Patient engagement is becoming a core competency for many healthcare organizations. One recent report found that 60 percent of all healthcare organizations plan on investing in IT infrastructure [PDF] in 2015 to support initiatives related to population health and patient engagement.
There are a few reasons behind this surge. Many organizations are looking for ways to better manage patient care without overextending the resources of their clinical staff. Others are looking for ways technology can move care beyond traditional face-to-face encounters and help them incorporate non face-to-face encounters into the delivery of care.
But for most, changes at the federal level are driving this movement: In January, the Centers for Medicare and Medicaid announced specific goals for the transition to value-based reimbursements. CMS will pay providers more if they help Medicare patients get healthier — and less if their patients don’t make progress toward recovery. How? By tying 85 percent of all Medicare payments to outcomes by the end of 2016 – and increasing this target to 90 percent by 2018.
As we move away from the traditional fee-for-service model, finding ways to extend the delivery of care beyond discharge, and to implement proactive strategies to address risks that may invite costly readmissions has become mission critical. When the average cost for a congestive heart failure readmission is $13,000, and your hospital system or ACO takes the financial hit for that one episode, actionable patient engagement to avoid that readmission is essential.
Technology-driven patient engagement initiatives can help stem bounce-back admissions (and reimbursement penalties) – and help patients achieve better outcomes, too.
Consider this: A recent report found that at discharge, only 42 percent of patients are able to state their diagnosis [PDF] and only 37 percent are able to state the purpose of their medications. But by deploying technologies that use proactive outreach to engage post-acute and chronic patients with quick and easy online health check-ins, clinical teams prevent adverse health events. In addition, patients receive regular, informed follow-up care that helps them understand their condition, and provides resources and guidance to help them better manage their health in the future.
If your organization is among the 60 percent planning to implement patient engagement strategies in 2015, self-assessment of your organization’s understanding of patient engagement and readiness to roll out an effective program are an important first step.
Here are five important questions to ask yourself, and your leadership team, before you begin the process:
1. Does your organization have a clear definition of patient engagement?
This may sound like an obvious question. Don’t we all already know what it is? The answer is no. The definitions of what patient engagement is are wildly diverse.
In current discussions about patient engagement, what most people are really referring to are the tools and technologies healthcare organizations use to engage patients before or after acute episodes of care (like a hospitalization) or the times between in-person visits.
Unless your organization has a clearly defined understanding of what patient engagement is to your organization, you can’t expect to know when to use it, where to use it and why.
2. How does patient engagement align with our organizational objectives?
Why patient engagement matters to healthcare organizations depends on the impact it can have on your organization’s objectives. Many healthcare organizations are stretched thin as it is. Assimilating a new initiative with no clear tie to organizational priorities and objectives is an uphill battle. Failure to articulate why patient engagement matters will stunt efforts made to incorporate it into your organization’s processes and workflows.
Here are some possible organizational objectives with which patient engagement aligns:
- Prevention of adverse health events, like avoidable readmissions or unwanted utilization
- Capture of additional revenue, like Chronic Care Management (CCM) services
- Efficient patient management
- Improved patient population loyalty and retention
- Population health management initiatives
- Value-based reimbursement models
3. How can patient engagement help us prevent adverse health events, and why does that matter?
As more and more dollars are tied to value-based reimbursement models, healthcare organizations are looking at every step of their care delivery processes for inefficiencies. One of the biggest opportunities is to extend the care delivery process beyond synchronous face-to-face encounters. Not every patient need requires a face-to-face visit, or even a phone call.
Asynchronous virtual visits or digital check-ins allow providers and patients to address some issues more conveniently than in-person visits and phone calls. It’s not that in-person visits or phone calls are going away. Patient engagement tools simply augment those existing modalities with an option that is sometimes more appropriate, convenient and less costly than the existing modalities.
4. Can patient engagement really scale in our organization?
Yes, it can. But patient engagement will only be able to scale if it meets two key criteria:
Patient engagement depends on automating parts of the care delivery process. Fully manual patient engagement initiatives will not scale. There isn’t enough time or money to scale a patient engagement initiative that’s fully dependent on clinicians. For example, instead of making random phone calls to check on patients and gauge their health status, digital patient engagement technology can perform this task more consistently and more efficiently for a larger patient population than a clinician team ever could.
Patient engagement has to be smartly integrated with the clinician team’s workflow. For patient engagement to scale, it cannot be tacked on as an afterthought. This means redesigning key care delivery processes to incorporate engagement activities, designating team members to be responsible for managing the initiative, and equipping them with software tools that brings it all to life.
5. What kind of ROI can we expect from patient engagement?
Depending on the initiatives with which patient engagement aligns, it can either be a revenue generator, a cost reducer, or both. For example, let’s look at one example of how patient engagement can help organization earn incremental revenue, specifically as it relates to chronic care management.
The Centers for Disease Control reports one in four U.S. adults have been diagnosed with two or more chronic health conditions. These ballooning numbers were a major factor in CMS’s recent move to allow providers to cover the costs of chronic care management under CPT code 99490. Medicare patients with two or more chronic conditions are eligible to receive CCM services totaling at least 20 minutes of non-face-to-face time per month, at a reimbursement rate around $42 per patient, per month.
The 20 minutes of CCM services per month includes time the patient spends engaging with their provider using patient engagement tools. When providers use a platform that includes patient engagement capabilities, the focus for them becomes less about hitting the 20-minute quota per patient and more about responding to the most pressing issues facing a patient population.
For example, let’s say in a practice with 1,000 patients, 80 percent are Medicare patients with two or more chronic conditions. That’s 800 patients. In a given month, 80 percent of those patients (640 individuals) receive CCM services – equaling about 213 hours of CCM services.
A conservative estimate of time that can be allocated to patient engagement is around 70 hours per month, which leaves 141 hours remaining for clinician team time. That equates to almost 35 hours per week of CCM services, which is either a full-time clinical position, or 7 hours per clinician in a team of 5 clinicians.
In this example, the reimbursement revenue for a month of CCM services for 640 patients is $26,880. Annually, the reimbursement would total $322,560. Even after factoring in costs for additional clinician resources and technology, the return on investment for the patient engagement program is around 3x ROI.
By asking – and answering – these five questions, healthcare organizations can put themselves on track for successful patient engagement deployments. The big payoff is the ability to optimize operations, and create impactful, informed and personalized care plans for patients – all while staying profitable.