Patients with chronic conditions constantly face the risk of contracting additional illness or hospitalization due to complications from their conditions. The elderly and the sickest of them have to contend with many challenges to their care like keeping several appointments with various physicians and complying with complex care instructions. The challenge to the healthcare sector is how to make patients themselves commit to staying healthy and avoiding hospitalization. The simple truth is, that even with the provider’s best intentions and treatment plans, patients will not maintain their health status if they will not get involved in their care.
What is Patient Engagement?
So what is patient engagement? How does it improve chronic care? What are the strategies to keep patients engaged?
Patient engagement can be defined as the “desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, to maximize outcomes or improve experiences of care.”
It is a process participated by the patient and their provider, whose level of relationship affects how much the patients are engaged or involved in their care. This process can lead to a stronger patient-physician bond that could impact patients’ behavior when it comes to their care. Hence, patient engagement is both a process and a behavior.
The Role of the Primary Care Provider
The first line of care, first diagnosis, and the first step in engaging patients begin with the primary care provider (PCP). The primary care physician is tasked to oversee the patient’s overall wellness and encourage them to adopt healthy habits centered on prevention.
PCPs need to provide wellness care as a complement to sick care to prevent escalation or an additional illness from poor or uninformed lifestyle choices. This focus on a value-based care model promotes wellness, which requires physicians to go in-depth into the patient’s lifestyle and habits. Does the patient eat properly? Does the patient keep his appointments? Is he a good candidate for a wellness plan? Asking questions like these is a critical element in patient engagement. The patient’s answers enable the physician to identify prevention steps or detect the onset of a chronic illness.
Patient Engagement Promotes Preventive Care
Engaged patients also often ask questions and raise concerns to their providers, who are now able to detect even the most minor issues before they become big problems. Most often, patients start with just one chronic condition but soon develop one or more.
Many of these additional illnesses could have been prevented if patients are more attentive to their symptoms and more open with their providers. By keeping the line of communication always open and available, providers could easily implement the appropriate prevention.
Technology Enhances Patient Engagement
Nowadays, patient engagement technology has become advanced and intuitive, which further enhances the patient experience.
So how do these technological innovations help patients become more engaged?
- Digital communication pathways enable individualized and always available support to the patient. Care teams have many options in communicating with their patients telephonically, via secure text messaging, or through patient portals that provide support in self-management, give encouragement, deliver patient education, promote medication or device adherence, and assist patients to have the necessary skills to keep them healthy. The phone calls also allow patients to report if they are experiencing barriers clinically and socially.
- Intuitive software enables patients to participate in surveys to report on their progress, particularly on how they feel about their care journey. This same software is where patient data are sent from Remote Patient Monitoring (RPM) devices as well as collate Patient Reported Outcome Measures (PROMs). This particular feature enables providers to monitor patients’ health status and identify the required changes to medications or care instructions.
- Artificial Intelligence can send alerts to patients when scheduled measurements are not taken. In the same manner, care teams are also alerted when measurements go beyond the set range so they can alter the trajectory of care.
Strategies To Improve Patient Engagement
1. Leverage Telehealth Solutions
Virtual care services can provide care to chronic patients facing barriers like the remote location of their home, mobility issues, or transportation costs. Telehealth can provide faster and more consistent check-ins that can be used not just for a consult but also to provide education and conduct home visits. High-risk patients can also benefit from this remote service because they would need more frequent check-ins without the risk of exposing them to disease and having them go through the stressful ordeal of traveling and waiting in the doctor’s clinic.
2. Add a personalized touch
The most effective approach to improve patient engagement is through personal communication. Automated outreach has its advantages but elderly high-risk patients would often prefer a phone call with a person like a care coach who understands their situation and can offer the support they need. True, innovative solutions are now in place to lessen the administrative burden, particularly in care gap reporting, that requires so much time to accomplish. Tasks that do not need a human touch can be automated to enable staff to have more time to build relationships with their patients and keep them engaged.
3. Assign a dedicated care manager
High-risk patients often require frequent check-ins and close monitoring that providers may not have the time to do. Assigning dedicated care managers like nurses can ensure that high-risk patients have the support they need. A key to helping patients engage is when they develop a meaningful relationship with their care managers, with whom they can ask questions or share their concerns related to their care.
4. Utilize community resources
It is important that the care managers can address the social determinants to care like food security, housing, and transportation. All of these could impact the patient’s care journey. To illustrate, a patient suffering from diabetes may not be able to follow the prescribed diet if the patient is facing food insecurity. Care managers need to acknowledge the social challenges patients face and be able to discuss these with their patients to build a deeper connection. When patients feel their care providers are invested in their care, it will give them the confidence they need to stick to their care plans despite the difficulties they encounter.
5. Participate in Value-Based Care
Embedding a care manager into the practice can be costly and charging services to insurance could be cost-prohibitive. To mitigate the costs in optimizing chronic care, enroll in value-based care like Chronic Care Management (CCM), Principal Care Management (PCM), or Transitional Care Management (TCM) which are billable services that Medicare reimburses. In addition, physicians who have invested heavily in ACOs and other alternative modes of payment can forego the hassle of billing insurance separately for the care they provide.
High-risk patients can still live a quality of life with all the elements of sound chronic disease management particularly when it comes to patient engagement.
A Patient Methodology That Works
Ascent Care Partners (ACP) is a virtual healthcare provider that understands that patient engagement is key to producing positive health outcomes. Our turnkey CCM solutions provide multiple touch points to ensure patients stick to their care plans and medications. In addition, physician practices can gain a clinical team composed of highly trained care coaches who call the patients once a month to check in on their progress and other concerns.
ACP follows a unique patient methodology of assigning the same care coach to the same patient to foster a close bond that could be helpful in detecting even the subtlest changes to the patient’s behavior for effective intervention. It is a White Glove setup from patient enrollment and education up to the preparation of billing charges to provide practices with a new revenue stream. All these at no increased overhead, no upfront cost, no setup fees, and no risk to the practice.
