TOPIC: Accountable Care Organizations, Competitive Marketplace, Innovation, Population Health, Triple Aim and Healthier Data
It is easy to picture an internist lamenting his patients’ seeming inability to improve their health by making better lifestyle choices: “If I could just get some of my patients to eat less, exercise more and quit smoking, they’d have a much greater quality of life and need to see me far less.”
Encouraging patients to participate in the quality of their health is key to improving care coordination and creating better health outcomes. According to a report by the American Hospital Association Committee on Research, patient engagement is perhaps the single greatest factor toward reaching the IHI Triple Aim of better population health, enhanced patient experience and lower costs. Patient engagement is one of the six National Quality Strategy priorities, as well as an ongoing main goal of the Centers for Medicare & Medicaid Services (CMS). The shift to engaging patients in their care is also important to providers as they switch to reimbursement models based on the quality and value of care.
So why – in the view of the internist above, as well as thousands of other providers – are patients not more engaged in their health care? The answer is based in large part on how patients and providers typically interact with each other.
Barriers to Health Improvement
Even when patients know they should and could lead healthier lifestyles, it can be challenging for them to overcome past, less healthy behaviors. Patient resistance to self-health improvement is often due to one or more of the following behavioral, emotional and/or environmental factors that often manifest themselves during clinical visits:
- Psychological – “set” behavioral routines and habits around diet and exercise; negative thoughts/beliefs; depression/anxiety
- Cultural – lack of support from family/friends; lack of workplace support; language barriers
- Socioeconomic – inadequate access to healthy foods and preventative care; limited financial resources to pay for medicine, appointments, and good nutrition
- Logistical – limited transportation; time management/scheduling issues; lack of access to community resources
- Cognitive – lack of health literacy; lack of cognitive ability; lack of awareness of lifestyle alternatives
According to researchers, we’re hardwired to do habitual, repetitive tasks and be resistant to change as a self-protection mechanism. Thus, it’s nearly impossible to elicit behavioral change from others in one single effort. Instead, change must occur in increments, using changes to begin new habits. In health care, behavioral change often requires health care organizations and providers to look at their care delivery practices and patient interactions much differently than they’ve done in the past.
Let’s look at three distinct ways that organizations and providers are improving patient engagement by enhancing the patient experience.
1. Improve Provider Communications to Enhance Patient Relationships
Rather than bemoaning the lack of patient compliance, as the internist in the example above does, many providers are achieving breakthrough success by enhancing their patient communication and consultation skills. It has been documented many times before that positive provider-patient communication is linked to improved patient satisfaction, better patient care and a reduced likelihood of malpractice lawsuits. Plus, now that patients are rating their providers’ communications skills on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey, with results linked to reimbursement, providers have a built-in interest in improving their patient communications.
The need for improved provider-patient communication is well-established. The Joint Commission reports that 70 percent of sentinel events can be attributed to communication failure. And in a recent study of primary care residents, patients were allowed to speak for only 12 seconds on average before being interrupted, with female patients interrupted more frequently than males.
How can providers improve their patient communications within the constraints of their practices? To start, providers should review their current patient processes and practices and, if necessary, update or revamp them accordingly. That’s the approach taken by Iora Health, a system of highly rated, patient-centric primary care clinics located across the country. Iora’s founders created an entirely new model of primary care based on proactively listening to patients and putting their needs and interests first.
From physicians to all other clinicians, Iora employees are hired and retained for their listening abilities and for demonstrating such attributes as empathy, creativity and humility. The result? Significantly high levels of provider-patient trust. In fact, Iora has net promoter scores higher than Apple (indicating high patient satisfaction) as well as a consistently high employee satisfaction rate.
Iora co-founder Rushika Fernandopulle, M.D. describes how establishing a trusting provider-patient relationship made a profound difference for a chronically ill patient in his clinic named Joyce: “When she first came to the practice…her health was a mess – her diabetes and hypertension were way out of control, she was only intermittently taking her medications, her diet was awful, she was in and out of the emergency department, and hadn’t been able to hold down a job.”
Fernandopulle’s clinic intervened with Joyce and took a deep-seated interest in her personal welfare, listening to her concerns. The clinic assigned her a health coach, revised her medication regimen and saw her regularly. Six months later, Joyce’s health had improved significantly. Fernandopulle thought Joyce looked great, told her so, and asked: “Can you tell me what we’ve done to help you?” Joyce replied: “Actually doc, it’s quite simple. My health coach and the entire team cared about me, you taught me to care about myself, and I didn’t want to let any of us down.”
2. Apply Technology to Improve Patient Experience Accessibility
Gains for providers are possible by making patient service – aka customer service in the non-health care world – the top priority for all employed within the health care system, from clinicians and administrators to housekeeping, facility layout and parking services. The days of requiring patients to go through multiple hand-offs and inefficient patient flow to receive care are quickly waning, as these barriers directly impact patients’ satisfaction and engagement, and ultimately their clinical results. Instead, a “one stop shop” mentality in health care is supplanting prior models of care delivery.
For example, a major health care provider (and Freed Associates’ client) recently replaced a frustratingly inefficient decentralized clinical registration process for cancer patients – many of whom required multiple appointments within a single visit for clinic and lab services – with a new, universal registration process. Time-constrained patients no longer needed to repeat – and repeat – the same registration information at each stop in their daily visits. Instead, patients could simply check in once, at the start of their day. Both patients and staff have embraced the revised registration system, which clearly places first the personal interests of the patients.
To better experience the needs and interests of their patients, some forward-looking providers, clinicians and administrators have even gone so far as walking or wheeling themselves (via a wheelchair) through their own facilities or gone to the ER for a visit. Why? They want to see and experience the clinical experience directly from their patients’ point-of-view. This information, along with other data, allows organizations to make better-informed improvements when and where needed.
By improving registration handling and efficiency using a centralized system, as well as making other, similar enhancements to patient flow, organizations can easily improve their interactions with patients and enhance overall patient experience. It stands to reason: No one likes to wait in lines or deal with maddeningly inefficient processes.
3. Increase Transparency and Communication with Patients
While potential opportunities for health care providers to help patients improve their self-care are as varied as providers themselves, one of the most straightforward and effective ways to do so is for providers and their organizations to communicate before visits and procedures and be transparent and accessible as possible with their patients. For example, becoming much clearer with patients on their personal costs to receive health care services, such as informing them up-front about deductibles for procedures, as well as for other out-of-pocket costs. Another practice is to begin the care coordination process up front, informing patients about what to expect with a procedure and the care and logistics that will be needed afterward.
Better-informed patients are beneficial in two distinct ways. First, patients who have a clearer understanding of costs and co-payments up-front have greater satisfaction with an organization’s billing department and are more likely to pay their bills on-time. This then leads to better revenue cycle management.
Second, and more importantly, better-informed patients have superior clinical and surgical outcomes and satisfaction. Gallup researchers recently asked patients undergoing medical device implantation about three important aspects of their pre-surgery education:
- I knew what to expect after surgery.
- I was prepared for my experience post-surgery.
- I followed post-surgery instructions, such as rehabilitation or medication.
Only 37 percent of respondents strongly agreed with all three aspects of patient education, while 17 percent strongly agreed with none of them. This suggests significant opportunity to improve patients’ pre-surgery education. Tellingly, the patients with well-informed expectations tended to be less anxious before procedures and less surprised after them.
More than anything, getting more patients involved in managing their own health isn’t simply a matter of implementing the right set of policies and personnel, it is about improving interactions and one-to-one communications between providers and patients. It’s a lesson that premier companies in the hospitality industry have been applying for years with their customers.
Health care organizations that improve their provider communications, effectively use technology to enhance the patient experience, and increase their communication and transparency are more likely to reap the financial rewards of increasingly patient-centric reimbursement models. They’re also more likely to see improved patient satisfaction, greater referrals and increased positive branding.