It's easy for busy healthcare providers and staff to overestimate how well they're managing patient engagement. The face-to-face interactions they have with patients in the office can create an illusion that they’re engaged. However, while patients may be responsive during their appointments, their level of engagement can drop significantly once they leave.
For this reason, patient engagement shouldn’t be measured solely by what happens during the appointment. The real story is often told by what providers don’t see: missed or postponed appointments, unhappy patients who’ve left the practice, unfilled prescriptions, and ignored post-care instructions.
Despite the challenges of measuring patient engagement, patients’ health and the financial viability of practices rely on accurate patient engagement measures and improvements. This article will explain patient engagement benchmarks and measurements and what healthcare organizations can learn from them.
Why Measuring Patient Engagement Is Important
Engaged patients are more likely to regularly visit their providers and actively monitor their health than disengaged patients. They’re also more likely to seek help from their primary care provider instead of a hospital or urgent care facility, keep appointments, fill prescriptions, adhere to care plans, and manage chronic diseases—all of which contribute to better outcomes.
Providers should promote patient engagement because of the many benefits it offers both them and their patients. However, engagement can't be improved if it can't be measured.
Let’s dive into four ways you can measure patient engagement, assess what’s working well, and identify areas that might need improvement.
Measure 1: Patient Behavior
Providers are responsible for giving patients opportunities to engage, but patients must respond to these opportunities to experience the benefits discussed above.
Patient behavior can be a strong indicator of their willingness to participate in or interact with various engagement tactics. It can also reflect their feelings toward the practice and provider. While some patients may openly discuss their concerns, many do not. When patients don’t voice their issues, their actions often reveal dissatisfaction or a lack of engagement.
Behaviors that reflect unhappy or disengaged patients can be observed in the following ways:
No-Shows and High Cancellation Rates
Barring unavoidable circumstances, engaged patients keep their appointments. Repeat no-shows and cancellations can indicate a problem for one patient; but an overall high rate can flag a bigger problem with the practice.
The average no-show rate is about 19% but can vary by the type of provider and patient base. Ideally, practices should aim to lower that rate to anywhere from 11% to 14%, reflecting happier patients and improving revenue and efficiency. Automated appointment reminders, confirmation texts, no-show and cancellation fees, and other practices can be implemented to safeguard the practice from these inconveniences.
Patient Retention Rates (PRR)
Patient retention rates (PRR) measure the percentage of patients who return to your office for appointments over a certain time. Because it’s five times more expensive to acquire a new patient than to retain one, your PRR can significantly impact revenue. A quality patient experience keeps them coming back, earns you more referrals, and helps you attract new patients.
Patient retention can be calculated using this formula: [(E-N)/S] x 100 = PRR
- E is the number of existing patients at the end of the period being measured
- N is the number of new patients gained during that period
- S is the number of patients at the beginning of that period
- PRR is the patient retention rate
For example, a medical practice wanted to measure PRR for one year. The practice ended the year with 300 patients, 170 of whom were new, and started the year with 275 patients. Using the formula, the calculation would be: [(300 - 170)/275] x 100 = a PRR of 47.27%. The average 5-year new patient retention rate is 43%, so this medical practice’s PRR is on par.
Quality of Communication
Two-way communication between providers and patients is crucial for fostering engagement. In the exam room, clinicians should practice active listening to ensure patients feel heard and respected. An engaged patient is comfortable discussing both health and practice-related concerns, and providers who promote open communication are more likely to build trust by clearly explaining their actions and sharing post-visit instructions.
However, effective communication shouldn’t be confined to the appointment itself. The frequency and quality of asynchronous communication—such as phone calls, text or email appointment reminders, answering after-hours questions, delivering test results, and providing educational materials—are strong indicators of patient engagement. A well-designed and comprehensive patient engagement platform can facilitate this ongoing communication with minimal strain on staff and providers, ultimately serving as a key measure of how connected and engaged patients are with their health and the practice.
Consistently Unpaid Balances
A patient might carry an unpaid balance for many reasons. While an outstanding balance isn’t always a sign of disengagement, it can be an indicator. A patient might fail to pay a bill because they’re unhappy with the care they received, they haven’t been able to get answers to their questions about the charges, or they don’t plan on returning to the practice. Additionally, the process for paying a bill might be too complicated, or technology could be a barrier—if a patient finds it difficult to log in online to pay a bill, they may also struggle with using the patient portal to manage their health, check lab results, or refill medications. Practice administrators should consider checking for correlations between patients with unpaid balances and potential retention, dissatisfaction, or engagement issues.
Measure 2: Technology Adoption
Organizations can measure patient involvement by examining patient’s adoption and use of technology, including patient portals, digital intake, and telehealth.
Patient Portals
Portals are now nearly universal among healthcare systems and independent practices, and their adoption has been linked to positive health outcomes, improved patient-provider communication, greater patient satisfaction and retention, and increased patient participation in healthcare decisions. However, patient adoption and use of portals are not yet universal. In 2022, about three in five patients accessed their online medical records or portals—a 50% increase since 2020. Yet, this still means that around 40% of patients don’t actively use their portal.
Organizations should check the adoption and usage statistics for their portals and analyze the data to identify trends in use and adoption. They can increase portal adoption and usage by educating patients about its capabilities and training them to use the portal. Providers should also listen to patient complaints about the portal and make changes when possible to ensure user-friendliness.
Digital Intake
Today, patients can either complete intake forms online or in the office. Because some patients may struggle with technology and other hinderances, it’s necessary to allow them to choose their preferred intake method. However, those who use digital intake forms are often more inclined to use technology to monitor test results, communicate with providers, and engage in their healthcare altogether.
Digital intake forms can improve patient flow and patient experience before they ever step into the office. By measuring how many patients fill out forms online versus in-person, you can get a glimpse of who’s ready to use technology as another means to take charge of their health.
Telehealth
Telehealth is an attractive option for patients who either can’t or prefer not to make an in-office visit. According to a recent study, the no-show rate for telemedicine appointments was 12% compared with 25% for in-person appointments. Although virtual visits don’t present the same opportunities as face-to-face interactions, they’re a powerful alternative to ensure patients don't skip their appointments altogether. Plus, they give patients an additional opportunity to engage with their providers.
A good way to measure engagement is to consider patients who rarely visit the office in-person and determine whether they’re more likely to book and attend appointments via telehealth.
Measure 3: Clinical Outcomes
Because patient engagement is often reflected in outcomes, practices can use certain clinical measures to evaluate involvement and participation. Among them are:
Patient-Reported Outcomes
Patient-Reported Outcomes (PROs) are defined by the National Quality Forum as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” Many providers are unsure if it’s worth it to measure PROs, but these responses offer the clearest glimpse of the patient's experience and are critical to guiding and improving care.
PROs measure responses such as how a patient feels about:
- Overall quality of care
- Functional status
- Symptom severity
- Level of pain
In addition, in a value-based payment model, PROs can help to ensure a provider is profitable. While gathering the data requires extra work, the information you can extract from the data is valuable.
Here are four ways to improve patient participation in surveys and increase the chances of a positive report:
1. Get buy-in from the team. Explain to staff why PROs are important and how they can improve the practice. Share the improvement plan and explain each team member’s role.
2. Educate your patients. Take time to ensure patients understand their post-care instructions and the importance of completing the survey. This will improve adherence to care plans and increase the odds of receiving positive PROs.
3. Share PROs data regularly with your team and act on the results. When teams are up-to-date on survey results, they can better understand how they might personally incite change to improve patient’s experiences. As such, better decisions, improved care, reduced costs, and more engaged patients will be easier to achieve.
4. Use automated surveys and survey reminders for patients. Surveys can be automated and sent following an appointment to collect PROs without burdening staff.
Patient Activation Measures
Patient Activation Measures (PAM) assess a patient’s knowledge, skills, and confidence in managing their health and healthcare. It is often used as an outcome measure for health interventions, particularly in managing chronic conditions. However, PAM also provides insight into a patient's level of engagement by evaluating their readiness and ability to take an active role in their health.
Providers can use PAM to assess how likely a patient is to engage with their providers outside of the visit and align resources and tailor support to better help patients manage their health. Unlike Consumer Assessment of Healthcare Providers and Systems (CAHPS) and self-created surveys, PAM must be licensed for use.
Medication Adherence
Medical adherence is one of the most important features of patient engagement. Adherence can be measured by several methods, including self-reporting questionnaires or structured interviews, therapeutic drug monitoring, electronic devices and pickup/refill rates. Education, communication, and listening to patients’ concerns and questions can increase medication adherence.
Hospital Readmissions
Readmission within 30 days is a standard quality metric for hospitalized patients. Because engaged patients tend to have fewer hospital readmissions, the rate of readmissions can be used to roughly gauge patient engagement. If a patient is readmitted several times for the same issue, you may want to consider how to collaborate to help them understand and manage the problem.
Measure 4: Patient Satisfaction
A recent poll of more than 2,000 patients revealed that 73% keep “mental scorecards” of their healthcare experiences. The average patient gives their provider four strikes before leaving them for another. Patients might never share their dissatisfaction; the only indication of trouble the practice will receive is the patients’ requests to transfer their medical records. Some patients might not switch providers. Instead, they’ll disengage from their care and skip appointments.
Here are a few ways you can measure patient satisfaction:
Satisfaction Surveys
Once patients become unhappy or disengaged, rectifying the situation is difficult. Satisfaction surveys can help uncover and address problems well before reaching the point of no return. Patients may be reluctant to complain in person. An online survey enables them to share feedback without being face-to-face and sometimes grants them anonymity as well.
Online surveys can be created, sent, and collected via patient engagement platforms, like InteliChart. These surveys capture self-reported patient assessments of multiple touchpoints during their experience, including ease of scheduling an appointment, satisfaction with care, experience with staff, and ways to improve the overall care experience.
Well-designed surveys do more than gather patient anecdotes or vague feelings. Rather, they collect data that can be analyzed and used to make direct improvements in the practice.
CAHPS Survey Scores
The federal government has its own patient experience surveys, Consumer Assessment of Healthcare Providers and Systems (CAHPS). While these are most associated with Medicare, CAHPS can be used for free by any organization to gauge communication with providers, appointment availability, coordinated care, easy access to information, and more. The surveys are scientifically designed by the Agency for Healthcare Research and Quality to provide accurate unhappy feedback.
Of course, practices have another reason to pay attention to CAHPS surveys. The Centers for Medicare and Medicaid Services (CMS) uses some of the surveys to determine value-based reimbursement.
Referrals
Referrals are another measure of satisfaction. A disengaged or unhappy patient is unlikely to recommend a provider to someone else. A practice that receives several referrals more than likely has good patient engagement.
Online Reviews
Online reviews are another way of gauging patient satisfaction, though an inexact one. Only patients with the strongest feelings about a practice or provider are likely to post an online review. Consequently, online reviews are often less comprehensive and representative than patient surveys.
However, that doesn’t mean online reviews and ratings don’t matter. They can attract or repel new patients, particularly younger ones. A 2023 survey found that 72% of Millennials read online reviews before making an appointment with a physician and 77% consider online written reviews more important than star or numerical ratings.
Although it may be tempting, negative reviews and ratings should not be ignored. Recurring complaints or a focus on a particular aspect of the patient experience could indicate a problem with patient engagement you should address.
How Measuring Patient Engagement Impacts Value-Based Care Reimbursement
Patient engagement has always been important, but the transition to value-based care (VBC) and value-based payments makes it even more so. VBC emphasizes prevention, outcomes, and population health rather than procedures. This method heavily relies on engagement to help patients refrain from needing higher-cost care or hospitalization. It also reduces risk, builds loyalty, and helps meet quality measures used to determine patient satisfaction scores and practice reimbursement.
Value-based care lets providers deliver more routine, low-cost care and maintain regular contact with patients to spot and address health issues before they escalate. Patient engagement can help prevent avoidable health issues by promoting timely interventions. As a result, providers can better course correct and help both engaged and disengaged patients stay on a path that enables them to maximize VBC reimbursements.
Overcoming the Challenges of Measuring Patient Engagement
In a busy practice, it can be difficult to find time to measure patient engagement. In fact, it might seem unnecessary. But patient engagement is too important to patient outcomes and practice revenue to ignore.
Keep in mind that it’s neither practical nor necessary for most organizations to use all the metrics discussed in this post. Instead, you should determine which ones are most relevant for your circumstances and adopt those. To save staff time and effort, organizations should look for measurement tools that can be automated and that encourage patient participation. These tools should deliver not just data, but analysis with insights to guide corrective action.
Measuring engagement should not be an annual task, but an ongoing process of continuous improvement for both practices and patients.
Conclusion
Patient engagement can seem too nebulous to measure. It can vary from patient to patient, provider to provider, even from appointment to appointment. It can be influenced by everything from patient education to the trust they have in their physician. It’s tempting for providers to simply do their best and leave it up to their patients to decide how engaged they want to be.
But the ramifications of engagement are real. They can be seen in patients’ chronic care management, medication and care plan adherence, hospital admissions, and more. In a value-based care environment, engagement also affects an organization’s bottom line.
Organizations that measure patient engagement and act to improve it are positioned to reap the benefits in patient health and in their bottom line.
