2012: The Year of the Patient?
What will it take to make this a Happy New Year for healthcare users?
By George Martin, MD – Senior Medical Director for Health Integrated
In keeping with several comments from readers provided in December to this blog, I plan to begin this year with a focus on the patient. Making 2012 “the year of the patient” was a specific request and so we will try. In doing so, I would like to not only identify the patient’s needs but also their wants. They are, after all, the end user and ultimate customer of the health care system. Unfortunately, like most systems, healthcare would rather ignore the customer. As I have heard it said “This job would be easy if we didn’t have to deal with patients”.
So what do health care customers want? First, they generally want to be left alone during times they perceive as private, and often, rightly so. Witness the telemarketing issue and the national do not call list. As you begin to eat dinner the phone rings. Dinner time is well known to be an opportune time to reach people. So, be it telemarketer or care manager, this interrupts what the customer views as their private moments.
Since most people are polite, we get many to discuss their health care while dinner gets cold. Others screen the call with ubiquitous caller ID and just ignore the phone. Some answer and then hang up; others answer and are intentionally rude before hanging up. In any case, due to our own insensitivity to our patients’ personal needs, we have established resistance to further interaction. But, as a care management team, we chalk up another contact against the performance goals. Bully for us! What we really need is to establish more effective methods of contact and encourage participation for patients that need care management, not poison the well for future intervention.
So a rule of conduct might be:
- Leave the customer alone until and unless we can demonstrate that they need, or they indicate that they want, intervention
- Reach out to them at a time and in a manner that is mutually agreeable
These principles lead to two further actions:
- Provide the customer with constant education as to how and when to access the care management system. This includes patients, their families and their physicians. Having changed insurance carriers several times in the past few years, I have yet to see a company that is pro-active in this regard. I sense fear that allowing or even encouraging those durned patients to access the care management system will use resources that we wish to conserve.
- There is an obvious need for transitions in care to be identified in real time. Most systems rely heavily on claims data, either high loss ratios or specific high-cost events like hospitalizations, to trigger a care management referral. By the time that claims data make its way to the level of referral to care management the patient may be dead. Even relying on hospital discharge lists is sub-optimal. At best we would like to avoid the initial hospitalization but, at least, we should be aware of the admission – not the discharge.
Many health plans also use claims data to establish trends. HEDIS data exemplifies this use. For example, we know that dilated retinal exams (DRE) for patients with diabetes are important. Therefore, we track this service as an important measure and it is commonly used to assess health plan and provider performance.
When we fail to achieve our targeted goal (in this case, the number of diabetic patients getting DREs), we educate the population as to the need. We also educate, and sometimes punish, providers that fail to meet the HEDIS standard. Would it perhaps be better to transition from the HEDIS population measure to health plan specific goals once we have used HEDIS to identify a trend? By this I mean once DRE has been identified as an opportunity by the health plan, shift away from the use of generic responses such as education and move toward identifying the patients that should have had, but have not had, their DRE. Then we could identify the specific issues for those who did not have the exam and identify and remove barriers that have kept them from getting their DRE, as appropriate. Following this approach, we just might find out that the patient had actually had the exam and/or did not need the exam if, for instance, the patient is already blind. By setting specific goals, we will know whether or not the DRE is indicated. Claims data is often lacking in this level of detail.
It appears to be a human issue to pass general rules to address specific issues. A more effective path to improvement is to identify the specific issues and address them.
In this, my self-declared Year of the Patient, I look forward to your continued thoughts, feedback and suggestions. Can we get there? What will it take to make this paradigm shift? Will it be like turning around the Titanic? Let’s hope not!
You can reach me directly at healthexecforum@healthintegrated.com, or comment directly in the blog.
As always, thanks for reading and for your input.
George Martin, MD
Year of the patient? Nicely done.
I think you are highlighting a few of the challenges with population health managment. Population measures improve by helping one unique person at a time. For the majority of healthcare, this happens in a one-on-one setting unless your covered lives happen to belong to the same tribe (borrowed term from Seth Godin who writes extensively on modern “Tribes”).
Unfortunately, most population health programs assume their covered lives are part of the same tribe that cares about the same things they do like, DRE’s. Our tools and processes must bridge this tribal gap if we are to make progress on a population level. The new medical homes must be integrated into the tribes they serve for maximum efficiency and effectiveness.
Agreed. And still we resist understanding our member’s (customer’s) needs by simply asking them.
I applaud you on your uncomplicated common sense approach to improving patient service. So many healthcare executives become so mired in performance goal setting that the most obvious solutions fly under the radar.
So true. We do get caught up in analysis paralysis and what ifs. I do believe we need to return to basics and common sense to resolve many of our healthcare issues.