NACHC Blog

Authored by Andrea Wilson (AllianceChicago), Manav Mohanty (AllianceChicago), Gabriela Villalobos (Settlement Health), Warria Esmond (Settlement Health), and Bobbi Weber (QliqSOFT, Inc.).

We know routine preventive care plays a crucial role in maintaining overall health and preventing costly medical conditions. Yet, it’s still hard for vulnerable populations to access preventive care– or fully appreciate the need to pursue it. That’s why AllianceChicago and New York’s Settlement Health partnered to tackle access and education challenges with an innovative outreach strategy using artificial intelligence-enabled and customized chatbots.

Customized by software company QliqSOFT, the chatbots were created to engage patients, especially high-risk or underserved patients, in bi-directional conversations (English or Spanish) about their health and care available to them. The aim has been to use these chatbots to educate patients about preventive services available, invite patients to share concerns about preventive services, let them know why they should care, evaluate the social drivers of health (SDOH) that may be preventing them from getting care, and identify the scheduling services that are available to them now.

For this innovative effort, AllianceChicago and Settlement Health merged expertise in population health and human-centered design to codevelop a digital-patient engagement strategy with AI. The chatbots were programmed to proactively reach targeted patients and draw their attention to relevant preventive care services such as cancer screening. With new digital channels for patient access, education, and engagement like smartphone secure text messaging using conversational chatbots, the health centers were able to use the chatbots to connect with patients and unlock opportunities to reduce health disparities.

The program’s success hinged on identifying and addressing the SDOH factors that pose barriers to primary care use but can be addressed, such as care coordination or transportation assistance. (SDOH impacts up to 80% of health outcomes.) AllianceChicago and Settlement identified patients eligible for specific services, engaged them in screening for SDOH, and promoted preventive care (like immunizations, cancer screenings, well-child visits, etc.) that were easily accessible and could help. Exciting improvements were observed in the uptake of preventive care, patient engagement, and provider satisfaction.

How did this program work?

1. Population Health Approach: The initiative promoted equitable care by meeting the specific needs of vulnerable populations with the help of programmed chatbots that could engage with patients, learn their barriers to care, and promote preventive care services at the health center based on the patient’s needs.
2. Patient-Centric Design: The chatbots were designed to personalize patient interactions, gather sensitive data, and preserve patient privacy and preference.
3. Staff Involvement: The development team included front-line clinicians, leadership, quality, data, and IT representatives. This team determined the tenor and timing of the communication with patients, and how a trusted care team member could introduce this technology. For example, they informed the chatbot designer about digital literacy and patient preferences for communication.
4. Continuous Improvement: Iterative refinement (with PDSA cycles) was followed, based on quantitative and qualitative data that could help make the chatbots more effective.
5. Technological Enablement: AI-enabled chatbots enabled the health center to leverage real-time communication and engagement in ways that are scalable and feasible.

What made this effort successful?

• Focused outreach for specific services like breast cancer screening, colon cancer screening, pediatric well-child visits, immunizations, SDOH screening, and remote blood pressure screening.
• Collaborative partnerships that enabled partners to share expertise and contributions, enhancing the initiative’s impact. In this case a Health Center Controlled Network (AllianceChicago), QliqSOFT (AI/chatbot company), FQHC leadership (Settlement Health), providers, and patients.
• Patient satisfaction with chatbot interactions led to an increase in the number of patients who completed surveys and then sought needed preventive services. Survey results demonstrated that patients found the chatbot interactions “personal and interactive.” Although it was a virtual conversation, she knew, “someone was behind the scenes.” 
• A system for SDOH screening, which revealed and addressed significant patient needs in areas like housing, transportation, and food assistance.
• Referral navigation. Once SDOH screening identified patient needs, health center staff could take additional steps to recommend and schedule follow-up care.
• Patient privacy. Patients disclosed SDOH needs at higher rates than noted in other published initiatives, which may indicate a greater willingness to disclose sensitive issues. 

Getting an innovative effort like this to work takes lots of trial and error. After 6 months, the chatbot project was able to successfully streamline aspects of SDOH screening, address care coordination challenges, and improve workflows. AllianceChicago and Settlement Health also created educational materials and leveraged multi-media resources through strategic partnerships to help motivate new patients to access services and improve health literacy for a wider range of patients.

Leveraging chatbots to promote preventive care to a broader patient base is one of the interesting and innovative ways health centers around the country are tapping into AI to enhance their services and engage patients.

To learn more about this AllianceChicago and Settlement effort, contact AllianceChicago at info@alliangechicago.org.