- As the healthcare industry shifts payment models from volume to value, innovative care approaches such as accountable care organizations (ACOs), care coordination, and patient engagement continue to gain popularity.
Alternative payment models are the drivers for these new care strategies. Physicians being paid for the quality of their care must adopt new strategies for enabling patient wellness - and getting that wellness to last.
Patient engagement is one of the most important guiding principles for these efforts. But how do alternative payment models like accountable care organizations intersect with patient engagement strategies?
Patient engagement is the provider’s attempt to shape patient behavior to help facilitate better care outcomes. Through patient engagement, providers can influence patient actions, like encouraging wellness visits and preventative care, helping to increase overall patient health.
Increasing that overall health is important to ACOs because they receive capitated payments, making it critical for their patients to stay consistently healthy.
By using patient outcomes and care quality to determine reimbursement, providers see the benefit of keeping patients in the loop and encouraging them to make wise health decisions, driving their care outcomes by patient engagement.
Understand that providers can’t change patient behavior
Although patient engagement may be a driver for a successful ACO, the actual structure of the ACO will not in and of itself increase patient engagement.
“An ACO is trying to make people accountable for the outcomes but it doesn’t drive patient behavior. They’re two separate animals,” Bruce Hallowell, managing director at Navigant, told RevCycleIntelligence.com last year.
That said, providers should be conscious of the fact that patient engagement will be an integral part of the success of an ACO.
“The way it’s structured, I have to get the patient somewhat engaged to the health organization if I’m going to make money,” Hallowell explained. “If I can’t control the patient’s behavior and engagement, the patient is going to go wherever they want to go. What that means is that the ACO will be unsuccessful in cutting cost.”
Patient engagement driving success to ACOs boils down to two things: making sure patients are keeping themselves healthy through preventative care, and making sure patients have regular access to care.
Push for preventative care
One of the primary functions of an ACO is getting patients healthy through quality care, and keeping them that way. Through a capitated payment, it becomes vital for providers to foster healthier habits within their patients, which can best be encouraged through patient engagement strategies.
At its most basic level, patients can prevent emergency health events through preventative care approaches such as wellness visits and regular screenings.
Although the point of an ACO is to decrease the amount of superfluous procedures, pushing for preventative care helps providers reduce the number of large price tag procedures, helping them to adhere to the capitated payment in the ACO.
Studies show that preventative care reduces overall costs, and analyses show that more and more patients are taking advantage of preventative care. In 2015 alone, nearly 40 million patients had accessed some kind of preventative care through a government payment model.
Facilitating constant provider access
Consistent patient access to care is a significant tenet to an ACO. Research shows that mHealth technologies, specifically telemedicine, can help increase this access.
According to Reena Pande, MD, a cardiologist at Brigham and Women’s Hospital, telehealth is a key driver in increasing patient engagement and removing barriers to care access.
“I do strongly believe that making it simple for a patient and a provider to engage with one another remotely – by telephone or video – and removing the barriers is a key factor to improving patient engagement. It is beneficial to simplify access to that type of care and reach a provider at a time that patients need to,” Dr. Pande explained.
Patient access to care and patient engagement can also be facilitated through other health technologies, like the patient portal. By providing patients with access to the patient portal, providers open up more lines of communication through secure messaging and email. These patient portals also increase patient’s understanding of their own care by providing access to patient data.
While an ACO is not a patient engagement initiative itself, it drives provider behavior toward engaging patients. These alternative payment models do this through their emphasis on care outcomes and value-based care. When faced with capitated payments and value-based reimbursement, providers must adopt patient engagement strategies as a means to increase overall patient health and wellness.