Borrego Health succeeds with multicultural patient engagement technology

Healthcare provider organizations face an ongoing need to engage patients to help them get the care they need. This engagement has multiple benefits to both patients and providers.


It can increase access to healthcare, improve care, reduce costs and drive better health outcomes. It can also impact patient retention and have a range of other value.

Borrego Health, a federally qualified health center (FQHC) organization, is unique in that it also has one of the most diverse patient populations in the United States, which it serves in its clinics across Southern California. They are predominantly Medicaid beneficiaries, and include Hispanic, Russian, Japanese and Iranian patients, with other cultures and countries of origin constantly increasing.

These patients are often considered “hard to reach” in healthcare, largely because of income, culture, language and other factors. They are not always able to access and use healthcare the way that other patient populations might be able to because of these factors.

“Traditional methods of engaging patients and driving their care, like mailers or phone calls to remind them of cancer screenings, aren’t always effective with any patient population today,” said Dr. Alfredo Ratniewski, executive chief medical officer at Borrego Health. “But with a very diverse, lower income population, it can be even more challenging.”

As Borrego sought to increase engagement and care with its patients, it needed to take all of this into consideration. So it turned to technology because it offered a solution that could meet the organization’s needs, as well as the needs of patients, Ratniewski said.


Borrego now uses ConsejoSano, a vendor of multicultural patient communication and engagement technology and services.

It uses the vendor’s health determinants engine and patient engagement platform, combined with the vendor’s care coordinator team, which is adept in language, culture and other factors. This has enabled Borrego to customize how it connects with and helps its patients.

“For example, if we reach out to our patients about the well-child services available to them, we can use the technology to identify and analyze any social determinants that might be affecting our patient population regarding visits, as well as additional data such as language, culture and other specifics,” Ratniewski explained. “We can then tailor our communication and content accordingly to best reach them.”

“We used the technology to conduct an appointment reminder campaign that impacted more than 7,000 patients with an 85 percent success rate.”

Dr. Alfredo Ratniewski, Borrego Health

The technology can support Borrego in more than 22 languages through its care coordinator team. Borrego does not translate its patient content and communications because it is always created in the natural language to begin with.

“We can also deliver it in the way our patients prefer to communicate,” Ratniewski said. “A lot of Borrego patients are not able to take phone calls during the day due to their jobs, where text messages are a more effective method of communication. Traditional mailers can also be challenging because many rent their homes and may relocate to other areas of the community more frequently than homeowners.”

Taking action on a mailer, like calling to book an appointment, or returning a phone call, can be difficult because they aren’t able to make calls during the workday. The ConsejoSano technology helps solve these issues. Borrego can be far more customized and targeted than in the past in how it connects, communicates and meets its patients where they are at, Ratniewski explained.


There is a variety of patient engagement technology vendors on the health IT market today; some offer multicultural services, some do not. Overall, some patient engagement technology vendors include AdvancedMD, Allscripts, CipherHealth, DoctorConnect, Greenway Health, LexisNexis, Luma Health, Santovia and Solutionreach.


“We created patient campaigns in Spanish, Arabic, Russian, English, Japanese and Iranian language across all of our clinics in Southern California,” Ratniewski said. “The clinics leveraged ConsejoSano’s solutions to notify patients of colorectal and cervical cancer screenings, well-child visits, flu shots, and other gaps in care.”

Borrego began by sharing what it needed, what it wanted to accomplish, and other details with the technology vendor. The vendor’s team provided support and insight to help Borrego determine a strategy and plan for using its technology, and to customize Borrego efforts to each of its patient populations. Borrego also had access to teams and people at ConsejoSano who matched the language, culture and other aspects of patients to further help in driving success, Ratniewski added.

“The campaigns were then launched by our clinics to directly reach the patients each serves,” Ratniewski stated. “We did not integrate with any other software solutions, but we leveraged mobile phones and text messages with ConsejoSano’s solutions.”


Overall, Borrego saw increased engagement and improvement in care with its patients across all of its clinics. More than 15,000 patients that were not engaging in their health received care from these new efforts. Ratniewski said that Borrego also improved efficiency and gained data that can help Borrego better understand its patients, who they are, what they need, and what campaigns and communication best reach and engage them.

“We used the technology to conduct an appointment reminder campaign that impacted more than 7,000 patients with an 85 percent success rate,” Ratniewski reported. “We also completed a campaign to improve gap closures that reached more than 7,000 patients and had a 59 percent success rate. Our no-show rates dropped by an estimated 23 percent to 15 percent. Campaigns were held in English, Hispanic, Russian, Japanese and Iranian languages.”


“Patient populations can be very diverse and different within the same city, state, region or across the country,” Ratniewski advised. “What worked for one provider and its patients may not work for you and yours. Look for technology solutions that can be flexible for this. If you’re located in a community that has a large number of multicultural and multilingual patients like Borrego is, look for solutions designed for this.”

A healthcare organization also should make sure that the system it chooses has teams with the type of background and expertise needed to help.

“Your executive staff, and even the team that manages your website online, won’t always have experience with the solutions available to you,” Ratniewski said. “Look for and use technology vendors and solution providers that can give you this. For example, if your patient population is predominantly Medicare beneficiaries, a solution with a team that has expertise in Medicare can bring more value and return on your investment.”

Technology won’t replace care, he added. It’s meant to help to improve it, whether it’s to lower costs, increase access to services, or better serve patients, he said.

“Before considering solutions, think about what you and your patients need,” he concluded. “If they’re lower income, a solution that leverages text messages might be the best option. Don’t assume every solution is right for every provider and patient population, or that every solution should be used the same way.”

Twitter: @SiwickiHealthIT
Email the writer: [email protected]

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