4 Keys to Engage Patients and Operate in an Outcomes-Based Reimbursement Environment

Emerging models such as accountable care organizations will require better care coordination among providers, hospitals and their patients. Furthermore, Medicare, Medicaid, private and self-insured payors will continue to pay hospitals and physician practices based on quality of care measures, eventually moving to outcomes-based and bundled payments that are predicated on outcomes. The more engaged and involved patients are in managing their conditions, the greater the likelihood that they will experience better outcomes and satisfaction while avoiding adverse events, such as readmissions, that negatively impact their health as well as the hospital or health system. Here are four strategies and tools to help realize those goals.

1. Understand the patient population. It is crucial that hospitals and health systems gain a detailed understanding of the make-up and needs of their patients at an individual or population level. With this understanding, it will be easier to anticipate, address and prevent avoidable problems and deliver improved care at a lower cost.

2. Empower patients. It is important to empower patients to assume greater responsibility and ownership of their care by explaining why their active involvement and open communication are crucial to achieving good outcomes. An easy way providers can do this is to encourage patients to email or call with any questions or concerns. The goal is to get individuals to call before a problem flares up or worsens.

3. Target the chronically ill and those at risk of developing chronic diseases. It is imperative to focus on patients with chronic conditions because they require long-term care, daily management and account for more than 75 percent of U.S. healthcare spending. By intervening early, providers can prevent individuals from developing a chronic illness and lessen its impact, positioning for a percentage of the savings generated for payers under new care delivery models.

4. Develop capabilities and strategies to engage patients. Studies show that patient engagement is linked to better outcomes, appropriate utilization of services and patient satisfaction. Anecdotal evidence shows promise for improved reimbursement. Utilities, whether independent of or synergistic with electronic medical records, are invaluable because they enable providers to automate and streamline management of chronic conditions by collecting, disseminating and personalizing treatment information at the individual level. Drawing upon clinical data, these systems can notify providers of patient needs, enabling them to craft messages urging individuals to follow the recommended care plan and clinical guidelines including scheduling exams, screenings tests or preventive or follow-up care visits.

Benjamin Littenberg, MD,  is the Henry and Carleen Tufo Professor of Medicine at the University of Vermont. He also is an internist at the 480-physician University of Vermont Medical Group at Fletcher Allen and CMO of Patient Engagement Systems, a healthcare technology company that provides solutions for improving primary care for people with chronic diseases.

James Rose, MBA, is senior vice president of Patient Engagement Systems. Mr. Rose also serves as an advisor to the National Institute of Health's Commercialization Assistance Program and as principal advisor to the Health Care Technology, Telemedicine & Advanced Technology Research Center of the U.S. Army Medical Research and Materiel Command.

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