9. Recruiting clinicians and patients

Many integrated care efforts rely on enrolment into a new model or program of care, yet struggle to ramp up with sufficient clinicians or patients to prove cost effectiveness. Even pharmaceutical trials with large marketing budgets struggle – attached is a graph we plotted of comparable studies during the Diabetes Care Project for Australian Government.

Short of legislated change or opt-out trials (e.g. MyHealth clinical records in Australia), successful enrolment requires a handful of ingredients:

  1. Burning platform – clear rationale for change. This can be fact-based (e.g. International surveys show half of Australian patients have a coordination gap when discharging from hospitals to their GPs) or emotive (e.g. our elderly family members with chronic health conditions need better support than what we can provide in typical 10 minute consults)
  2. Clear benefits for participant – compelling reasons why. Clinician benefits can be financial, time savings, access to tools or resources, professional connectivity, training and learning, help to improve quality of care or advice in operating a business etc. Patient benefits can be feeling better, going to hospital less, taking less medications, living longer, doing more enjoyable activities, attending to hobbies, greater mobility, less pain, more function at home, improved sleep and appetite, social connectivity, peace of mind etc.
  3. Easy sign up – minimal time, steps and disruption to workflow (e.g. training events off-site), no pain points (e.g. enrolment website crashing) and allowance for multiple channels. For typical patient recruitment, in person enrolment and endorsement by clinicians known to patients is most effective (over 70 percent of patients contacted can be enrolled), followed by warm phone calls (over 50 percent), followed by cold calls (over 30 percent), and least effective is non-personalised email or mail (as low as 10 percent conversion).
  4. Knowing others are doing it – behavioural economists have demonstrated people are more inclined to participate in an event or change if they know it is the norm; this is powerful in prevention programs such as vaccinations and cancer screening. In integrated care, working with key influencers is important to drive the adoption curve.
  5. No financial, time or reputation risk – uptake will be low if clinicians risk losing money (e.g. healthcare homes providing a lower capitation payment than high fee for service funding), time devoted to administration of a new program or workflow (e.g. case reviews that require GPs to dial into teleconferences at a specific time when they may be consulting), or their reputation amongst patients or within their medical community (e.g. super clinics in the past decade that alienate existing GP clinics in the same location)

Best in class recruitment rates exceed 80 percent overseas, admittedly from Health Maintenance Organisations (HMOs) that have captive provider and patient networks.

References:

  • Australian Diabetes Care Project, Federal Health Department
  • Humana, InterMountain interviews
  • Commonwealth Fund surveys