Healthcare in the past several decades has been marked by consumers seeking healthcare services; visiting a physician, being admitted to a hospital, seeking emergency room care. But achieving positive patient outcomes today will mean taking healthcare to consumers, as well as encouraging them to want that healthcare. A panel of four experts discussed engagement strategies at the HealthCare IT Connect Accountable Care and Healthcare IT Strategies Summit.
One key to understanding engagement is understanding what barriers exist to prevent that engagement, said Gary Capistrant, senior director of public policy at the American Telemedicine Association. “A lot of people are invested in the status quo and they are a barrier. And while the idea of patient engagement is very appealing, it’s useful to think beyond that, to consumer management and consumer direction. What are the tools to get the consumer beyond engagement?” he said.
Telehealth is one avenue of engagement, bringing services to patients from a remote site. But these services currently are only in rural areas, delivered only by physicians and only involve television, largely because of Medicare coverage, Capistrant said. “But urban people may also have problems reaching a doctor,” he said.
But barriers to telehealth also include doctors who don’t want to do telehealth. State to state licensing and practice rules also are barriers. Even “doctor-patient relationships are a way to keep telehealth out by enshrining the relationship,” Capistrant said. “I think a consumers should decide what their relationship is, and how they will deal with a doctor.”
Capistrant pointed to a number of state actions (Arkansas and Mississippi are leaders) in telehealth, as well as bills in Congress on changing Medicare coverage of telehealth.
Customizing the Patient Experience
Vree health provides patient-centered care through customizable configurable patient experience, said Lena Lattanzi, Executive Director of Product Management at Vree Health. “We can organize patient care, aggregate data from EMRs and systems to provide a central location for everyone to have access to information,” she said.
Vree provides care for patients before a physician visit, and even leading up to surgery. When the patient goes home, the company’s services offer patient monitoring and clinical health checks. “We can make sure medications are accessible, patients can get to appointments, have a primary care physician, and are going to the right site for care,” she said. Vree also analyzes its results and compares success with other initiatives.
Today’s organizations largely focus on the highest cost patients (the sickest), totaling 3% of all patients. Vree, however, offers services across the spectrum.
But technology alone is not engaging patients, Lattanzi warns. Most healthcare apps are used for less than a week, largely because the apps are not personalized. “We need to engage patients without engaging them.”
Cost savings from engaging the sickest
Huge differences in monthly healthcare costs exist between the healthiest patients (making up half the patient mix) and the sickest 3%. Costs could run up to $6,000 per month for sickest patients, said Brian Ralston, CMIO Chicago Market for Tenet Healthcare.
Tenet, however, experienced dramatic savings from the sickest patients, using complex case managers, contacting patients constantly and making decisions. “A lot of it was access—they could get information to me quickly and efficiently,” Ralston said. Online tools for analytics, data evaluation and care management also helped get information quickly to those who needed it, and could make a doctor visit more efficient. “It is horrible what’s being dumped into the short patient visit (refills, health maintenance, symptom announcement),” Ralston said.
One challenge of meaningful use is to strategically use online patient portals. While a hospital or health system can introduce a portal, outpatient settings probably already have similar portals, producing too many sources of information.
Engagement at an academic medical center
Northwestern Medicine, an academic medical center north of Chicago, uses a team-based care approach, “and the patient is the most important part of that team,” said Lyle Berkowitz, Associate Chief Medical Officer of Innovation. He noted that a very small percentage of a patient’s life is spent with a healthcare provider. So, how can they provide high quality care, efficiently?
Telehealth—Northwestern has offered these services for years but “in a fee for service environment, it’s better to have patients come in.” But for certain patients, convenience is key. But for certain patients, convenience is important.
Patient portals—a lot of interactions are conducted online. The patients are often happier and more engaged, “but they’ve signed up for the system so they would be. And most physicians find it easier than phone tag,” Berkowitz said.
Remote patient monitoring—Northwest has used monitoring on its own employees, the uninsured and higher risk patients. The healthcare system has been experimenting with these unique groups, including giving them an app monitor every day, and asking them if they felt better compared to the previous day.
These initiatives have generated questions: Will patients actually download it? Will they continue with it? If they continue, will it provide something valuable? Can we act on a problem that arises?view all