Plotting the ACO roadmap

Part 2: Getting patients onboard by prioritizing engagement
By Sarah Corley, MD
09:31 AM
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In Part 1 of this series, Chris Emper, director of government and industry affairs at NextGen Healthcare discussed how organizations looking to become ACOs should strategically plan based on both internal and external factors. Building on that foundation, Part 2 provides insight into ACOs from a patient engagement perspective and why it's so important to success.

At the center of any profitable accountable care organization (ACO) are well-informed patients who actively participate in their care. Yet this is not the traditional role patients have played in the healthcare delivery system. Historically, they have been mostly passive participants, receiving recommendations and treatment plans from care providers with little incentive or encouragement to make decisions about their healthcare.

Now, with the advent of value-driven models, healthcare organizations are shifting to more holistic patient care model in order to achieve consistent quality and reduce costs. While ACOs can design processes and procedures to realize their goals (see Part 1 of this series to learn about strategically planning for an ACO), without patient buy-in, these organizations will fall short in attaining significant improvement in outcomes.

Why Engaging Patients is So Important

Although there is a great deal of emphasis on how a provider delivers care to a patient, data demonstrates that only a portion of positive health outcomes can be attributed to physician intervention. Other influences, such as an individual's genetic factors, socio-economic context and lifestyle choices play an even more critical part in overall health. While physicians can take these other influences into consideration when designing and providing treatment, they can only go so far. In other words, clinicians can set up best practices and deliver comprehensive and reliable care, but if a patient isn't committed to making the necessary lifestyle choices and or engaged in their wellness, providers will be limited in how much they can affect patient outcomes.

Consider an asthma patient who regularly smokes cigarettes and hasn't seen a doctor in three years. An ACO can identify this individual's need for treatment, reach out with an appointment, follow evidence-based protocols in setting up a treatment plan and prescribe the right medications to manage the asthma. That said, if the person won't take the medicine, neglects to kick his cigarette habit or refuses to keep appointments, the organization will not be able to positively influence his health outcomes, regardless of clinician intervention.

What about a patient who has a genetic history of colon cancer but refuses to have an annual colonoscopy? In this case, the ACO can do little to proactively monitor the individual's condition and respond early to potential issues. Although the patient may not get cancer, there is a risk and if he or she does contract the disease it will go untreated until he or she seeks care.

In both cases, the ACO is committed to delivering quality care at a lower cost, but without the patient's buy-in, the individual's outcomes will not improve. In the end, for value-based care to work, healthcare providers must find ways to actively and effectively empower people to take ownership of their health.

Moving Beyond Existing Efforts

Healthcare organizations have been talking about engaging patients for years and have taken some steps in this area--sending appointment reminders, making follow-up phone calls and providing interactive patient education, for example. That said, these efforts haven't been enough; many patients and providers alike have not seen the value in these tools for improving engagement or outcomes. To achieve the level of involvement necessary to move the needle on care quality, organizations must develop new and novel methods for getting patients on board. ACOs in particular must invest in engagement strategies so they can ensure their member populations are fully committed to proactive care.

What these interventions look like will depend in large part on the ACO setting, patient population and the cultural norms present in the organization and community. For example, what works for an ACO that treats primarily geriatric patients will be different than what works for one that has a younger or more diverse population.

When determining what types of strategies might be effective, organizations can explore the practices of other high-functioning ACOs. These organizations leverage a variety of tactics as part of a comprehensive plan to improve engagement. Following are a few best practices to consider:

·       Offering interactive patient portals that enable 24/7 communication with physicians;

·       Using social media and texting for quick communications, such as appointment reminders, test result alerts and so on;

·       Providing robust patient education targeted to an individual's specific health condition and delivered electronically;

·       Leveraging home monitoring devices, such as diabetes monitors, cardiac monitors or even fitness trackers, to check adherence to treatment plans and wellness commitments;

·       Getting patients rallied around a common cause, such as partnering with the physician's office to run a local 5K or participate in other fitness activities; and

·       Connecting people with community resources, such as exercise classes, twelve step programs and nutrition counselors to help patients remain committed to health goals.

Employing some or all of these best practices can provide major benefits to both patients and providers by engaging the whole patient across various modes of communication and outreach.

Organizations can also look at ways they manage patients to see if the facility can improve efficiencies, which can indirectly engage patients. For example, those ACOs that embrace same-day scheduling, bundled appointments, video appointments and other tools can streamline the care experience, making it easier and more pleasant for patients to access care. When an organization pairs these strategies with detailed data analytics, it can ensure that high-risk patients in need of care are seen quickly in a manner that is convenient and well-timed, improving the likelihood these individuals will seek treatment.

Making the Commitment

When patients are empowered and can reliably and easily access targeted care, it can not only improve satisfaction and outcomes, but help the organization keep costs in check and enable better quality reporting. Ultimately, an ACO's success will depend in large part on the organization's ability to get patients involved in care. By committing time and resources to this effort, ACOs will be more likely to see the degree of meaningful improvement for which they strive.