Evantage has been working in the healthcare realm for over 12 years now in a variety of projects. For the past 2 years, we have been working with a large hospital system to redesign the way they care for patients with chron
ic conditions. We’ve helped them establish and implement standard care guidelines for all providers and staff to proactively monitor and manage people with conditions like asthma, diabetes, heart failure, kidney disease, heart disease and hypertension (high blood pressure). This is a big change for providers, who today generally treat these patients only when they have complications or their condition worsens.
So why are they changing now? Like many other provider groups across the country, they are taking advantage of one key aspect of the Health Care Reform that was passed March 2010 called Accountable Care Organizations, or ACOs. NPR describes the Center for Medicare and Medicaid Services (CMS) guidelines for ACOs as a group of physicians and/or hospitals who follow guidelines to reduce healthcare costs among the Medicare population (January 18, 2011).This is done by keeping chronic conditions from worsening and resulting in hospitalization, not by denying care to individuals. The logic behind this is that healthier an individual is, the less expensive they are. According to the draft regulations released in April, ACOs who show savings greater than 2% for each of the three years they participate in the program and they have achieved required metrics (there are 65 quality metrics ACOs need to meet), they are eligible to share a portion of the savings with CMS. If they don’t get that savings or achieve those outcomes, they may be required to pay cialis online a penalty to CMS.
CMS has put together guidelines for how ACOs will be measured and compensated, and one of their requirements is through increased patient engagement. The goal is to monitor information about patients with chronic conditions on a regular basis so that they can help healthcare providers discover issues early. Catching issues early means healthier patients, fewer hospitalizations and fewer expenses.
The overall goal of ACOs is to improve the quality and reduce the costs of healthcare and with the work Evantage is doing we see great opportunities to improve how providers engage with patients. That being said, there are a few stumbling blocks that CMS needs to overcome in order to get buy in from the provider community on ACOs. Showing cost savings greater than 2% each year over 3 years seems small, but this isn’t an easy percentage to achieve. For instance, in 2005 CMS initiated a pilot, where participants were eligible for bonuses if they met certain performance goals (a subset of the proposed ACO guidelines). Out of the 10 organizations, only 3 received the financial bonus at the end of the experiment though none of the organizations had to pay any penalties to CMS. The newly released ACO guidelines are so stringent, some of the organizations that are already doing ACO-like work, such as the Mayo Clinic and Cleveland Clinic, have stated that the ACO guidelines need a fair number of revisions before they will participate. When CMS released the guidelines, they provided a comment period, whereby the medical community can submit suggested revisions to CMS. That window just closed, so there will likely be revisions to the guidelines.
We know that the more a patient is engaged with their care, the better their outcome. A recent study confirms this: Kaiser Permanente studied over 35,000 patients with diabetes and hypertension and found that those who engaged in secure messaging with their providers had better cholesterol and blood pressure levels than those who were not engaged. But doctors can’t do this alone – now more than ever, they will need patients to truly engage in the management of their condition. The success of ACO
model requires patients to be more educated about their condition, compliant with treatment and prevention recommendations and more involved in the day-to-day monitoring.
So how might ACOs better engage their patients? We’ve put some thought into this. Through the course of our work at Evantage, we frequently interview people with chronic conditions in their home to understand how they live with their conditions and to gather data on the ways they monitor the status of their conditions. Based on this research, Evantage has discovered several ways that people can live with and manage conditions in ways that don’t interfere with their lives and encourage engagement, such as
- Ensure that people with chronic conditions can access lab results, make appointments and email physicians online.
- Make it easy for people to track and share their data in between visits. Any tool used to track health needs to be easy—and preferably not visible in their home—or it won’t be used. The devices that work the best are ones that store data (like blood sugar monitors that store your glucose numbers and can be taken to appointments and be read by healthcare providers), or Telehealth services require the person to call a number to report health information. Any tool that is bought or built should be easy for its audience to use, or it will
Evantage also frequently interviews providers, shadows them in their work place, and gathers data on how providers would like to improve the experiences they have with their patients. Wishes we have heard include:
- Alerts that help them quickly analyze stored data from patients in the event that they need to change a medication or have a patient come into the clinic before they end up in the hospital.
- Electronic medical records that allow for general practitioners and specialists to collaborate on a patient’s care and provide a better diagnosis or treatment.
Our advice to providers is this: consider getting to know your patients as a crucial part of your ACO development work. Do your homework to find out which