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Defining Patient Engagement for Value-Based Care

Value-based care hinges on low healthcare spending through tailored and innovative care delivery models, all of which rely on effective patient engagement.

Value-based care, the care delivery and reimbursement reform movement that emphasizes outcomes over volume of services rendered, could not be successful without strong and meaningful patient engagement.

Defined by the Centers for Medicare & Medicaid Services as programs that “reward health care providers with incentive payments for the quality of care they give to people with Medicare,” value-based care success relies on positive patient outcomes.

And although positive outcomes do rely heavily on clinical decision-making, it would be nearly impossible for healthcare providers to hit the clinical quality metrics needed for value-based care success without strong patient engagement.

After all, the entire point of value-based care is to achieve the best outcomes possible at the lowest cost possible. In most cases, that is going to mean stemming the upstream factors that lead to high-cost and high-acuity care.

And to achieve that, organizations need to engage patients in preventive care, or when chronic illness does occur, strong chronic disease management. Meanwhile, achieving good patient satisfaction scores—which are part of value-based care clinical quality measures—will be key.

Provider organizations need to fulfill those goals across all patient populations, including traditionally marginalized groups, many of which are at high-risk for some of the chronic illnesses that so often result in high costs.

Below, PatientEngagementHIT outlines what patient engagement means for value-based care, and how healthcare organizations can leverage patient engagement strategies for value-based care success.

Engaging patients in preventive care

The most seamless way to see good outcomes at a low cost is to get strong patient engagement in preventive care. Preventive care can yield an upfront cost, but usually that cost will be lower than what would occur during a high-acuity encounter.

For example, administering flu shots is less costly than treating a patient who becomes seriously ill with the virus.

But although preventive care is a simple solution to high-cost care episodes, getting patients to engage in it is not as easy. In November 2020, a literature review published in JAMA Network Open showed that patient engagement in preventive care was trending downward. The study specifically looked at lung cancer screening completion and found that only about 55 percent of all patients in 95 studies were adherent to lung cancer screening regimens.

Healthcare providers working to improve engagement with preventive care should consider a number of factors that could influence whether or not a patient accesses preventive care. Factors might include but are not limited to:

  • Patient health literacy
  • Patient finances
  • Ability to get time off work
  • Patient knowledge of care gaps, missed screenings

With those care access barriers in mind, healthcare organizations and design care delivery models and patient engagement strategies to compel engagement in preventive care. Strategies may include:

  • After-hours screenings
  • Payment plans
  • Patient navigation services
  • Patient education about the importance of preventive care
  • Patient outreach, appointment reminders for documented care gaps

Supporting chronic disease management

Even when a patient has developed a chronic illness, value-based care models demand organizations be able to deliver good outcomes at a low cost. That requires clinicians to coach good chronic disease management, staving off high-acuity episodes in exchange for periodic, low-cost, and low-acuity touchpoints.

For example, a healthcare provider might design a chronic disease management plan for a patient managing high blood pressure, complete with a regular medication, some healthy behavior change, and regular blood pressure monitoring. Each of those measures is a lower-cost option than a high-acuity emergency department visit, but like preventive care, it requires patient buy-in.

Healthcare professionals should be cautious of admonishing patients as non-adherent to chronic disease management; rather, clinicians should work to uncover the key barriers that keep patients for engaging in their care plans.

“I don't think people are non-compliant when it comes to their health,” Alisahah Cole, MD, system vice president of population health at CommonSpirit Health, asserted during Xtelligent Healthcare Media’s Patient Experience virtual event in 2021.

“I think they have barriers to achieving great health. The question is not about if a patient is non-compliant or if they are non-adherent, but why. What is happening to put those barriers up for that patient?”

Many of the barriers limiting engagement in chronic disease management overlap with those limiting access to preventive care:

  • Social determinants of health
  • Limited healthcare literacy
  • Patient finances

In addition to organizational operations that can accommodate patient needs, clinicians should work with patients to uncover the individual barriers that are getting in the way of effective disease management. Perhaps the clinician could suggest a lower-cost medication regimen, or could sign the patient up for the non-emergency medical transportation service offered at the clinic.

Through social determinants of health screening, healthcare providers can better shape their chronic disease management plans.

Driving positive patient experience, satisfaction

The overall healthcare experience and patient satisfaction scores play key roles in value-based care largely because they are part of the clinical quality measures assessed when determining value-based care reimbursement. Healthcare organizations that fail to achieve optimal patient satisfaction scores may not qualify for the maximum reimbursement rate in a value-based care model.

For example, CAHPS (Consumer Assessment of Healthcare Providers and Systems) scores directly inform some value-based reimbursement models; good performance on these surveys is imperative for getting maximum reimbursement.

Delivering a good patient experience is challenging because satisfaction is often in the eye of the beholder. On other words, a good experience for one may fall short for another.

Healthcare organizations can improve patient satisfaction assessment scores by zeroing in on the key areas measured in these surveys, including patient-provider communication, facility cleanliness, patient safety, and patient education during hospital discharge. These are each key domains of the CAHPS surveys.

And outside of formal patient satisfaction surveying, using good communication skills, reducing discomfort, and giving good self-care instructions all simply constitute good care that can, in and of themselves, improve outcomes.

Considering health equity, SDOH

Health equity and consideration for social determinants of health are the two common threads that weave through each domain of patient engagement. Value-based care relies on good patient engagement for all patients, and that means delivering care with cultural competency, understanding the social factors that influence patient care access and engagement, and being compassionate to patients with all needs.

In addition to the ethical obligations most feel regarding health equity, ensuring equitable outcomes will also be essential to driving good outcomes at a low cost. Traditionally underserved patients—communities of color, low-income patients, sexual or gender minorities, and folks experiencing numerous social determinants of health—are at the highest risk for the costliest illnesses.

“But there is a business case around advancing health equity,” according to Kulleni Gebreyes, MD, Deloitte's US consulting healthcare sector leader and recently appointed leader of the Deloitte Health Equity Institute. “We can't make that false choice or continue that narrative that says you have to do good, or you have to do well. There's room for both.”

Healthcare organizations cannot be successful in value-based care if they do not account for those underserved populations and design care delivery to overcome the SDOH that affect them. Said otherwise, health equity makes good business sense.

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