By Mandi Bishop
The new medical economy is being driven by patients as consumers and the demands of value-based care to demonstrate and measure the patient experience. An understanding of how to practice patient-centered medicine is going to be integral to success.
At the start, we first must define patient-centricity. Most healthcare stakeholders tend to think about it in terms of care coordination, contact terms, and how they’re going to serve the patients in ways that align to the appropriate contract arrangement.
Defining patient-centricity it is one thing; measuring it is another. I have observed that how a practice defines and measures patient-centricity varies depending on how it is reimbursed: if it is part of an ACO, its tier within a patient-centered medical home model, or if it is working under a more traditional pay-for-performance program. For example, practices using a P4P model might focus on hospital admittance data, provider use of technology, and completion of medical record-sharing. While patient portals and meaningful use Stage 2 measures are common tools to monitor patient-centricity metrics across the board, there are limits to each of these systems.
What’s the problem with all these measures and tools? They are inherently provider- and payer-centric, not patient-centric.
This is a big concept. Let’s unpack it.
We know that 95% of what influences health is what happens outside of the healthcare setting. Being able to address needs at the patient-as-a-person level and recognizing these outside influences is what Harvard defines as “patient-centric medicine.” But how is a physician to address value systems, support systems, and physical comfort within the span of a seven-minute average office visit? How and where do you capture these data points in a way that is actionable?
The information and technology built for a provider-centric system are getting in the way of well-intentioned patient-centric initiatives. Consider:
- We let patients assign preferences for how we communicate with them, but would that communication improve if we knew more about reading levels, the community, personal support structures, and belief systems?
- How much do these variables influence a patient’s ability to manage their care and effectively drive value in the healthcare system?
- How much does, or should, the caregiver influence patients?
- Studies show that even hospital systems that have met the 20% initial meaningful use measure are not seeing continued usage. Patients who logged into a patient portal to initially view a medical record, perhaps because they were incentivized to do so, have not consistently continued to use them.
- Most portals failed to support the three key features of a patient portal in a way that was intertwined or interoperable across providers: appointment management, bill payment, and the ability to view records.
So how do we bridge these gaps? The key lies in these core strategies:
- Improving the exchange of health information among all participants in a patient’s care.
- Understanding the factors that influence patient satisfaction, even though they may seem outside our control.
Two Ways to Capture Non-Standard Data
- Use of a scribe to speed up the documentation and allow more meaningful connections with your patients, increasing trust and driving improved outcomes.
- Incorporate insights and personal stories into EHR free text fields to ensure these notes become a part of the patient record that you can then share to improve overall care.
“The lack of health information exchange is frustrating as a provider, expensive to the system, and expensive to the patient in terms of cost as well as potential health harm.”
Patient-centricity: It’s about trust
The other side of the patient-centricity discussion is how the patient participates in their care. Behavioral science tells us that trust plays a significant role not only in the quality of the patient-physician relationship but also in the quality of the decisions patients make about their health.
How much do patients trust their doctors? Do some populations trust their doctors more than others? In a survey conducted in Jacksonville, Florida, I was able to shed some light on this issue that resonates both locally and nationally.
The data shows that there are pockets of patient distrust in Jacksonville. Within one local zip code, 17% of adults said they distrusted their doctors. Of this group, 19% have chronic conditions, 29% have low digital engagement (no ready access or comfort using technology), and 76% are racial minorities.
So what does this data really tell us, and how can we use it to improve the trust in this zip code and others like it?
Consider: Does your office staff reflect the patient population you serve? It’s human nature to seek out people who are like ourselves. So if we’re trying to help patients living in a specific area, it’s important to consider if we have people within the practice who can understand and empathize with the experience of these patients. Who can help them overcome that lack of digital engagement? Overcome their conditions? Build trust?
Insight: If we can understand and help them understand how the health plan we’re putting in place will help them in the ways they care about, we’ll be more successful because they will be more successful.
“Simply making that eye-to-eye contact with a patient is tremendous. Much is going to happen in response to storytelling.”
Consider: When it comes to digital engagement, don’t assume that patients will trust you and augment the information you provide with information from their end to improve their health and outcomes. This isn’t always the case. For example, 44% of adults at high risk for diabetes in one zip code had low digital engagement but a high trust in direct mail. Research also revealed pockets where trust in friends and family was 100%.
Insight: By changing tactics, we can engage across the right channel or include the family and friends of the patient, ensuring patient health is more likely to improve.
Why does this matter? If we don’t understand these nuances, we erode trust and lower our performance scores, which now is part of our revenue. We need to expand how we think about patient-centricity. It also means understanding 95% of the data that influences patient decisions and health management.
It’s not reasonable to assume we are all going to be able to go out there and understand everything we possibly could ever know about our patients. However, by optimizing our time and technology and making use of services such as scribes, we’ll see, hear, learn, and share more — and that will lead to better outcomes and more satisfied patients.
As the CEO and founder of Lifely Insights, Mandi Bishop is bringing life context to healthcare decision-making by applying behavioral economics to epidemiology, helping communities partner with health systems and payors to tailor and optimize population health management program design, care plans, interventions, and engagements. She believes that participatory medicine is a moral imperative, and that there is no value-based care without recognizable value delivered to the very people healthcare exists to serve. Contact Mandi at www.linkedin.com/company/lifelyinsights or on Twitter @LifelyInsights