It is universally accepted that we have an unsustainable and broken healthcare model. It’s also becoming more and more a priority to engage patients in the their care as a way to improve healthcare.
New Rules Require Physicians To Provide Patient Engagement
Many providers today are worried about what’s required for them tomorrow, that it’s difficult sometimes to look up from their day to day responsibilities to see what’s coming. Patient engagement is quickly becoming a requirement, whether it’s HIPAA, HITECH Meaningful Use, Medical Home, and Accountable Care Organizations. Why does patient engagement matter? There’s a universal belief that patients are an important stakeholder in healthcare, after all they have the most at stake, and their involvement can lead to better healthcare outcomes at a better overall cost.
New Studies Prove Lower Costs and Better Clinical Outcomes with Patient Engagement
New studies recently published in HealthAffairs find that patients who are engaged in their own healthcare not only have better clinical outcomes but also have lower costs of healthcare.
By analyzing records for 33,163 patients, researchers at Fairview Health Services, a Minnesota health system, found that patients who were “least activated” — less involved in managing their health — had 8 percent higher costs than those who were actively engaged. While average costs were 8 percent higher in the first year, that figure shot up to 21 percent in the second year.
The definition of patient activation according to researcher Hibbard in the study: “understanding one’s role in the care process and having the knowledge, skills and confidence to take on that role”. Hibbard defines “engagement” as a broader term which includes, but isn’t limited to patient activation.
The Patient Activation score is calculated based on a patient-administered questionnaire that covers 13 areas describing their beliefs, knowledge and confidence in managing their own healthcare. Hibbard and colleague have published many articles asserting that patients with higher scores are more adherent to doctors’ instructions, engage in healthier behaviors, seek out health information, and get preventative care more often than people with lower scores.
A separate study also found that patients who received help from their providers such that they could share in decision making saw 12.5 percent fewer hospital admissions and lower healthcare costs.
“The evidence assembled in this issue of Health Affairs is a wake-up call for healthcare providers, who must recognize patient and family engagement as a top priority,” said George Bo-Linn, chief program officer of the Gordon and Betty Moore Foundation, which funded the studies, in a statement. “This collective research clearly demonstrates that we must do a better job of helping patients and families to play an active role in their care, and we must redesign the healthcare system in ways that makes this possible.”
Engaging patients, however requires a fundamental cultural shift at the provider level.
“Further involving patients in decision making will mean some changes to how healthcare providers deliver care,” said Dominick Frosch, a Moore Foundation fellow, whose research is appearing in the February issue of Health Affairs. “Additional training, changes to team-based care models and incentives for adopting this new approach can go a long way toward enabling these changes in the current healthcare system.
Patient Engagement and Cancer Patients: Why, How, Who, When?
Cancer is one of the most complex and expensive therapeutic categories. With the personalization of medicines and the advent of diagnostic tools in cancer, the category will become even more complicated and expensive in the coming years. Understanding the right intervention for the right patient based on their unique disease characteristics will be increasingly complex. This is at a time when payors are trying to understand cancer costs in a more predictive way and are working on alternate payment models with physicians, such as medical home or accountable care organizations with shared savings components. Engaging cancer patients to take a more active role is a key component of medical home and accountable care organizations to improve care coordination, drive down costs, and develop a system of shared accountability.
To do this effectively, a practice will need a patient portal, or an electronic system for patient relationship management, to better coordinate and manage their patients. HITECH Meaningful Use Stage 2, which comes into effect in 2014, will require that providers provide patients with the ability to view, download and transmit their health information electronically. In addition, the new HIPAA laws, which go into effect September 21, 2013, also provide patients with additional rights to access their information, including electronically, and more provisions to ensure that their data is secure as well. To meet these requirements effectively, a portal will be required.
Healthcare professionals have two choices when selecting a portal, they can use the module provided by their EMR vendor or a best of breed portal provided by an independent portal company. The advantages of using the module from their EMR vendor is that it’s perceived to be “easy” and doesn’t require an additional system. Because it’s one database, interoperability is already built in and data can flow seamlessly as it’s essentially the same system. The downside of using the existing EMR system is that generally speaking, EMR vendors are only providing the basic features and functions needed to meet HITECH and aren’t truly thinking about the patient experience, patient engagement or the functionality needed to meet emerging trends such as medical home and accountable care organizations. Many providers aren’t happy with their EMR vendors, and a recent report indicates that many providers are looking to switch their EMR’s in 2013. If a practice isn’t happy with their current EMR vendors service, it would be foolish to invest in using a system, such as a patient portal, that is not core to their offering.
For best in breed solutions, the main negative is that you need to create connectivity via an interface with your EMR and your portal system. Make sure you understand your potential portals interfacing and talk to current customers. If they can prove they can create the right interface, then you can feel comfortable with moving forward. The benefits of the best in breed system is that the companies sole focus is patient engagement. They most likely will have a larger vision and understanding of healthcare beyond the next 12 months and will be supporting initiatives, such as medical home and ACO’s, that can catapult you ahead in your market and ensure that you are ready to meet the challenges ahead.
For providers, it’s not too early to start building your plan around patient engagement. With new HIPAA requirements this year, the time to start the process is now. Your staff will need time to transition to the new workflow requirements, and your patients will happily appreciate the new services you will be providing them. The benefits to starting now is that you will be ready to meet requirements and will start the path to better outcomes for your patients at a lower cost.
1 Pfister, H, Ingargiola, S. Improving Patient Access and Engagement Ongoing Federal Effort. HITECH Answers. August 16, 2012
2 Hibbard, J, Greene, J. What The Evidence Shows about Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data on Costs. Health Affairs. February 2013. 32:2: 207-2014
3 Hibbard, J, Greene, J. What The Evidence Shows about Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data on Costs. Health Affairs. February 2013. 32:2: 207-2014
4 Hall, Susan D. Will 2013 be the ‘year of the great EHR vendor switch’? Dissatisfied physician practices considering other options, according to Black Book Rankings. FierceEMR. February 20, 2013