Within two days of receiving chemotherapy, patients at the Center for Blood and Cancer Disorders in Fort Worth, Texas, receive a text from the practice to find out how they’re feeling.
Patients can respond by reporting that their reaction to the treatment, such as diarrhea or nausea, is mild, moderate, or high, says Barry Russo, CEO at the Center for Blood and Cancer Disorders. All responses from patients appear on a nurse’s dashboard, where the nurse then makes a clinical judgement based on the patient’s history. And if a patient doesn’t respond to the check-in text, they receive a phone call to find out how they’re feeling.
For example, one patient had responded after his two previous chemotherapy sessions that his symptoms were mild—only to present at the emergency department after his self-reported assessment. When this patient reports mild nausea or diarrhea now, he receives a phone call from the nurse to validate his self-reported health status.
Also, since many patients, especially those with blood-related cancers, such as multiple myeloma, take oral therapies—and, thus, don’t need to come into the office in person—the Center for Blood and Cancer Disorders uses a medication tracker that sends a text to patients to confirm that they took their medication.
The alternative is waiting a month for the patient to come into the practice, says Russo.
Oral therapies can have complicated treatment regimens, such as taking the medication on alternating weeks, says Russo. If the patient doesn’t respond by the third text, that information appears on a nurse’s triage dashboard, which then prompts the nurse to call the patient.
What’s driving the patient-centered communication
The practice is participating in value-based contracts with CMS and Aetna. It also plans to work with Blue Cross Blue Shield of Texas on a value-based care contract starting in January 2019.
Currently, 70% of the practice’s patients are in an alternative payment model, says Russo. That requires the practice to analyze patients’ claims data and isolate trends, issues, and problems to keep them out of the emergency room.
It would be impossible for his practice to communicate with and monitor its patients without relying on smartphones and the patient portal, he says. “We have so much more communication [with patients] on an ongoing basis. We can’t do that by phone or face-to-face in the office.”
Response from senior patients
Russo wasn’t sure that seniors would be responsive to getting texts from the practice, before rolling out this capability to patients. He’s found, instead, that seniors participate in significantly higher numbers than non-senior patients.
“I will tell you this about the Medicare population: They love to get texts. It’s a connection for them,” he says.
Socioeconomic status does impact patients’ ability to respond to text-based health status checks from the practice, says Russo. But he says this is diminishing over time as smartphones become more reasonably priced.
For patients without a smartphone, the practice needs to spend more time educating them to call the triage nurse or their case manager if they’re experiencing side effects from their treatment.