Health plans and their sponsors should pay close attention to the health care providers that are improving consumer experiences and clinical outcomes, and take note of how they are doing it.
In a system where it’s every provider for himself, provider have little incentives to make it easier for patients to get care, to improve quality, or to publish quality ratings that help patients make choices. But when an integrated care system is in place, it is much easier to rate outcomes and patient satisfaction, health care executives told an April 12 session of the World Health Care Congress.
Opportunities for improvements in cost, time and convenience exist in (1) scheduling, (2) making test results available, (3) consultations and (4) diagnosing illnesses.
First steps to personalized care include enabling more consultations between physician and patient to take place via telephone, secure e-mail, image and video, according to Robert Pearl, MD, CEO of the Permanente Medical Group. Pearl said his organization, Kaiser Permanente, has performed 13 million virtual physician visits using these communication methods in the last 12 months.
A second example is storing a patient’s DNA samples in the provider’s electronic health record to figure out the best care for a given individual. This results in cost savings, more patient convenience and better quality of care, Pearl said.
But under the fee-for-service payment system, providers are not adopting the consumer improvements that arise from information technology, communication and innovative thinking like other economy sectors have. And patient care continues to be delivered at times and places that suit providers exclusively. The evolution to delivering care when and where it is best for the patient is long overdue, the speakers agreed.
Patient-centered Innovations
Improving care delivery and results requires structures that integrate several providers and change what providers are getting paid for, Pearl said, “because if every physician is trying to maximize their own revenue, then you can’t leverage things.”
“If what you’re paying for is each unit in the FFS model, then you’re really in trouble,” Pearl added. For example, if phone consultations are not billable, they will rarely happen — no matter how good they are for the patient — because they don’t fit in the provider’s revenue model. So health plans want to look for things like electronic medical records, mobile technologies for patient management and a strong leadership structure.
The source of consumer guidance should not be just the health plan, but health plans in partnership with hospital and other institutional partners to enhance patient choice and experience. Such partnerships help develop systems that enable patients to log on to a portal to find out information about cost, quality, recovery times and providers with the best outcomes, said Donald (Skip) Trump, MD, CEO of Inova Cancer Institute.
Patients have been asking for more convenient ways of scheduling and receiving care. Practices and health systems are seeing that these are worth it, because patients who have the opportunity to get care at 11 p.m. will not have to go to an emergency room at greater cost to insurers and the health system in general, added Ryan Petrizzi, vice president for consumer markets and product development at Amerihealth New Jersey.
Consumers must be disabused of the notion that higher cost and more inconvenient care are linked to better outcomes, Pearl said. Kaiser does that by controlling a large number of providers, and setting patient out-of-pocket fees at the same rate across the board. Then quality is honed though a centers-of-excellence model, which holds that providers that perform high numbers of the procedures (such as heart repair and transplants) cure patients better and faster, achieve fewer complications and save on costs.
Finally, price breaks are given to patients who choose to use telemedicine, emails and phone calls. Patients pay zero copays if they select the video, email or even telephone options, Pearl said. This is “much faster, from your physician, and in a way that’s more convenient for the patient.”
Customizing Cancer Treatment
One important form of personalized care is having all aspects of cancer care (radiation, chemotherapy, rehabilitative therapy and other consultations) being delivered in a single place. Patients sick with cancer are better off not having to travel all over the community to get interdisciplinary care, Trump said. It’s also good to broaden the types of professionals participating in the care, such as adding psychosocial counseling to cancer treatment. Another example is a home visits to address the dietary aspects of cancer and diabetes, Pearl and Trump agreed.
Secondly, genomic analysis can help individualize treatment — for example, by characterizing patient tumors to customize treatments and choose correct medications. Also, analyzing the genetic marks of healthy tissue helps to predict who is at risk, so doctors can tailor lifestyle changes and preventive approaches, Trump said.
Opportunities to streamline care are not always obvious, but they can be identified by listening to patient preferences. For example, Pearl learned that one-third of Kaiser cancer patients are willing to get surgery without meeting the surgeon in person first. The system also found that 70 percent of skin rashes can be diagnosed using images or video, without having an office visit.