By Susan Robinson, MS, Consultant, GE Healthcare Camden Group
As CMS continues to test various alternative payment models, financial success will come to those hospitals that learn to effectively engage their patients. The recent cardiac Episode Payment Model (“EPM”) is just the second mandated bundled payment arrangement with more anticipated to follow. Whereas the Comprehensive Care for Joint Replacement (“CJR”) model mandated bundling for primarily elective procedures, hospitals will have to modify their engagement strategies as the patient population associated with the medical and surgical cardiac services are fundamentally different. The unique co-morbidities, health outcomes, and lifestyle habits of each person must be accounted for as organizations partner with cardiac patients to improve their health status.
CMS added a twist to this summer’s proposal by introducing incentive payments for cardiac and intensive cardiac rehabilitation (“CR”) services. These medically supervised programs focus on exercise, education for heart-healthy living (e.g., nutrition and smoking cessation), and counseling to reduce stress; all are efforts that have been shown to promote positive patient outcomes.1 CMS will be testing this approach on hospitals in 45 of the 98 mandated geographic areas participating in the cardiac EPM along with another 45 geographic areas outside those markets. The additional payments are intended to support beneficiary adherence to treatment plans, thereby leading to improved patient outcomes. Participant hospitals are wise to take advantage of CR programs to improve adherence and outcomes. A patient engagement workgroup needs to make sure two elements get put in place: ensuring providers refer beneficiaries to CR programs as part of standard discharge protocols; and utilizing care navigators to conduct post-discharge follow-up on participating patients.
If your organization hasn’t already dedicated resources to focus on patient, family, and caregiver engagement, then there’s no better time than….well, yesterday. Regardless of whether your organization’s patient engagement work group is an extension of another initiative or is designed specifically to prepare for cardiac EPM participation consider these 5 elements for success.
1. Involve the Right People
The workgroup should represent the key departments that serve cardiac patients such as the medical and surgical cardiac service lines, cardiac rehab, nursing, care management, nutrition, social work, pharmacy, and primary care. Adding the voice of a patient advocate or a recent patient who experienced cardiac care within your hospital can pinpoint the main determinants critical to actively engage patients in their care. When forming the team, don’t forget to look outside your organization to preferred post-acute and community partners—their involvement can help strengthen relationships and help keep patients accountable. Leverage IT and marketing for support to enhance the team’s ability to tap into other organizational capabilities.
2. Shape the Vision & Define Deliverables
Patient engagement efforts should constantly be evolving based upon feedback loops. Establishing a patient focus group to determine what went well, what didn’t go well, what they’d like to see improved based upon their previous experience is one way an organization can understand the patient’s experience and identify critical points in the episode to enhance patient engagement. With target prices and potential payments set by CMS on a quality first principle, the workgroup must understand the quality measures upon which reimbursement is based: CABG and AMI mortality, readmission rates and patient satisfaction scores. Incorporating other institutional measures of patient engagement, experience, or activation will help the team determine where to spend their time to make the most impact. As the goals and objectives of this workgroup may closely align with other population health strategies, it is important to define the desired deliverables in the context of organization priorities.
3. Focus On the Complex and High Risk
The roles and responsibilities of resources such as care navigators need to be prioritized. They will be accountable for developing and monitoring adherence to patient care plans, including follow-up appointments with cardiologists and primary care, but a significant amount of their attention should be focused on the higher risk patients in order to keep costs of readmissions down. Defining a process to identify high risk patients through risk stratification tools and learning how to best automate it should be a responsibility of this group supported by data and analytics. It will be important to understand the risk factors and reasons for potential noncompliance to treatment plans (e.g., medication, dietary, exercise regimes) specific to this population and how these factors can be mitigated.
4. Use the Patient Incentive Waivers
One hospital’s focus group highlighted how the lack of transportation to CR programs kept patients from participating.2 A hospital who experienced this same problem now provides patients with access to mobile applications to monitor progress after they leave the hospital. 3 Patients are able to log their exercise routines and receive reminders to take medications at prescribed times. The patient’s information is tracked on a clinical dashboard by their care team allowing them to intervene as necessary. Participant hospitals should take advantage of patient incentive waivers under the EMP to provide innovative technological solutions, but be smart and start by exploring the capabilities of current technologies within your organization.
The workgroup must design and deliver the strategy to monitor patient engagement efforts. Hospitals should as themselves the following questions. Are we giving our patients what they need to be successful? Are care plans aligned to patients’ health goals? Have we provided our patients the appropriate tools so they don’t end up back in the hospital? Are hospital staff and their partners effectively tracking the patient and their compliance to treatment, medication, and rehab plans throughout the entire episode of care? Not only should the key measures of success be monitored but they must also be communicated regularly to senior leaders and operational staff to illustrate the impacts of their efforts.
The investment in well-crafted strategies will pay for itself as highly engaged and accountable patients are critical to population health efforts. Patients who have positive experiences with your hospital are more likely to become a partner and loyal to your organization when it comes to receiving care and recommending your services.
Ms. Robinson is a consultant with GE Healthcare Camden Group, specializing in bundled payments, process improvement, workflow redesign, value stream mapping, and time efficiency studies. Prior to joining GE Healthcare Camden Group, Ms. Robinson served as an industrial engineer for New England Veterans Engineering Resource Center in Boston, Massachusetts, where she applied systems engineering approaches to a variety of healthcare problems. She may be reached at email@example.com.