Patient Engagement Efforts Under the ACA

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October 9th, 2014

Patient EngagementPatient Engagement is now being referred to as the “Blockbuster Drug of the Century” as we continue to make the turn towards value-based care under the ACA. Facilitated through the Patient Centered Outcomes Research Institute (PCORI), the ACA encourages patients and providers to become more active partners in making the crucial strategic decisions over improving individual health.

PCORI continues to report growing evidence showing that patients, once engaged, take better care of themselves. For providers, this means that engaging patients – teaching them, soliciting their input, and communication with family members and other caregivers – can result in better, more efficient health care outcomes. As result, patients will become more likely to monitor their own health, take their medicines and communicate more thoroughly with their care providers.

Patient Engagement Changing the Healthcare Landscape

With meaningful patient engagement the aim of both PCORI and the ACA, profound changes are in store for healthcare stakeholders in terms of building new relationships with their patients. The idea aligns patients as active and central contributors to their own care, making the healthcare delivery system more responsive to their needs and easier to navigate.

Patient engagement advocates believe that as consumers get more of a say in their care cycle and how their health dollars are spent, new stakeholders will emerge to accommodate and innovate patient-centered care. Areas like technology, big-data and home healthcare are likely to experience exponential growth.

PCORI has emphasized the importance of engaging patients as collaborators in planning and conducting research, and disseminating its results, with the goal of producing evidence that can help patients and those who care for them make better-informed decisions abut the clinical choices. One initiative that PCORI has heavily concentrated its efforts in is encouraging more participation by minorities and underserved populations in research designed to find how best to reach such populations.

Under the ACA and via PCORI’s efforts to promote patient engagement, leveraging a patient’s expertise on their own histories, tolerances, priorities and pains is a step in the right direction towards patient-centered care and improved outcomes. However, it remains clear that caregivers must find an effective way to utilize the value behind patient contributions.

Providers & Patient Engagement

Many providers fail to see the value behind patient engagement and view it as unreimbursed services. While the healthcare benefit towards the patient and its value remains clear, providers must recognize that patient engagement can yield many financial benefits also. The ACA has aligned many of its governing provisions and reimbursement models to incorporate value-based and patient-centered outcomes, most commonly through incentives and penalties based on certain metrics. For providers, this allows great opportunity to utilize patient engagement as a tool for meeting these mandated standards.

Engaging patients can benefit hospitals’ and doctors’ bottom line in a number of ways:

  1. Meaningful Use Requirements

Meaningful Use Stage 2 requires an organization to engage with at least 5% of their patient population. This means incentives are tied to patient engagement and penalties will be enforced on those who fail to accommodate these strategies.

  1. Out-of-Pocket Reimbursements

The growing trend of high-deductible health plans where patients are paying more out-of-pocket costs means providers must maintain engagement with patients and find more convenient methods of collecting the bill.

  1. Patient Referrals

Attracting patients is highly competitive, however the best way to do this is through patient referrals. A patient is more likely to refer a doctor whom they’ve had a great care experience with – something that often stems from high-quality patient engagement.

  1. Pre-Patient Engagement

By expanding the idea of patient engagement beyond the hospital or doctor’s office, providers can often turn on-the-fence visitors into new patients by engaging them prior to their treatment.

  1. Increase Adherence

Ensuring patient adherence and health improvement is the easiest way to turn patients into ambassadors and stimulate more and more patient referrals. Proving the value behind your engagement strategies and adhering to them is the best insight into a programs success.

  1. ACOs & Value Based Reimbursement

As the shift continues to value-based reimbursement, providers will be held more and more accountable for how effectively and efficiently they care for their patient population. Engaging patients efficiently and improving the quality of care or outcomes will become the bedrock of seeking value-based reimbursement.

PayerFusion is a proud advocate of patient engagement as we hope to make strides towards a value-based and patient-centered healthcare landscape. As we celebrate Patient-Centered Awareness Month, we continue to support the efforts of both the ACA & PCORI in its emphasis on the importance of aligning patients as a stakeholder in their own care cycle. We offer a number of patient services that aligns each individual as a central and key contributor to the decision-making process surrounding their treatment or care. For more information regarding these services, visit our Case Management page here.