invasive course of care. Through a demand-management system, hospitals can connect with patients prior to surgery to discuss the decision and recommend non-surgical or less-invasive procedures.
Chronic disease management: Driving good decisions from hospital to home Under accountable care arrangements, providers can no longer afford to view their focus as only those in need of current treatment. Individuals with chronic diseases are high-cost, high-frequency consumers of healthcare, and effectively managing their care in a home setting is important for physicians to reduce unnecessary medical
Miles Snowden is chief medical offi cer of OptumHealth. For more on OptumHealth: www.rsleads. com/204ht-201
spending. By leveraging contemporary population health- management technology, providers can increase patient compliance by 20 percent.
Hospitals and physicians participating in accountable care-reimbursement arrangements are in a uniquely favored position to effectively apply care-management tools to ad- dress the specifi c health needs of their attributed patient populations. In general, the provider’s patient panel is liv- ing relatively proximate to the provider’s medical services facilities. This provides a distinct advantage over the tradi- tional payer. Payers more often serve a more geographically diffused population. This difference allows providers to deliver more of their population health-management ser- vices face to face, in their facilities, during patient visits. This model, along with the physician-directed component of population health management, has proven more effec- tive than models relying on telephone outreach from health coach operations centers.
In effective models of accountable care, providers will need to connect with patients not just at the point of care, but also with other attributed members in the community not currently using health services in the system. According to a commercial insurer’s 2010 population analysis, half of the high-cost patients had minimal to no engagement with the care-delivery system in the prior year. It’s important to identify and engage these individuals before they require acute care. Population management technologies require hospitals to partner with organizations that specialize in identifying and engaging individuals who will become future sources of medical costs, particularly patients with immobility and lack of access to care.
When deploying population health-management tech- nologies to reduce unnecessary medical costs, hospitals and physicians in ACO arrangements should consider employ- ing specialized staff trained in outpatient or post-discharge consumer education rather than repurposing existing facility-based clinical staff. For example, an ICU nurse placing follow-up calls to discharged patients is not the
best clinician to provide support for the patient suffering from diabetes and related compliance with proper diet and medicine. Providers will need to deploy staff specifi cally trained in population health management, supported by the necessary technology to assure appropriate member identifi cation, engagement, measurement and impacts.
Network management: Fueling transparency for informed decision making A strong relationship between physicians and patients is crucial to changing patient behavior. In models of ac- countable care, hospitals and physicians will assume the role of ensuring that patients choose and access the best source of care for each clinical need. As patients begin to function as consumers in the healthcare industry, becom- ing accountable for their care, they will need transparency tools for the information necessary to make good decisions. Hospitals and physicians in at-risk arrangements will also have a stake in providing the network management tools traditionally deployed by payers to assist patients in select- ing the appropriate physician for their situation. Patients covered in an ACO arrangement accessing care at the wrong place and time may prove an important source of ineffi ciency for hospitals. Network management technologies empower patients to research the best care provider for their health condition. With contemporary transparency tools, providers can positively influence
Reducing the volume of procedures performed has a direct fi nancial benefi t to hospitals and health systems when participating in ACO or other value-based contract arrangements. Two ways hospitals can use demand-management tools are to lower readmission rates and to reduce unnecessary elective procedures.
patients’ decisions and increase patient involvement. Furthermore, transparency assures that both patients and providers in ACO arrangements benefi t from the best care at the optimal time, and in the optimal clinical setting, and open the door for better communication across the care continuum. With the right technologies, staff and programs in place, hospitals, physicians and health systems can be empowered to infl uence all membership for which they are accountable to make optimal health decisions. In models of accountable care, providers are positioned to take on both fi nancial risk and reward, motivating and rewarding them to take an active role in patient lifestyles and behaviors, includ- ing compliance with appropriate preventive and chronic disease follow up.
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