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The Extraordinary Value of Chronic Care Management As Seen Through The Lens Of The Patient

Posted on November 28, 2018 I Written By

The following is a guest blog post by Spencer Kubo MD, Chief Medical Officer at CareCognitics.

The concept of adding chronic care management (CCM) to primary care practices is appealing on many different levels, but implementation has been sporadic.  The dismal uptake is multifactorial and is largely based on the perception that the value (return) may not be worth the investment.  However, Wendi Capers, Practice Manager of Priority Health Group, a primary care practice in Las Vegas, Nevada, recently relayed to me three patient stories that are guaranteed to change your perspective.  This group was an early adopter of CCM and is using Cariatrix as their CCM provider.

Patient #1 is an 82-year-old male veteran who was becoming increasingly isolated, lonely and depressed after the death of his dog.  The patient did not have any family or friends.  He had no physical complaints that would have necessitated a call to his doctor and did not feel he had any reasons to request an appointment.  The Care Ally from Cariatrix noticed that the patient was not responding to the regular emails and texts that give reminders about upcoming preventative health measures. She called the patient and astutely picked up on the feelings of isolation. After their conversation, she found a program that could provide animal therapy for vets.  She also located a community center that held classes in Tai Chi, one of the patient’s favorite forms of exercise.  The patient is responding well to these interventions and has “turned around.”  Now the patient promptly responds to the emails/texts, and even calls the Care Ally every month just to check in, clear signs of greater engagement and well-being.

Patient #2 is a 62-year-old male with diabetes that was not well controlled, as evinced by a baseline A1C that was elevated to 11.9.  When asked about the suboptimal A1C result, the patient was taken aback, saying, “I can take care of myself.”  Again, this patient did not see the need to contact his doctor.  But the CCM team slowly won him over through multiple contacts.  The Care Ally then observed during medication reconciliation that there were extended periods between refills of his insulin and oral medications.  The patient at first did not acknowledge this gap, but then finally admitted that the co-pay had forced him to delay refills. He remarked, “I can eat and heat my home, or I can get my meds, but I can’t do both.”  The Care Ally was able to petition the manufacturers for hardship papers, and now there is no gap in prescription refills.  Most importantly, his A1C has been reduced to 7.9!

Patient #3 is an 83-year-old male who has a cognitive impairment.  After an annual wellness visit, the primary physician ordered home health care visits to help with the patient’s weakness and general limitations.  However, the patient became increasingly disoriented and refused to let the home health aide into the home, thinking she was a photographer.   As in the other cases, this patient was not responding to the regularly scheduled emails and texts that are standard components of CCM.  However, the Care Ally received an automated alert, read about his refusal to admit the home health aide in the EMR, and then called the patient directly.  The Care Ally immediately recognized the patient’s disorientation and called the police department to do a well check on the patient.  The police found the patient to be obviously confused and called an ambulance to take the patient to the hospital for an emergent evaluation.

You will notice some common themes in these patient stories.  The first is that the CCM program had established a digital two-way communication platform with the patient.  This is a game changer from the traditional paradigm of medical interaction, which is dependent upon the patient calling the office to report a problem.  None of these patients felt they had any reason to call the doctor’s office (in that they were unable to recognize that they were in need of any care). However, the lack of responses to email and texts served as an indicator to the Care Ally that something might be amiss. In the traditional paradigm, corrective actions are initiated only AFTER the patient contacts the doctor about a problem.  In the new CCM paradigm, there is outbound communication that can help detect problems even if the patient is not contacting the clinic.

Second, the CCM program could provide VIP services that truly made a difference in patient outcomes–these are simple yet extraordinarily effective.  One problem with the term “VIP Services” is that many think of limousines, suite upgrades and free meals.  But here we see that “VIP Services” can be low cost but directed interventions to resolve specific issues facing a patient.  Most clinical practices do not have the resources to contact patients who are not complaining, and most do not have the resources to respond to the cases above in the same proactive fashion that CCM allows.  A CCM program can truly provide that competitive edge and get medical practices paid for the effort!

Third, these examples point to the synergistic effects of technology and the human touch.  Technology is an answer because it can help us monitor patients for signals and provide additional communication channels.  But we need the human touch in many cases to really make the difference.  As a practicing cardiologist, I get excited about how much technology can help, but at the same time, I am humbled by how much technology still cannot do. It is the balance of technology and human touch that will be a game changer in healthcare.

Finally, it is important to assess the value of CCM in terms of revenue, improvement in quality scores and other hard metrics.  But there is a “softer” side to the value equation that makes CCM valuable and helpful to patient outcomes.  These stories from the “trenches” of CCM providers happen all the time–they form a compelling testament to the value of CCM!

About Spencer Kubo, MD
Spencer brings a diverse set of experiences and expertise to the chronic care management strategies of CareCognitics. Previously, he was Medical Director of the Heart Failure-Heart Transplantation Program of the University of Minnesota, where he authored over 250 original articles and abstracts. He has also been Chief Medical Officer or a consultant to numerous medical device companies developing breakthrough treatments to improve the lives of patients with cardiac diseases. He maintains a part time clinical practice and most recently was the Physician Lead of the Heart Failure Service Line for Allina Health. In that capacity, he leads a multidisciplinary group focused on improving outcomes of heart failure patients treated at any of the 12 hospitals and over 90 clinics in the Allina system.

Note: John Lynn, Founder of Healthcare Scene, is an advisor to CareCognitics.

What Can the Casino Industry Teach Healthcare about Patient Experience?

Posted on October 4, 2018 I Written By

The following is a guest blog post by Spencer Kubo MD, Chief Medical Officer at CareCognitics.

Two of the hottest topics in medicine today are patient engagement and patient experience.  It is well accepted that patients who are engaged in their medical care have better outcomes, compared to patients who “passively” receive instructions, likely due to variable adherence to doctor recommendations.  It is also becoming increasingly clear that patients who have better experiences with medical contacts will have higher levels of patient engagement. But the medical community has been slow to identify, measure, and implement the specific steps that would enhance patient levels of engagement and experience.

This lack of momentum within the medical community is not surprising to some since “traditional” interactions with medicine are now often viewed by patients as paternalistic.  Indeed, many practitioners within the medical community have trouble adopting the term “customer” and still favor the use of “patient,” viewing medical interactions as inherently different from consumer interactions.

These challenges have caused doctors and health care administrators to look outside of the medical community for better ways to improve the patient experience and engagement.  The CareCognitics team spoke to a Product Manager at Nordstrom, a company with legendary customer service and loyalty, who noted, “The most important factor in making the customer feel special is to create the sense that the sale or interaction was special to both the sales associate AND the customer.”  And in many instances, doing this creates no additional cost to Nordstrom; the very basic rules of respect and personable service are all that are needed.

In our work at CareCognitics, we’ve seen success with improving patient experience and engagement using a similar focus on making the patient feel special.  CareCognitics is a digital health company founded in 2016 that leverages casino and hospitality loyalty principles, along with data science, to improve the patient experience.  Sunny Tara and Vishal Argawal, co-founders of CareCognitics, shared some of the “secret sauce” that is already helping five clinics in Nevada and California: “We started small and focused our efforts on chronic care management, especially since these activities were well supported by chronic care management code CPT 99490 and therefore brought in additional revenue for each clinic.” Here are just a couple of the ways that Tara and Argawal were able to ameliorate patient experiences by leveraging the best practices of the hospitality industry.

Make the conversation two-way: Traditional communication with patients, outside of in-person doctor’s visits, usually occurs via phone and is restricted to business hours.  CareCognitics developed a HIPAA compliant digital platform so that patients could engage in a dialogue with the medical team using a format that was convenient to the patient’s schedule and not confined to office hours.  Tara also commented, “We were also pleasantly surprised to break many myths about digital literacy in the Medicare population – over 70% of patients were responding to texts and emails.”  People loved having a “conversation” and felt the platform provided a much more interactive experience with the doctor’s office. “Our success is not defined by the technology we use, but rather by personalized content that is delivered to the patient every month, that reinforces the feeling that their doctor cares about their well-being.  We use technology and digital channels to strengthen the patient-physician relationship and provide personalized care at scale,” Tara explained.

Offer encouragement and a personal touch: “Let’s face it – completing tests as part of a chronic care management (e.g. flu shots and mammograms) is not very exciting,” says Agarwal.  Each time a patient completes a test, CareCognitics sends a congratulatory note and a message on the importance of the test (e.g. dramatically reducing the chances of suffering from flu symptoms.)  And each message is branded to the physician office (rather than a 3rd party), so the patient feels the communication is with the doctor’s staff.

In addition, CareCognitics supplies a “Care Ally,” a Certified Medical Assistant (CMA) who can respond to requests for additional details, schedule changes, etc., on behalf of the physician’s office, further enhancing the personal VIP touch, similar to a VIP host in the casino industry.  All patients who enroll in the program get instant benefits like “VIP phone” access (a special priority access phone line that physician offices aren’t responsible to run), next day appointments, and interactive personalized care.

All these perks help to reinforce the relationship between the patient/customer and the physician’s office.  The patient feels “special” because there is a pervasive sense of being uniquely cared about by doctors. Many of these principles of VIP service overlap with the principles of concierge medicine, but in this program, there is no large monthly fee to the patient!  All the patient has to do is be an active participant in his or her own healthcare.

Hey, let’s not forget about the docs!

Yes, the focus of all these activities is on the patient, but physician acceptance is critical for the program to be sustainable and incorporated as an essential feature of medical treatment, and not just a fancy add-on. Physicians’ feedback has pointed out at least 4 features of this chronic care management program which are particularly attractive to physicians: engaging dialogue with patients, natively documents in the EMR, improved PQRS scores, and incremental revenue. 

According to Dr. Cliff Molin, a family practitioner with PHG, physicians like the fact that patients are engaging in a dialogue with representatives of the physician practice, without taking time out away from the daily workings of the practice. The key elements of interaction are embedded into the EMR, so physicians can oversee the progress without having to access a different website. Because the program encourages completion of positive health behaviors, all the practices are reporting improved results on PQRS quality reports.  And finally, the program has brought in incremental revenue since all the care coordination activities are reimbursed by CMS at ~$42 pmpm.

Carecognitics improves physician’s ability to compete with large health systems and provide excellent care while improving payment for the work they do. Technology is leveling the playing field in improving patient care without increasing costs for physician practices.

Note: John Lynn, Founder of Healthcare Scene, is an advisor to CareCognitics.