How patient personalization can aid the transition to value-based care models

Transitioning to value-based care in health care is long overdue. As a former practicing physician, one of the reasons I left primary care was the fee-for-service payment model. At the time, things that were critically important from a clinical standpoint – quality, outcomes, patient education and care management, to name a few – were missing in the management and delivery of patient care.

Even worse, fee-for-service care absolves the provider of responsibility for the outcome of their work, as patients are charged regardless of whether they receive the care they need to solve their health issue. This outdated process doesn’t hold up in any other type of business. For example, you wouldn’t hire someone to fix the plumbing or HVAC in your home if they don’t have any accountability for the outcome. Why shouldn’t health care be the same?

Value-based care models place outcomes at the center and make care more equitable for all. Considering that only 10-20% of a patient's health outcomes are impacted by the health care system directly, a value-based care model requires providers to understand and optimize the other factors affectig a patient's health. Personalizing patient care based on each patient’s social determinants of health is no longer a nice-to-have – it’s a must.

What does patient personalization really mean?

Patient personalization is at the heart of the value-based care model. Centered on the principles of understanding patients as individuals and tailoring communications that will motivate them to act, good patient personalization strategies leverage data and analytics to understand how best to work with the patient to achieve the common goal of health and recovery. For care providers that are trying out value-based care models, it ​​helps to personalize the patient experience as much as possible to avoid repeat visits to address a patient concern.

From a patient engagement perspective, personalization starts with selecting the best communication channels for that patient. For example, if you know a patient always sends phone calls straight to voicemail, consider contacting them through text or email. It’s also important to keep in mind the communication styles your patient is most likely to respond to--do they prefer gentle nudges or more direct follow-ups?--as well as the timing of your communication (if they work the night shift, don’t call at 9 am!).

While these factors may not seem like they would have a significant impact on patient health, it’s critical to keep in mind just how much patient outcomes are determined outside the four walls of a doctor’s office. The right communication can make all the difference.

From a clinical perspective, improving patient personalization means taking a 360-degree view of the patient with a particular focus on the social determinants affecting their health. Some patients may not have easy or consistent access to transportation, for example, so providers need to pay attention to things like sending prescriptions to local pharmacies in the patient’s neighborhood, and that they’re minimizing the number of patient office visits. For others, every dollar might count, so prescribing a less-expensive medicine could be the key to ensuring they fill it.

It’s worth noting that currently, patient personalization for value-based care is focused on the Medicare and Medicaid populations, as private insurers have yet to adopt this model widely. While this is good news because it covers some of the most vulnerable populations, these populations are also likely to have more social factors like ​​variability of health and technology literacy, financial status, and trust in the health care system affecting their health. This makes individual assessment of each patient even more critical to determine the best course for treatment.

Accelerating patient personalization capabilities

Accurate, real-time data is a critical component to building more personalized experiences. Health care organizations that want to support their switch to value-based care by improving patient personalization should start with an assessment of their current technology environment and data sources. It’s important to ensure your technology stack supports integration of electronic health record data that reports on a patient’s physical health (medical history, recent procedures, medications, etc.). But records should also include broader data on the social factors of health for each patient to better customize care and minimize the number of visits needed.

Once technology needs are squared away, health care organizations will also need to implement a process for analyzing these combined datasets to drive action. A great way to get started is to have a conversation with an experienced data and analytics team, whether in-house a third-party vendor.They can review the available data to develop personalized care strategies, suggest additional data sources that could further improve patient personalization, and build algorithms to make analysis less manual for health care providers. That way, they can focus on what they do best – practice medicine – backed by data-driven insights into how best to treat their patients.

Overall, patient personalization is critical to a successful value-based care model. Organizations that invest in improving patient personalization today will reap the benefits as the value-based care model inevitably expands in the public and private sectors. Change is on the horizon, and it’s time for health care to focus on outcomes, not dollars.

Kaushal is clinical innovation consulting lead at NTT DATA Services