Technology Turned Patient Centered
Technology is, indeed, evolving and breaking down the barriers between patient and provider. Developers are realizing the importance of patient-engagement tools and features, because patients want them and providers will come to rely on them as they embrace new reimbursement models.
“I agree that patient engagement was largely left out of the earlier IT equation,” said Dave Chase, Senior Vice President of WebMD. “Naturally, any reimbursement model has intended and unintended consequences, including the fee-for-service (FFS) model. FFS has incentivized a procedure-centric model. In a procedure-centric model, patient engagement isn’t at the forefront. In contrast, a fee-for-value (FFV) model makes patient engagement an imperative.”
Chase continued, “It is rational and logical that legacy health IT was optimized for the FFS model. The byproduct was that procedures and billing were central to the architectural decisions of those systems. That is a fundamentally different focus than what is required in a FFV environment, and not something that can be pinned on after the fact.”
It was that line of thinking that led Chase to the founding of Avado in 2011, which focused on developing a patient relationship management (PRM) system to complement existing systems such as EHRs. Much the way CRM tools help marketers connect with consumers, Chase and his cofounders set out to create the tools to better connect with healthcare’s biggest consumers: patients. They would seek to accomplish that goal by making the patient a full-fledged, central part of a health organization’s care team.
“After all, if more than 75 percent of healthcare spend is around lifestyle-related conditions and one is paid on outcomes, it’s the patient that drives lifestyle and related decisions that will most influence outcomes,” said Chase. “For example, it’s the patient/family/caregiver who makes decisions such as filling prescriptions, adhering to prescription directions, diet, exercise, etc. that ultimately drive outcomes. In other words, it’s not the professionals who drive the majority of decisions most influencing outcomes – it’s the patient/family/caregiver.”
The Copernican Moment
Are enough healthcare organizations placing that value on the patient these days? Chase seems to think organizations are starting to understand the value there, and for the health organizations that “get it” are growing. It’s that type of mindset that led to WebMD’s acquisition of Avado last year. WebMD, which has products for both consumers and professionals, is looking to make its own connection between the two with patient perspective as the tie that binds.
At the time, Bill Pence, CTO and COO at WebMD had this to say of the acquisition: “Traditionally, patients and healthcare providers have lived in separate silos, but with the growing adoption of electronic health records, mobile devices, coupled with the advance in sensor technology, there are now more opportunities than ever before to connect the two and offer personalized, direct-to consumer services.”
Forward-facing organizations like WebMD are having what Chase calls the “Copernican Moment.” Chase, who is a respected thought leader and regular contributor to HIT matters, had this to say about the transformation that’s taking place within the industry:
“After the Copernican Moment, there is recognition that being patient-centric is a fundamental rethink of how one approaches healthcare. In the “7 Habits of Highly Patient Centric Providers”, I expanded on the implications of being patient-centric. For most organizations, these ‘habits’ are aspirational. Each of those ‘habits’ has technological implications.”
Chase believes that market-leading healthcare organizations will have technology that supports each of those seven habits, which include using patient-facing tools, having multi-provider access via PRM tools, and providing communicable and portable data on the patient’s terms.
As for the providers who feel like there is a lot of technology being thrown their way, Chase empathizes with their position: “It goes back to my earlier point on aligning outcomes and payment,” said Chase. “The fact is that the transition from FFS to FFV isn’t an overnight phenomenon. At the same time, the outstanding examples I have seen range from Medicare to Medicaid to private insurance based systems where there has been a shift to FFV. The perception I have is that the ONC’s Meaningful Use objectives are intended to be a shot across the bow, so that providers are prepared for the full shift.”
He continued: “For example, Stage Two is largely about patient engagement, which becomes imperative once the shift has happened. The intent was to give them time to implement new tools and processes to familiarize themselves with new models before the full impact hits them. It may be true that some are just ‘checking the boxes’ but it’s likely better than having those system changes happen at the same time or after payment reform happens.”
Patient Engagement: Much More than Electronic Measures
Chase may have a good point; a slow introduction is better than a hurried one. However, the gaps between attesting to Stage One MU and Stage Two MU are proving that while the approach may be staggered, it still requires providers to take a leap when it comes to tackling patient engagement. Some providers feel that the structured timeline of MU is providing more burden than betterment, citing one problem of obtaining certified technology in a timely fashion from vendors.
Smaller or more rural vendors are also having problems with attesting to the program, due to lack of funding and technical infrastructure to take their practices to the next level. Even larger more substantial health systems like the Dallas, TX-based Methodist Health System are facing the challenge. In a recent article published from iHealth Beat, Pamela McNutt, Senior Vice President and CIO at Methodist Health System, said that while MU was “well intended” it may be “before it’s time.” She further elaborated that the measures of MU that hold hospitals responsible for someone else’s actions are particularly difficult.
Attesting to those measures, which includes ensuring that patients are using the hospital system’s portal to view information, may result in what McNutt describes as “contrived’ and not necessarily “meaningful” results. Has McNutt simply not had her Copernican moment, or does she have a point? While the staggered steps of patient engagement may feel somewhat arbitrary, there are those that say these are the types of online offerings today’s ePatient will come to expect, especially in the wake of high deductible health plans (HDHPs).
According to Tower’s Watson’s 2013 Health Benefits Survey, 66 percent of companies with 1,000 employees or more offered at least one HDHP last year. That figure was predicted to grow by 80 percent this year. Nearly 15 percent of the companies surveyed claimed an HDHP was their only insurance offering. A similar 2014 survey conducted by PwC Touchstone revealed 44 percent of employers were considering offering an HDHP as the only benefit option in 2014. The idea behind the switch: when consumers pay more for their healthcare, they often make more cost-conscious decisions.
With that idea in mind, patients will need access to all the information they can get about their healthcare delivery. Therefore, what may seem like going through the motions now may help providers keep an edge on the competition in the long run. Chase points out that patient engagement isn’t just about performance-based incentives; it’s really about connecting to the patient on a much deeper level.
“It’s well recognized that healthcare is shifting to a population health model that leaders have long employed,” he said. “A key means of achieving their population health objectives was deploying patient portals and they’ve seen a very high percentage (greater than 60%) of their patients happily engaged this way. They did this without any MU incentive payments. It was simply the logical way to achieve their objectives, and patients are more than ready to engage.”
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