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Engaging the Chronic Care Patient

Joe Cantlupe, for HealthLeaders Media, November 27, 2013

Frustrated and noncompliant patients can lead to increased healthcare costs. Through remote monitoring, video conferencing, and nurse navigators, health systems and hospitals are tapping into the needs of patients facing an array of chronic conditions – and lowering their cost of care.

This article appears in the November issue of HealthLeaders magazine.

Emily Lieb, MD, medical director of Bon Secours Health System's Care-A-Van program regularly goes into the community to connect with patients. She and a nurse colleague and medical assistants drive to sites in Virginia on scheduled days in the hospital's mobile health clinic to provide free, urgent, and preventive care to patients who are uninsured and might not have seen a family doctor for a while. Their patients have chronic conditions and have lost track of their own medical history.

A typical patient is one who steps inside the van with a nagging cough and asks to be checked for bronchitis. After an initial examination is done, the diagnosis of bronchitis is confirmed, much as the patient suspected. But there's more to it than the patient realized. "Did you know your blood pressure is high? And you may have other complications?" The patient is surprised but agrees to follow-up care with a primary care physician.

By providing that convenient and unassuming healthcare presence in the van, "you can work hard to reverse their problems," Lieb says. "You have dodged a bullet. The patient is empowered in that situation to change things and is very happy about it."

The health provider's van makes at least 400 visits a month in remote areas of Virginia where the patients may lack transportation. Bon Secours is a $3.3 billon not-for-profit Catholic health system based in Marriottsville, Md., that has 4,400 beds among 19 acute care hospitals in six states.

The medical director of the Carolina Advanced Health medical practice in Chapel Hill, N.C.,Thomas Warcup, MD, DO, FAOBFP, looks at a monitoring screen and listens to a patient's rundown of ailments. The doctor is glad to hear from the patient because, like many who call in through the practice's telemonitoring system, this patient was expressing frustration with his previous experiences in healthcare and hadn't seen a doctor for a while. To engage such patients, the Carolina Advanced Health program is involved in a care partnership with BlueCross BlueShield of North Carolina and the University of North Carolina Health Care.

After months of telehealth talks, and tapping into self-monitoring programs through the practice's advanced technology, these patients are finding something unusual in the sometimes arduous journey of taking care of themselves: They are actually enjoying it, Warcup says.

Lieb and Warcup, in different ways, are making inroads in the care of patients with chronic conditions who have been among the most reluctant partakers in healthcare. Ironically, they are among those most in need. In the process, these providers are developing improved engagement, loyalty, and satisfaction among the most disenfranchised patients.

Patients with chronic condition are the "heaviest users" of healthcare services, according to Medicare studies.

In a report this year, the Centers for Medicare & Medicaid Services stated that about one in five Medicare beneficiaries was admitted to a hospital in 2010, resulting in costs of more than $100 billion. Chronic care is the crushing fiscal blow: Among the 14% of beneficiaries with six or more chronic conditions, more than 60% were hospitalized and accounted for 55% of total Medicare spending for hospitalizations.

"Beneficiaries with multiple chronic conditions were more likely to be hospitalized and had more hospitalizations during the year," according to CMS.

Yet these patients are often frustrated with their healthcare or are noncompliant, leading to increased costs.

"Some people are just dissatisfied with the throughput process; some are unhappy with their providers, have a misunderstanding of their disease, and just haven't been able to break through their static inertia," says Warcup. "Certainly, when they come to see us in our practice, maybe they haven't seen anybody in a while."

A major focus for his practice, says Warcup, is to help patients "get motivated, or stay motivated, when they hadn't been before. Sometimes they had felt dictated to, or never understood their disease well enough to stay motivated."

Physician practices and healthcare systems are focusing on various engagement strategies to help patients become more empowered in their care and also leading them toward greater patient satisfaction through technology or improved communication in chronic care management.

Through remote monitoring, video conferencing, nurse navigators, coaches, and various educational programs, healthcare systems and hospitals are tapping into the needs of patients facing an array of chronic conditions, from high cholesterol, asthma, and diabetes to congestive heart failure and depression. That's not all: They are using remote apps for "real-time" care so they can adjust medication when needed, schedule appointments quickly, and effectively monitor their patients, ease their concerns, and thwart potential hospital admissions or readmissions.

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