With stagnant reimbursement rates for fee-for-service, and medical cost inflation, the value-based care model (VBC) is increasingly present in health care organizations. To have success in a VBC environment, practices should embrace patient engagement as a foundational capability. Engaging patients not only keeps them healthier and prevents patients from requiring costly care or potential hospitalization, it also builds practice loyalty, and helps meet quality measures.
Value-based care (VBC), providers are financially rewarded for improving patient outcomes while reducing costs. This model is in direct contrast to the traditional “fee for service (FFS) model, where providers are reimbursed based on volume of provided services.
Patient engagement is as equally important to the success of VBC initiatives as are operational efficiency and cost controls. Patients who are not fully engaged with their providers make care coordination and management more difficult, and less effective.
Typically, patient engagement initiatives focus on improving provider understanding of patient status. This involves stratifying patient populations to identify pockets of disease and patient populations with multiple chronic diseases. By stratifying and identifying these individuals, providers can then offer outreach to educate patients on improving their healthcare.
When identifying patients who would benefit most from a care intervention, a Patient Activation Measure (PAM) is a standardized tool. The patient’s PAM score falls into one of four activation levels. Level 1 being patients who are the least capable of managing their own health. Patients who are not competent to care for their health independently and navigate the health care system are more likely to develop a chronic disease over a three-year period than engaged patients who have been taught self-management skills. By establishing a baseline PAM score, providers can improve a patient’s ability to self-manage, and conduct follow-up measurements to assess and adjust progress.
In primary care, patient engagement initiatives can be continuous and thorough, particularly when providers are reminding patients about regular tests, routine visits, and medication adherence as part of a continuous care model. Patient’s share both positive and negative feedback on social media. Frequently staying in touch with and proactive engagement is proven to prevent future adverse health scenarios.
Patient Engagement and Payers
Payers can use stratifying information to identify potential program opportunities, such as carve-outs and other “pay for quality” programs. This enables payers to play a significant role in care coordination, management, and patient engagement. Payers can view all the care team data for a patient, instead of bits and pieces. When payers share this information across care under a VBC program, it can improve both patient care management and patient experience.
Empower your Patients
An engaged patient is an empowered patient. It had become standard for providers and payers to share medical history with patients and include educational materials that help patients take a more proactive and effective stance in their care management. Patients shouldn’t have to struggle to obtain their most recent health data, it should be made as user friendly as possible.
Monitoring and SDoH via Remote Access
To provide a holistic view of the patient, remote patient monitoring, whether through telehealth or wearables that collect and transmit relevant patient health data to a shared health record has become increasingly critical for the success of chronic disease management.
Identifying the external factors that are most likely to motivate patient populations can also be achieved through patient engagement. These social determinants of health (SDoH) can reveal health equity-related issues such as transportation or food access that impact an individual’s ability to stay healthy. SDoH can be used by providers to target individuals via educational programs, or referrals to social service agencies and other community-based organizations. Several VBC programs will incorporate patient outreach metrics based on the number of anticipated annual visits, or quality outcomes, like medication compliance.
Payers and Patient Engagement
Payers and providers can benefit from stratifying patients by risk level and PAM score. PAM information can be used by payers to identify potential program opportunities, such as carve-outs and pay for quality programs. Payers can then play a significant role in care coordination, management, and patient engagement. Instead of seeing bits and pieces of data, payers can see all the data the care team has for a patient. A VBC program should result in better care management and patient satisfaction when payers share this information across the care continuum. Collaboration between providers and payers to meet VBC goals cannot succeed unless it truly focuses on the patient. Providers and payers should share their personal medical histories with patients as well as educational materials that help patients take a more proactive and effective role in their care.
Patients shouldn’t have to struggle to obtain their health data; it should be as easy as a few clicks on a computer screen or mobile app. Data standards necessary to support robust patient engagement initiatives do not exist for all providers and payers.
VBC Success is Powerful
Engaging patients often leads to improved health outcomes. When patients feel they have provider guidance, two-way communication, and the empowerment to self-serve when needed, they are more likely to follow their physician’s advice and make necessary lifestyle changes and more informed decisions.
Patient engagement can foster loyalty and continuity of care. By partnering with patients throughout their health care journey, practices can create a positive and nurturing patient experience. These trusted patient relationships often improves outcomes, enhances quality measurements, and grows practices.
Delivering routine, low-cost care, and encouraging digital contact, providers can identify and address health issues before they become problematic. This helps practices reduce costs and minimizes the need for expensive interventions and improves reimbursement rates.
Steps to Engage Patients Digitally
To support a VBC model, health care organizations should focus on creating meaningful engagement throughout the patient’s journey. This includes contacting patients at the right time through the right channel with relevant messages. By using automated wellness campaigns and patient reminders, practices can encourage patients to make steps toward self-care, like annual wellness visits and immunizations.
For care management tasks, such as scheduling appointments, accessing test results, and asking non-urgent questions, the practice should obtain patients’ contact information and consent to connect with them via convenient, patient-preferred channels, such as email and text messages. By providing easy access to providers and keeping patients informed about their care, patients can take charge of their health.
Use Tools and Training
Use digital tools to simplify patient communication and care management. Features like online scheduling, text messaging notifications, self-check-in, and online bill payment are easily accessible and secure. As new features become available, continue to improve your capabilities and operations. Staff must be trained on how to use digital tools effectively and understand the value and efficiencies they offer. The staff should be able to explain the benefits of using online tools to patients and assist them in navigating and managing their health care.
Integrate digital engagement into patient encounters. Clinicians and staff should discuss online tools during consultations, at the front desk, and through messages. Remind patients to use self-scheduling, self-check-in, online payments, and the patient portal.
By prioritizing patient engagement, health care organizations can overcome VBC challenges and deliver better patient care. As a result, costs are reduced, loyalty is built, and quality of care is improved. If your practice needs assistance with quality care measures under the value-based care model, please contact Virtual OfficeWare Healthcare Solutions at firstname.lastname@example.org or 412.424.2260.