Patient Engagement Moves Front & Center

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Hospitals are facing a "perfect storm" of new regulations and market forces that will require an unprecedented level of patient engagement over the next year and beyond. Meaningful use of electronic health records (EHRs), the creation of accountable care organizations (ACOs), the transition to value-based purchasing (VBP) and increased quality initiatives like the reduction of preventable hospital readmissions are just a few of the drivers leading providers toward a patient-centric model of care delivery.

Institutions can no longer "settle" for hit-or-miss communication with passive patients who often don't comply with treatment regimens. They must first capture patients' attention, and then educate, empower and encourage them to switch from being bystanders to active participants in their medical care.

Facilities have always sought to educate patients while they were in the hospital. Until now, however, organizations have not had the incentive to mount an all-out effort to ensure patients fully understand and adhere to treatment regimens because health insurers have paid for the majority of visits. But as the government migrates from this volume-based, fee-for-service reimbursement model to value-based payments tied to clinical outcomes, providers will be compelled to work relentlessly to engage their "customers".

To manage the approaching storm and its potentially mammoth impact on revenue, providers must deliver the right information, to the right patient, at the right time and place. They must accomplish this throughout the care delivery cycle - before, during and after hospitalization.

Domino Effect
Educated and involved patients are far more likely to follow treatment recommendations, use preventive services, take medications appropriately, pursue follow-up treatment and choose healthier lifestyles. Involved patients avoid many preventable complications and the corresponding need to be admitted (or readmitted) to the hospital. Not only is this good for the patient, but it also helps hospitals comply with expanding quality-related initiatives.

Many providers are using existing technology investments such as in-room televisions to expand and strengthen patient engagement initiatives. Through the use of an interactive television (iTV) system, nurses, physicians and patient educators can "prescribe" education videos and information to hospitalized patients based on an individual's diagnosis/condition, age, preferred language, health literacy and other important criteria. Patients can utilize the TV, a universally familiar device, to educate themselves on their condition and become active participants in their care plan. A series of on-screen questions can measure comprehension and an alert can be automatically sent when additional intervention is required to ensure that a patient understands the information he or she has been given. The system tracks each patient's viewing activity and the results can be automatically documented in the EHR.

Some advanced iTV solutions also enable patients to access personalized information about their care team, daily schedule, medications, procedures and post-discharge care instructions. They can even use the TV to order meals and control the room temperature and lighting, thereby eliminating the most common reason for patient falls. These systems also deliver entertainment options including family-friendly movies, television shows on demand, music and games that can further increase patient satisfaction.

Although most of these applications are designed strictly for inpatients, hospitals can seek out additional solutions that utilize smart phones, computers and eventually Web-enabled TVs - whichever a patient prefers - to establish communication before admission and after discharge. By accommodating a broad range of communication tools, these applications enable hospitals to reach up to 90 percent of patients post-discharge, including those in traditionally underserved populations. Clinical outcomes can be improved - and preventable readmissions reduced - by utilizing these tools to ensure that even difficult-to-reach patients continue receiving understandable information designed to help them stay involved in their care.

In the July 19, 2011 issue of Annals of Internal Medicine, researchers from the Agency for Healthcare Research and Quality (AHRQ) concluded that low health literacy was associated with poorer health outcomes and lower use of health services after reviewing 96 health literacy studies. Patients who had difficulty understanding medical information were more likely to be hospitalized and have trouble interpreting labels. They were less likely to take medications appropriately, have mammograms and be immunized against influenza.

Many patient engagement tools have the capacity to reach the "ideal" patient, but some of the most vulnerable and highest-cost patient groups are difficult to reach outside the inpatient care setting. Therefore, it is important for hospitals to maximize patient outreach opportunities during the inpatient stay, when they have the advantage of a captive audience.

Financial Impact
In addition to reducing health disparities, patient engagement tools can facilitate compliance with the patient engagement requirements of several healthcare reform regulations.

The federal government has launched a number of initiatives designed to improve the quality of healthcare while reducing costs. Backed by more than $135 billion authorized by the American Recovery and Reinvestment Act (ARRA), these initiatives will be implemented through a combination of incentive and penalty programs through the Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

Four programs - Meaningful Use, Value-Based Purchasing, Hospital Avoidable Readmissions and Accountable Care Organization Formation - are commencing at approximately the same time. They will be subject to phased-in stages (with initial requirements being expanded each year), and will directly impact Medicare reimbursement rates.

Hospitals that are already contending with the financial reality of negative margins on Medicare admissions face the potential of further reductions if they don't meet quality standards, adopt health information technology, establish a patient-centered environment for care delivery and reduce preventable readmissions.

According to a 2009 New England Journal of Medicine study, approximately one fifth of Medicare beneficiaries are readmitted within 30 days after leaving a facility, costing more than $17 billion annually. Poor discharge planning and care coordination are two causes of re-hospitalizations. And, according to a 2007 report by the Medicare Payment Advisory Commission, "Research shows that specific hospital-based initiatives to improve communication with beneficiaries and their other caregivers, coordinate care after discharge, and improve the quality of care during the initial admission can avert many readmissions." Seventy-six percent of 30-day readmissions are "potentially preventable," said the independent congressional agency. To address this issue, CMS will begin cutting Medicare payments to hospitals that don't reduce 30-day readmission rates for patients with heart attacks, heart failure and pneumonia.

Additionally, patient engagement technologies can help organizations maximize Medicare revenue by boosting patient satisfaction scores. Beginning in October 2012, CMS will integrate the scores into the formula it uses to determine payments for providers. VBP signals the move by CMS toward true pay-for-performance, which several private insurers have already implemented. Depending on the results of patient surveys, average-sized hospitals with poor results stand to lose up to $2 million over a five-year period.

With their viability and a huge sum of money at stake, patient engagement is a quality improvement and business imperative for providers. By deploying tools that facilitate the patient-centered care movement, hospitals can earn the loyalty of patients, improve clinical outcomes, optimize revenue and prepare for the collaborative care and value-based reimbursements that will affect income in the future. Organizations that don't move proactively to empower customers - or who are tardy in their response to marketplace and regulatory developments - will be at competitive disadvantage that may be impossible to overcome.