- As bundled payments become mainstays in the healthcare’s shift to value-based care, health organization leaders are working to identify top strategies for success. Tapping into key patient outreach strategies helps practices in risk-based care models ensure they are facilitating optimal outcomes at a lower cost.
At Illinois Bone and Joint Institute (IBJI), value-based care success comes from putting a priority on the patient. Providers activate patients in their own care and work to deliver on optimal outcomes through extensive patient outreach, according to IBJI Chief Operating Officer Andre Blom.
The organization is involved in six bundles in total – total knee replacement, hip replacement, ankle replacement, revision, bilateral lower extremity, spine procedures, and shoulder procedures. Additionally, IBJI is involved in bundled payment models with Aetna and Cigna, and is currently forging an arrangement with BlueCross BlueShield.
The key to success in these models is knowing which patients to engage and how, Blom noted in an interview with PatientEngagementHIT.com. Blom and his team at IBJI – called the OrthoSync Team – use risk stratification to identify how they will conduct outreach to specific patient profiles.
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.
What kind of care plan are these patients following? Did they encounter any extraordinary care barriers? Did they have any unpredicted outreach?
Blom and his team can begin to create an individualized care plan for patients by answering these questions.
Driving these individualized care plans keeps in line with IBJI’s time-honored practice of putting the patient first. While the OrthoSync Team does focus on that 15 percent of patients outside of the norm, offering patient-centered care is an imperative for all healthcare consumers.
“Since 2013, our philosophy has been to make sure that you always start with the patient first,” Blom explained. “I know it’s an overused term in medicine, but the reason is that if the patient is committed to their own health and they have specific goals that you can personalize around them, they’ll be more engaged.”
For example, IBJI no longer offers general total joint repair preparation classes. Instead, it hosts individualized classes that cater to a specific patient need. This helps patients make a greater investment in their care, and ultimately carry out their individual recovery responsibilities.
The recovery process is then characterized by continuous patient outreach, Blom explained. The OrthoSync team must connect with patients the way patients want and when patients need.
When a patient experiences adverse side effects after surgery – pain in their calves or symptoms of a potential incision site infection – IBJI wants to be the place the patients visit.
When patients know there are numerous qualified providers who can tend to their needs (there are 44 physicians on the OrthoSync Team), patients will visit IBJI instead of self-referring to the emergency department.
“We can connect to patients during the global period and make anyone in our office available to do, for example, an ultrasound,” Blom explained. “The patient can come to us immediately so the surgeon can make the critical care decision about what the intervention should be instead of sending the patient to the hospital.”
Orthopedists in value-based care models need to remain connected with the patient even when there aren’t obvious adverse events. Being in constant, near real-time contact with the patient allows physicians to detect irregularities in patient recovery that otherwise may have gone unnoticed.
Health technology has emerged as an enormous facilitator in this area, Blom noted. However, although patient portals and other secure messaging media have grown in popularity in recent years, these tools are not always conducive to the orthopedic and value-based world.
“The patient portal is a little too static for a risk-based model,” Blom said. “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.”
Blom suggested that risk-based situations call for more agile technology, such as an mHealth monitoring tool that connects with the provider. Working with health IT provider SRS Health, the OrthoSync Team can integrate both the anticipated care plan and changes to the expected recovery pathway into the EHR system.
OrthoSync Team members can adapt to new patient challenges in real-time and build upon an evolving care plan for patients.
“Finding a balance of checking in with your patients without annoying them has moved beyond emails,” Blom said. “I can email over the patient portal, but I need to be able to get in touch with patients in real time through an app on their phone if I’m going to be a true player in risk.”
Though it may appear as though a patient-centric approach to managing risk-based payment models is driving success at IBJI, Blom conceded that there are some challenges to embracing the patient at the center of care.
Patients who are more involved in their care often understand the different rights they have in their care. And although this is a positive thing for healthcare transparency, nebulous value-based models can cause confusion.
Patients communicate with one another about the care they’ve received, and sharing their expectations – which might be rooted in two different value-based models – could be putting a strain on the patient-as-consumer mindset in the context of the value-based world.
“Patients talk to their neighbors and learn that they have a right to XYZ, even though that might be completely detached to the clinical need of their specific case,” Blom explained. “So that old mindset of fee-for-service and going into value-based medicine and the timing of the ‘patient as consumer’ versus the practice change to be relevant, reconciling those two things is actually pretty difficult.”
The various risk-based models can also make it tough for clinics themselves to keep up, Blom noted.
“If you’re in a clinical environment trying to synchronize and standardize your practices, it’s hard to do that if the rules change every six months,” he said. “That is part of the challenge that all care teams are facing.”
However, being a part of an orthopedic practice with the means to practice in risk-based care has had its benefits, Blom stated.
Ultimately, a significant percentage of the industry is going to move to value-based payment models of some sort. As an orthopedic practice offering procedures conducive to bundled payments, IBJI is able to get insight into what is required to be successful in this new paradigm of care early on.
“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. “It will be interesting to see how bundled payments and value-based care change in the future relative to that issue.”
Blom’s role at an orthopedic organization has prepared him for the overhauls the entire healthcare industry is undergoing, despite any challenges he has encountered. Orthopedists who have adopted several bundled payment models might be ahead of the curve as the industry continues to transform.
“The biggest advantage of being involved in BPCI is that it’s the first wave of what will eventually happen,” Blom concluded. “The biggest advantage to us is that we can learn how to integrate and how to connect the surgeon throughout the continuum, which previously hadn’t been the case.”