As the health care industry considers new delivery models, there is a strong focus on patient accountability. But at the end of the day, there are very few individuals who can become so empowered unilaterally, so informed in regard to complex medical decisions, that they will choose something contrary to what their physician advises them to do.
In navigating the medical system, patients typically want to achieve the best clinical outcome in the shortest amount of time. However, physicians have traditionally been rewarded for doing more services, not fewer. So if the decision-making process of the physician and patient are not fully aligned in seeking the highest quality of care in the most financially and qualitatively efficient manner, then it is not reasonable to deploy a strategy focused solely on stimulating greater accountability in the patient. The burden of responsibility has to be directed equally at all stakeholders.
In order to achieve this, patients, physicians and hospital systems need tools—or accountability enablers—to determine the best clinical outcome and the most effective path to it. At OptumHealth, we have found that accountability enablers generally fall under three categories:
- Demand management: It has been well-documented that stakeholders often demand a greater intensity or frequency of service than necessary to achieve clinical success—for example, patients go through more readmissions, endure more ER visits, or receive more MRI or CT scans than needed. To counter some of the system inefficiencies that haven’t been proven to achieve clinical outcomes and to become better at moderating the unnecessary demand in the medical system, providers can use tools that have been developed, scaled and proven effective in the employer and payer market. For example, in 2010, OptumHealth coaches met with more than 200,000 patients post-discharge and followed up with them on the phone to help mitigate any risk of readmission. They asked basic questions, such as: Where will you go post discharge? Are you certain any equipment or physical therapy has been arranged? How can we reach you? These questions allowed patients to anticipate outreach once they got home. While this may sound very simple, it is very impactful. As a result of such efforts, we cut in half the readmit rate for that group.
- Population Management: An OptumHealth analysis revealed that nearly half of high cost medical claimants are not meaningfully engaged in their health care decision-making. Therefore, providers must look across that population and identify those that need to be doing something differently to reduce their risk of an unfavorable medical event. To accomplish this, at OptumHealth, we apply our eSync Platform, which monitors medical claims, lab values, pharmacy data, health assessment results and other measures, to identify every member of a population that is making a suboptimal health decision. And then we establish a way to reach these people, whether via phone, mail, email, text or with direct outreach from their physicians to make sure they are brought back in for further care. There is no question that alternative means of delivering information is important for accomplishing this. Patient portals, mobile messaging and telehealth services are particularly effective for two categories of individuals—those with a relatively low intensity of need (those who do not currently consider themselves patients) and those who are unable to receive care due to immobility or lack of access.
- Network Management: Oftentimes, individuals choose to access care at the wrong place. Network management is about getting people to the best specialist at the preferred location. By creating a system that encourages patients to call for information about where to go for care, you can influence their decision. In 2010, more than 100,000 individuals called us seeking advice on where to go for care. Through network management, we helped 6,600 of those people who initially planned to see a lower-quality physician or one that was outside the system switch to the highest-quality physician within the preferred system of care.
For this model to be truly successful, 100 percent of the patients need to be participants. The process must be set up so that it not only addresses high-risk individuals but also meets the needs of those who may not require immediate care. Unfortunately, one of the barriers to achieving a fully functioning accountability model is that physicians and hospitals are not familiar with the tools necessary to engage individuals who aren’t active in the system. Instead, they focus on patients in their exam rooms, on their operating tables or in their hospital beds. This is a significant challenge that can be overcome by partnering with organizations that specialize in identifying and engaging individuals who will become future sources of medical costs.
Through the use of accountability enablers, the dangers inherent in relying too heavily and unrealistically on patient accountability can be avoided. We should not be focusing directly on changing a physician’s practice or reducing a hospital’s patient load, but instead on implementing an accountability model that aligns both physician and patient expectations in as little time as possible.
To learn more, watch our video on strategies for patient accountability.
This article was featured in the Fall 2011 issue of Ignite magazine. To find additional content from this issue, click the links below: