Navigating Around Failed Patient Engagement

Healthcare topics like preventing readmissions, accountable care, bundled payments, meaningful use and the individual mandate dominate today's headlines. These stories include alarming statistics on readmission rates and disproportionate spending on chronically ill and dual-eligible patients meant to draw attention to the problems of our unsustainable healthcare system.

The savior everyone points to is technology. In our mobile technology-dominated world of iPads, iPhones, Kindles and Android devices, it is easy to see how patient engagement and healthcare consumerism continue to be hot topics for vendors and investors alike. It seems self-evident to say we can reach people so much easier by giving them better, more convenient access to information. However, every time we hear a clinician state that a patient is "non-compliant," blaming them for not engaging in their own care, we cringe. To put it in medical terms, this is a symptom of a bigger problem, not the problem itself.

Care navigation

The problem, as we see it, is one of care navigation, not patient compliance. Many of the most costly patients are not able to take advantage of the great technology that exists to support "activated" patients in their self-management goals. These patients have a tough enough time struggling with their co-morbidities. What they need is to be guided by clinicians through their care at every step to ensure that they don't fall through the cracks.

The elderly represent 13.2 percent of the overall population, yet they represent 42.9 percent of those individuals who remained in the top decile of healthcare spenders. Perhaps more striking is that the elderly represented only 2.8 percent of the population in the bottom half of healthcare spenders.

Caring for this patient population requires acknowledging, and compensating for, their specific situations via good old fashioned clinical judgment — in other words, it takes time with the patient on an ongoing basis.

It's important to distinguish between those patients who don't engage and those who can't. Communities, health systems and the government itself are most focused on the latter group today because of the spiraling cost of caring for these individuals who need more time and attention than the current systems allows. Primary care providers know this, but they cannot afford to do anything about it without outside financial help from payers like CMS or commercial health plans.

Lacking incentives

As a group, primary care physicians want to, and feel the burden of, being accountable for their patients, and would like to spend more time with each patient. According to a recent Medscape study, primary care physicians are the least satisfied of all the major specialties. Furthermore, orthopedic surgeons, radiologists, anesthesiologists and cardiologists made twice the average income of primary care physicians. As a result, only 43 percent of primary care physicians would get into primary care if they were to select a specialty today, according to the Medscape study.

Spending the time that is truly needed with many patients is, unfortunately, not good business today. Primary care physicians simply do not have the financial incentives to support patients through enhanced care navigation and coordination between visits.

Using technology, people to improve care navigation

Provider-based care coaches, care managers and/or care navigators, on the other hand, increasingly are taking on this essential role in primary care. They are dedicated to activating community resources, families and even to playing a role on a care team. Without care navigation, primary care is essentially an appointment-driven business that relies on in-office patient visits to financially survive. When primary care is visit-driven, patients develop a feeling of helplessness and uncertainty about what to do. In other words, they become "non-compliant." The right technology makes care navigators more efficient, it does not supplant them. We can make a bigger impact on high-cost patients by enabling practices to cost effectively support care navigation through distributed and well-coordinated care.

In recent years, we have been fortunate enough to work with a number of passionate, visionary proponents of provider-based care navigation, and to document the success they are having in their respective communities. Witness Sun Health Care Transitions in Arizona; 100 patients have participated in their care navigation program since November 2011, and in that time care navigators have helped identify and correct 243 medication discrepancies, readmissions have been reduced 80 percent, and they have generated an estimated $214,000 in Medicare savings. Call it the Triple AIM or call it good medicine, but the right combination of people and technology consistently generates better outcomes at lower costs. 

When it comes to helping patients, we all know it takes time and patience. The first step is to establish a care team in support of them, with a care manager/navigator in charge of coordinating efforts. This eliminates confusion and redundancies while creating an aura of accountability and visibility for everyone involved, including, and especially, the patient. Do not get stuck into building care navigation processes around your existing visit-driven workflow. This is a new nurse-driven role, and requires a new process and workflow to be successful. 

When it comes to managing chronic conditions, treatment regimens are often highly complex. To avoid a patient simply giving up, utilize available tools to break up complex regimens into simple tasks that are less daunting, like a clean, easy-to-use medication schedule or symptom management guide.

It also helps keep patients engaged when they feel like they are making progress. Setting goals, documenting outcomes and celebrating success is a great way to keep a patient's spirits up, and we all know how important a positive mental attitude is to getting better.

Taken together, these strategies help keep patients engaged in their own care, making the job of caring for them easier, less costly, and ultimately more effective. New technologies hitting the marketplace make putting these practices in place an easier task. The most successful providers we come into contact with combine strategic program development with technology that makes it easier to scale these programs to more and more patients.

Benjamin Albert is founder and CEO of Care Team Connect, a web-based care coordination platform for hospitals, community providers and family caregivers. Care Team Connect is based in Evanston, Ill.

More Articles on Patient Engagement:

5 Gaps in Hospitals' Patient Engagement Strategies
4 Keys to Engage Patients and Operate in an Outcomes-Based Reimbursement Environment
5 Key Elements of a Patient-Engagement Strategy

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