Numerous studies have shown that the majority of healthcare spending goes toward the care of a small percentage of patients. Those statistics hold true down to the individual accountable care organization. Therefore, controlling spending on high cost patients means controlling spending for the entire ACO.
Here are five strategies to keep in mind to engage with high cost patients.
1. Include patients in all care coordination discussions.
Consumers who take an active role in discussing their healthcare with physicians are more likely to adhere to good healthcare practices, such as taking medications as prescribed, according to Jacqueline DiChiara in a February 2016 RevCycle Intelligence article.
“Shared-decision making promotes strong dialogue between healthcare providers and healthcare consumers and builds stronger value-based care outcomes. At its core, shared-decision making gives beneficiaries more choice about their care and treatment options, thus advancing patient-centered results,” DiChiara writes.
But research published in 2015 by the American Association for Physician Leadership and the Healthcare Financial Management Association, shows that a top concern among most chief medical officers and chief financial officers is “a lack of benefit plans designed to engage patients in their care and encourage shared decision-making.”
How do ACOs encourage shared decision-making, especially among high cost patients and providers?
A recent Health Affairs report by France Légaré and Holly O. Witteman suggests three elements must be present between the provider and patient: both must recognize the need for a decision, both must know and understand the risks and benefits of all options, and both physician recommendations and patient preferences must be factored into the decision.
Once the discussion has begun in the office, providers can continue dialoguing with patients through an integrated platform solution that enables clinical information, like lab or radiology results, to be shared with the patient and other providers, along with two-way communication among all parties through secure email or messaging options.
2. Provide simple, evidence-based health information to patients.
In addition to the patient’s own clinical information, ACOs can take advantage of an integrated platform to push simple, evidence-based health information to patients to help with acute decision-making, as well as ongoing management of chronic diseases.
According to Légaré and Wittemant, much of the evidence-based information that could be helpful to patients comes “packaged in a stream of numbers” and is incomprehensible even to the most educated and numerate among us, including health professionals.
Instead of providing scientific abstracts or other difficult-to-read evidenced-based information, they suggest offering “well-crafted tools for shared decision making.… For example, decision aids can be specifically designed to meet the needs of people with lower health literacy and numeracy.”
Moreover, the Pew Research Center found that “72% of internet users say they looked online for health information within the past year.”
Make sure the members of your ACO are finding reliable, evidence-based research that will actually help improve or maintain their health by providing that information to them yourself through your own patient portal.
3. Ensure primary care physicians have the tools they need to coordinate care.
Primary physicians serve on the frontline of coordinating care for high cost patients, but often the information or resources they need to make in-network referrals or efficient place of service recommendations is hidden across multiple EHRs, clinical support systems, or provider portals.
According to a study of ACOs by the Pharmacy Benefit Management Institute, 59 percent of respondents reported using multiple EHR systems and a whopping 23 percent were still using paper-based charts. “Not even one out of three respondents stated being on a single electronic medical record platform,” Vera Gruessnerreported for RevCycle Intelligence.
A single platform that integrates multiple systems will not only allow primary care providers to communicate better with physicians and other facility-based providers, it will also provide data analytics to show which in-network specialists offer the best outcomes for patients while also controlling costs.
A recent report from Blue Cross Blue Shield also shows that moving some medical procedures from an inpatient to an outpatient setting can save patients and ACOs hundreds, even thousands, of dollars without compromising care.
By cross referencing in-network providers with cost and outcomes-based information, primary care doctors can make better referrals that will benefit high-cost patients and the ACO.
4. Include pharmacies in your ACO.
Prescription drug costs represent more than 13 percent of overall healthcare spending in the United States. According to Gruessner, “The costs of prescription drugs relate directly to overall healthcare spending across the industry. Innovative care delivery networks like the accountable care organization or the patient-centered medical home could bring real change to the costs of prescription medication and general healthcare spending.”
While not all ACOs are accountable for prescription drug costs, the Pharmacy Benefit Management Institute study showed that just about half of ACOs had a “formal relationship with a pharmacy.” Another quarter of those polled said they had a pharmacy within the ACO, and about a fifth of ACOs use contracted pharmaceutical services.
The study also found that “ACOs who work more directly with pharmacies tend to have greater experience in payment reform, both private and public contracts, and have access to more provider types,” Gruessner writes.
By including pharmacies within the ACO, not only are lower costs achieved through in-network arrangements, but pharmacy analytics can also be combined with other clinical and demographic information to track adherence and to push better refill and adherence reminders and notifications.
5. Don’t neglect preventive care for patients being treated for other chronic conditions.
Just because a patient is being treated for a high cost and/or chronic health conditions doesn’t mean they won’t also benefit from health screenings, immunizations, and other preventive care measures.
According to a Kaiser Permanente study, patients are more likely to engage in preventive care when they have access to “their health information online and receive alerts on gaps in care.” Specifically, health plan members who use Kaiser’s Online Personal Action Plan, which includes access to health data through an online portal and emailed preventive care reminders, were “9 percent more likely to have mammograms, 6 percent more likely to receive a Pap smear and 12 percent more likely to schedule HbA1c testing for diabetes.”
Every ACO is going to have a small percentage of high cost users, just like the healthcare industry in general. But by engaging these patients directly, you can limit spending and improve the quality of care at the same time.
Chuck Rolfsen is the Chief Revenue Officer for Healthx. The Healthx collaboration platform connects payers, providers, and members to lower administrative costs, improve member health and manage the healthcare ecosystem.