Patient Engagement Strategies and Technologies that Are Positively Impacting Value-Based Care Models
Digital transformation is upon us. As hospitals and health systems evolve from fee-for-service to value-based-care models, it is paramount that patient engagement and experience be part of the long-term strategy. Streamlining and optimizing administrative and clinical workflows so that patient outreach and engagement are timely, relevant, and proactive has never been more important. In this roundtable, sponsored by Allscripts and Microsoft, several healthcare leaders share insights into how they are cultivating patient engagement strategies and implementing open, flexible, enterprise technologies to improve quality and the patient experience.
As your organization makes the shift to value-based care, what role does patient engagement play in making the transition?
Bob Mueller: Like other organizations shifting to value-based care models, we at St. Luke's Health System are aiming for better outcomes and service utilization while lowering costs. Patient involvement and engagement are essential to our value-based transition. Communicating with and engaging the patient's family or caregiver is also an important part of this equation. Patients need to understand their own health, treatment plans, and prevention options. They also need to know when and how to seek appropriate services, such as when to see their primary care provider versus going to the emergency room. Without this level of patient understanding and engagement, the transition to value-based care will be difficult.
Todd Schonherz: At Florida Cancer Specialists, about 50 percent of the patients we treat fall under a value-based care arrangement. In each one of these arrangements, patient engagement and patient satisfaction are critical quality indicators, and they are vital to our value-based care transition across our markets. High levels of patient engagement are incredibly important in providing quality oncology care because of the intense and sometimes prolonged nature of the conditions we treat. Having a strong, multifaceted engagement strategy is crucial to enable more proactive and responsive interventions, which contribute to our success within value-based care.
Raj Toleti: Value-based care is all about being proactive with patients and managing different populations to achieve better outcomes. However, the ability to compute, understand, and stratify patient populations is meaningless if a provider organization does not use this information to engage and influence patient behavior or intervene when outcomes are heading in the wrong direction. Patient engagement is essential for empowering patients and allows organizations to move the needle on value-based care models.
Jim Heffernan: Since the early years of value-based care contracting (mid-1990s to mid-2000s), Massachusetts General Physicians Organization has identified patient engagement as a key element of both patient care and financial risk. We participated in a Medicare pilot program for the highest-risk patients, where embedded practice-based care managers were a major part of the program's success. What we found is that when physicians, nurses, or nurse practitioners encouraged patients to participate, and patients understood the benefits of these programs, they were much more likely to remain involved, which made a significant difference in their care. While patient engagement in any form is essential to value-based care, our experience has shown that these models are more effective when it's the patient's choice to participate. As such, engagement activities need to zero in on how to enable patients to make the choice to better their health. The results are shown in very strong scores for patient and physician satisfaction, as well as the financial results.
How does your organization engage patients in their care and financial experience? How do you ensure outreach and engagement are timely, relevant, and proactive? Do you employ technology to support these efforts?
Heffernan: At Massachusetts General Physicians Organization, we use one-on-one visits, patient portals, follow-up calls, and, in some cases, electronic monitoring to keep patients engaged in their care. Our care manager program is one of the mainstays of engagement for the highest-cost patients, who typically account for 5 to 10 percent of our total population. We rely on patient- reported outcomes and risk reporting to determine how individuals are performing post-care and base interventions on information that is collected to ensure outreach is timely.
Care managers, social workers, and pharmacists use an automated system to track patients' progress. This helps monitor whether patients are getting prescriptions and vaccines and attending follow-up visits. We also have a tracking tool that notifies the care team if a high-risk individual arrives in the emergency department or is admitted. That way someone from the care team can get involved immediately. These tools ensure we get the right resources to our patients. That early connection during the course of treatment has been beneficial.
On the financial side, we see a wide variety of patients, some of whom have limited ability to pay for care. We engage these individuals in many ways. For some, this may mean we help them navigate housing and transportation hurdles. For others, it may mean assisting them in affording their copays. In addition to the knowledge and expertise of the direct care team, we have engaged with community organizations to help meet additional patient needs.
Mueller: Digital engagement tools are immensely valuable and make it easy and convenient for patients to be involved in their care. Paper often just gets thrown out, so the digital world is essential for keeping patients and their families informed and engaged. St. Luke's leverages several digital tools that are integrated into the patient portal to help with patient engagement on both the clinical and financial sides. Here, patients can ask questions, schedule appointments, obtain test results, and renew prescriptions. In the future, telemedicine, e-visits, and self-triage also will be accessible through these channels—along with e-check-in on mobile phones. These technologies will increase accessibility and convenience while reducing time and money spent. Through digital tools, the patient's family and/or caregivers can also be engaged, which is particularly advantageous for those monitoring loved ones remotely.
Beyond our digital engagement platforms, we also connect patients with a care coordinator, who walks individuals through their care plans in higher-risk cases and is available if patients have any questions when they get home. The care coordinator also ensures patients follow through with after-visit activities.
Affordability is a huge concern. Our financial engagement tools are integrated with our patient portal and also available through a separate financial portal. Through these portals, patients can access estimation tools for some services and eventually will be able to do so for all our services. Patients can also set up their own payment plans within parameters through a robust digital solution. We're in the process of setting up a financial clearance center, which would allow us to talk through service affordability with patients and make sure they understand their financial obligations, so they don't have to worry about how they're going to pay for a service.
Schonherz: We take steps to engage patients even before they come to the office. They are assigned to care managers, which is important to prepare them for their first appointments. They're encouraged to complete paperwork prior to their appointment since time in the clinic is best spent with the provider identifying optimal treatment, rather than filling out forms.
While patients are under our care, we leverage several technology solutions to keep individuals engaged. We create a campaign around each patient, which provides protocols to our care managers, so they know the best times to reach out depending on the patient's treatment plan. We also built a solution that allows us to risk-stratify patients to identify who might be at higher risk for adverse events, which could lead to hospitalizations or emergency room visits. These technologies enable care managers to send notes and alerts to other caregivers on the team, including physicians, advanced practice providers, and other clinical staff.
Our care managers and providers engage patients proactively throughout the process to ensure they're being treated holistically. We ask about various aspects of their health to understand and assess any changes to their conditions or pain management needs. In between office visits, patients can contact their care managers through multiple channels, including by phone or secure email. They can also reach out to our care management services, which are available 24/7, to proactively keep healthy, avoid unnecessary emergency rooms visits, or lessen the likelihood of hospitalization. Our care management technology platform is integrated into what we do every day: Information is always current and accessible by everyone on the care team. Patients are also able to access lab results, visit notes, radiology reports, and other information through a self-service portal.
In cancer treatment, it's especially important to keep the patient's family involved and educated on the treatment and care plan. When patients consent to the appropriate releases, we allow the family to access our technology platform to stay engaged. We also provide educational videos, so caregivers can better understand what their loved ones are experiencing and what to expect down the road. This enables some of the knowledge transfer that doesn't always occur when families are engaged remotely, which is common in Florida as individuals retire and move south, away from their families.
To ensure our care team remains cognizant of when patients are enrolled in value-based care programs, we also have alerts built into our electronic health record (EHR). Our EHR provides physicians with literature-supported treatment regimens to ensure optimal treatment selection.
To support patients' financial well-being, we've developed a multipronged approach. For all our patients, we strive to provide an accurate treatment plan summary as the physician decides what course of action will be most effective in winning the patient's personal battle against cancer. Using financial tools, we develop treatment estimates based on the regimen selections made by our physicians. This allows us to give patients upfront support financially. Every one of our offices has dedicated financial counselors, and we also have a robust team that provides financial aid and support for patients through various grants and patient assistance foundations. This lets them stay on their life-saving medications and treatment therapies. Our organization also has a foundation that helps patients with their nonmedical expenses, so they never have to choose between paying their electric bill or filling a prescription.
Toleti: Most provider organizations in the last 15 to 20 years have relied on the patient portal to engage patients digitally. Yet, patient portals are used by only a small percentage of patients. As more systems have become automated, most organizations have added additional electronic tools, which means providers—and their patients—have to manage and interact with multiple tools to share test results, facilitate payments, schedule appointments, and perform other types of functions.
Providers will best serve their patient populations by continuing to offer multiple channels and modalities, ensuring accessibility and that functions are convenient and easy for patients. We believe providers should unify and streamline digital solutions used throughout the patient's entire care journey into one digital platform, so patients don't have to log into multiple devices and/or applications. This will not only enhance engagement; it will improve their overall experience and satisfaction.
Have you seen patient engagement efforts close gaps in care and/or reduce readmissions? What have the financial implications been?
Toleti: There's a higher probability that patients will take action and close care gaps with good, effective digital engagement. When they are able to set up and check into appointments, view test results, and perform other tasks at their convenience from their phones, such as paying bills, they are more likely to stay involved. Among our clients, we've actually seen 40 percent more care gap closures with effective, digital patient engagement platforms. This contributes not only to improved outcomes but also to the organization's bottom line because value-based payment is outcomes-driven. With more efficient scheduling, fewer appointments are missed and providers are able to see more patients throughout the day. In addition, patients are more likely to pay their bills when it's convenient and easy for them to do.
Schonherz: We've seen fantastic results from our patient engagement efforts, particularly through our care management program. After our first year in the program with one payer, we saw a 34 percent reduction in inpatient days, and we've seen 16–17 percent reductions in patient admissions with two other payers. We're of the belief that a knowledgeable patient will ultimately be more compliant, resulting in higher levels of adherence and ultimately better outcomes. There are also significant savings opportunities when you keep patients healthy.
Heffernan: Likewise, we've seen patient engagement endeavors close gaps in care. By touching base with patients before they get into crisis situations, our physicians are able to ask questions to avoid a condition becoming more serious. We're also able to leverage more cost-effective alternatives, such as telemedicine and home health options, when we keep patients engaged. Through these efforts, we've been able to intervene and avoid unnecessary and costly emergency room visits and admissions. It is important to be sure that we actively reach out to patients and not always wait for their request. A key performance indicator of our care management program is the length of time since the last contact.
Mueller: Our patient engagement work has led to large payoffs both clinically and financially. For instance, these activities result in better care and they close gaps, contributing to St. Luke's low readmission rate, which is below the national average. We have also found that patients who are engaged digitally on the financial side are more likely to meet their monetary obligations and are more satisfied with their care overall.
Has your focus on patient engagement improved satisfaction scores and/or helped reduce leakage? How does work in this area tie into quality-based payments? What overall impact has it had on the bottom line?
Schonherz: We have found that making investments in care management and patient engagement technology has led to highly satisfied customers. To understand and measure our patient satisfaction, we use the Net Promoter Score. We conducted more than 80,000 surveys in the last year, and as of Oct. 30, 2018, we have a Net Promoter Score of 87.5 percent. In comparison, organizations are considered "best in class" when their scores hit 75 percent. Our care management program is rated even higher, with a score of 96 percent.
We believe having happy and engaged patients has helped in multiple parts of our business, including our ability to transform ourselves from a volume- to a value-based care provider of cancer care services. We can now take our cost-effective, high-quality programs directly to payers and employers, show them our outcomes, and aim to be their cancer care destination of choice. Our high patient satisfaction scores not only prevent leakage, they contribute to our growth.
Heffernan: Patient engagement efforts at Massachusetts General Physicians Organization have had a big impact on satisfaction levels. Our nurse and physician communication scores are especially high. We've put a great deal of time into our engagement strategies, particularly in the high-risk areas, and are working toward applying and expanding these to more effectively engage patients at a population health level.
Mueller: At St. Luke's, we have a significant amount of business in value-based care, where more than 30 percent of our volume is at-risk. Patient engagement activities are a crucial part of our strategy. We provide digital tools and other resources to promote engagement and empower patients to be actively involved in their own care plans. We believe this leads to better outcomes and also higher patient satisfaction. In turn, this drives loyalty to the health system and has proven to boost our cash flow, reduce medical costs, and limit utilization of more costly services. These strategies are pointing us in the right direction. Our value-based care services are working and profitable.
In addition, this approach is contributing to our growth. Because our clinical and financial engagement platforms are more robust than those of other providers in our region, we've had many individuals come to St. Luke's for second opinions or through referrals and end up transferring their services to us because of the differences in the patient experience.
Toleti: It's important not just to know patients for who they are but to meet them where they are in their care journey and build on their trust. A lot of leakage occurs when patients fall through the cracks and don't know where to turn for care. Using effective, efficient technology that drives patients to downstream providers, making it convenient for them to make appointments, can decrease leakage by nearly 40 percent. Moreover, we've seen satisfaction scores increase by 36 percent when providers leverage a streamlined, digital platform for patients.
The primary goal of value-based payment models is to provide high-quality care and reduce costs while achieving optimal outcomes. Patient engagement in any form is a critical component of this. Offering a convenient and continuous engagement experience for patients will ensure they not only are informed but empowered to make better decisions about their health.
Participants in this HFMA Executive Roundtable
James Heffernan is senior vice president and treasurer for Massachusetts General Physicians Organization in Boston.
Bob Mueller is vice president, revenue cycle at St Luke's Health System in Boise, Idaho.
Todd Schonherz is chief operating officer for Florida Cancer Specialists and American Oncology Network in Fort Myers, Fla.
Raj Toleti is founder and CEO of HealthGrid (acquired by Allscripts in June 2018) in Orlando.
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