Much of the discussion taking place about accountable care organizations focuses on the provider’s accountability in population-based healthcare. What appears to be getting lost in this discussion is the patient’s role in the accountability equation. The challenge most providers face with accountable care organizations is not just how to manage risk, but also how to assist and coach individuals on making positive and sustained changes in their lifestyles.
Ultimately, the success or failure of accountable care organizations, should they become a reality, will depend upon their ability to establish genuine partnerships between those who dispense medical care and those who consume it.
The accountability partnership is a two-way street. Consumers cannot determine the medical efficacy and cost-effectiveness of tests and procedures without unbiased knowledge of the benefits, value, and costs associated with various diagnostic and therapeutic modalities.
Considering that up to 80% of health costs are related to chronic conditions that have their origin in poor lifestyle behaviors, providers must find ways to motivate the chronically ill patient to make every effort to modify those lifestyle behaviors that can worsen their condition. While physicians may know evidence-based approaches to disease management, the very nature of the physician-patient interaction (“I’m the doctor—you need to do what I tell you”) can thwart patients’ compliance with the physician’s prescribed solutions. Patients often express that they feel rushed in the exam room, and the language of medicine can create a palpable communication barrier between physicians and patients. The physician’s focus is on “what is your chief complaint?” (i.e. what can I fix) whereas the patient’s is “how do I make my life better”?
One way to facilitate the accountability partnership is to employ or contract the services of integrative health coaches within the ACO. Integrative health coaching (IHC) encourages patients to change personal behavioral patterns. Armed with behavior modification tools and skilled in the art of motivational interviewing, integrative health coaches are specially trained to motivate clients into taking positive steps and assuming personal responsibility for lifestyle improvements. The purpose of IHC is to create structured and dynamic partnerships that move people toward not just wanting to adopt a healthy lifestyle, but to actually do it.
Additionally, integrative health coaches use both innovative and practical strategies to help patients explore options for which the primary care physician may not have the time or knowledge. Suppose, for example, a patient sees a primary care physician in the ACO for a back-related issue. Depending upon the seriousness of the patient’s condition (e.g. how long she/he has had the back pain, what may have caused it), the patient may have several options, including do nothing, seeing a physiatrist, an orthopedist, a neurosurgeon, an anesthesiology-trained pain management specialist, or maybe a chiropractor.
After initially consulting with the PCP who prescribes a muscle relaxant, the patient meets with an integrative health coach to review the benefits, costs, likely outcomes, and lifestyle changes associated with treating back pain and with sustaining a healthy back. Together, the coach and patient develop a personalized healthy back plan with specific actions designed toward achieving concrete milestones. The plan is geared toward achieving the best outcome possible for the patient while utilizing the most cost-effective diagnostic and therapeutic modalities in the process.
In the above example, the integrative health coach acts as a conduit between the primary care physician and the patient, providing assistance to patients and feedback to the medical team as to the patient’s progress with his or her issues. Employing health coaches particularly works well with the medical home model, as professionally trained coaches provide a bridge between the interdisciplinary specialties (pharmacy, dietary and nutrition, physical therapy, etc.) and the patient or a group of patients. Health coaches are not case managers in the traditional sense; rather, they encourage self-health management and personal goal-setting among patients.
The benefits health coaches bring to physicians and patients are numerous:
- Coached patients learn how to effectively navigate the health system, resulting in increased customer satisfaction.
- Coached patients are more committed to making permanent improvements in their lifestyle behaviors, which improves the physician’s performance on outcome measures
- There is significant improvement in the quality of the patient/provider relationship: patients are more engaged in and informed about their care options whereas providers are less stressed because they can more easily get positive results for their patients.
- Coached patients generally show sustained health improvements and have less likelihood to require re-admission to a hospital during the 30 days post-discharge.
- IHC provides patients with continuity before, during, and after engagement with the health system. It levels out the episodic nature the care process, so that physician-patient interaction time can focus on productive solutions as opposed to re-hashing information in the exam room.
- IHC strengthens the loyalty of patients and helps to keep them from leaving the system due to fragmented and disjointed care coordination.
A lot of lip service is being given to “patient-centered care” and “consumer-driven healthcare”. As more and more health leaders ponder the organizational, financial, operating and cost management aspects of managing a successful accountable care organization, they need to be careful not to lose sight of the patient’s role in the accountabilty partnership. Because the chances are good that the ACO’s that get patients to actually make the lifestyle changes will be the ones that thrive.
Patrick T. Buckley is President and CEO of PB Healthcare Business Solutions LLC, located in Milwaukee, WI. He is the author of The Complete Guide To Hospital Marketing and Physician Entrepreneurs: A Marketing Toolkit (both published by HCPRO).