The Pandemic Points Us Toward Value Based Care Enhanced with Patient Engagement

 

Bob Abrahamson
Vice President, Marketing
pCare

The start of the academic year is upon us and school systems across the country are scrambling with how to re-open. Everyone WANTS to be back in the classroom but that simply may not be feasible to keep staff and children safe. Hybrid and 100% online options are being explored. The hard reality is that a vaccine is going to take time and COVID-19 is going to with us for the foreseeable future. As a result, we are faced with the having to re-engineer education delivery. It is not going to be easy. We cannot simply flip a switch and go online. Existing distance learning was not created with elementary school aged students in mind. Nor is it feasible to expect teachers to adequately deliver both in person and online lessons. Patience will be required as we find our way to educate during the pandemic, but paradigm change is upon us.

The same goes for our healthcare system. The media is fraught with stories about hospitals having to permanently layoff furloughed workers in the face of declining revenues. A July 30 article in Fierce Healthcare reported that fewer than 10% of primary care practices have stabilized operations amid the pandemic. Among the many challenges of the fee for service model (volume over value, uncoordinated care), during the pandemic the model fails providers who cannot sustain their business without interacting/transacting with patients. Yes, relaxing barriers to telehealth helped but it doesn’t address the underlying issues. Unlike our education system, we have been working on solutions to this issue for quite some time. There are various value based care models that have proven successful. Paradigm change may finally be upon us.

With so much uncertainty when the pandemic struck, provider organizations did the right thing; prepared for a potential surge of infected patients while strictly limiting interactions in an effort to contain the spread of the virus. In the fee for service structure, this created an untenable situation for their business. Yes, the federal government has provided some level of bail out but not enough. On the flip side, insurance companies have recorded record profits. A July 29 article in Forbes reports Anthem Blue Cross Profits soar As Patients Postpone Care during the Pandemic. Makes sense, they are paying less claims. But let’s NOT DEMONIZE PAYERS. Many plans have waived co-pays during the pandemic as people struggle with bills. The fact that payers are profiting and providers are struggling is an indication the system is not working. The time for paradigm change is upon us.

Value based care which compensates providers for managing the health of people as opposed to performing services can fairly address the problem. The failures of managed care in the 1980’s should not prevent us from capitalizing on the recent successes achieved across the healthcare spectrum by various ACOs and integrated delivery networks, both payer-led (think Kaiser) and provider-led (think Geisinger). Structured properly and receiving payments for outcomes, providers will figure out how to keep their patients healthy during those periods of time when access is restricted. To work, it requires collaborative care; it requires engaged and activated patients.

Most agree that value based care needs to be patient-centric; that care needs to be guided by patient preferences, aptitudes and attitudes. Yet, it is important to note that in service of the quadruple aim – best health outcomes with superior patient experience at optimal costs facilitated by providers with high job satisfaction – patients cannot be passive participants in the process. Quality should be measured by overall health status. It is more important that people are educated and empowered to manage their health during the times when they are not interacting with providers that systems be in place to check the boxes against specific quality measure captured by health care professionals. The good news is that with rising consumerism comes the ability and often desire to become more engaged in making the behavior changes required to effectively manage health.

For those of us in the patient engagement industry, the challenge is to populate the ecosystem with the toolsets – content, software, hardware – that can be used by all stakeholders – patients, providers, and payers – to drive the collaboration required for value based care to succeed. This solution set needs to extend across the various touch points in the care continuum, facilitate any number of functions (from finding a doctor to understanding lab results and diagnosis, to choosing a treatment option, to understanding fees and making payments, to adhering to treatment plans and managing care), and should aspire to be frictionless for all stakeholders. A tall order. And it will require collaboration, but I do believe we are well positioned to drive interoperability. It won’t always be easy, yet impactful patient engagement is table stakes for the success of value based care. The time for paradigm change is upon us.

I look forward to seeing how value based care enhanced by patient engagement unfolds over time. And, in the short term, I’m very interested to see how school systems handle the upcoming year. My high school junior daughter goes back next month in a hybrid model.

 

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