How about Patient Considerations in your PCMH Strategy
By Chris Valerian, DO, MMM – Executive Medical Director, Health Integrated 

As I mentioned last week, the physician is the key component to driving the success of any PCMH.  The doctor is the one that has to identify, convince, manage and change the behaviors of the patient to improve health outcomes.  These efforts need to be planned meticulously and executed flawlessly to get the best results.  There is no question how important the physician and the supporting network are in establishing and successfully running a PCMH.  That said, it really is all about the patient – and we all know that this may be one of the biggest challenges of all.

So, what about the patient?  The bottom line is that it really is all about the patient.  I have read so many articles, papers, blogs and websites that very intently focus on the logistics of creating a PCMH.  They target the planning activities with checklists and details.  But you know, it really is all about the patient.  Those reimbursement strategies that involve engaging more physicians and health care systems into this line of thinking will allow both stakeholders a clear path to better focus on the patient.  This program drives proactive healthcare rather than a reactive and episodic approach.  Reimbursement strategies can catalyze the improvement of the provider framework and provide effective incentives all while both improving the health of the patient AND saving overall cost to the healthcare system.  Imagine what could be done if these saved funds were reallocated?  How many more patients could be helped or programs could be launched?  Maybe this is a topic for another post.  What do you think?

Let’s get back to the patient for now.   The most significant thing we can do for any patient is to provide an environment in which they can realize that the benefits of participation are well worth the efforts.  Motivation is the key concept.  Much has been written about this.  One thing for sure, is that to increase a patient’s motivation, the physician and the health plan must increase the activities thought to be most beneficial to the patient[1].  In order to determine these activities, many PCMH facilities conduct ongoing patient surveys which assist in defining challenging areas as well as charting progress.  From a study of 700 family medical offices in Virginia[2], less than half of the non-PCMH facilities actually used patient surveys.  Overall we agree that the integration of a PCMH program improves the outcomes for patients primarily based on understanding and addressing the established needs of the patient population.  This would indicate to me that by uncovering the needs of the patient, you will be better equipped to provide the highest value-based programs which in turn lead to better health and financial outcomes.

Having said all of that, there are other things we as physicians can do for the patient.  We can make it as easy as possible to participate.  The Center for the Advancement of Health[3] has written a patient guide which is helpful in the creation of a medial home physician practice.  (I have attached it below for your reference)  Of the many things discussed, creating a guide for patients which details how they can benefit from and use the medical services offered gets to the point we discussed earlier.  They talk about things like providing key contact, location and logistical information (e.g. making appointments, special needs, payments, testing, results, emergency care, prescriptions, etc.).  Additionally, some basic motivational techniques such as modeling, visualization and small but attainable goals can all drive patient participation and compliance.

TransforMED, in their summary of the National Demonstration Project (NDP)[4], speak to transforming not only at a practice-level, but at a personal level.  The transformation of moving from a ‘patient-processing practice’ where patient visits are part of an assembly line, to a more proactive, population-based planned-care model, not only changes the way a practice views itself, but also changes the way medicine is administered thus more positively affecting the patient.

The bottom line, it is all about the patient and anything we can do to encourage participation and allow patients to realize their goals, makes for good business medically and financially, not to mention the positive effect on human factors.  What are you doing to both solicit participation as well as compliance with your patient population?  I would love to hear.    

Finally, I have listed some future topics in which I would welcome your review and comments.  Thanks in advance for your comments.  As always, you are welcome to contact me directly as well at pcmhdialog@healthintegrated.com.  

Best Regards,

 Notes:

1.  Download:  CFAH Medical Home Patient Guide

This entry was posted on Wednesday, August 5th, 2009 at 8:58 am and is filed under PCMH General. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.