Digital transformation is upon us. As hospitals and health systems evolve from fee-for-service to value-based-care models, it is paramount that patient engagement and experience be part of the long-term strategy. Streamlining and optimizing administrative and clinical workflows so that patient outreach and engagement are timely, relevant, and proactive has never been more important. In this HFMA virtual roundtable, several healthcare leaders share insights into how they are cultivating patient engagement strategies and implementing open, flexible, enterprise technologies to improve quality and the patient experience.
As your organization makes the shift to value-based care, what role does patient engagement play in making the transition?
Todd Schonherz: At Florida Cancer Specialists, about 50 percent of the patients we treat fall under a value-based care arrangement. In each one of these arrangements, patient engagement and patient satisfaction are critical quality indicators, and they are vital to our value-based care transition across our markets. High levels of patient engagement are incredibly important in providing quality oncology care because of the intense and sometimes prolonged nature of the conditions we treat. Having a strong, multifaceted engagement strategy is crucial to enable more proactive and responsive interventions, which contribute to our success within value-based care.
Raj Toleti: Value-based care is all about being proactive with patients and managing different populations to achieve better outcomes. However, the ability to compute, understand, and stratify patient populations is meaningless if a provider organization does not use this information to engage and influence patient behavior or intervene when outcomes are heading in the wrong direction. Patient engagement is essential for empowering patients and allows organizations to move the needle on value-based care models.
How does your organization engage patients in their care and financial experience? How do you ensure outreach and engagement are timely, relevant, and proactive? Do you employ technology to support these efforts?
Schonherz: We take steps to engage patients even before they come to the office. They are assigned to care managers, which is important to prepare them for their first appointments. They're encouraged to complete paperwork prior to their appointment since time in the clinic is best spent with the provider identifying optimal treatment, rather than filling out forms.
While patients are under our care, we leverage several technology solutions to keep individuals engaged. We create a campaign around each patient, which provides protocols to our care managers, so they know the best times to reach out depending on the patient's treatment plan. We also built a solution that allows us to risk-stratify patients to identify who might be at higher risk for adverse events, which could lead to hospitalizations or emergency room visits. These technologies enable care managers to send notes and alerts to other caregivers on the team, including physicians, advanced practice providers, and other clinical staff.
Our care managers and providers engage patients proactively throughout the process to ensure they're being treated holistically. We ask about various aspects of their health to understand and assess any changes to their conditions or pain management needs. In between office visits, patients can contact their care managers through multiple channels, including by phone or secure email. They can also reach out to our care management services, which are available 24/7, to proactively keep healthy, avoid unnecessary emergency rooms visits, or lessen the likelihood of hospitalization. Our care management technology platform is integrated into what we do every day: Information is always current and accessible by everyone on the care team. Patients are also able to access lab results, visit notes, radiology reports, and other information through a self-service portal.
In cancer treatment, it's especially important to keep the patient's family involved and educated on the treatment and care plan. When patients consent to the appropriate releases, we allow the family to access our technology platform to stay engaged. We also provide educational videos, so caregivers can better understand what their loved ones are experiencing and what to expect down the road. This enables some of the knowledge transfer that doesn't always occur when families are engaged remotely, which is common in Florida as individuals retire and move south, away from their families.
To ensure our care team remains cognizant of when patients are enrolled in value-based care programs, we also have alerts built into our electronic health record (EHR). Our EHR provides physicians with literature-supported treatment regimens to ensure optimal treatment selection.
To support patients' financial well-being, we've developed a multipronged approach. For all our patients, we strive to provide an accurate treatment plan summary as the physician decides what course of action will be most effective in winning the patient's personal battle against cancer. Using financial tools, we develop treatment estimates based on the regimen selections made by our physicians. This allows us to give patients upfront support financially. Every one of our offices has dedicated financial counselors, and we also have a robust team that provides financial aid and support for patients through various grants and patient assistance foundations. This lets them stay on their life-saving medications and treatment therapies. Our organization also has a foundation that helps patients with their nonmedical expenses, so they never have to choose between paying their electric bill or filling a prescription.
Toleti: Most provider organizations in the last 15 to 20 years have relied on the patient portal to engage patients digitally. Yet, patient portals are used by only a small percentage of patients. As more systems have become automated, most organizations have added additional electronic tools, which means providers—and their patients—have to manage and interact with multiple tools to share test results, facilitate payments, schedule appointments, and perform other types of functions.
Providers will best serve their patient populations by continuing to offer multiple channels and modalities, ensuring accessibility and that functions are convenient and easy for patients. We believe providers should unify and streamline digital solutions used throughout the patient's entire care journey into one digital platform, so patients don't have to log into multiple devices and/or applications. This will not only enhance engagement; it will improve their overall experience and satisfaction.
Have you seen patient engagement efforts close gaps in care and/or reduce readmissions? What have the financial implications been?
Toleti: There's a higher probability that patients will take action and close care gaps with good, effective digital engagement. When they are able to set up and check into appointments, view test results, and perform other tasks at their convenience from their phones, such as paying bills, they are more likely to stay involved. Among our clients, we've actually seen 40 percent more care gap closures with effective, digital patient engagement platforms. This contributes not only to improved outcomes but also to the organization's bottom line because value-based payment is outcomes-driven. With more efficient scheduling, fewer appointments are missed and providers are able to see more patients throughout the day. In addition, patients are more likely to pay their bills when it's convenient and easy for them to do.
Schonherz: We've seen fantastic results from our patient engagement efforts, particularly through our care management program. After our first year in the program with one payer, we saw a 34 percent reduction in inpatient days, and we've seen 16–17 percent reductions in patient admissions with two other payers. We're of the belief that a knowledgeable patient will ultimately be more compliant, resulting in higher levels of adherence and ultimately better outcomes. There are also significant savings opportunities when you keep patients healthy.
Has your focus on patient engagement improved satisfaction scores and/or helped reduce leakage? How does work in this area tie into quality-based payments? What overall impact has it had on the bottom line?
Schonherz: We have found that making investments in care management and patient engagement technology has led to highly satisfied customers. To understand and measure our patient satisfaction, we use the Net Promoter Score. We conducted more than 80,000 surveys in the last year, and as of Oct. 30, 2018, we have a Net Promoter Score of 87.5 percent. In comparison, organizations are considered "best in class" when their scores hit 75 percent. Our care management program is rated even higher, with a score of 96 percent.
We believe having happy and engaged patients has helped in multiple parts of our business, including our ability to transform ourselves from a volume- to a value-based care provider of cancer care services. We can now take our cost-effective, high-quality programs directly to payers and employers, show them our outcomes, and aim to be their cancer care destination of choice. Our high patient satisfaction scores not only prevent leakage, they contribute to our growth.
Toleti: It's important not just to know patients for who they are but to meet them where they are in their care journey and build on their trust. A lot of leakage occurs when patients fall through the cracks and don't know where to turn for care. Using effective, efficient technology that drives patients to downstream providers, making it convenient for them to make appointments, can decrease leakage by nearly 40 percent. Moreover, we've seen satisfaction scores increase by 36 percent when providers leverage a streamlined, digital platform for patients.
The primary goal of value-based payment models is to provide high-quality care and reduce costs while achieving optimal outcomes. Patient engagement in any form is a critical component of this. Offering a convenient and continuous engagement experience for patients will ensure they not only are informed but empowered to make better decisions about their health.
Full Round Table discussion can be accessed here.