When Urology Centers of Alabama started a data analytics program last year, they discovered that over 50 percent of their overactive bladder (OAB) and benign prostatic hyperplasia (BPH) patients never showed back up for a second visit. That was clearly a problem, both from a patient care perspective as well as the practice's bottom line.

With this difficulty in mind, Urology Centers established patient care pathways and hired patient navigators to monitor patient compliance with those pathways. By all measures, the program has been a success.

"The first treatment for OAB and BPH is usually medicine," said Jason Biddy, chief executive officer. "But patients may not take their medicine correctly, or long enough. Or they may not even get it because it's too expensive. And if they didn't make another appointment before they leave the first time, there was no follow up. They often think the symptoms are just something they have to live with."

"I find that's particularly true with women," said Cassidy Henningsen, female health navigator. "There is this train of thought that this is what happens as you get older. But it's not true. There are treatments for OAB. It's common, but it's not normal."

The program maps treatment options and shows the patient what to expect upfront, so even if the first choice of treatment isn't successful, patients know there will be other treatments to try. "The best thing about the pathway is it sets expectations. They know we are going to start with some medicine and exercise, but if those don't work, they don't have to get frustrated or give up," Henningsen said.

New patients are entered into the program, and if they don't return for scheduled follow ups, the program alerts Peyton Muskett, the data analyst. She then sends the name to a navigator who will call the patient.

"The pathway is like lines on the road," Biddy said. "As long as the patient stays between the lines, they will not show up on a list. If they get outside of the lines -- they miss the first follow up, for instance -- they will show up on a list and our data analyst will send their file to a navigator for follow-up. It creates a uniform approach to make sure every patient is getting the appropriate follow-up care."

Henningsen said most patients come as the result of referrals from other physicians, and they have usually tried one medicine already, which is not working. After they see a specialist in the practice, she will call the patient in a week or two to go over a questionnaire and see how they are doing. In addition to assessing the effectiveness of the medicine, she will ask about side effects.

"There are a shocking number of patients who won't say anything about the side effects of medicine," she said. "They just deal with it. But this is about quality of life, and we want the patients to be able to do whatever they want to do. I act as an advocate for my patients. They can ask me questions they may be embarrassed to ask the doctor. If I don't know the answer, I'll find it out and get back with them. I'm not a doctor, so I talk about their condition and medications in layman's terms."

Pathways have also been set up for prostate cancer patients. "That pathway is more complicated," Biddy said. "But it shows a patient all the options available to them at the right time. At least they hear all the options as they progress through the different stages."

Muskett is the single data analyst for the practice and feeds information to four navigators, who can effectively serve 700 to 800 patients at a time.

Biddy stresses the importance of using data to ensure patients don't fall through the cracks. "Before we started analyzing data, our doctors thought we were doing follow-up well," he said. "But doctors don't always know the quality of patient compliance. They didn't notice how many patients fell off, because new ones came in, and they were still busy."

Now with the pathway program, UCA is seeing the metrics improve considerably. And while that's good for their patients, it has also proven to be good for the bottom line. "When you look at the financial value of retaining those patients, the return on investment has been incredible," Biddy said.

While improvement to the bottom line is an important factor, it's the improvement to patient care that is the ultimate reason UCA is satisfied with their move to patient pathways. Navigators are now seeing more referrals from patients as well as physicians, a sign that patients are satisfied with the quality of care they receive.