Consumerism and value-based payment are spurring healthcare organizations to reconsider traditional care delivery models. Payers and providers are vying to improve the patient experience, close care gaps, and stay competitive amid new retail powerhouses and industry incumbents alike. To meet these objectives, leading healthcare enterprises are adopting consumer-centric strategies and technologies to make care more accessible and convenient for patients.
Advancements in digital health are paving the way for payers and providers to meet evolving patient expectations and stay in step with consumers throughout the patient life cycle. The groundwork being laid to support digital engagement is helping providers bridge gaps between patient visits. That sustained engagement is introducing new mechanisms to help drive consumer participation in reaching health outcomes. When executed effectively, those engagement channels can help realize big wins for population health, patient and member retention, and cost management.
Prevention’s Role in Population Health
As patient engagement strategies evolve, healthcare organizations have a unique opportunity to diversify services and introduce wellness-oriented resources to patients. Insurers and providers naturally want to promote the health of the members and patients they manage. They also want to avoid financial threats posed by failure to intervene. By broadening preventive care and early detection offerings, health systems can offset dips in traditional revenue streams while intervening in the threat of catastrophic health events down the road.
Estimates from the Centers for Medicare & Medicaid Services (CMS) suggest that chronic disease management accounts for roughly 75 percent of the $2.5 trillion spent on U.S. healthcare each year. Preventive outreach programs represent scalable population health management strategies that insurers and providers can implement today to mitigate long-term expenses, improve patient outcomes, and fortify patient engagement.
Making Proactive Care a Priority
The benefits associated with early intervention through health screenings and other preventive measures are manifold. Colorectal cancer (CRC), for example, is one of the leading causes of cancer-related deaths in the United States, with an estimated 135,000 cases in 2017. It’s also one of the most preventable and most treatable forms of cancer when caught early.
Early detection of CRC not only saves lives, but also costs far less to treat than when it is caught later. A 2017 study places the average first-year costs associated with Stage I CRC treatment at roughly $49,000 compared with $108,000 for first-year Stage IV treatment. There is a clear correlation between later diagnosis and higher costs.
Although the patient health and financial benefits are clear, the challenge for clinicians is having enough bandwidth to support preventive care efforts. Many providers struggle to keep up with responsive care, let alone proactive care. Consumers are equally inundated with distractions and competing priorities. The gains being made in patient engagement, however, can breathe new life into CRC and other health screening and preventive care programs.
Best Practices in Preventive Patient Outreach
Preventive outreach programs need not be complicated to be effective. CRC screening is one example of how simple, convenient offerings can be leveraged to boost patient follow-through and reduce costs. Healthcare organizations increasingly are turning to employer-site screening programs, direct-to-consumer solutions, and partnerships with community resources such as retail clinics to offer consumers cheaper, easier ways to engage in health care.
Research findings published in JAMA Internal Medicine, for example, show that healthcare providers can triple or quadruple CRC screening rates simply by furnishing patients with at-home test kits for CRC and calling to follow up. These tests are a cheaper alternative to colonoscopies, reducing costs and closing care gaps for providers while bringing greater privacy and convenience to patients.
When coupled with technology platforms that support populationwide outreach, intervention programs can be delivered to at-risk patients at scale. Health IT solutions can help unify the components of patient engagement while minimizing the administrative burden on providers. Whether building programs internally or working with third-party solutions and partners, healthcare organizations should implement engagement programs that integrate:
- Eligibility determination
- Population analysis
- Program design
- Payer and provider coordination
- Patient engagement and reminders
- Specimen processing
- Results distribution
- Follow-up and recommendations
- Clinical reporting
- Performance analysis and planning
Robust analytics functionality is paramount to patient risk determination when targeting outreach efforts. Solutions that incorporate patient preference and social health determinant data further support population segmentation by enabling providers to personalize messaging to support maximum return on investment. Collaboration between insurers and providers on outreach efforts increases the likelihood that patients will follow through on their treatment plans and providers will appropriately follow up with the patients. Mobile patient and clinician access supports the delivery of real-time screening alerts, helping providers prioritize next steps with at-risk patients.
As consumerism and value-based payment collide, providers would be remiss to neglect the important role that preventive patient intervention programs can play in improving the health of patient populations. Preventive care programs represent an ideal stepping stone into scalable population health management strategies that help payers and providers save lives, mitigate downstream costs, and avoid potential penalties associated with failure to meet quality reporting goals.
Pete Desai is chief operating officer at BioIQ, Atlanta.