Patient engagement at the practice level is identified as a key factor that contributed to the success of a Pioneer ACO in New York.
This week, dozens of healthcare leaders will converge in La Jolla, California, for HealthLeaders Media's inaugural Health IT and Quality Exchange. We have held this type of invitation-only event for CEOs and CFOs for a few years now to glean insight into the challenges of delivering quality care to patients amid a dynamic environment of regulatory change.
This newest event highlights the need—and requirement—to integrate technology into nearly every step of healthcare delivery.
Competing Priorities
Healthcare system leaders are charged with responding to the transformation of healthcare delivery on a number of fronts. Preparing for new payment models, keeping pace with new care partners, and trying to align with the latest health information technology demands all seem to be screaming for priority status.
One strategy that may help reduce the distractions that inevitably arise from such large undertakings is to focus on how each change or redesign in process empowers patients. They are the single entity that binds healthcare's complex and connected issues together.
Improving patients engagement, whether it is getting them to adhere to medication regimens, care plans, or even just following up with a PCP after a hospital stay not only improves outcomes, but could also play a role in improving patient experience.
Improving Outcomes
Keeping patients healthy is the core of a physician's work. That's a no-brainer, but the fee-for-service payment model doesn't give doctors any incentive for healthy patients. Transitioning out of a decades-old reimbursement environment that rewards doctors for the number of patients they see and not the outcomes of the patients is tough.
It's a clinical and cultural shift; however, patient outcomes are a key component to value-based payment systems. With Medicare and commercial accountable care organizations beginning to report on systems that are saving money and sharing in those savings, some leaders are using the momentum to increase their patient engagement strategies, despite the debate over whether these payment models are truly sustainable.
"Patient engagement is one of the differentiators between health systems or physician groups that can deliver quality care," says Kristofer Smith, MD, vice president and medical director of North Shore-LIJ Care Solutions, the health system's care management organization.
Improving Cost
North Shore-LIJ and University Physicians Group are part of the Montefiore ACO, a Pioneer ACO that saved Medicare $24.5 million in 2013. UPG physicians took care of 4,917 of the 25,000 Medicare beneficiaries that participated in the Montefiore ACO, just 5%, but the multi-specialty physician group generated 14% of the total savings.
Smith attributes patient engagement at the practice level as one of the key factors that contributed to the ACO's success.
House Calls Key to Pioneer ACO Success
"The practice has a relationship with the patient, and so as UPG started to get information, they saw gaps and reached out," says Smith. "Patients heard, 'This is your doctor calling,' and to leverage prior relationships, that's a more effective strategy."
To close, or at least, narrow the gaps in care, Medicare ACO participants received reminders about blood draws, vaccines, and other important components to their care. UPG also incorporated the clinical measures as determined by CMS into its electronic health record.
Another gap closed when North Shore-LIJ, in conjunction with UPG, used real-time notification tools with patients.
"We knew when one of the patients was in one of our hospitals," says Smith. "We would arrange to follow up after they were discharged, and we had much higher engagement rates."
Communication is key, says Smith. The upside to that kind of communication is that the person who is engaging with the patient does not always have to be a physician. Front office receptionists, medical assistants, nurse practitioners, navigators, etc., are playing important roles now in physician offices across the country.
Patient Experience
North Shore-LIJ is one of the dozens of health systems that will be joining and leading the discussion around how to leverage technology, leadership, and population health strategies that help empower patients in their own care.
HealthLeaders Media research has shown repeatedly that healthcare leaders believe that improving patient engagement can lead to an uptick in patient experience, which also has downstream implications.
For example, in our August Intelligence Report, Patient Experience Transformation: Engaged Patients, Measurable Standards, 65% of organizations surveyed reported that delivering a positive patient experience will lead to better quality safety, clinical, and experience outcomes.
But connecting with patients is still a work in progress. Despite the gains made in the Montefiore ACO, Smith says the system is working on an accurate way to capture the patient's voice.
It will likely be a complicated journey to answer the seemingly simple question, "What do patients want?" But, finding out what a patient needs and how they view the value of their healthcare offers insight into how a patient wants to communicate with a provider. And that answer may unlock other points of connection impact quality and cost, says Smith.
"Patient-centered communication is key. You have to figure out how to elicit information, and if you've explained things in a way they understand. The starting point is care management."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.