By Jordan Dolin
As healthcare shifts from fee-for-service to fee-for-value, hospitals and physicians are increasingly being held accountable for outcomes by the government, payers and patients. Historically, provider organizations only had to meet performance criteria to earn a pay-for-performance bonuses or hospital certification, but with the arrival of Accountable Care Organizations (ACO), Meaningful Use and other programs, payment is now based on to quality of care rather than quantity of services.
Health information technology (HIT) systems are able to track physician actions and measure outcomes down to the individual patient level and allow organizations to closely monitor the quality levels of a given physician. These same tools should be able to monitor the performance of the vendors who are there to support these clinicians. With patient engagement solutions, for example, vendors claim they can help improve HCAHPS scores, treatment adherence, patient outcomes, and reduce costs, but have no evidence to back it up.
Vendors should be willing to commit to their patient engagement promises, present proof showing improved outcomes and face some financial risk for failing to deliver.
Global accountability
Since patient engagement was included in the Centers for Medicare and Medicaid Solutions' Meaningful Use of Electronic Health Records program, it has become a popular buzzword. Every HIT vendor claims to offer tools to assist providers with this important clinical quality issue, but no one is holding anyone accountable.
Part of the problem is patient engagement lacks a standard definition. The ambiguity allows publishers of diabetes fact sheets to call it patient engagement when a newly diagnosed patient is handed a 100-page binder of information that is more likely to become a doorstop than an interactive engagement tool. Likewise, call centers that remind patients of their appointments, in-room entertainment systems, or printed discharge instructions, could also erroneously be called "patient engagement." The reality is handing someone a piece of paper is not engaging them in their care. When the industry talks about patient engagement, they mean motivating patients to take an active role in their care to drive outcomes. A piece of paper will not change their care. Calling someone may help them show up for an appointment, but is unlikely to change their behavior and better control their chronic condition. What specific outcomes are improved by these activities? Can it even be measured or shown to deliver a return on investment?
Delivering results, not promises
This is the era of buyer beware. Provider organizations should demand proof statements—not promises—from patient engagement vendors. If organizations want to make patient engagement a part of their care process, then their technology partner should support the needs of everyone who delivers and receives care across the continuum. Can you truly engage someone "across the continuum" from a hospital bed, when roughly 90 percent of patient encounters occur outside the hospital setting [1]?
Organizations need engagement partners with longevity that deliver case examples showing how their solutions have improved clinical quality and/or financial performance across all care settings. These vendors also need to be able to support their claims with assurances that if they fail to meet expectations, the provider organization won't be at financial risk.
For a patient engagement initiative, organizations need a comprehensive enterprise-wide solution that imparts actionable information to patients and then measures the impact. This doesn't mean providers should just put information in front of patients, but rather present it in a way that they understand and will take action on it.
Comprehensive outcomes-driven engagement needs to track not only the delivery, but also the consumption of information, which then enables the measurement of impact – on individuals and populations of patients. True technology-driven patient engagement has already been proven effective in numerous provider organizations where data analyses have demonstrated it results in higher HCAHPS scores, reduced length of stay, fewer malpractice claims, the list goes on…
Technology cannot and should not replace physicians' skills, experience and face-to-face interaction. However, technology can and should be held accountable as a partner. A provider organization would never hire a physician who refused to be held accountable for their performance, so why should they invest as much, if not more, on technology that won't offer the same?
Jordan Dolin is the founder and vice chairman of Emmi Solutions, a pioneer of outcomes-driven patient engagement.
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