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Digging out of a Hole: The Two Sides of Patient Engagement

February 27, 2015
by Gabriel Perna
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Implementing a patient-centered strategy will not only improve the care given by healthcare providers but it can also increase practice revenue, advised Adele Allison, former co-chair of the Office of the National Coordinator for Health IT’s (ONC) Beacon-EHR Vendor Affinity Group.

Allison, currently with DST’s Health Solutions, a Birmingham, Ala.-based vendor of payer and provider analytics platforms, shared her advice with providers during a Healthcare Informatics –hosted webinar this week. She said the “patient-centeredness” mentality, including implementing patient engagement technology and cultural training of providers, has several benefits. It can eliminate patient dependence, encourage health behavior, reduce attrition, bolster adherence, as well as drive revenue.

She started out the webinar defining patient-centeredness. Essentially, the patient-centered provider doesn’t talk to the patient, they talk with them. In this regard, one reverberating anecdote from Allison was the “Hole Man,” which was an adaption of a short story from Larry Niven. In her version, a man falls down a hole and receives “help” from a lawyer (who throws him a business card and promises to sue on his behalf), a priest (who prays for him), and a doctor (who throws him a prescription). Then a “patient-centered” provider comes along, jumps in the hole, and shows the man the way out.

"We have to have strong provider/patient communication. One that allows patients needs/wants to be understood and addressed,” Allison said during the webinar.

The Time is Now

The time is ripe for payers and providers to implement this strategy, Allison made clear during the webinar. The cost of care, at $2.8 trillion in 2012 with projections estimating $903 billion being spent for Medicare alone in less than 10 years, is skyrocketing. She noted that actively engaged patients cost 21 percent less. Patients with chronic conditions account for 84 percent of healthcare costs.

Worse, most consumers are unfamiliar with their options. Seventy-two percent of patients surveyed in a poll referenced by Allison, from InstaMed, a Philadelphia-based vendor, did not know their responsibility for payments. Over the past six years, the amount patients have paid out of pocket has shifted from $250 billion in 2009 to $420 billion projected this year. “Which patients knew the most? Those in a consumer-driven health plan” Allison said.

The federal government is heavily pushing the path to patient-centered care, making this even more of a necessity for providers. It’s all over various policy measures, with it being referenced in the Affordable Care Act (ACA) specifically 36 times. It’s also in meaningful use, the Centers for Medicare and Medicaid Services’ (CMS) Patient-Centered Outcomes Research Institute (PCORI) funded research, Hospital and Physician Compare, and the Veterans Administration. Much of this comes from value-based reimbursement models, which reimburse based on quality outcomes.

Where do we Rank?

Thus far, healthcare providers have been average at best in utilizing technologies to engage patients and create a patient-centered atmosphere, Allison said. While most eligible providers (EPs) attesting in 2011 did well when it came to core measures related to patient engagement Stage 1, the numbers were less impressive for menu measures. Only a third of providers sent patients reminders electronically, only 72 percent gave them electronic access to their health information, and less than half provided patient-specific education resources. The numbers gradually improved over time, although none ever eclipsed the 80 percent mark.

Quite simply, patient engagement technology is the “last frontier,” Allison said.

Still, all hope is not lost on that front. Allison says plenty of technologies do in fact exist today that can help providers match patient expectations. Providers should be leveraging strategies around secure messaging, patient reminders, patient-specific education, and other technologies that can help in the near-term, while waiting for other areas to evolve.  

Also achievable in the short term is cultural training. Simple things clinical etiquette, letting the patient tell their story, and inviting patient to read encounter notes will go a long way in creating that patient-centered environment. She cited a study from IHI International that reported more than 50 percent of patients admitting if they had read encounter notes they’d better adhere to medication.

Through value-based reimbursement and population health management, Allison made a key point that patient-centered care can increase practice revenue. This is important. Patient engagement is not just a vanity investment. These technologies can help providers be proactive and not reactive, she said. The patient-facing technologies, through population health platforms, can help increase in preventative services such as a wellness visit, A1C testing. These services combined with reductions in complications lead to an increase in quality revenue, Allison said.