Hospital-tested strategies for placing patients at the center of care delivery

Healthcare providers constantly strive to improve quality of care and patient outcomes. But now, more than ever, hospitals and health systems are seeking ways to build and sustain value-based care models. Tackling such endeavors involves understanding the innumerable moving parts that impact patient safety and the patient experience. However, for many organizations, the sum of all of those components can boil down to a single question: How can we put the patient at the center of care delivery in a meaningful way?

A panel of patient care experts recently detailed the ways their respective health systems are solving that question in a webinar hosted by Becker's Hospital Review.They did so in partnership with CipherHealth, whose patient-centered solutions provide a higher quality of care that benefits providers as well as patients.

CipherHealth, a New York-based healthcare solutions company, has been building tech-based platforms to help hospitals improve care management while better utilizing their staff and data since it was first founded in 2009. CipherHealth has forged patient-focused partnerships with health systems like OSF HealthCare in Peoria, Ill., and Beaufort (S.C.) MemorialHospital, among others.

Gina Intinarelli, RN, PhD, executive director for the office of population health and accountable care at the UCSF Medical Center says implementing programs such as complex care management, population health management and transitional care has improved the patient experience for the hospital in recent years, both in terms of helping patients develop self-management skills and enabling staff to deliver better care.

"Our patients have really embraced this extra care that delivery systems without a value-based business model haven't been able to offer them," says Dr. Intinarelli. UCSF Medical Center has seen a significant reduction in readmissions and a notable impact on patient satisfaction. A recent study published by UCSF found that the use of intensive, home-based assessments involving outreach and high-touch coordinated care significantly reduced emergency room and inpatient visits in the system's most complex care patient group.

Indianapolis based-Indiana University Health System has also been working with CipherHealth on a number of projects related to improving patient outcomes and experience.

"In the past two years we have implemented several initiatives trying to address length of stay management and readmission avoidance as well as looking at patient satisfaction initiatives," says Adria Grillo-Peck, RN, vice president of integrated care management at IU Health.

IU Health has taken a number of steps to improve care delivery and outcomes, including implementing an extensive electronic follow-up program that focuses on patient populations at high-risk for readmission and team-based collaborative planning for early discharge.

"We've partnered with our pharmacy staff to get patients the medications they need before they leave our facility, and we've formed a care alliance collaborative with post-acute care facilities in our area to ensure they are delivering the highest quality of care," says Ms. Grillo-Peck. "We've begun to look at all of these components to perform root-cause analysis on readmitted patients."

Technology's role in changing care delivery

Enacting solutions to better the patient experience by identifying systemic inefficiencies also enables a hospital to better know its patient populations and their unmet needs, and address those needs once they're identified, Dr. Intinarelli says.

"Using our callback program has been critical in understanding which patients need to have a nurse calling back and helping them with their critically important transition issues," Dr. Intinarelli says. "Without that technology, we could never reach that amount of patients or that level of quality."

The right technology can make meeting a patient care goal more feasible, as it allows for scalability and eliminates logistical challenges in terms of costs, which can be prohibitive. It can also be a critical tool for enabling staff members to use their expertise and skill sets to their fullest capacities. UCSF Medical Center has found that patients seem to embrace any technology that puts them in closer contact with their care team. Even for elderly populations embrace the use of technology, and have reported some of the highest compliance rates with automated calls.

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"We've been shocked to see that uptick, mainly because in healthcare we're old fashioned and we know the human touch is really important," Dr. Intinarelli says. "This is still the human touch, but it allows us to implement the human touch on a bigger, more efficient scale."

For IU Health, talk of technological changes, such as an automated call back program, was initially a turn-off. But those initial doubts were trumped by the customizable nature of the solution and its impact on helping streamline workflows.

"After seeing that it was received very well," Ms. Grillo-Peck says, "it allows us to work much smarter, and focus on and prioritize those patients who are at greater risk. Our reach rate was very poor when we had no standardized mechanism in place for patients to reach out to us with questions or concerns."

Additionally, the insights gleaned from data and analytics tools generated by the automated technology helped give the organization a fuller picture of how and where to target change in the future. Ms. Grillo-Peck also sees it as a way of communicating with patients using methods they've grown used to. Many older adults today use smartphones, and much of the population is comfortable with text-based messaging, and taking that approach to care improves the experience.

Picking the right technology to implement can be tough, Ms. Grillo-Peck says. But garnering support from both formal and informal leaders within a health system and doing the homework to ensure the solutions align with your initiatives and will be best for your staff, organization and patient population will result in more patient-centered care.

The human side of care delivery

It's easy to get caught up in thinking that technology can solve all problems, but focusing on improvements to the human aspect of care delivery is equally, if not more, critical according to Dr. Intinarelli. The care team itself is key to fostering an environment where patients feel attended to and considered. It's impossible to drive those lasting improvements without team buy-in.

"I think the biggest indicator is really involving the staff in decisions and having a shared governance model," Ms. Grillo-Peck says. "At IU Health we have employee engagement teams focused on working with leadership to determine what's important to both sides. What makes everyone want to come to work everyday? We work together to focus on that."

Sourcing ideas from staff as well as administration is one of the clearest ways to offer a voice to team members who have valuable insights, which results in improvements and initiatives that might not otherwise have come about.

Gathering input and insight from staff about how to allocate their time most effectively can also help to determine where change needs to happen, explains Dr. Intinarelli. When UCSF was addressing ways to improve employee morale, it found nurses were spending their time in ways they didn't feel best utilized their skills. That offered insights into the kind of technology needed to free up that time and enable nurses to do what they wanted to do, and also highlighted tasks that might require bringing on new team members to tackle.

"You can't underestimate the time and training it takes to build teams," Dr. Intinarelli says. "In order to do this we have to think of healthcare differently — to really invest that kind of infrastructure and resources on your team is really important. It will motivate them to innovate and get the job done." 

As easy as it is to have a top-down perspective on implementations, involving the staff from the ground up will foster engagement and commitment to measurable change in the long run, in addition to boosting morale, Dr. Intinarelli says. Patients report a higher quality of interaction when their care team members contact them electronically — once the programs are online, staff involvement will pay off.

Long-term investments in changing care delivery

This type of long-term improvement and a shift in the focus of care delivery doesn't happen overnight. For many organizations, it requires choosing one space within which it's most important for them to see improvement and making investments to bring about that change.

"For us, it started with transitional care and trying to reduce readmissions in our Medicare patient populations," Dr. Intinarelli says. "We've invested from the inside out and learned from our mistakes, we've put the time into picking the right technology to make a difference for those readmissions and the engagement of those patients, beyond just when they show up for primary care."

At IU Health, Ms. Grillo-Peck has seen a number of quantifiable improvements in metrics, such as no-show rates and consistency between units, among others.

"Since partnering with CipherHealth we've gotten to a reach rate of about 75 percent," Ms. Grillo-Peck says. "Though we don't know the impact on readmissions as of yet, we believe implementing the programs we have is going certainly make a difference."

According to Dr. Intinarelli, actively seeking out the tools and systems to shift the way care is being delivered is a way to meet head-on the changes that have taken place in healthcare. Traditionally, patients came to see their providers, and then turned around and went home, which has clearly changed, she says.

"We now realize that the home is where healthcare really happens and we have to consider the barriers to achieving those care goals. The infrastructure to do that might not exist for many organizations, but enabling a workforce to build solid relationships with patients and having those patients better manage their own care produces results."

Click here to view the webinar recording. 

Click here to view the webinar slides. 

More information on CipherHealth is available here.

More articles on patient-centered care:

Community health workers reduce readmissions and costs: 4 study findings
HHS hits goal of shifting 30% of Medicare payments to alternative models
5 insights on developing a successful care management program

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