The following is a guest blog post by Matt Adamson, vice president of product management for ACO and value-based health at ZeOmega
Healthcare providers are preparing to engage patients at a deeper level than ever before as they strive to achieve quality and savings metrics required of accountable care models being implemented across the country. However, a critical, lingering question remains – will patients participate? Patients have grown accustomed to seeking out healthcare information on their own, with the top five healthcare websites logging more than 78 million unique visitors monthly.[i] While this is clearly a positive sign that must be leveraged to move the needle even further, the answer could lie with the addition of the care coordinator that exists in most accountable care and medical homes.
A patient portal is seen as the most likely way that care providers will interact with patients outside of resource intensive office visits or telephone conversations, but any technology adoption must be accompanied by monumental shifts in attitudes among both physicians and patients in order to be successful. Physicians already are strapped for time and few are reimbursed for patient engagement beyond the traditional face-to-face interaction. Likewise, patients may hesitate to “bother” their doctors with questions or access their personal healthcare information online.
Care coordinators could serve as the bridge that connects physicians and patients, bringing them together at a clinical connection point. Relatively new in the healthcare system, care coordinators generally are nurses with care management experience who can help put conditions and diagnoses into the appropriate clinical context while speaking with patients on their level. The patient portal would provide another avenue for patients to communicate with the care coordinator, who would serve as the liaison to the physician when appropriate.
Meaningful Use Drives Push for Patient Engagement
Patient engagement will be a critical consideration in achieving Stage 2 Meaningful Use. Now extended through 2016, Stage 2 includes objectives to improve patient care through better clinical decision support, care coordination and patient engagement. Patient engagement metrics will require that more than 5% of a practice’s patients send secure messages to the provider and more than 5% of the patients access their health information online.[ii]
The Medicare Shared Savings Programs (MSSP) and the Partnership for Patients community-based care transitions program both have measures related directly to demonstrating an enhanced communication experience between patients and physicians that can lead to recognition and additional revenue for practices and hospitals. The NCQA Patient-Centered Medical Home certification also includes elements related to patient engagement. One of the critical certification factors requires contact with at least 50% of patients to develop and document self-management plans and goals.[iii]
Beyond regulations and certifications, patient engagement is also being shown to help meet the cost savings aspects of accountable care. Patients who are more engaged have fewer hospital stays, adhere more often to prescribed medical treatments, recover faster and are more satisfied with their care.[iv]
Engaged patients are also more successful at managing chronic illness than those who are not. More than 40% of Americans are living with at least one chronic disease, which overall cause seven in 10 deaths each year in the United States, according to the Centers for Disease Control and Prevention.
Getting Patients Involved in Their Own Health
As clinicians work more closely with patients who are trying to manage chronic illness, it is important to note that the time patients spend with physicians, nurses and other care providers represents a very small percentage of the overall time spent managing conditions or treatments. The patient and other caregivers are largely responsible for adhering to care plans and making the necessary lifestyle changes to accommodate chronic conditions. Patients who are educated about their conditions and engaged in the process will more likely succeed in keeping their chronic conditions in check.
So using a patient portal or similar technology would seem a rational, logical way for patients to learn more about their conditions and interact with care providers in a secure, HIPAA-compliant environment. Unfortunately, it isn’t as easy as that. With all of the rules, metrics and evidence that are mandated for the clinician community, there are no such rules in place that require compliance for patients.
A portal would allow patients to contact their doctor any time, day or night, to ask a question or relate treatment information. But few doctors are trained for or desire that type of high-touch interaction, especially since reimbursement for that type of interaction is rare. The United States also is facing a rather serious primary care shortage in many areas, one that will be exacerbated as up to 30 million uninsured obtain coverage under the Affordable Care Act. So what’s the best use of physician time – diagnosing and treating an increasing number of patients or answering questions by secure email?
Patient portals and other technologies that Meaningful Use is bringing into common usage will not move the needle toward smarter health choices on their own. The technology has to be helpful and interesting for patients, providing them with an easy way to connect with care providers when they need help and to get updates and reminders when needed.
This is why the idea of using care coordinators in the role of engaging patients when not in the physician office or receiving direct care is gaining traction. The goal of care coordinators would be to guide patients and help them to navigate the healthcare system so that they stay on track with their treatments between physician visits. Care coordinators would have a direct link to a patient’s physicians, bringing them in only when needed.
Secure messaging and emails could provide an easy way for patients to submit questions or take action when they are ready to do so. Platforms that can connect and share the nursing care plans between the care coordinator, caregivers and the patient could be highly effective, especially if there are issues resulting from chronic or acute conditions. This seamless connection would allow the care coordinator to pass along educational content and become part of a two-way mechanism for tracking medications in a manner that allows patients to update and print the list.
From there, embedding incentive management and gaming features into the portal would provide a reason for the patient to keep coming back to continue the engagement.
Technology platforms built to enable the connection between the patient and the care coordinator could be the missing pieces of the puzzle that would allow patients to become more involved in their health and allow the promise of patient engagement to become a reality.