As healthcare providers grapple with greater risk and thinner margins in the move to value-based care, they’re seeking ways to better engage patients in managing their own health. Many organizations have implemented patient portals, electronic messaging and the like. While giving patients better access to their medical information is an important step, there is much more that can be done to better engage patients and consumers; and beyond engagement, we must activate them to better manage their own health.Many consumers want to take a more active role in their healthMany consumers want to take a more active role in their health, and are using connected devices such as health watches and health apps to track key health metrics. Consumers that have become used to the on-demand delivery from companies such as Amazon, Netflix and Uber are demanding greater convenience from healthcare services. Further, now that they’re paying more for healthcare out of their own pockets, due to high deductible health plans and other cost-sharing measures, they want those services delivered at a lower cost. It’s incumbent on healthcare providers and technology companies to develop solutions that are both convenient and cost-effective.
Having people take a more active role in their health will help providers move away from the long-standing “Groundhog Day” approach to care, in which patients interact with the healthcare system during a health crisis, then largely drop out of sight until they get sick again. Avoiding that cycle of crisis care requires better interoperability among different EHR systems and data sets, and a more longitudinal view of health that starts and ends in the community, not within the four walls of a health facility.
As a result, providers increasingly need integrated solutions that can serve consumers along the entire risk pyramid, from those who are healthy to those who are the high utilizers of the healthcare system, consuming the most healthcare resources – often, though not always, the frail and elderly.
The first step is investing in a robust analytics platform that provides a deep understanding of different populations and their needs. A useful platform:
- Aggregates clinical, financial and operational data from the entire enterprise
- Analyzes the information to make it actionable, stratifying patients by groups and identifying care gaps
- Implements a robust care management program to translate data into action
Providers can then select from numerous connected monitoring and intervention solutions to provide long-term, proactive solutions to keep people healthier before and after they use healthcare services.
While many vendors provide analytics, few have significant experience in care management systems and even fewer provide effective monitoring and intervention solutions that can meet consumer demand for convenience and cost to short-circuit the Groundhog Day effect.
A population health management (PHM) program that engages patients should focus its finite resources where they will deliver the most value, with appropriate intervention strategies for each population segment based on their risk.
That’s why we’re working at all levels of the health continuum – from healthy individuals to frail seniors seeking to remain independent at home – to provide customizable monitoring and intervention tools that help prevent and manage disease. We believe that, by creating connected tools that engage people in managing their health, and working in concert with employers, providers and payers, we can begin to move the needle on compliance and decrease care utilization.
For people who are healthy or at risk for chronic conditions, a growing array of connected devices are emerging: smart toothbrushes that connect consumer data with dental providers to promote better dental hygiene, sleep apnea interventions that improve adherence to the therapy and programs and devices that help parents raise healthier babies.
Preventing diabetes, heart disease and respiratory illnesses has been a focus of much of the early efforts of risk intervention programs. In the past, some 15 to 30 percent of those at risk for a chronic disease would develop the condition within a few years, at a staggering cost to the country and to individuals’ quality of life. Intensive behavior change programs that use coaching, apps and devices to promote a healthier lifestyle are proving effective in modifying that trajectory. For the pre-diabetic population alone, the potential cost savings is in the billions, along with the chance to vastly improve the lives of millions of Americans.
Engaging high-cost populations in health-preserving behaviors, however, remains a significant population health challenge, especially since many are not comfortable with or unable to actively engage with technology. Less frail populations with chronic conditions can benefit from telehealth and connected devices. They can be discharged to home and monitored over time with easy-to-use devices that record and relay key health metrics to providers, so they can intervene before small problems become emergencies.
For more frail populations, passive technology can help them remain in their homes. Falls and lack of medication adherence are two key reasons elderly people aren’t safe to remain in their homes. They can benefit from devices that automatically detect falls and alert a central call center that can triage the appropriate level of intervention. Predictive analytics can help providers know who’s at risk for transport in the next month so they can devote additional cost-effective resources to prevent costly health crises.
Further, increasingly small and sophisticated medication management systems can vastly improve medication adherence, and sensors placed in key areas of the home can help loved ones and providers track activities. These approaches are a win for health systems, patients and loved ones alike, with encouraging results that include significant reductions in ED visits, readmissions, and morbidity/mortality. A side benefit of using these programs is that they also increase patient loyalty, protecting the future of health systems that invest in these programs.
If you make wise investments in technology with a partner who guides you throughout this journey to continuous health, the health of your organization will benefit along with the health of the populations you serve. Such a strategy can help you grow your existing revenue streams with more satisfied, loyal patients while you transition to the margin-oriented realities of value-based care.