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PATIENT ENGAGEMENT AND THE BOTTOM LINE. NJMGMA October, 2015. OBJECTIVES. Understand the Business Case for Patient Engagement and Your Role Define What Patient Engagement Is and Is Not Identify Successful Patient Engagement Strategies (Clinical, Operational, Revenue Cycle): People
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PATIENT ENGAGEMENT AND THE BOTTOM LINE NJMGMA October, 2015
OBJECTIVES • Understand the Business Case for Patient Engagement and Your Role • Define What Patient Engagement Is and Is Not • Identify Successful Patient Engagement Strategies (Clinical, Operational, Revenue Cycle): • People • Processes • Technology
BUSINESS CASE • Federal Quality Reporting Programs • MU, PQRS, VBPM • CG CAHPS • Physician Compare • New Payment/Delivery Models – Shift from Volume to Value • ACOs, Shared Savings • PCMH, PCSP • MACRA - MIPS, APMs • Triple Aim – Improved Outcomes (population), Decreased Cost (per capita), Improved Patient Experience
FACTS • Engaged Patients • Overall medical costs decreased by 5.3% • 12.5 fewer hospital admissions1 • Activated Patients • Lower Activation Scores 21% higher costs2 • Veroff, David, et al., “Enhanced Support for Shared Decision making Reduced Costs of Care for Patients with Preference-Sensitive Conditions,” Health Affairs 32, No. 2 (2013): 285-83 • Hibbard, Judith H, et al, “What Evidence Show about Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data on Costs, “ Health affiars 32, No. 2 (2013): 207 - 14
PATIENT ENGAGEMENT: “THE BLOCKBUSTER DRUG OF THE CENTURY”
WHAT’S IN A NAME? WHAT’S THE DIFFERENCE ANYWAY?
PATIENT ENGAGEMENT WHAT IS PATIENT ENGAGEMENT? PATIENT ENGAGEMENT ≠ PATIENT PORTAL
DEFINITIONS • Patient Experience • The sum of all interactions, shaped by an organization’s culture, that influences patient perceptions, across the continuum of care • Patient Satisfaction • Patient’s opinion of care
DEFINITIONS • Patient Compliance • The provider assumes a paternal role in healthcare decisions and the patient follows the providers instructions • Influenced by culture, age, sociodemographics • Patient Adherence • The extent to which a patient’s behavior corresponds with agreed upon recommendations from the provider • Shared Decision Making
DEFINITIONS • Patient Activation • Patient’s knowledge, skills, ability, and willingness to manage his/her own healthcare. • PAM Score (Patient Activation Measure) Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Behaviours, Health Serv Res 2007; 42(4):1443-1463.
DEFINITIONS • Patient Engagement • A patient is involved in the process of their care – actively processing information, deciding how best to fit care into their lives, and acting on their decisions • Behavior-oriented • Provider: gain patient’s attention and actively motivate to participate Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Behaviours, Health Serv Res 2007; 42(4):1443-1463.
DEFINITIONS • Care Direction – AtulGawande, MD, MGMA - 2015 • Care aligned with the patient’s priorities and goals. • Not just what the patient wants, but the goal of where the patient wants to be • Shared Decision Making ≠ Provider Capitulation Goal: Align Patient Engagement with Care Direction
PATIENT EMPOWERMENT PATIENT EMPOWERMENT:
YOUR OFFICE’S GOALS Areas: • People • Processes • Technology Question: What are Your Office’s Goals for Patient Engagement?
PRACTICE ADMININSTRATOR Answer: LEADERSHIP! • People • Processes • Technology Question: What is Your Role in Patient Engagement?
LEADERSHIP • 7 Habits of Highly Effective Leaders • Inspire Action/Vision • Be Optimistic • Have Integrity • Role Model • Facilitate Teamwork • Cowboys v. Pit Crew • Have Confidence • Communicate • Be Decisive
LEADERSHIP • Responsibilities of an Effective Leader • Organizational Culture • Accountability • “What You Permit you Promote” • Clear Expectations • Have you told your staff what’s expected? • Have you defined expectations & standards? • Example: Respect • What’s your onboarding and continuing education process? • Have you developed quality measures and monitor expectations/standards?
LEADERSHIP • Results of Effective Leadership – Transformation • Staff Activation & Engagement • Teamwork • Office Efficiency & Effectiveness • Does office efficiency = Patient Satisfaction? • Provider & Staff Job Satisfaction • Patient Satisfaction & Engagement • Loyal Patients • Healthy Bottom Line • Profitability • Volume Value
LEADERSHIP • Barriers • Operational • Time constraints • Provider/staff resistance • Lack of technology
LEADERSHIP • Barriers • Perceptions • “My physicians don’t want to do it.” • “It’s not up to me.” • “These are clinical issues, so I can’t do anything.” • “I don’t have enough staff.” • “I don’t have the budget to do it.” • “Our patients aren’t capable of it.”
YOUR ROLE • People – Set the Tone!! • Training • Accountability • Results - Monitoring/Measuring • Processes • Workflow – Patient, Operational, Revenue Cycle • AMA Steps Forward –How To Guides; Calculates ROI, www.stepsforward.org • Pre-Visit Planning • Huddles - TeamSTEPPS • www.teamsteppsportal.org/teamstepps-materials
YOUR ROLE • Technology • Questions in EHR • Patient Portal Implementation • Patient Satisfaction Survey • Social Media • mApps
PHYSICIAN ENGAGEMENT • What Do Physicians Want? • Business Case - Profitability • Quality of Life • Efficiencies – Minimal Extra Work • Caring for People Clinically
STAFF ENGAGEMENT • Incentives & Accountability • Rewards? • Part of Performance Appraisal • Redefining Staff Roles – MA, Licensed Professionals, Care Coordinators/Coaches. • Job Satisfaction • Teamwork • Less Rework & Duplication • Happier Patients • Training • Communication Skills
COMMUNICATION SKILLS AIDET AND MANAGE UP – Speak about staff/providers positively Resources: AIDET Tools, www.studergroup.com
COMMUNICATION SKILLS AIDET
COMMUNICATION SKILLS The C.L.E.A.R. Service Model Resource: SullivanLuallin Group, Star-Studded Service – 6 Steps to Winning Patient Satisfaction
PUTTING IT INTO ACTION AIDET EXERCISE
COMMUNICATION SKILLS AIDET AND MANAGE UP – Speak about staff/providers positively Resources: AIDET Tools, www.studergroup.com
PATIENT ENGAGEMENT • What Do Patients Really Want? • Access • Efficiency – short wait times • Friendliness & Helpfulness • Communication • Information • Follow Through
PATIENT ENGAGEMENT • What Do Patients Really Need? • Meet Health/Life Goals • Medication Adherence • Understanding/Instructions – written • Laymen’s terminology • Healthcare Literacy • Self Care at Home – lifestyle, nutrition, etc. • Follow Up • Appointment Reminders
PATIENT ENGAGEMENT • Know Your Patient Population • > 65 • Baby Boomers • Gen X • Gen Y/Millennials • Cultural Diversity/Sensitivity • NJ’s Camden Project, Dr. Jeffrey Brenner
PATIENT ENGAGEMENT • Patient Satisfaction Surveys • Frequency? • Validity? • Relevancy? • Results? • Types: • CG CAHPS • Press Ganey • Specialty Specific
REVENUE CYCLE • Patient Engagement in Getting Paid – The Time is NOW: • High Deductible Plans • Co-Pays • Health Insurance Exchanges
REVENUE CYCLE • Front End Billing • Pre-Visit • At Visit (Check-in & Check-out) • Payment Scripts • Back End Billing • After the Visit • Coordination Between Front & Back Office! Resource: Keegan, Deborah Walker & Elizabeth Woodcock, The Physician Billing Process – Navigating Potholes on the Road to Getting Paid, MGMA, 2016
REVENUE CYCLE • PAYMENT AT TIME OF SERVICE! • Balances are a Must • Coinsurance Calculation • Automate the Process • Unmet Deductibles Trump Coinsurance • Financial Clearance a Must • Expect More Refunds • Present the Contractual Adjustment as a Discount • Collect in Advance for Surgeries • Don’t Leave the Uninsured Out of the Process Resource: Woodcock, Elizabeth W, “Collections,” Conventus White Paper, 2015
TECHNOLOGY Patient Portal • Benefits: • Increased Access • Patient/Staff Satisfaction • Workflow Efficiency • Planned Processes • Decreased Phone Calls • Decreased Overtime • Reduction in Expenses • Meet MU Requirements
TECHNOLOGY • Develop Implementation Strategy • Posters • Flyers • All Staff Communicate to Patients • User a “Staffer” to Enroll On-Site with “Quick Tour” • Create a “Quick Reference” Card for Staff/Patients • Set Enrollment Goals • Send “Welcome” Message • Staff Response Times to Messages
TECHNOLOGY Other Technologies • Secure Messaging • Social Media • m-Apps • Telemedicine • Need license in each state • Guidelines – AMA, FSMB, ATA
QUESTIONS? Susan Lieberman, MBA, BSN Vice President, Practice Resources Conventus Inter-Insurance Exchange www.conventusnj.com slieberman@nipgroup.com 877-444-0484, x7466