Some may say that the transition to value-based care is taking baby steps. Well, significant time and effort are needed to amend FFS payments with quality-driven reimbursements. But before this change will happen, the actual quality standard supported by benchmarks should be established first, and on the way there are multiple pitfalls emerging one by one.
As patients are at the core of care delivery results, we’ve decided to discuss the challenge of analyzing these patient-centric results that arises from the context of wide variations between patients’ health statuses and subsequent outcomes. The need to analyze care results is essential for care delivery management and improvement, yet this challenge stays unsolved in most cases.
Technology can empower caregivers with necessary resources to handle it. However, while CMS puts EHR into the center of technology-aided care, it can’t tackle this challenge due to a fragmented approach to patient information. Even some of EHR vendors, such as eClinicalWorks (represented by Girish Navani), say that a lot of EHRs are “sophisticated billing systems,” not full-fledged patient profiles providing caregivers with a holistic view of each patient.
Is there a solution that can tackle the challenge of analyzing patients’ care results? We say yes.
CRM as a tool to handle care delivery results
EHR stores massive data related to patients’ health statuses, and it is supposed to offer strong analyzing and reporting capabilities. Unfortunately, most of EHR systems don’t allow that, thus caregivers are bound to seek the needed functionality somewhere else and experiment with other tools. This is where a healthcare CRM comes into play, allowing to set up certain algorithms to automate a major part of solving the challenge. Now let’s see how it can be done.
Patients’ health statuses as a care result
Each patient is unique, two individuals with the same disease differ in initial vitals, related symptoms and condition progression. Treatment will vary as well. Therefore, there’s a challenge in how to structure all patients. We came up with the concept of such a structure within a healthcare CRM system.
Recently, we’ve published a guide on how to start with patient health profiling in CRM. As healthcare CRM is all about knowing patients and their needs, caregivers can segment patients into narrow groups to interact with them in a personal and relevant way.
The following range of care results can also become an additional set of criteria within the ‘Disease status’ dimension in a caregiver’s CRM patient health profiling variant.
Now let’s see what each result means and how to divide patients between categories.
Complete recovery
This is the happy ending all caregivers aspire for. A patient is recovered from their disease, and he or she can now forget about medications, procedures and appointments. Sadly, a complete recovery can be a result of treating non-chronic diseases and conditions only – infections, fractures, surgeries, burns and more. This result can also be applied to behavioral health conditions and traumas, when patients finally abandon harmful addictions and recover from psychological injuries.
Stabilization after an acute case
Patients that undergo a surgery are most frequently discharged long before they fully recover. The recovery process can take months, thus it is incorrect to immediately label a post-surgery patient with the ‘complete recovery’ tag.
This stabilization result can also be applied to patients with chronic diseases, such as COPD. In case patients develop acute exacerbations and / or complications, they are admitted and treated. When there’s no more immediate life threat and patients are discharged, they can be supported with an individual pulmonary rehabilitation program or with an adjusted program if they had one before an exacerbation. Accordingly, this is also the case of the stabilization period.
In behavioral health, a sudden return to addictions that is followed by a ‘probation’ period during rehabilitation, can also fall into this category. For example, the addict who seemed to reject old habits and start with his or her new life, unexpectedly snaps out. Then this patient recognizes the problem, takes steps to overcome the habit and gets help. Accordingly, in the course of a gradual recovery, he or she is in the middle of stabilization.
Long-term stabilization
The category of long-term stabilization contains patients who cope well with their chronic conditions. For example, patients with diabetes Type 2 can stay at the same level of compensation by being proactive about their physical activity and nutrition as well as tracking and controlling blood glucose. Sometimes they don’t need glucose lowering non-insulin medications to stay as healthy as it is possible for them.
Accordingly, patients with such conditions as cancer in remission, schizophrenia with less severe and even absent psychotic symptoms, stable autoimmune diseases and more also belong to this category.
Moderate improvement
In long-term diseases, any improvement is a small win. For example, in COPD, the functional improvement of lung capacity doesn’t necessarily lead to an objective improvement of the pulmonary function. Only repeated self-assessment of dyspnea and cough combined with oximetry results can shed light on the process of pulmonary rehabilitation. Even if the improvements are slight, patients need to keep going to eventually feel the actual result.
Some cancer cases can also be characterized by a moderate improvement during chemotherapy. The same mechanics work with mental disorders, addictions, psychologic traumas when patients gradually improve their health.
Lack of improvement
Chronic and long-term patients along with individuals with behavioral health problems and autoimmune diseases tend to fall into this category. This result helps caregivers to define what holds on a patient’s improvement. A slight change in the treatment plan, physical activity, pulmonary rehabilitation, nutrition, attitude – every detail matters and it can either make a patient feel better or decrease his or her health status.
Health deterioration
Any worsening of any disease or condition belongs to this section. Reasons for health deterioration, however, differ. Some diseases and conditions just progress over time, others develop negative results that are a priori preventable.
For example, diabetes Type 2 will progress over years, causing more frequent cases of hyperglycemia and hypoglycemia, troubled vision, numbness in feet and more. Accordingly, this progress will require changes in treatment, such as switching to another medications or adding insulin. These changes are negative, yet in most cases it is just the way how the disease develops, no matter how patients try to follow prescriptions. Brain ischemia, Alzheimer’s, Parkinson’s, Huntington’s and many more diseases also worsen over time, even despite an appropriate therapy.
We still don’t know exactly how human bodies work, thus certain patients may differently react to prescribed therapy, daily routine, nutrition, medications, etc. Therefore, health deteriorations also occur in preventable cases, such as the post-surgery period, pulmonary rehabilitation, mental disease treatment and others.
More challenges to come
While CRM is not a silver bullet to solve all possible puzzles in care delivery, EHR is also not the one to tackle multiple problems that will arise from the shift to the value-based environment.
We need to underline that the shift is more about new payment and reimbursement systems and evaluation criteria that should encourage health organizations to form an established care cycle with trackable touchpoints. It’s not that caregivers will suddenly care more for patients’ health as if they didn’t previously. Yet many measures, benchmarks and goals in care quality, which they didn’t encounter before, emerge as they go forward. To prepare for them, it’s necessary to fight the problems that are already in place, so that health organizations will enter the new era prepared to face new conditions, not still sticking to previous goals.
If you would like to name more challenges that hinder transition to the value-based care delivery, please feel free to mention them in comments.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
