Patient Engagement Requires Right IT Tools

Paul Cerrato, writing in Information Week, thoughtfully discusses how IT tools can help (or hinder) practices to engage patients in their care (and meet Meaningful Use requirements). He makes the point that engagement tools that look good in a controlled laboratory environment often fail when put into service in the messy day-to-day world of sick patients, anxious families, harried providers and overworked staffs. That's why it is critical to select tools that have proven themselves in large-scale, well-designed evaluations in real-world settings.

http://www.informationweek.com/news/healthcare/policy/240003073#

Managing chronic conditions through automated patient engagement

Thanks to the good folks at PhysBizTech for publishing my little screed on using health information to engage patients. Insomniacs among you can find it here.

Patient Engagement in the US and Abroad

Robin Osborne and David Squires from The Commonwealth Fund just published a survey of almost 19,000 patients from 11 developed nations (including the US) to see how engaged they are in their health care.  The US scores were fair-to-middling, better than Norway, Sweden and Canada, but nearly as good as the UK and Switzerland.

Remarkably, the US did very well on "Follow-up and Support Between Visits" for patients with a chronic condition: 77% said they could easily call to ask a question or get advice and 31% said that their health care professional contacts them to see how things are going. Although 31% was the best of any of the countries, it is not a very good showing at all. Clearly, this is a big opportunity area both at home and around the world.

What good is being engaged? The more engaged patients are, the higher the reported quality of care and the less likely they are to experience a medical error. Coupled with other, prospective, evidence that engagement improves medical outcomes and lowers costs of care, and this is a very big deal, indeed.

Osborn R, Squires D. International Perspectives on Patient Engagement: Results From the 2011 Commonwealth Fund Survey. The Journal of Ambulatory Care Management 2012;35(2):118-28

You can read the article here.

Informatics for Consumer Health

Informatics for Consumer Health is a consortium of federal agencies seeking to empower providers to manage care and increase the ability of consumers to gain mastery over their own health. Their web site offers news on health informatics from the academic literature, upcoming events and funding opportunities. It seems directed primarily to academics and IT professionals, but health care providers and patients might find it useful as well.


Enjoy!

More care means lower costs?

The Commonwealth Fund recently published one of their very excellent issue briefs titled Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve? by James D. Reschovsky, Arkadipta Ghosh, Kate Stewart, and Deborah Chollet. This paper reports on a simulation model of the effects of improving reimbursement for primary care services (as Medicare did last year). Based on data showing that more primary care leads to lower total costs via lower rates of hospitalizations and other expensive services, the authors conclude that "promoting primary care can help bend the Medicare cost curve."

Other than rationing, getting patients into primary care is just about the only known way to reduce utilization. There are many ways to increase use of primary care services (such as automated systems to increase engagement between patients and providers), but none of them will work if there aren't enough primary providers. There is clearly a shortage of primary care providers now and it will only get worse as demand grows in the future due to improved insurance coverage and an aging population. If primary specialties aren't made more attractive by increasing payments (and lowering administrative burdens, too, while we are at it), we will never see an end to the health care cost crisis.

Is Disease Management Dead?

Archelle Georgiou thinks so. Her very well-written post (on her own blog here and on Managed Care magazine here) is a thoughtful obituary. She puts the time of death last November, when the New England Journal published Nancy McCall and Jerry Cromwell's report on the CMS disease management pilot program (N Engl J Med 2011; 365:1704-1712). The various DM programs showed little or no benefit, but they cost CMS $400 million. Yes, I agree: disease management, as we know it, has bought the farm and ought to be buried.

Dr. Georgiou offers several quite cogent reasons for DM's failure. The most compelling is that DM as implemented has drifted from the format and target audience originally proven effective in clinical trials in the 1990's. Again, I think she is spot on.

What should we do to improve outcomes and reduce costs going forward? Many of the ideas being proposed appear promising, but have less of a justification than the currently-employed versions of DM have. We just wasted billions of dollars and many years by failing to use the evidence base correctly. It doesn't seem wise to me to abandon the requirement for solid evidence before we invest again. Rather, we should take steps to ensure that we use technologies and programs that are evidence-based AND that we employ them as close to tested as possible.

What are those technologies and programs? Classic disease management for heart failure patients has been proven effective many times and should be retained. Use of automatic systems to support chronic disease patients (and their providers) are very low cost and have also been proven in large randomized studies. Lowering co-pays and barriers to access for essential medications and services is another strategy with a large evidence base.

Let's not throw out the evidence-based baby with the DM bathwater.