Improving Patient Retention

Patient retention is a key metric used to assess care quality. Retaining patients leads to better health outcomes as it allows for the development of comprehensive, long-term treatment plans tailored to individual needs. High retention rates also improve the provider experience by minimizing unexpected schedule variability due to cancellations and no-shows. RDs at Nourish are expected to have high retention, with patients following at least 12 weekly appointments as outlined in the Standards of Care.

While no single retention metric tells the whole story, if patients see value in our services, they will try to attend appointments. That said, we understand that lots of things can get in the way, which is why we have set reasonable benchmarks for retention metrics.

The retention metrics that will count toward your performance evaluations as well as our expectations for each metric can be found live in your Provider Portal under the "Metrics" tab. Our expectation is for RDs to be in light green section of their retention dials across all of the time frames.

• Use our Clinical Standards of Care

  • Nourish’s Clinical Standards of Care call for 12 weekly sessions for patients to see best results/outcomes. These weekly sessions have shown to be positive for outcomes and patient rapport. You can also see additional information in the Standards of Care on best practices for initial sessions, follow up sessions, and between session support.

• Assuage the patient on insurance concerns

  • Many patients cancel appointments or do not schedule a follow-up because of insurance concerns. You should help the patient feel confident that they can keep having sessions, as Nourish will never charge a patient for a denial, and will cancel a claim that goes to deductible if the patient so chooses, so there is no risk for surprise high costs. They will only be charged a co-pay / co-insurance, which they can determine by filling out this information or by calling the number on the back of their insurance card.

• Schedule an immediate follow-up for the initial appointment

  • Patients who have an appointment the week after their first appointment are far more likely to have high retention throughout their patient journey. It is an expectation that RDs will schedule a second appointment the week after the first appointment to ensure you can quickly start building patient trust and giving recommendations.

• Ensure you have recurring appointments scheduled

  • Aim to schedule patients for weekly recurring appointments through Healthie (~8 at a time) to ensure you have the time on your calendar blocked, and to set expectations for the patient. You can always adjust the timing down the road!

• Assess which retention metrics are low & look for trends

  • Regularly review your performance metrics to assess your retention. Ask yourself:

    • How many sessions do patients attend (on average) prior to canceling/no-showing/refusing to schedule a f/u?

    • Is there any pattern in specialties for patients not returning?

• Ask for & assess patient feedback

  • Value honest patient feedback! Create space for patients to provide feedback in session. Remind them you are working as a team, and they are welcome to share how they are feeling about the process each step of the way.

  • In your Dashboard, review your NPS scores & patient feedback. Take note of

    what is going well and if there is any patient feedback indicating areas for

    improvement.

• Set clear expectations for the initial appointment

  • The initial appointment sets the tone for the rest of the work you will do with a patient. It’s vital to set clear expectations. Some patients may have worked with a dietitian in the past, while for many, it is a completely new experience. Being intentional to minimize surprises or misunderstandings establishes trust and outlines the care journey.

    • Explain purpose and structure of initial assessment

    • Explain Nourish’s approach to care

    • Set expectations for goal setting and education

    • Set expectations for ongoing scheduling and communication

    • Ask patient what their expectations are

• Assess Stages of Change to determine interventions & goals

  • Goal setting is an important part of nutrition counseling sessions—it can make or break retention. If a goal feels unattainable, it may be discouraging to the patient, whereas if a goal is too small, it may feel frustrating to the patient. Setting goals that are relevant, realistic and achievable is imperative.

    • Assess the patient’s stage of change.

    • Collaborate with patients on goal setting.

    • Let patients take the lead in creating goals, but guide them towards making realistic SMART Goals.

    • Understand patient’s motivations & connect with their why

    • Assess patient’s confidence level & barriers to change

• Prioritize rapport building

  • Every patient comes in with different experiences. While some patients will be very open, others will not be. Retention suffers if patients don’t trust their provider, and building trust takes time. Spending time in session to build rapport can help patients feel more comfortable with their provider, therefore resulting in higher value from sessions and increased retention.

    • Make small talk to create a comfortable environment and put patients at ease. Show genuine interest in your patient’s life. This could be asking about their weekend before jumping into session or commenting on their dog sitting in the corner of the room.

      • Focus on Connection. What are your patient’s values? What is their ‘Why’?

      • Establish yourself as an expert. It’s important patient’s feel confident in the recommendations being provided to them. Share your experience and expertise when introducing yourself.

      • Be curious. Avoid making assumptions about patients. Notice if questions are leading. Start with open ended questions.

      • Be yourself! It’s paramount to maintain professionalism at all times with patients, but letting your personality shine through is essential to building genuine rapport.

• Hold patient-led sessions & know when to guide

  • Patient-led counseling is critical. It empowers patients to share in the decision making process and builds trust, therefore improving patient satisfaction.

    • Meet the patient where they are at. Be aware of the patient’s stage of change. Support the patient on what they are willing to work on and change.

    • Validate your patient’s feelings and experiences when clinically appropriate.

    • Use active listening and reflection to encourage open communication and demonstrate to the patient that their input matters.

    • Collaborate with patients in the decision making process. Ask patients what they want to focus on & what goals they want to set.

    • Understand your patient’s motivations. Really get curious about your patient’s values and the ‘why’ behind their goals.

    • If a patient is unsure of what they want to work on, suggest options that align with their preferences and provide them with education so they can make informed choices.

• Provide quality education

  • Many patients are excited to learn about nutrition! It’s important that education is delivered clearly and effectively.

  • Assessing a patient’s education enables you to effectively educate and ensure you are providing them with new, relevant information.

  • Have resources ready when helpful or necessary.

  • With any new skill or habit, education is the start. Make sure you are setting SMART goals that allow the patient to practice and apply skills in everyday life.

  • Review education materials prior to sessions

  • Try to include educational tidbits (however general) in the first session to try to build the trust that you know your stuff!

• Brush up on motivational interviewing skills

  • Motivational Interviewing is foundational to behavior change. Utilize the resources below to continuously improve your MI skills.

    • Guide to Motivational Interviewing

    • OARS Techniques

    • Do’s and Don’ts of Motivational Interviewing

• Reach out to patients that have not rescheduled

  • Use the Nudge feature within your Provider Portal patients page to identify and remind patients who have not rescheduled yet to make their next appointment.

1. Have I reviewed the Nourish Standards of care?

2. Have I assessed which retention metrics need improvement?

3. Have I reviewed and asked for patient feedback?

4. Am I scheduling most follow-up appointments within a week of the initial appointment? Am I setting clear expectations for the initial assessment?

5. Am I setting clear expectations for working with a dietitian at Nourish?

6. Am I assessing the patient’s stage of change to determine interventions and goals?

7. Am I prioritizing building rapport in sessions?

8. Am I holding patient led sessions? Do I know when to step in and help guide the patient? Am I prepared to effectively educate the patient in session?

9. Have I brushed up on motivational interviewing skills recently?

10. Have I reached out to patients who have not rescheduled using the ‘Nudge’ feature?