Putting Patients At The Center Of Improved Outcomes

By Leonard Kish, Writer, Corepoint Health, www.HL7standards.com
Twitter: @leonardkish

In October of 2012, as part of the Affordable Care Act, providers with “excess” readmissions began to receive reduced DRG (diagnosis related group) payments for AMI (acute myocardial infarction), heart failure, and pneumonia. Real money is on the line — enough money to determine the financial viability and survival for many hospitals.

Success or failure in reducing readmissions, and therefore provider survival, will in part be driven by how accurately providers will be able to predict the likelihood of a patient’s outcome, and how to intervene at the right time for the right patient to ensure the patient is following care plans. Consensus is building that the best way to predict and intervene is through better communication and active engagement with patients.

Although it’s getting a lot more attention, we’re really at the earliest stages of patient engagement. Most providers are just beginning to learn a) just how effective patient engagement is, b) that it’s really possible to get a patient to take an active role, and c) it’s much harder, if not impossible, to predict and improve patient outcomes once they’ve left the hospital without keeping them actively engaged in their own care.

Historically, reducing readmissions has been seen as an internal quality control responsibility for hospitals. Hospitals have looked to see what processes and workflows they can put in place to deliver higher quality care. However, hospitals are now beginning to find that patients are the ones who have the most control over their health. In fact, many hospitals are beginning to focus on patient education to reduce infection rather than internal quality improvement measures. I expect this trend to continue.

Medicare payments for DRGs are just one of the incentives that will lead to a closer look at patient engagement. Meaningful Use incentives are shifting more toward patient-centered care. Accountable care organizations (ACOs) are recognizing that patient centricity and engagement are effective ways to enable shared savings, as well as a major part of the CMS ACO application. Meanwhile, technologies will continue to expand for patient engagement beyond patient portals. Much like CRM, patient relationship management and networked technologies can greatly improve patient outcomes.

There is a learning curve in patient engagement, and we’re all just at the beginning. The next couple of years are likely going to provide early entrants with specific, long-term strategic advantages. The early results have been good for patient engagement. Long-term results promise to be even better when it comes to improving patient outcomes while driving down costs.