The cornerstone of value-based care: The patient experience
Ben Alexander, MD
Senior Vice President, Digital Health and Analytics, Lumeris
Healthcare pivoted in the pandemic – an industry-wide, lightning-fast about-face to deliver care when people could not leave home to get it. With an unprecedented single focus, hospitals, health systems, and independent physicians made access to care easier and more convenient for all people, including vulnerable populations. After a decade of discussion, telehealth, apps, remote monitoring and new points of care entered the mainstream of healthcare in a matter of months.
The pandemic was a catalyst for change in an industry infamous for its resistance to change. The crisis proved that healthcare delivery can evolve. Our healthcare system crossed a threshold and as the pandemic eventually wanes, we will not be going back. Initiated before the crisis, new dynamics in care delivery will continue to alter the landscape, moving us toward a digitized, consumer-focused, dispersed system of care – sooner than anyone predicted.
To survive and thrive in a fundamentally transformed system, organizations must act now in three key areas:
1. Rise to consumer expectations
The use of digital tools and dispersed locations, initially for COVID-safe care, will persist in a response to the sea change in people’s expectations for their care. Consumers, already accustomed to seamless, digital always-on, everywhere shopping and entertainment, grew increasingly frustrated with their healthcare experience during the pandemic, reports McKinsey. People no longer accept that just because healthcare is complicated, getting their care must be inconvenient. The rapid success of many consumer-focused, non-traditional healthcare services entering the market shows the sway of easy access and a streamlined experience — and the risk to health systems that don’t meet those expectations. Health systems must match the convenience of 24/7 instant-access virtual care, or risk being disintermediated and see the further fragmentation of their patients’ care.
2. Reduce health disparities
Also changed for the better: Addressing inequities in access to and quality of healthcare. The pandemic made stark long-standing disparities in health among vulnerable communities. The impact of COVID-19 on marginalized populations joined an ignited movement for social justice to ensure that a person’s zip code no longer determines their health.
In addition to the moral imperative for society to address health disparities, there is significant evidence that those disparities are also a significant cause of wasteful, unnecessary care and reduced productivity in the economy. Health systems who take a leadership role in their communities, working to meaningfully reduce disparities and address social determinants of health should see return for those efforts, provided they operate in a value-based payment model.
3. Strengthen the patient-provider relationship
To meet consumer expectations and to ensure equity in healthcare, the patient experience is now paramount – and relies on the quality of people’s relationships with a trusted primary care provider.
- Consumers identified the top factor (44%) for “an ideal health care experience” was that the physician listened to them and cared about them, reports Deloitte.
- More than 75% of consumers believe that the better a provider stays in touch with them, the more patients will trust that doctor’s management of their health.
At the core of care, patient-provider relationship ensures engagement and care continuity from prevention to recovery, optimizing outcomes and ultimately lowering the total cost of care.
Begin with primary care
Like healthcare’s unified pivot to deliver care in new ways and places, a dedicated industry-wide focus on the quality of the patient experience is now needed. And the Centers for Medicaid and Medicare Services (CMS) agree. In 2021, CMS will double the weight of consumer experience measures in its Star Ratings calculations for 2022. And that weighting begins with primary care. “If we really want to coordinate care for the chronically ill and seriously ill patients, we need to get primary care right,” says Liz Fowler, director for the Center for Medicare and Medicaid Innovation (CMMI).
CMS and CMMI recognize that the quality of the relationship between people and their primary care physician is a powerful lever to lift key metrics shown to lower the total cost of care, particularly for complex patients. An enduring relationship enables care continuity from prevention to recovery. With care continuity comes the essential longitudinal data and holistic visibility into the drivers of a person’s health. With those drivers identified for both individuals and specific populations, they can be addressed by primary care and coordination teams. The patient experience is defined by the quality of a person’s relationship with their physician – and so, therefore, is a healthcare organization’s ability to succeed under risk-based contracting.
The patient experience is defined by the quality of a person’s relationship with their physician – and so, therefore, is a healthcare organization’s ability to succeed under risk-based contracting.
An ongoing dialogue – enabled by technology
The vision to work toward is always-on, everywhere care that conforms to the context of people’s lives, not centered in the structures and facilities of health systems. Episodic care must now evolve to fluid, ongoing care – an extended conversation between a person and their physician and care team. It’s a patient-provider relationship based on ongoing dialogue built on bi-directional information sharing. It’s care delivery that matches the seamless consumer encounters people already enjoy in the rest of their lives – and fully expect to experience in their healthcare. And organizations that don’t address those expectations are the ones that will see patients go elsewhere. Organizations that do hit the nail on patient experience may also see additional benefits, including improved financial performance and growing profit margins.
This new relationship-based model of care relies equally on physicians being freed to focus on patients and on the burgeoning collection of digital tools, remote monitoring and virtual platforms entering healthcare that potentially help to simplify care coordination. It also represents a path forward to mitigate inequities in health underscored by the impact of the pandemic on marginalized populations.
Digital tools – whether telehealth, apps to track chronic conditions, remote monitoring for home care, and other virtual platforms – coupled with data and predictive analytics extend providers’ reach beyond in-person encounters. Used in this way, technology doesn’t replace the in-person encounter and human relationship between people and their providers. Instead, it enables a more proactive, cohesive care experience that keeps people engaged throughout their care journey — creating a win-win for both providers and patients.
Employing digital tools in primary care also enables health systems to capture rich and real-time data sets, a pillar to succeeding in value-based care. Proactive interventions become targeted, personalized and contextualized to an individual’s needs when triggered by data analytics. Primary care physicians can rely on aggregated, continuous information flow of data processed and analyzed automatically to detect and alert the need for an intervention instead of waiting for a person to present with acute symptoms. Follow-up care can be tracked and supported rather than leaving it to chance that patient will follow through on a treatment plan, helping to promote better outcomes.
A path forward for health equity
Hybridizing personal and digitized care opens the door at last to addressing persistent health disparities among populations. Shifting the center of care to people’s homes and communities enables meeting them where they are in their ability to engage in their own care. And that can rebalance people’s relationships with their providers, reducing the powerlessness many feel when faced with today’s healthcare complexities. The convenience of digital tools and distributed access points of care means delivering the right care at the right time and in the right place. Standardized guidance at the point of care, wherever it is, is made possible by aggregated diverse data sets and understanding every patient’s unique social and environmental circumstances that drive their health, further mitigating health disparities.
By ensuring continuity of care, capturing data from every point of care, and with a united focus on the patient experience, health systems can retain patients, strengthen their networks, and transition to value-based care on solid ground.
To promote a more cohesive care experience your technology needs to:
Enable Providers to
Enable Consumers to