Value-based care: looking through the patient’s lens
Patients increasingly viewed as top stakeholder in healthcare
If there is a companion theme that has most accompanied the shift from volume-based to value-based care in the U.S., it’s “patient-centered care,” recently featured on this Fierce Healthcare list of most overused buzzwords. But think about it — if businesses in most every other sector focus their success around customer satisfaction (plus the happy financial ramifications that brings), patients are the ultimate end-customer with any healthcare organization. And current reform happening around healthcare business practices is designed to provide more pricing transparency for patients, to empower patients by giving them more choices and more control over their own data, and other measures that would ultimately improve outcomes and drive down exorbitant costs.
Every person on the planet is a healthcare consumer in one way or another, and this is how our lives are most affected by our healthcare interactions — “Did this physician or procedure help me get well, and is it going to break the bank?”
What is patient satisfaction, really?
Thanks to social media sites that allow for user comments or ratings, like Yelp or Facebook business page “reviews” sections, and online physician ratings systems like RateMDs or Healthgrades, there is more opportunity than ever before for patients to provide feedback regarding their customer satisfaction or lack thereof. Many health insurance online portals have also started incorporating ratings and reviews.
That being said, reviews by their very nature are subjective. Beyond the quality and convenience of care, it can be difficult to assess the soft skills that are often described as a doctor’s “bedside manner,” how empathetic they are as a communicator, or whether or not they were culturally sensitive. Some reviews can even be politically motivated, and paid search engine placement can supplant “sort by ratings” order on some sites. Further food for thought: a recent study estimated that only 1.5 percent of people leave reviews. A New York Times article dove into this further, largely centered around consumer purchase sites, but they make a good point — should we be relying on what 15 out of 1,000 people have to say?
Customer experience surveys administered directly by providers or payers after, say, a phone call to verify benefits, can identify breakdowns in a way that is more targeted and useful for their purposes, and also predict customer loyalty — the tell-tale indicator of a satisfied customer being a “repeat” one.
Disconnected patients won’t drive value-based care reform
At a Value-Based Care Summit last fall, Deborah Yolin, associate medical director at Steward Healthcare said, “When I think about the value these care models bring to patients … (it has) to do with clinical integration and visibility across the continuum of care. What that does is set patients up for wrap-around services.” This is otherwise known as “continuity of care,” or the quality of care over time. And fragmentation of care leads to poor outcomes, she says.
Thus, the second most overused buzzword, “patient engagement” has emerged. Patients have to be actively engaged, invested and interacting with information about their own care, for value-based initiatives to work.
“Continuous patient engagement,” it was suggested in a recent Becker’s article, is also a “fundamentally new approach for physicians to cut through social determinants of health,” or SDOH, which we have certainly been hearing more about recently — how to treat the whole person, including referring them to social services like transportation or housing assistance, as being pivotal to improving outcomes and realizing “value” over the long-term.
Patient portals as hub for engagement
If you’ve provided an email address on a patient intake form in recent years, that has likely been followed up with an invitation to create some sort of online “patient portal,” where you can access your records, from lab test results to billing statements. These portals serve as the hub for patient engagement, because they empower patients from an education perspective, leading them to do more research and feel more proactive, which results in more thoughtful questions at their next physician visit.
In a recent survey, 80 percent of patients have said that online portals have helped them to take better care of themselves. Information equals power, and it turns out patients most always want more of both to inform their care decisions. For example, a technology called OpenNotes directly shares physician notes within patient portals. Contradicting the assumption that people want to avoid potentially confusing or negative information, a study revealed that very few people actually felt this way.
In another study, patients responded better to physicians that made direct contact with them during visits, as opposed to when physicians have to spend most of their time with patients entering data into computers. And patient portals provide yet another solution for better engagement in this regard — they can present a secure messaging platform functionality as well. Maybe there was a concern a patient forgot to address during their in-person visit, or something they were too embarrassed to discuss? For various reasons, you can understand why this type of communications tool can fill in critical information gaps providers may have been missing while making a patient feel more empowered and engaged.
Communications and tech: expectations vs. reality
What are patients’ expectations when it comes to communication tools in the general marketplace vs. what current healthcare organizations are equipped to deliver? Imagine a world where you could sift through providers, price-compare and read reviews like you’re sifting through home decor items on Amazon, schedule your own appointments with an interface that looks like Google Calendar, or have prescriptions delivered to comfort of your own home. (OK, well that last part is already happening.) But it’s safe to say that the previously discussed fragmentation, coupled with HIPAA concerns and consent issues, leaves healthcare seriously lagging behind where technology solutions have already been served up in other industries. “In this era of consumer-driven healthcare, if providers or payers fail to make partners of their patients or members,” via patient engagement tools and services, per a 2019 Pulse of the Healthcare Industry survey, then “they run the risk of losing them.”
John Greenwood, the president of UMMACO and UMass Memorial Population Health division, who also spoke at the Value-Based Care Summit adds that the difference in patient communication preferences presents an additional layer of variables to address. “I think all of us who are healthcare professionals don’t recognize how challenging that is because we’re dealing with patients who want phone calls and patients who want text messages” he said. “(We have) to understand that people want to (communicate) in different ways.” (Only around 10 percent of physicians are currently identifying these communication preferences, by the way.)
Younger, relatively healthy patients may not recognize the need for a consistent primary care physician, and instead, they want a doctor-on-demand who they only have to engage with as needed. Again, once pesky communication preferences have been taken into account, advances in communication technology may be able to present solutions that can achieve better continuity of care over the long-term.
Innovations in tech communication
One example of how healthcare delivery is being disrupted with advances in communication technology is via “voice assistants.” In fact, “voice as the new medium” was discussed at both CES and HIMSS this year as one of the most exciting technology advances that could directly improve healthcare.
Imagine a disabled individual being able to say, “Alexa, how do I know if I need to go to the doctor for XYZ symptom?” The “Voice Experience Designer,” launched by Orbita, provides software for home-connected healthcare and could deliver exactly this type of information.
Then there’s a company called HealthTap which has already launched a stand-alone app called TalkDocs. It combines an “extensive library of physician knowledge with artificial intelligence and a voice-activated interface.” This app is being designed to work regardless of whether the user knows how to operate a smartphone.
These are just two of many forward-thinking ideas that could allow arguably the most important healthcare stakeholder in value-based care, patients, to better manage the sorts of issues we’ve discussed — to become more engaged, experience greater customer satisfaction from their healthcare interactions, and increase communication to work together with their providers to achieve health goals.
Go figure that patients seem to be driving innovation, a la “the consumerism of healthcare,” faster than any reimbursement model ever could.