PE is the superhero that watches, engages, and protects as many patients as possible. It uses technologies, tools, and processes to improve patient communication and clinical outcomes. PHM, on the other hand, parameterizes clinical and financial variables across an entire population. It’s essentially PE’s superpower — an X-ray into the health of hundreds of thousands of people at once.
But patients slip through the cracks, particularly the sickest, poorest, and most difficult-to-reach individuals who don’t produce enough data through PE tools to work well with PHM efforts. This creates a vicious cycle: PE can’t reach those who need the most help and support, rendering PHM useless for this population.
With technology as its sidekick, though, PE can begin to bridge the gap to connected health management, leaving few or no areas that the powers of PE can’t reach.
Vulnerable patients, an expensive problem
The toughest patients suffer the most from the gap between PE and PHM, and they’re also the most expensive patients to manage. Five percent of patients account for half of the nation’s annual healthcare spending, which is now $3 trillion.
Of course, improving outcomes for the sickest and poorest population is a worthy goal in itself, but it also carries heavy financial reward. Simply moving 20 percent of the top 5 percent of utilizers into the second-highest decile would save more than $100 billion each year. While the financial pain is still borne primarily by CMS, new quality reporting requirements will steadily move this onus onto providers that were recently partially immune.
Hospitals are already preparing in droves by investing in innovative patient engagement functions. According to the American Hospital Association, more than 69 percent of hospitals have invested in engagement by granting patients the ability to view and download their health information online. In addition, more than 60 percent of hospitals allow patients to communicate with their providers through secure electronic messaging.
3 strategies to close the gap
Recognizing the divide between PE and PHM is a good first step, and healthcare technology will continue to be a vital avenue to engaging the most at-risk patients. Executives who are willing to take more risks will be able to increase top line growth and manage impinging costs.
The real game changers in healthcare consistently employ three specific strategies to close the PE and PHM gap:
1. Determine which patients are most vulnerable. Hospital frequent fliers can bounce among various emergency departments, clinics, and even geographic locations, so claims data and a full set of updated diagnostic codes may be the most reliable tools for ferreting out which patients need the most assistance. To differentiate between patients with seemingly similar chronic conditions, use risk stratification software along with a keen eye for exceptionally high A1C scores and poorly controlled comorbidities.
2. Engage patients where they are. Meet patients who need the most support where they are, both medically and technologically. Integrate mobile health and digital health solutions into your existing infrastructure to remotely deliver care to a wider variety of patients.
A strong case for this type of delivery is the rising cost of rural healthcare. Nearly 60 million patients now require some form of rural care, but in-person visits are prohibitively expensive and time-consuming. However, telephonic or “virtual” care teams are on the rise. These medical professionals can use tools that align with patients’ individual comfort levels with different types of technology. While an elderly COPD patient might be most likely to engage with a phone call, for instance, a tech-savvy diabetes patient might readily respond to text messages.
3. Make the most of existing personnel. Align new technologies with the existing staff members’ workflow, resources, and expertise so they can operate at the top of their licenses. Far too many physicians, nurses, and other medical professionals allocate precious time filling in fields or sifting through paperwork. In other words, they’re being forced to operate at the bottom of their licenses, which makes it more difficult to implement changes.
The healthcare industry faces a pernicious catch-22: Innovation is most necessary for the most expensive patients, but the most expensive patients are the toughest to engage. Taking steps toward reconciling PE and PHM, however, is a highly effective way to jump-start improvement.
The availability of evidence-based technologies is increasing. At the end of the day, extending PE to benefit the people who need it most not only strengthens PHM, but it also helps hospitals prosper.
Blake Marggraff is CEO of Epharmix, a company at the intersection of medicine and consumer technology offering interventions that use automated phone calls or text messages to help care teams manage patients’ conditions while collecting disease-specific data. With interventions designed by leading doctors and clinically proven at medical institutions, every patient can benefit from Epharmix.
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.
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