge impact. If you’re in a bundle payment scenario, if you’re an ACO, if you’re within an ACO or you are an ACO, let’s look at that cost of care journey across time and how patients behave accordingly and how adherent they are and how that can impact those approaches.

So, as a practice administrator, let’s pick one, let’s look at it, let’s watch it for a short amount of time, maybe just a few months, let’s you see just how exciting it can be, the impact it will have, and then from there, we can expand based upon your priorities, not ours, on what’s the most important to you. And by the way, we’re this will be a white glove scenario. This will be, we don’t drop it on your doorstep and then run away like Amazon. We’re actually going to hold your hand, make suggestions on how to set up a care plan specific to what you just said, what you asked us, and then that way we can help monitor your success.

Melissa Gilkes-Smith: So this is not just a you’ve you’ve not only just improved the post-visit communication for a practice, but you are in the process of improving their post-visit communication. You are improving the pro the new process. So over time by showing those trends, and this is your adherence level, and this is where we need to make some updates. Let’s make a little bit of you know, a change here and a change there, and let’s see how we can get that adherence rate even higher.

Larry Estes: You’re exactly right. The one of the most exciting one of the most exciting things about what we do is we capture data. Data gives you options. And so now then, if you understand to your point, Melissa, if these are adherent, well, what changes could be implemented? Why is this group a little bit better than this group? What might cause that? And so now then the analyses can actually take place because you have the data to use. Before, again, we’re just kind of proverbial spaghetti in the wall. I’m going to make a phone call and I’ll, oh, I reminded Larry about his appointment, but he wasn’t here. I sent a text. I called him, but he didn’t show up for a procedure. Well, what if you knew, you know, ahead of time how I behave relevant to text messages?

I read the material. And so now then I can adapt it, et cetera. All these pieces of the all these pieces of information is what exactly let me back up just a second and say this. Data has been out there in healthcare forever. It’s a lot of it. We’ve been collecting it for so long. We are now getting to the point where we can actually utilize, understand, and act upon the data being collected. That’s a whole different ballgame. And where Subflow sits is, I would argue, a new area of data that has not existed before. And if you think about healthcare in general, this is a very rough number, but 1% of the time of your year is spent in the doctor’s office. The other 99%, you’re not in the doctor’s office, but yet you still have the chronic condition.

You still have the recovery from a from a surgery, you still have whatever it may be. So that 99% has been, for lack of a better term, in the dark. What SoFlow can do is shed some light on that 99% of the time, and then help the providers improve it even more. And if I was a provider and knew that I was able to make that patient’s life even better, that’s why I went into medicine.

Melissa Gilkes-Smith: And using your numbers, the 99% and 1%, it it feels like most practices focus on the 99% is getting the patient to the appointment and then what happens within the appointment. Then the 1% is the focus on what happens to that patient when they’re at home. When they’re not at home. Yeah, yeah.

Larry Estes: Yeah. Yeah. That they and but that’s sort of that makes perfect sense. Yeah, I can see why that’s and that’s probably the challenge of why I’m so excited about what we do. Mm-hmm. Because I mean, it’s if it I think the percentages is probably very familiar to you. Um, you know, 70% of clinical outcomes does not happen. I mean, this is like documented, and it’s particularly relevant to um um uh you know demographics. And I I apologize, I I never remember the terminology, so forgive me, but it was previously classified as uh social determinants, where 70%, that’s actually what determined the outcome, even if they were frankly adherent. Well, it’s kind of the same thing, 70 versus 30, and really the 99% of the time, whatever the number is, that’s where things happen or don’t that will impact that patient’s outcome.

And if you think about the patient’s clinical outcome, we obviously under know, I mean, we we want to focus on that, but there’s a financial implication to that as well. It’s it’s going to increase the cost of care. And we we talked about this earlier on about uh if I come out of an ASC and uh I had some type of surgery, typically what happens, I call, they they call, hey Larry, how are you doing? Good, blah, blah, blah, blah. If I listen to it, right? As opposed to receiving a text, Larry, thank you for choosing our ASC. We really appreciate it. I have a quick question for you about your pain level. How’s your pain level? One to two, perfect, take a Tylenol, call me in the morning. Three to four, I’m gonna check in with you because that’s a little high.

Five to above, you know what? Time to come in, just show up, or someone’s gonna call you in the next half hour, please answer the phone. What was happening is patients had that pain level, they just went to the ED. And so again, you’re in that scenario, that emergent situation. Think about a cardiac scenario, uh, recovery from a stroke, anything like that, a TIA, where that post-encounter is so important on how that patient’s long-term recovery and outcome will be. If you can stay in front of that and pick up those signals on how adherent are they to their medication, to their exercise, to things that will, maybe it’s a breathing exercise because they had lung, whatever the case may be, things that you can identify as being actionable that can improve or mitigate, improve their scenario or mitigate potential problems.

Melissa Gilkes-Smith: So, what is one thing, if you were to leave just what one note, one comment, one statement to our listeners right now, what would that be when it comes to post-visit communication when it comes to this follow-up? That’s a good question. What would the one thing be? I would say this, I guess, and that would be how would you feel if you could improve your patients’ uh outcomes even more? What would it mean to you as a professional? What would it mean to you as a human to know that you made your patients even better because of your ability to connect with them and act upon how they’re doing even because even when they’re not in front of you. That’s a good question. That’s good, that’s some good food for thought.

Larry, what you brought to this conversation is something that patient experienced practitioners and healthcare administrators need to hear together in the same room. The case for post-visit communication is not just a patient satisfaction argument. It is a clinical argument and a financial argument. And when you have to make all three cases at once, it becomes very hard to dismiss as a nice to have. Here’s what I want our listeners to carry away. The visit is the beginning, not the end. The clinical encounter sets the plan. What comes after determines whether the plan actually works. And every practice has an opportunity right now with the technology that exists today to close the gap between what they promise in the exam room and what they deliver in the days and weeks that follow.

Your challenge this week: pick one appointment type at your practice, the one with the highest no-show rate, the highest readmission risk, or the lowest follow-up compliance. Write down every communication that patient currently receives after their visit. Then ask, is that enough to actually support what we ask them to do? That gap is your post-visit communication strategy, and it’s yours to close. Larry, thank you for your time and your perspective. I think this conversation is going to have to move some things for the people who hear it.

Larry Estes: Fantastic. Well, Melissa, thank you again for having me. I’ve really enjoyed it. Uh, I certainly hope that your listeners take away something that will be beneficial to their practices, but especially their patients. And uh that’s why we’re all in healthcare is for the improvement of patients. So it’s it’s a pretty exciting place for everything. Thanks so much for having me. I enjoyed myself.

Melissa Gilkes-Smith: Absolutely. We enjoyed having you. Larry’s contact information and subflow health are in the show notes. Every interaction is a moment that matters. I’m Melissa Jilk Smith, and this is Touch Points. If this conversation moved you, subscribe wherever you listen and connect with me on LinkedIn. I’ll see you at the next Touchpoint.