4 critical focal points for healthcare innovation, Part 1: Chronic and behavioral care

In the face of such a large, industry-wide challenge, there is a wide spectrum of interests motivating healthcare systems to respond to the chronic care challenge.
By W. Roy Smythe, MD
04:03 PM

Editor's note: This is the first segment of Roy Smythe’s four-part series that takes a deeper look at healthcare innovation from the perspective of four Contemporary Provider Challenges: Chronic and Behavior Care, Operations 2.0, Patient as Consumer and Post-Acute Care. HX360, co-developed by HIMSS and AVIA, was established to advance innovation in these four areas through the thoughtful use of emerging technologies. Though not exhaustive, this series is designed to advance the dialogue among healthcare stakeholders and begin clearing the way for innovation in care delivery. Part one focuses on Chronic and Behavioral Care.

The opportunities to improve the delivery of health care are evident, but how do we more effectively engage patients in their health and wellness?

A recent study by the RAND Corporation demonstrates the massive challenge that chronic diseases pose to healthcare. It reports about 141 million U.S. citizens lived with one or more chronic conditions in 2010. Citing another study, the RAND Corporation projects this number to increase to 171 million by 2030, with diabetes and cardiovascular disease as two leading drivers:

  • By 2034, the number of people with diabetes in the United States will double to 42 million with a healthcare price tag of $336 billion.
  • The American Heart Association projects that by 2030, 40 percent of the U.S. population will have some type of cardiovascular disease. Healthcare costs will triple to $818 billion.

In the face of such a large, industry-wide challenge, as might be expected, there is a wide spectrum of interests motivating healthcare systems and providers to respond to the chronic care challenge.

RAND’s 2011 Health Plan Survey shows the top reasons health plans implement chronic care management programs include:

  1. Contain Cost – 96%
  2. Respond to market demands – 92%
  3. Improve patient health – 76%
  4. Improve clinical care – 64%
  5. Empower patients – 44%
  6. Respond to demographic changes – 32%
  7. Increase patient satisfaction – 20%

So, what can be done, in the words of the World Health Organization, to face this “invisible epidemic”? 

Pitfalls to Avoid in Chronic Care

One established approach to chronic care uses individual risk identification and population risk stratification to drive care management program content and intensity that is matched to patients’ risk profiles. 

Many health systems are using this approach, but two potential pitfalls can derail these efforts:

Pitfall 1: Underutilizing emerging technologies to enhance and scale current services. Many care management programs use phone calls and home visits to monitor patient progress. This high-touch, low-tech option can be highly effective but difficult to scale to support a broader population.

Pitfall 2: Bypassing the first two steps of risk stratification and care management infrastructure and jumping directly to patient engagement. Technology doesn’t solve internal workflow challenges; it amplifies what is already set up. It is important to ensure patients are stratified with the right focus; to clarify the role of care providers and how they interact with patients; and to define the information flow from provider to care manager to patient and vice versa before incorporating technology to engage patients.

Promising Areas for Innovative Technology

Emerging technologies have enormous promise in the care management and patient engagement stages, especially in relation to the EMR.

Care Management Strategy and Programming

Developing strong chronic patient care leaders, teams and programs is top priority. For health systems and hospitals with resources, this is straight-forward. Specific challenges for hospitals in this category, center on taking an existing workforce and building in efficiency and scale. Care management platforms such as CipherHealth's View, allow providers to streamline care coordination, improve patient engagement with automated touch points and assign evidence-based care plans.

For smaller hospitals with more modest budgets or healthcare organizations with limited resources and internal staffing, creating a care management program may be out of reach. Turnkey solutions that include outsourced care management resources, in addition to patient engagement applications, such as MD Revolution, may be the best option to consider.

Patient Engagement

The good news is that there is a cornucopia of technologies that can be used for increasing patient engagement and satisfaction, but each takes a different approach.

For example, all communicate with the patient but do so through different channels, like mobile, web, text, email, chat or EMR patient portals.

Engagement solutions are also enabling a customized patient experience by translating patient data into more tailored insights and messaging, which can lead to better self-care management and patient satisfaction.

Learn more about the chronic and behavioral provider challenge and emerging technology solutions at HX360 during HIMSS16. Don’t miss the HX360 Innovation Pavilion plus cutting-edge programming led by world-class healthcare thought leaders, investors, innovators and leaders.