Payers have long embraced the idea that patients who are engaged in their care are ultimately healthier than those who are not. In recent years, insurers have worked to boost patient engagement by creating incentive programs, social media campaigns and targeted education that encourages healthier lifestyles, regular wellness visits and chronic disease management. The underlying goal is to educate beneficiaries on the critical role they play in preserving their health.
While these efforts are laudable, it is ironic that payers are taking the lead in patient engagement when healthcare providers have more direct contact with patients. Providers are in the middle of a cultural evolution from delivering care to patients to partnering with patients. Moreover, current payment models do not reward engagement strategies because reimbursement is tied to care episodes rather than long-term health management.
However, things are changing as hospitals, health systems and physician practices start to participate in payment models that reward proactive thinking. Risk-sharing strategies, accountable care organizations and other value-focused payment arrangements are pushing providers to build stronger relationships with patients. In addition, as organizations are penalized for results like unplanned readmissions, they are seeing the need to be more proactive in chronic disease care.
When looking for ways to bolster patient engagement, healthcare providers may benefit from the work payers have done so far. Following are five lessons learned providers can use from payers to get patients involved.
Leverage Data to Identify High-Risk Patients
Looking across a population and identifying individuals at-risk for negative health outcomes—due to unmanaged chronic disease, lack of wellness care, missed appointments and so on—is not a new concept. Payers have been doing this for years to improve Healthcare Effectiveness Data and Information Set (HEDIS) scores, reduce the likelihood of unplanned hospital admissions and elevate the overall health of their beneficiaries.
Providers can also benefit from this strategy. By leveraging technology to analyze clinical data, providers can gain a clearer understanding of which patients warrant better chronic disease management or are at risk for readmission. For example, a health system can analyze data on all its diabetic patients to see who requires an A1C3 test, who hasn’t seen a physician recently or who has other conditions—such as asthma or congestive heart failure—that could increase their risk for acute care. By identifying these high-risk patients and getting them the care they need before their condition becomes emergent, providers can not only reduce risk, but also improve patient relationships.
Help Patients Manage Their Meds
A main reason for less-than-optimal patient outcomes is poor medication management once an individual leaves the hospital or physician’s office. Technology can help in improving patient understanding of medications, increasing the chance of adherence. For example, there are many healthcare apps entering the market that patients can use to mind their medications. These apps offer alerts, dosage information and even patient education. While many payers have introduced their beneficiaries to these kinds of apps, providers can also talk with patients about the possibility of using one. In some cases, it may be appropriate for providers to “prescribe” an app—enabling patients to take their medications at the right time and in the right way.
A patient portal is another tool for fostering medication adherence. Providers can use this product to quickly answer patient medication questions and provide real-time education, enhancing patient understanding while reducing information overload.
Designate a Patient Engagement Advocate
To keep patient engagement top of mind, providers may want to appoint a patient engagement advocate to turn strategic ideas into concrete actions. Functioning similarly to a patient safety officer, a patient engagement advocate would be charged with finding improvement opportunities, implementing programs and monitoring progress. Because many payer organizations already have this position in place, it may be beneficial for providers to reach out to payers to get a sense of how they view the role and what a possible job description might look like.
To spur patients in taking charge of their health, many payers have introduced incentive programs where patients receive a discount on their insurance or sometimes a financial payment if they make better lifestyle choices. For example, if a patient regularly uses a fitness tracker and logs a certain number of steps per day, he or she may receive some form of incentive. Providers should reach out to payers and learn more about what incentives they offer and how the provider might be able to partner in those efforts. By working together, payers and providers can make further progress in getting patients invested.
Seek Interoperability Opportunities
Access to comprehensive data is key to cultivating patient engagement. When payers and providers find better ways to share information (clinical data from providers and claims data from payers), they can pursue more informed strategies for involving patients. Having ready access to both kinds of data allows for a more detailed view of how patients manage their health. For example, today payers often have a more complete view of a patient’s medical history through claims submissions from multiple providers. A physician, on the other hand, does not have access to medical information held by other providers or the payer, and can only review medical history from episodes of care provided by his or her organization.
A Logical Place to Start
As healthcare continues to evolve, having concrete, data-driven strategies for engaging patients is becoming increasingly important. Looking to payer-patient engagement strategies could be a wise place for providers to start as they build relationships and encourage greater patient commitment to long-term health.