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Engaging the Chronic Care Patient

Joe Cantlupe, for HealthLeaders Media, November 13, 2013
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Medical groups and hospitals are asking patients not only about their clinical needs, but also about their social and economic conditions—beyond the scope of their disease—to tap into potential care needs. Physicians are changing their schedules to make it more convenient for patients to see them. Hospitals are also talking to patients about follow-up care, well before they are discharged from their rooms.

With a growing older population and those with chronic diseases, hospitals have little choice but to improve coordination of care for chronic ailments, says Don Bignotti, MD, senior vice president and CMO of CHE Trinity Health based in Livonia, Mich. Like other healthcare systems, CHE Trinity Health is concentrating on "chronic disease management to provide for the needs of the community," he says.

CHE Trinity Health is forming an "intense cardiac improvement program" and a "diabetes collaborative" that are included in a medical home care structure, Bignotti explains. In late 2012, Trinity merged with Catholic Health East, creating a health system with 84 hospitals, 89 continuing care facilities, plus home health and hospice programs serving residents of 21 states.

He says it's important that patients are engaged to improve their chronic conditions, and patient satisfaction also plays a role. "If patients are engaged and moving forward and their quality of life improves, we also believe they will become more satisfied in their care."

Improving patient engagement and loyalty is naturally linked with enhanced hospital processes of care, Bignotti says. By focusing on heart failure, for instance, Trinity, prior to the merger, reported a reduction of 30-day Medicare all-cause heart failure readmissions from 19% to fewer than 16.2% in a six-month period. Essentially, technology sometimes takes a back seat to improvising a care path. "It's about teamwork and a lot of interventions," Bignotti says. A major impact results from a simple formula: hospitals working with primary care physicians to ensure follow-up appointments for patients, he adds.

"For the patient, it's the experience in the sense of being connected and holistically involved in care," adds Mary Ellen Benzik, MD, CMO of Physician Network Services for CHE Trinity Health. "You have to have a holistic view, having the system surround the patient in a coordinated way. The patient says it feels different."

Success key No. 1: Technology, flexibility

Warcup knows the patients he sees at Carolina Advanced Health had been reluctant to see their doctors, and many said they were dissatisfied with their care. "They never understood their disease well," he explains.

Working with BlueCross BlueShield of North Carolina and the University of North Carolina Health Care, CAH has reached out to patients who hadn't seen their primary care physicians for at least a year, asking them to give CAH a try. Within two years at CAH, Warcup has seen these patients transformed, especially in their attitudes about seeking care.

Technology and flexible staff time have improved patient engagement and satisfaction.

Warcup says he emphasizes team-based care, and "on-time" electronic information for patients, with increasing use of telehealth. The practice focuses on care for chronic conditions, such as diabetes, hypertension, high cholesterol, congestive heart failure, coronary artery disease, and obesity.

The care team is robust, and includes physicians, specialists in internal medicine, a psychiatrist, physician assistants, behavioral specialists, nutrition/health coaches, clinical nurse managers, and social workers. By concentrating on chronic disease management, the team effectively reduced the number of patients seen by each physician, from 3,000 to about 1,300, Warcup says. That focus on chronic care has led to a 10.5% reduction in hospitalizations among the group's patients.

"We use motivational type interviewing: 'What's the optimal health for you? What does it look like?' We try to spend a lot of time educating [patients] on their disease and showing them different technologies to help them manage their disease. If they say, 'The goal is to be around and see my granddaughter or daughter get married,' we turn it around and say, 'Here's your goal, not my goal. Your goal can be achieved if we do this.' It helps them stay motivated when they hadn't been before," he says.

Within one year, patient satisfaction scores reached 95% and 100%; that was especially unusual, Warcup says, because many of the group's patients weren't welcoming of medical care. More than 100 patients were polled.

"Some [patients] haven't seen anybody in a while," Warcup says of those who had stopped seeking medical attention. "We spend a lot of time educating them about their disease, and we show the different technologies we have to manage their disease. We have expectations that they are part of the team. We use that language constantly: You are part of the team."

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