Now more than ever, it’s about quality… and quantity - The transition from volume to valued-based healthcare

Individuals perform better when they have a vested interest in the outcome of a given situation.

Employees with ownership stake in their company traditionally perform better, in turn they enjoy an increase of satisfaction from their respective jobs than their non-stake-holding counterparts.0

Recent research has highlighted a similar premise in healthcare. Patients who are engaged in their own care generally have better outcomes and enjoy a higher satisfaction in the care they received. According to the American Journal of Managed Care, “A growing body of research has established the benefits of patient activation, which is defined as the knowledge, skills, confidence and motivation to make effective decisions and take action to maintain or improve one’s health.”1

According to a 2016 New England Journal of Medicine survey of 340 U.S. healthcare executives, clinician leaders and clinicians at organizations directly involved in healthcare delivery, 42% of respondents indicated that less than a quarter of their patients were highly engaged, and more than 70% reported having less than half of their patients highly engaged. And to underscore the importance of this result, 47% of those surveyed revealed that low patient engagement was the biggest challenge they faced in improving patient health outcomes.6

This is not only true for hospitals, but also for specialty care practices. In these environments, it is a necessity for practices to understand the needs and behavior of their patients, so they can determine how best to conduct effective outreach that will increase patient engagement and patient portal utilization.

Prioritizing User Interface
A results-driven (or high performance) patient engagement platform helps turn patients into stewards of their own healthcare. An appropriate next-generation solution supports compliance with MIPS (Merit-based Incentive Payment System), a component of MACRA (Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act), and with meaningful use (MU), by providing patients the capability to view, download and share their medical record. Payback is many-fold: In addition to helping providers meet regulations through a user-friendly interface, patients are freeing up time for caregivers to spend with them by self-populating data fields that would previously have been handled by caregivers. This reorganization of the patient intake process delivers significant time and cost savings to the practice.

Equally important is a patient portal that helps patients remain engaged while enabling practices to comply with government requirements under meaningful use and the MACRA regulations, thereby increasing Medicare payments and minimizing takebacks. It is critical that the patient portal integrates seamlessly with the organization’s electronic health record (EHR), health information exchange (HIE) and accountable care organization (ACO), if the practice is participating in one. Ideally, the solution should be able to adapt to any healthcare facility’s IT system—not the other way around. Patient engagement initiatives should influence the entire practice’s healthcare ecosystem.

Engaging for ACOs, Triple Aim
Originally a concept born of healthcare reform, accountable care organizations (ACOs) began as a way of redefining the shared responsibility of doctors and hospital staff to coordinate care, improve quality and lower costs. It did not, however, specifically examine the role of the patient. That all changed when the Affordable Care Act (ACA) came along and the ACOs were officially codified into law. Furthermore, the law also recognized that ACOs could not succeed without patient engagement.4 According to the IHI, “quality,” in this case, is defined from the perspective of an individual member of a given population, hence the logical focus on patient-centric care and patient engagement.3

Quality over Quantity
The resulting increase focus on value-based contracts puts healthcare providers at risk for the total cost and quality of care provided, regardless of when and where the care occurred. This change in payment has highlighted significant holes in IT and data strategies that need to be addressed if an organization is to achieve success in this new payment paradigm, but the top of that list of improvements that need to be made is patient engagement.

Why Engage, the transition from volume to value?
As we transition from volume- to value-based reimbursement, it is vital to understand and how to best utilize these tools and solutions available to get patients actively engaged in their healthcare. Ultimately, by achieving this goal, we will be creating better outcomes, both for patients and the healthcare practices that care for them.

0www.sciencedirect.com/science/article/pii/S1053482210000409
1www.ajmc.com/journals/issue/2017/2017-vol23-n2/an-examination-of-the-relationship-between-care-management-with-coaching-for-activation-and-patient-outcomes/P-1#sthash.XiQ5Pmrb.dpuf
3www.ihi.org/engage/initiatives/tripleaim/Pages/default.aspx
4www.nationalpartnership.org/research-library/health-care/building-patient-centeredness-in-the-real-world.pdf
6http://catalyst.nejm.org/patient-engagement-report-improved-engagement-leads-better-outcomes-better-tools-needed/

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