In a complex regulated healthcare world, providers are constantly trying to ensure that they can remain viable and provide the best quality services to patients. However, the ever-changing regulations impact how providers are permitted to provide care, share information, bill for services, document services and where the services can be delivered. While the regulations constantly change the providers’ day-to-day behavior, two themes are consistent throughout the laws. First, providers will soon be paid based upon quality outcomes instead of the volume of patients treated. Second, providers will be driven to reduce costs related to delivering care to be viable. In order to achieve quality outcomes and reduce costs, the provider is not in complete control. In fact, providers can only accomplish quality outcomes and reduce costs when a patient is engaged and accountable for his or her healthcare.
Because of Accountable Care Organizations (ACOs), the hospital compare websites, the soon to come physician compare studies and the changes in the reimbursement models, providers, ranging from the single doctor in his office to the large health system and its multiple hospitals, are evaluating patient engagement strategies. For example, in ACOs and in several Medicare demonstration projects, physicians and hospitals will be paid partially based upon the outcomes of patient satisfaction surveys. Therefore, improving the patient experience is one component of patient engagement. We are starting to see more and more Disney programs, Ritz Carlton training and other customer service training programs being launched within healthcare facilities. These programs are intended to emphasize the customer service side of healthcare and improve the patient caregiver experience. Ultimately, the goal is to improve the patient care survey scores so that providers will continue to be paid for the services rendered. For example, if a provider participates in an ACO, 7 of the 33 quality indicators that the provider will be scored on in order to obtain a share of the savings focus upon the patient caregiver experience. Therefore, the patient caregiver experience is a critical component of ensuring that the reimbursement will be received for services rendered to the patient.
Beyond customer service, other patient engagement strategies range from providing patients with a personal health records to phone apps and text messaging to electronically communicate with the patient about his or her healthcare needs. We are also seeing more information technology systems that are trying to engage the patient to be more accountable for his or her care. Today you may go to the physician receive your medication and then receive a reminder within seven (7) days of your follow-up visit or receive an electronic reminder to take your medication. There are also innovative programs where an individual will have a Bluetooth weight scale that can wirelessly transmit the patient’s weight results back to the physician so that it can be tracked as part of the treatment plan for the patient. By remotely relaying clinical information to the physician, it may reduce the number of times a patient must be seen in the physician’s office which reduces costs and supports patient’s desire for convenience.
Integrating patients with the healthcare providers is another form of patient engagement intended to maintain and secure reimbursement. Historically, patients would go to the provider, receive their medications go home and continue on with their day-to-day routines. Many patients see multiple providers so the patient may have several different types of medications and treatment plans. Unfortunately, this disjointed method of delivering care results in multiple providers ordering lab or diagnostic tests and potentially multiple visits to several providers. Today, in order to reduce costs, the patient’s entire treatment team may be integrated through a multi-disciplinary team that can actually address all of the patient’s needs, reconcile the medications, and ensure that diagnostic and laboratory tests are only performed once and the results shared with all the providers. Integrated care will help cut down on the cost and ensure that the patients’ healthcare needs are being addressed by all of their providers in one treatment plan instead of multiple treatment plans that might conflict. Overall, this integrated delivery model reduces the cost of the delivery of care and ensures that the patient’s entire care is being treated through one patient-centered plan.
Thus, the new reimbursement models are turning the concept of healthcare delivery on its ear. Today, instead of focusing on what type of equipment, surgeries and medication should be used, physicians are focused upon how do I talk to my patient, how do I improve their experience and how do I ensure that the comprehensive care of the patient will be integrated with other patient providers. All of these efforts are intended to ensure a better outcome for the patient and ultimately reimbursement to the provider. However, the patient engagement strategies will only work if the patient participates.