Sickness is costly. Globally, healthcare systems have been buckling under the cost of managing disease — particularly chronic disease, which accounts for about 75 percent of total expenditures. As reimbursement models shift away from fee-for-service — where clinicians are paid per patient visit — and toward value-based care — where reimbursement is based on the quality of care provided to patients — healthcare systems have focused more on prevention and improving outcomes, areas in which patients and their families tend to be most influential. This shift requires moving to a patient-driven care model, where patients are empowered and involved in their health outcomes.
One of the biggest contributors to healthcare costs is hospital readmissions. In the United States, the Agency for Healthcare Research and Quality (AHRQ) has estimated hospital readmission costs within 30 days of discharge at $41.3 billion. To reduce complications — and costs — providers are looking for new ways to manage patients post-discharge. Rather than simply giving out explanations that are poorly understood, prevention should focus on a patient-centered approach using various tools: interactive education tools, patient portals to track adherence to treatment, follow-up phone calls, patient apps to share information with a clinician, outcomes reporting, or an orchestrated approach across the patient’s care team.
As patients take a more proactive role in their care process and health, new payment models are also being introduced to allow clinical teams to move toward a more holistic approach. In the U.S. public sector, the Centers for Medicare and Medicaid Services (CMS) is launching a value-based, patient-driven care payment model for skilled nursing facilities (SNF). Rather than reimbursing based on the volume of services provided, the Medicare SNF Patient-Driven Payment Model (PDPM) reimburses based on addressing patient conditions and healthcare needs, allowing nursing home staff and care teams to take a more holistic approach to care that emphasizes patient outcomes.
Improved oversight for better cost and health outcomes
Healthcare organizations have struggled with poor oversight across the patient journey. Prevention and wellness can encompass many different measures for patients with chronic illnesses, but improving health means being able to track patient-reported outcomes that matter. Organizations such as the International Consortium for Health Outcomes Measurement (ICHOM) have developed open access measurements to track items that matter to patients, such as quality of life, level of pain and psychological well-being. Well-being and morale are important to recovery, and having clear patient-reported outcomes enables healthcare organizations to assess how their patients are doing and what action may be needed to avoid a more serious health incident or hospital admission. This is key to realizing value-based care.
Patient-driven care and better care coordination requires collaboration across the organization, which has been difficult for historically siloed healthcare organizations. Resource management tools that support patient-driven care make it possible to track what is being done to manage a patient’s care and by whom. With new analytical tools, healthcare providers can track where a program is doing well or where there is room for improvement.
Even an issue as seemingly straightforward as scheduling has been a headache in healthcare. In a patient-driven care model, healthcare organizations are finding ways to improve scheduling so that patients can seamlessly book and change appointments. In addition to improving patient satisfaction, improved scheduling logistics will enable clinics and hospitals to fill gaps. For example, many outpatient clinics in the United Kingdom have empty slots or empty rooms, while patients are queuing for physicians at other sites, unaware that appointments are available. Having advanced online scheduling would fill these gaps, reduce the no-show rate and allow hospitals to reduce the administrative burden and costs of employing staff simply to answer phones, take bookings and organize patients.
The impact of increased patient engagement cannot be overstated. Studies carried out by healthcare organizations such as the Mayo Clinic and Kaiser Permanente have shown improvements in outcomes where the patients are engaged. Empowering and communicating with patients about wellness and prevention will help drive down the cost of care, enable healthcare organizations to improve their bottom line, and help the entire healthcare system to achieve the objective of value-based care.