Still struggling to find the monetary value of a strong patient communications program? This white paper maps the advantages and provides evidence about the ROI of using sustained electronic communications to improve patient satisfaction and outcomes.

2. ! YOUR AUDIENCE IS EVERYWHERE, SHOULDN’T UBI?
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UNDER PRESSURE
Hospitals today are under tremendous pressure to improve patient outcomes and, at the same time,
reduce costs. One of the best ways to achieve this goal is to make patients and their families part of
their own care team.
In a systematic review of research on the links between patient experience and clinic safety and
effectiveness, British researchers noted “positive associations between the quality of clinician-patient
communications and adherence to medical treatment in 125 of 127 studies analyzed … [which]
showed the odds of patient adherence was 1.62 times higher where physicians had communication
training.” They also observed “evidence of impacts on resource use of primary and secondary care,
such as hospitalizations, readmissions and primary care visits.”1
To this end, electronic communications via email, social media and the hospital’s website can
effectively augment and reinforce in-person communication to improve patient education, compliance
and outcomes.
The ideal approach is to be in regular contact with the patient (and a family member or caretaker when
appropriate) beginning as early in the process as possible.
One-to-one channels of electronic communication are ideal
for this purpose. Even the majority of the senior population
(age 65+) is online and more than 90% of adults ages 18–49
use the internet.2
Internet users already go online when they have health
concerns: 72% have conducted a health-related search,
according to the Pew Research Center.3
Email communication
provides the most efficient means— in terms of time, effort
and cost—of sustained connection with patients to educate
and encourage adherence to hospital recommendations.
However, as noted by Betsy Weaver, Ed.D., CEO of e-
communications solutions provider UbiCare, to stand out in the queue of emails in the patient’s inbox,
“messages must be concise, of high value, contain reliable content and be precisely timed to coincide
with what is happening in the recipient’s healthcare life at the time of delivery. And the message must
be worth taking action on—now!”4
Hospitals are finally finding ways to routinely collect patients’ email addresses. For example, classes
educating prospective patients about an elective surgical procedure represent an opportunity to
obtain email addresses—from the prospective patient as well as family members. These contacts
should be entered in a database, labeled as class attendees, and uploaded into a software platform
with customer relationship management (CRM) capabilities. This enables the hospital to stay in touch
The result is patients
who are more educated
about the “whys”
behind their care
instructions and are
therefore more
compliant. This, of
course, fosters better
outcomes and increased
patient satisfaction.

3. ! 2!YOUR AUDIENCE IS EVERYWHERE, SHOULDN’T UBI?
!
with this target population on a regular basis, sending
out additional information and positioning the hospital
as the expert health resource in the community.
Once a prospective patient schedules a surgery, the
hospital has an opportunity to begin sending regular
email messages related to the surgery date—and the
multiple benefits and cost savings of timeline-specific
email messaging begin to accrue. Each message walks
the patient through important steps from pre-op
through the procedure itself and then the stages of
post-op rehab. By including FAQs, information on
selected diagnoses and the hospital’s resources, as well
as links to additional details, these email messages
reinforce the in-person communications between
healthcare providers and patients.
The result is patients who are more educated about the
“whys” behind their care instructions and are,
therefore, more compliant. This fosters better
outcomes and increased patient satisfaction, which
(measured by HCAHPS) has been shown to be more
highly associated than any clinical measure with
reduced “avoidable” readmissions.5
And that is money
in the bank.
SELLING IT TO THE C SUITE
This sounds like the right thing to do for patients, but how can the need for this be best explained to
hospital executives in charge of a clinical department’s budget?
In order to determine the return on investment (ROI) of implementing targeted patient messaging, it is
helpful to look at avoidable readmissions. Last year (2012) was the first year for Medicare hospital
readmission penalties with a maximum penalty of 1% of Medicare payments to the hospital. In 2013
the maximum penalty goes up to 2% (and again in 2014 to 3%). Furthermore, additional measures—
including hip and knee replacement surgery—have been announced for 2013.
Here are a few thoughts about ROI that may prove helpful when discussing the financial benefits of
implementing a new process at the hospital.
!
Preventing Blood Clots
Blood clots are normally not a problem after
spine surgery, but when they do occur they can
be serious. So we take special precautions to
prevent them, which may include prescribing
blood-thinning medication.
In the hospital, you will be fitted with special
elastic stockings while you are in the holding
room prior to surgery. Before being put to sleep
in the OR, you will be fitted with plastic boots
that surround your lower legs with air and
inflate and deflate to aid circulation.
After surgery, we will teach you leg exercises
that will keep your blood circulating, prevent
blood clots and strengthen your back.
Sample support section from UbiCare's Spine Surgery email!

4. ! 3!YOUR AUDIENCE IS EVERYWHERE, SHOULDN’T UBI?
!
ROI can be divided into “hard dollars”
and “soft dollars.” Hard dollars are
direct cost savings, while soft dollars
are generally time savings (which free
up staff to do other tasks) or
improvements in patient and/or
employee satisfaction leading to
recommendations (bringing in new
patients), reduced staff turnover
(savings in hiring/training costs) and
improved perception of the hospital as
a great place to work (thus attracting
the best applicants for positions).
Whenever possible, try to assign some
dollar value to the soft dollar ROI
items to obtain a more accurate
picture of the true value of adding a
new process. This is often not done,
making the up-front cost of a new
process look too expensive.
Implementing change is a challenge for everyone, so the ROI needs to be demonstrated to be
worthwhile and have a positive effect on as many departments as possible.
Here are examples of ROI for an email patient education and engagement product for hip and knee
replacement patients at a hospital with an annual operating revenue of $200 million and an annual
Emergency Department capacity of 20,000 patients):
• Annual license fee for an effective e-communication product = $19,000
• Medicare reimbursement penalty avoided = $31,250 (1/4 of $125,000 – CMS’ average penalty
for 2012)6
• Increased bed capacity = $500 (assuming operating at or near capacity, with $1,000 per
admitted patient vs. $500 per discharged patient)7
• Additional patients able to be admitted from ED = $40,0007
(4% of 20,000 patients leave ER
without being seen = 800 patients x 10% admitted = 80 x $500 per patient)
• Hospital operating revenue at risk based upon transitions of care measures = $20,000 (0.1% of
$200 million)7
d"
Patient"Education"and"Engagement"
Increased)patient)education)has)been)shown)to:)
! Reduce)healthcare)providers’)costs)due)to)fewer)
readmissions)(these)are)direct)savings)for)ACOs).)
! Avoid)or)reduce)Medicare)reimbursement)penalties)
(due)to)reduced)readmissions).)
! Increase)hospital)bed)capacity)(beds)that)were)being)
used)for)readmitted)patients)could)be)used)for)more)
profitable)patients)and)for)timely)transfers)from)the)
Emergency)Department).)
! Reduce)Emergency)Department)wait)times)(avoiding)
patients)leaving)without)being)seen).)
! Improve)patientDsatisfaction)ratings.)
! Improve)patient)careDquality)measures)(due)to)
improved)compliance).)
! Reduce)adverse)events)(due)to)improved)compliance).)
! Improve)hospital)ratings)(attract)new)patients)and)staff)
applicant)pool).)
! Reduce)medical)malpractice)costs.)
! Increase)payDforDperformance)reimbursements.)
! Increase)staff)satisfaction)(and)reduce)turnover).)
!

5. ! 4!YOUR AUDIENCE IS EVERYWHERE, SHOULDN’T UBI?
!
• Cost per readmitted patient = $2,0006
up to $60,0008
(applicable for ACOs and bundled
payments)
In addition to the financial benefit to the hospital, consider the improvements in patient perception
and willingness to recommend the facility. These perceptions are likely to be reflected in improved
HCAHPS scores. Higher HCAHPS scores not only improve hospital ranking in various “Best Hospital”
reports, but represent 30% of the performance scores for incentive payments (CMS Value Based
Purchasing Program).
STAFF-PATIENT CONNECTIONS: TWO-WAY IMPACT
Standardized, automated patient education and communications resulting in knowledgeable,
compliant patients reduces stress on staff. This, too, can impact patient satisfaction.
As noted in “Healthcare HR and the Bottom Line,” a 2012 white paper from Healthcare Source,
“happy employees help make patients happy. Therefore, when institutions provide a satisfying and
supportive workplace for employees, patients are more likely to have a positive in-hospital
experience.” In other words, “happy employees result in happy patients and HCAHPS scores go up.”9
DEMONSTRABLE VALUE
Hip and knee joint replacement procedures are ideal occasions for implementation of a measureable
education and communication initiative. Provision of a unique, hospital-branded, compelling and time-
relevant education tool to patients having an elective procedure can be used to demonstrate the value
of this approach. Patient satisfaction scores should rise, outcomes should improve and, ultimately, the
volume of patients choosing the hospital should increase.
For example, New England Baptist Hospital (NEBH) learned from an ongoing survey of post-op hip
and knee replacement patients (1,381 respondents) that 86% found the hospital’s email education so
valuable that it “would be a factor in recommending NEBH to friends and family.”10
Need more convincing? Consider these quotes from joint-replacement patients who have received
email education in addition to attending pre-surgical classes:
“Being a nurse anesthetist, I have seen many knee replacements; therefore, I felt I
had a good understanding of what to expect from the surgery standpoint. The
emails kept me informed of post-op progress and I found them to be very helpful. I
found the pre-op classes were good. ... I found several of the PT's tips on how to
get around during early recovery very beneficial, especially since I had bilateral TKR.
I am fortunate to have a medical background, but I still found that I didn't know
everything and was glad to receive a lot of good information. I have recommended
St. Vincent [Health System] to several friends who have had the same surgery.”

6. ! 5!YOUR AUDIENCE IS EVERYWHERE, SHOULDN’T UBI?
!
“The emails came just as I had questions about the next step. … The emails were
very useful to me … and I have recommended New England Baptist Hospital to
others.” 11
Suzanne Nylander, O.D., B.S. is the director of business development and sales for UbiCare. Suzanne has
worked with numerous health plans providing healthcare survey research focused on quality improvement. She
has a Six Sigma Green Belt certificate in Healthcare and a Lean Six Sigma certificate. Her prior experience
includes professional relations/education for medical device manufacturers, technical articles in ophthalmic
publications and clinical practice.
Betsy Weaver, Ed.D., is the CEO, President and Co-Founder of TPR Media (d.b.a. UbiCare) and is a nationally
recognized innovator in patient education and healthcare communication. With the formation of TPR in 2002,
Weaver created the first email services designed to enhance hospitals’ care connections with patients and
streamline processes for staff. Building on this success, in 2010 Weaver created the first hub platform for
healthcare, incorporating email, social media, text messaging and web services.
UbiCare is an award-winning e-communications solutions company whose proprietary software creates
connections that impact behaviors to change outcomes. UbiCare’s evidence-based customizable, timely and
targeted products feature automated, mobile-optimized email newsletters, campaigns, surveys, microsites,
text messaging and social media. Management tools and real-time reports make it easy to track ROI and
make iterative changes as needs evolve. UbiCare’s unique technology enables its healthcare, education and
nonprofit clients to build and sustain strong relationships with target populations. Achieving 57% open and
84% interaction rates, UbiCare’s solutions educate and engage while building brand loyalty.
Contact UbiCare at info@ubicare.com or 617-524-8861 to learn how we can help you!
Foot Notes:
1.) Doyle et al., “A systematic review of evidence on the links between patient experience and clinical safety and effectiveness,” BMJ Open
2013, e001570, p.4, http://bmjopen.bmj.com/content/3/1/e001570.full
2.) Pew Internet & American Life Project Surveys, “Demographics of Internet Users,” Post Election Survey, Nov. 14 – Dec. 9 2012,
http://www.pewinternet.org/Static-Pages/Trend-Data-%28Adults%29/Whos-Online.aspx
3.) Fox, S. and Duggan, M. “Health Online 2013,” Pew Internet & American Life, http://www.pewinternet.org/Reports/2013/Health-
online/Summary-of-Findings.aspx
4.) Weaver, B., “Care Connections, 2012: What Will Today’s Trends Mean Tomorrow?” UbiCare white paper, 2012,
https://social.ubicare.com/whitepapers
5.) Press Ganey Performance Insights white paper, “The Relationship Between HCAHPS Performance and Readmission Rates,” 2012,
http://healthblawg.typepad.com/files/performanceinsights_readmissions-12-12-2012.pdf
6.) Laderman, M. et al, “The Effects of Medicare Readmission Penalties on Hospitals’ Efforts to Reduce Readmissions: Perspectives From the
Field,” The Commonwealth Fund Blog, Feb. 26, 2013, http://www.commonwealthfund.org/Blog/2013/Feb/The-Effect-of-Medicare-
Readmissions-Penalties-on-Hospitals.aspx
7.) “Project Boost: A Return on Investment Analysis,” Society of Hospital Medicine, 2010,
http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/PDFs/BOOST_ROI_Paper.final.pdf
8.) Donovan, P., “Payment Bundling Requires Suspension of FFS State of Mind,” Healthcare Intelligence Network, March 25, 2013,
http://hin.com/blog/2013/03/25/payment-bundling-requires-migration-from-ffs-state-of-mind/
9.) “Healthcare HR and the Bottom Line: 5 Focus Areas for Improving HCAHPS Scores,” Healthcare Source white paper, 2012, p. 5,
http://bit.ly/17iXhav
10.) “How Email Communication Impacts Patient Satisfaction,” results of survey of 1,381 New England Baptist Hospital patients receiving
UbiCare’s Joint Replacement Support Emails, June 2011 – April 2013.
11.) Satisfaction surveys to recipients of UbiCare’s Joint Replacement Support Emails, June 2011 and June 2012.
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