OneCity Health Schedules 1,100 Annual Primary Care Visits Through Proactive Phone Calls to Patients

Primary care is often referred to as the first line of defense. Having access to a regular primary care physician helps keep patients healthy, including by addressing patients’ needs early before symptoms worsen and require a visit to the Emergency Room. From our focus on palliative care integration and promoting cardiovascular health excellence to Patient-Centered Medical Home recognition, the foundation of many OneCity Health efforts is to support our Performing Provider System (PPS) partners in delivering high-quality primary and preventive care.

It is equally important that we help patients schedule and complete an annual visit with a primary care physician to receive these services. Through our program to conduct proactive, automated outreach phone calls to patients overdue for an annual primary care visit, OneCity Health has helped schedule over 1,100 primary care appointments since April 2017!

A variety of barriers can prevent patients from completing their annual visit with a physician. These include language challenges, difficulty navigating the health care system or a lack of awareness on the importance of preventative care. To help patients better engage with primary and preventive care, OneCity Health developed a strategy to identify patients in need of an annual visit and to proactively reach out to these members to arrange medical appointments.

OneCity Health identifies Medicaid members’ age 1-year-and-older who have not completed an annual visit with his or her pediatrician or primary care physician in the last 12 months using the electronic medical record. In coordination with a vendor, OneCity Health conducts automated phone calls to these patients in eight different languages, asking if they would like to schedule an appointment. Interested patients then receive a call from the NYC Health + Hospitals call center to schedule their primary care appointment.

Beginning with a 3-month test from April-June 2017 focused only in the Bronx and Brooklyn, OneCity Health initially helped schedule 434 primary care appointments for Medicaid members. In February 2018, OneCity Health relaunched and expanded the program to Manhattan and Queens. From February 2018 – April 2018, OneCity Health helped proactively schedule 711 primary care appointments for Medicaid members.

Early feedback from the call center indicates that patients did need some assistance navigating the health system, and appreciated that the calls were meant to connect them with care. OneCity Health will continue to track engagement and program feedback to enhance preventive care for patients.