Engaging patients to decrease costs and improve outcomes

Increasingly, healthcare providers face insurmountable opposing pressures: To bring down costs, but accomplish more

at every patient visit.

Today’s physician is responsible for a tremendous medical repertoire, evidenced by the increasing number of diagnoses in our codes. About 13,000 diagnostic codes will expand to 68,000 with adoption of the new ICD-10 system, originally set for 2011, but extended to 2015 out of concern for the administrative burden it presents.

Physicians also need to meet or consider 13 meaningful use objectives, 33 pay-for- performance measures, nine quality incentive measures, and 27 medical home elements. These include a daunting number of activities ranging from design of IT interfaces to medical assistant time, nursing interventions and physician effort.

To complicate the issue, these requirements have emerged in the context of a shortage of primary care physicians and certain types of specialists, generating further discrepancies between supply and demand. The demands cannot be met, even with substantial help from ancillary staff. And even if they could be met, the cost to provide such care would be prohibitive.

So how do we manage the myriad of initiatives, the impending physician workforce shortage while also reducing cost and improving quality? In healthcare, we continue to insist on human resource-intense solutions. However, the proportion of a provider organization’s cost borne by human resources is 56%, and healthcare workers are generally less productive than those in other sectors. A staff-heavy plan of action is doomed to fail.

Other industries, when faced with the quandary of accomplishing more with less, have resorted to customer-empowerment initiatives. As customers, we now do our own banking, pump our own gas, assemble our own furniture, check ourselves in at the airport and out at the grocery store. These examples allow those providing services to use human resources more efficiently, contributing to increased worker productivity.

In most cases, the advent of these strategies was viewed with concern, but now all are almost universally viewed as empowering consumers. Can we follow this model of customer empowerment and create an architecture that allows us to engage patients in their healthcare?

Patient self-management is not a new concept and represents an essential element of the chronic care model (CCM), a theoretical framework developed to guide higher-quality chronic illness management in primary care. Evidence has shown that incorporating CCM principles into practice results in favorable health outcomes.

Patient engagement initiatives have led to reductions in hospital visits, decreased morbidity and mortality, and improvements in treatment adherence and quality of life associated with chronic diseases such as heart failure, ulcerative colitis, and asthma. Although an overarching goal of patient engagement is to decrease cost, we do not have to sacrifice quality care.

Areas of opportunity for patient engagement include scheduling appointments, managing correspondence, refills and prior authorizations, and facilitating communication with the medical team. These tasks require more health literacy and familiarity with technology than we have asked of patients previously. Not all patients will be able or eager to handle this, but many will.

Most patients embrace responsibility for managing their health and view this approach as better quality care. A 2010 survey found that 79% of respondents were more likely to select a provider who allows them to conduct healthcare interactions online, on a mobile device, or at a self-service kiosk. One study found that many would even pay for such online services.

The majority of patients prefer a shared decision-making approach with their healthcare provider, an attitude that will aid a patient engagement initiative. Although barriers will exist for individual patients to adopt this system and its associated technologies, we must focus on developing an infrastructure that supports and encourages active patient participation in their healthcare.

Alexandra B. Kimball, MD, MPH, is senior vice president of practice improvement at the Mass General Physicians Organization and a professor at Harvard Medical School. Kristen C. Corey, MD, is an internal medicine physician in Boston, Massachusetts. Joseph C. Kvedar, MD, is director of connected health at Partners HealthCare and a professor at Harvard Medical School. This essay was an honorable mention in the 2014 Medical Economics doctors writing contest.