It’s no secret that healthcare organizations across the nation are still struggling to engage patients. While each patient care organization might have their own issues related to engagement, common widespread challenges include time and resources needed to develop programs, as well as some organizations simply relying on technology like portals to get the job done. Research has shown, though, that this isn’t sufficient on its own.
Across Colorado and western Kansas, however, Centura Health is making patient engagement simple. With 17 hospitals, two senior living communities, health neighborhoods, physician practices and clinics, home care and hospice services, Centura Health leaders realized early on that from a quality perspective, improving population health would be a key focus as the healthcare system shifts from paying for volume of services to paying for value. “So how can we keep our patients well and prevent them from coming into the hospital? That is a big paradigm shift from how healthcare has operated in past, and that has been the vision of [Centura Health’s] CEO,” says Matthew Vitaska, Centura Health physician group administrator.
In his role, Vitaska says he is essentially “an administrator of outcomes effectiveness,” which translates into partnering with other leaders in the organization to drive quality and patient safety within their physician practices, of which there are approximately 200 throughout the system.
About three years ago, Centura Health implemented interactive programs and personalized call campaigns, through Chicago-based Emmi, which offers a patient engagement technology-based solution, to deliver actionable health information to patients. “Patient engagement is a key component in changing behaviors, if you look at the literature. So if we are looking at preventative care screenings, chronic conditions and trying to motivate people to stop smoking, we thought this tool would be excellent for that,” says Vitaska.
Indeed, the patient engagement journey for Centura Health started with what its leaders called an “online education module,” meaning there are 100 to 200 of these modules covering a range of chronic conditions, such as preventative screenings, for example. Modules are written by subject matter experts, not just in terms of medical conditions and their treatments, but also in trying to engage patients in their care, Vitaska says.
Vitaska explains that the modules started to be used in one of two ways: at the patient appointment, in which a provider can assign the appropriate module to the patient; or by sending the module out to a mass group of patients. For the first approach, Vitaska gives an example of a doctor who is seeing a patient for diabetes and recognizing that the patient has poor control of blood sugar after doing an assessment and coming up with a collaborative care plan session. “The doctor and patient can then collectively decide that the patient can benefit on additional education such as how to manage blood sugar, what foods are better to eat versus others, what times of day are better to eat, and how exercise plays into it.” He adds, “So the patient will get an email with the module, which he or she can watch that [video] at home or work to learn that additional information that will help activate him or her to make lifestyle changes to help promote wellness.”
And for the mass group approach, Centura Health can query its electronic health record (EHR), identify patients that have blood sugars out of range, for instance, and then provide that to Emmi, who will then push that module out to the patients that Centura Health has identified may need it, Vitaska notes.
These early actions involved sending about half a dozen modules to a few thousand patients each time. And after sending those modules, Centura Health would get analytics back from Emmi, such as how many patients actually watch the health screening, Vitaska says. Emmi also has their own questions at the end for patient, asking him or her if the information was helpful, and if the information received will lead to a change in lifestyle or behavior. Centura Health additionally assesses patients’ satisfaction with the organization that sent the module. “We have seen good results, specifically in terms of patient satisfaction, and we were also pleased with the compliance rate of patients watching those modules,” Vitaska says.
Indeed, the data shows that for blood pressure improvement, patients utilizing one of these programs successfully achieved and maintained a healthy blood pressure within six months of viewing the program. This success was 22 percent greater for patients that viewed an Emmi program versus those that did not, Centura Health officials reported. And, regarding patient satisfaction across the health system, there were also positive results garnered from this program, including: 84 percent of patients reported they would take new action in managing their health; 78 percent reported increased motivation to change their lifestyle; 77 percent reported the program answered questions they would’ve called to discuss; and 91 percent reported the program prepared them for a procedure.
Vitaska admits he originally had trepidation that patients would not respond well to the emails that contained these education modules, thinking it might be a phishing scam or something of that nature. But that fear was solved when the health system decided to send “warm emails” that welcomed patients to the program, thus positively affecting compliance rates when the modules were sent later on.
“Our hypothesis is, and we haven’t tested this yet since we are in a transition with our EHR, is to have the doctor send out the module to the patient instead of doing the mass outreach,” Vitaska says. “That would allow for a conversation. It’s different when your healthcare provider says that he or she is going to send this module to you and really wants you to watch it, compared to getting a mass email,” he says.
But, Vitaska adds, the challenge of doing that now at the time of the patient appointment is that the technology hasn’t been embedded in the organization’s new EHR to streamline the workflow. So right now, the provider has to go to Emmi’s website and put the patient’s email in, Vitaska explains. “But down the road we will embed the technology into our EHR, so a provider can order the module like they order a medication. And on the back end it will be emailed to the patient. We are also hoping to build a bi-directional interface where data [such as additional patient questions] would flow back into the patient’s chart and a provider could then access that data and do additional follow up,” Vitaska says.
What’s more, Centura Health also uses the technology to place calls to patients. The organization gives Emmi a list of patients that meet the criteria of what they are looking for, such as identifying patients in the EHR who are due for a breast cancer screening. Those people get an automated phone call from Emmi to let them know that the records indicate they have not gotten a screening. “And they can automatically respond to that, by pressing 1 if they already got the screening, pressing 2 if they would like to be connected to the doctor’s office, or pressing 3 if they don’t want to receive calls,” Vitaska says. “This has been successful in terms of doing mass outreaches to large numbers of patients to help and engage them in those preventative screens. We think that links to where healthcare is going in terms of promoting wellness.”
Nonetheless, a key challenge of most patient engagement initiatives is convincing busy doctors of the benefit. Vitaska admits that for providers at his health system, this is definitely a work in progress, though he says that once they can streamline that workflow, there will be more favorable physician feedback. “Workflow aside, our doctors are always looking for ways to better use technology for enhanced patient engagement,” Vitaska notes. “And they are recognizing that as we move from fee-for-service healthcare to fee-for-value healthcare, office visits may not be the currency of how we will deliver care going forward. We will need different ways to do that. So this is an option to them that they think will be very helpful to them down the road, provided they have a streamlined workflow. More often now, patients aren’t coming into office routinely, so the ability to capture them outside of the office aligns with the direction healthcare is going,” he says.