Integrating meaningful patient engagement strategies into primary care is often cited as one of the industry’s greatest challenges, but specialty healthcare providers may face even more obstacles when trying to forge strong patient relationships.
Respecting patients, clear communication, appointment availability, and putting the patient at the center of the care team are important tactics for any clinician.
However, in subspecialty care, where clinicians may only see their patients once or twice to address an acute issue or a few times a year to monitor a chronic concern, providers may need to deploy different relationship-building techniques than their primary care peers.
A specialist can be successful in driving stronger patient engagement by assessing the health IT they use and how they use it, streamlining the patient care access process, and determining how patient relationships fit into shifting care delivery models.
Reframing the patient portal for specialty care
Patient portals are at the core of communication for patients, and have been widely adopted in the primary care setting. Patient portal adoption rates have reached 90 percent, per 2016 data from AHA.
Specialists are also investing heavily in using patient portals as a primary means of maintaining patient relationships and engagement. To ensure the patient portal works for the type of specialty care delivered, providers should consider the following:
- Identify the needs of the patient population. Acute care encounters in orthopedics, for example, will likely reframe the portal to establish a relationship. A cardiologist helping to manage heart disease will use the tool to facilitate conversation and answer questions via secure messaging.
- Leverage useful features. Patients who need a medication refill should know about the prescription requests function on the patient portal to efficiently receive the therapy they need.
- Establish the business case for the patient portal. Although a patient visiting the clinician only once will likely not actively use the portal, their portal registration might make them a returning customer if they fall ill again.
- Establish a need for follow-up reminders. For example, an eye doctor should reach out to her patients periodically to stay on top of their care.
Specialty groups can use the portal to foster pre-existing relationships with patients, says athenahealth CMO Todd Rothenhaus. This makes it more likely that patients will access that provider again in the future.
“[Specialists are] growing a business and they’re looking for that engagement, as well,” Rothenhaus said. “Specialty groups want to know if there’s a spouse or a family member who might seek care, and they want to be gaining their market share.”
The portal can make a key difference in gaining mindshare. For example, if the patient already has a portal account with a certain physical therapist, she could be more likely to visit if she should hurt her knee again.
In addition to the patient portal, specialists often rely on a suite of connected health tools to drive patient engagement.
In orthopedics, providers tend to turn to an integrated network of mHealth apps and remote monitoring tools to remain in contact with their patients during their recovery, said Andre Blom, COO at Illinois Bone and Joint Institute (IBJI).
“The patient portal is a little too static for a risk-based model,” Blom explained. “In a primary care situation, it is more about monitoring long-term or chronic conditions like diabetes or cancer, managing meds, etc. It’s more spread out.”
But in orthopedics, providers lean on a set of technologies that allow the provider to detect patient recovery progress and conduct outreach on a granular level, Blom added.
A more agile set of connected health tools – such as secure smartphone messaging technologies or Bluetooth monitoring tools – will help providers manage changes in a patient’s care plan. This is essential in specialty care, where many providers engage in capitated payment models that hinge on activating the patient consistently throughout the care journey.
Facilitating access to specialty care
Specialty care is perhaps most notorious for having long appointment wait times. Between the referral process and limited availability, patients often wait for weeks to access healthcare from a specialist. This can have a significantly negative impact on patient satisfaction and potentially even the likelihood that patients will adhere to recommendations for follow-ups or consults.
In a February 2017 study, ninety-three percent of parents of pediatric patients approved of the appointment scheduling timeline for their primary care providers, but just 87 percent of parents said the same of specialty care providers.
A 2017 report from Merritt Hawkins also found that appointment wait times varied across specialties. In dermatology, for example, patients waited an average of 32.3 days to receive an appointment. Conversely, patients seeking treatment from an orthopedic surgeon faced an 11-day wait time.
Although the Merritt Hawkins researchers could not make claims about the clinical effects of specialist wait times, they did argue that a wait time exceeding two weeks characterized a practice as “busy.”
“In such cases, the recruitment of a new physician partner or associate may be warranted,” the report said. “It also is at this point that patients in the community often begin to voice concerns about physician accessibility.”
Specialty offices usually have longer wait times because of the referral process. Typically, a patient’s primary care physician must refer the patient to the appropriate specialist. The specialist then needs to ensure the patient is the right fit for their service options and onboard the patient into the system.
This process can discourage patients from pursuing specialist care, says Morgan Porter of Mentis Neuro Health.
Texas-based Mentis Neuro Health offers specialty rehabilitation care following a traumatic brain injury. According to Porter, who serves as the practice’s Chief Technology Officer, their onboarding process used to take weeks. In addition to the usual referral steps, Mentis needed to assess the patient for comorbidities that would exclude patients from its type of specialty care.
This long wait period too often led patients and their families to seek recovery at home or in other facilities. Recovery at home did not yield optimal outcomes, Porter said.
“Even though the rehabilitation program was excellent here, the patients were typically going elsewhere because it was too hard to get into Mentis,” Porter told PatientEngagementHIT.com.
“It took too long to go through the process so that was a big challenge.”
Porter enlisted the help of a patient onboarding technology, which automates each step of the referral process. Porter and his team cut down on the onboarding timeline significantly by setting up time limits for each step of the process and keeping those steps streamlined. This produced a 21 percent increase in patients seen at Mentis.
Simply dropping patient onboarding technology into a practice will not necessarily make the process easier, however. Specialist organizations must assess their current onboarding protocol and identify areas for increased efficiency.
Health IT tools, as well as a cultural and procedural overhaul, can help with these tasks. Providers may wish to consider:
- Using digitization to assess the patient’s healthcare payer policy on subspecialty care
- Streamlining communication and care coordination between the subspecialty group and the referring clinician to help specialists identify concerning comorbidities and assess patient readiness for specialty care
- Setting up an ideal timeline for each step of the onboarding process and escalating efforts when that timeline is exceeded
- Clarifying outcomes goals and advantages of specialty care to help patients make informed treatment decisions
Expanding convenient access to healthcare is a priority for all healthcare professionals. However, because accessing care from a specialist is often more complicated, it is key that specialists make the onboarding process as simple as possible. Patients who can easily access a specialist are more apt to receive the care that they need.
Patient engagement in specialty care payment models
As the industry shifts toward value-based care models, more specialist providers are facing capitated payments for each care encounter. The push for value also drives a need for patient activation in care.
To be clear, all of healthcare is moving in a value-based direction. But as explained by IBJI COO Blom, specialty care providers – especially orthopedic surgeons – have been able to adapt to value-based models more easily than PCPs.
“In most cases, all medicine should be ‘value-based,’ right? It’s just that bundled payments can be measured more transparently in orthopedics than other elements of medicine,” Blom explained.
Specialist providers involved in value-based care models have had to shift how they engage their patients to drive success. At IBJI, Blom and his OrthoSync Team use risk stratification to determine which patients will need extra nudging.
Using EHR data, healthcare organizations can glean insights into patient populations and identify comorbidities that may put patients at-risk for complications during the recovery process. Leveraging big data analytics technology will help identify patients who fall outside of normal parameters.
Healthcare providers should also use strong patient-provider communication skills to uncover barriers to a normal recovery. A patient might have a normal clinical profile, but have difficulty getting to and from the office for follow-up care, which could hinder recovery and the chance of meeting bundled payment requirements in general.
Information about recovery barriers, like getting a ride to follow-up appointments, likely will not be in the EHR. Providers need to use their interpersonal skills to obtain this information. While this may not be data risk stratification, it is an important step in recognizing patients that will need targeted care that is outside of normal practice.
About 85 percent of IBJI’s patients fall within the clinical recovery norm, Blom explained. But for the remaining 15 percent, Blom and his team focus on the factors that might prohibit them from a typical recovery.
This requires extensive patient outreach, ensuring that IBJI can meet patients where they are. Blom and his team make themselves openly available to patients to ensure patients get the right follow-up care at the right time. And by leveraging health IT tools clinicians can detect when a patient’s recovery is not progressing smoothly.
When IBJI’s clinicians identify a complication, they can mitigate it immediately and in the most cost-effective fashion. When a patient experiences pain from a potentially infected incision, for example, patients know they can reach out to their clinicians instead of visiting the ER. This helps IBJI deliver care within the capitated payment model.
In the end, a care encounter – regardless of specialty – will be determined by standard factors. Clinical quality, communication, respect, and a patient’s partnership in care will always be important for any provider.
However, providers will need to make specific considerations to drive patient engagement in specialty care. Reframing health IT use, making appointment scheduling open and streamlined, and supporting the patient role in emerging care models, will help specialists support a better patient experience.
This article was originally published on August 4, 2017.