- Faced with an onslaught of clinical quality reporting requirements and unworkable healthcare technology, providers across the country experience a record level of burnout. But at Privia Health, those demands may begin to subside as providers leverage patient-reported data tools that measure care quality and close care gaps.
Identifying care gaps has long been a priority in value-based healthcare, according to Chris Voigt, Chief Technology Officer at Privia Health, a physician organization serving nearly 2,000 doctors across the country. Identifying and subsequently addressing care gaps is crucial to ensuring all patients have access to preventive care.
Challenges have arisen has providers become entangled in the different data collection and reporting requirements associated with care gaps, Voigt told PatientEngagementHIT.com in a recent interview.
Voigt and his team were faced with the challenge of creating a way to collect those clinical quality measures, connect patients to care, all while keeping provider burden to a minimum.
“We need to ensure that we're closing gaps in care, but that is definitely one of those administrative burnout kind of topics,” Voigt said. “For a doctor in an EMR to click through if patients got their flu shot and if they've had their pneumonia shot and all that stuff, it's a pain, right?” said Voigt.
Shishir Khetan, MD, who is an internist at Rockville Internal Medicine and part of Privia Health, can confirm that, saying that care quality data entry is a key driver of physician burnout.
“The traditional way to close care gaps is when the patient is there in front of you, you ask them when they've had their colonoscopy, their mammogram, their vaccines that we're giving them there in the office,” he said in a separate interview. “It's physically requiring a human to do that sort of input.”
That level of human input isn’t always feasible, Khetan said, especially when clinicians have to deal with patient queries, navigate the EHR, drive patient satisfaction, and work through the numerous other competing demands they face in a day.
Recognizing that, Voigt and his team at Privia worked to use technology that would streamline the data collection problem and identify care gaps.
The physician organization, which also develops and builds some of its own patient engagement and population health technology, built a patient-facing system to integrate patient-reported data through the patient portal and into the EHR.
“We looked at that problem and heard the feedback from our doctors,” Voigt recalled. “We talked to our payers and we figured out, if we can through technology ask patients if they've had a flu shot, if they had a mammogram, it would be more efficient. We can close those care gaps and form the patient chart with that patient reported data.”
Privia’s patient-reported data tool pushed text messages and emails to patients prompting them to check a patient portal message. Once the patient had logged into the portal, they were prompted to answer questions about whether they had received their flu shot, a mammogram, colonoscopy, or pneumonia vaccine.
The initiative has yielded visible results. In a six-week campaign, Privia providers were able to close 12,000 care gaps, ultimately saving staffers 125 days’ worth of work.
Anecdotally, the tool eased clinician workflows. For Khetan specifically, the tool has allowed him to connect with his patients more and be more present during the care encounter.
“That's a huge benefit to every practice because that reduces any data entry for anybody,” he said. “This data entry is now done outside of normal office visits, so during the office visit I can concentrate on the visit itself. I don't have to worry about those care gaps specifically. And it's seamless.”
Although the patient-reported data tool has helped Privia providers close care gaps, there are some challenges. For one, it relies heavily on patient portal utilization.
And although over 90 percent of providers offer the patient portal and most patients have even made portal accounts, the tool yields very low use rates. A 2017 report from the Government Accountability Office (GAO) found that only about one-third of patients actively use the portal, and similar reports published since have found similar trends.
But a patient-reported data platform must exist on the portal, Voigt explained, because it deals heavily with protected health information (PHI). Privia needed to leverage a secure, HIPAA-compliant tool, and the patient portal was the best option.
Privia worked around the portal uptake issue by being more tenacious than ever, Voigt said. Currently, Privia boasts one of the largest portal adoption rates of athenahealth’s user network and continues to push to ensure patients benefit from the tool and can contribute their own care quality information.
“Like in most of life, you get out of the portal what you put in,” Voigt said. “We actually drive great portal adoption statistics and utilization because we've extended the portal so much. We've made it a rich place to go. It's not just where you go to view your lab results.”
Instead, the patient portal is the central hub on which patients can message their providers, request medication refills, and view provider comments about their care.
For Privia providers, the patient portal is essential. Khetan’s entire practice hinges on the patient portal, a tool he says he cannot live without.
“The patient portal is vital to my sanity, my existence as a provider,” he explained. “When I meet a new patient or I have a patient who's not on the patient portal, I'll spend a few minutes talking about the portal, how vital it is, and how useful it is.”
And as often as some clinicians may say they encounter patients who simply won’t use the portal, Khetan said limited engagement has not been an issue for him, especially when it comes to the patient-reported data.
“It's supposed to be a seamless thing. I've never had a patient who's asked me why they are getting this message,” he said. “None who have said, ‘I don't want to do this, or I don't have the ability to do this.’ I've never really gotten that sort of resistance from patients. Patients are actually quite excited to be able to provide that information.”
All of this aligns with Privia’s culture of care quality improvement, at the heart of which is patient engagement and technology.
For example, Privia hosts a robust virtual care system that allows patients to connect with their providers via telehealth. These tools help connect patients to care that they otherwise would not have had access, Voigt said.
It also helps clinicians provide the right acuity of care depending on patient need. A patient presenting with a mild rash can certainly be seen via video conference, Khetan explained, saving essential resources and making care more convenient for the patient.
At the end of the day, Voigt and his team at Privia want to help their providers succeed in value-based care, and technology is the answer to that. And at only five years old, the physician group is agile enough to develop the technology to meet those demands.
The trouble isn’t necessarily developing the necessary tools – although Privia does rely on a top-notch IT team and athenahealth’s open enterprise suites.
Instead, it’s knowing where to begin. As value-based care requirements continue to hurdle toward providers, Privia struggles to know which technology solution they should develop first.
“What's the hardest part about building technology to help our physicians succeed in value-based care? At scale, I'd say prioritizing,” Voigt concluded. “There's just so much opportunity for what we think we can do and what we think we need and only so much time in the day to devote to solving those problems. So we're constantly managing a backlog of ideas.”