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Lesson # 4 – The Disparity between Patient Engagement and Patient Experience

Often used interchangeably, these have become completely different interactions and should be viewed from the based on the entities responsible for the specific quality. Patient engagement is primarily the interactions between the patients and his/her caregiver or doctor. On the other hand, patient experience refers to the patient’s interactions with the healthcare companies. There is a distinction between doctors and healthcare companies with regard to their priorities, systems and goals when it comes to healthcare.

At HIMSS 2017 Bridget Duffy, MD, Chief Medical Officer at Vocera, “called for caregivers and healthcare technology companies to think and act holistically about the patient experience. We should create technologies and processes that work together, turning fragmented encounters into seamless patient experiences.” She further adds that, “we often inflict solutions on nurses and doctors without engaging them in the design process, and then are surprised when caregivers are slow to adopt. This challenge can be overcome simply by inviting caregivers to the design table and incorporating their insights.”

Listed below are the challenges towards holistic patient engagements:

  1. Difference of opinion between doctors and healthcare companies creates negativity toward the entire engagement process between the patient on one hand and the doctor and healthcare company on the other.
  2. Due to the multiple opportunities and points of engagement, i.e., prior to entering the healthcare interaction, during treatment and post treatment, there end up being gaps in the system that compound negativity of patient experience.
  3. A lack of empathy, either on the part of the caregiver or the healthcare company, further contributes to negative patient experiences.
  4. The absence of clear communication between caregivers and healthcare organizations adversely affects holistic healthcare solutions for patients.

The Way Forward:

  • Patient engagements and experiences need to be considered as a whole and should work in tandem with the ultimate goal of providing holistic healthcare for the patient.
  • A caregiver and the healthcare company should be guided by the principle of empathy to be able to engage with the patients in an optimal fashion and make them feel engaged through every point of interaction.
  • Another important aspect of patient engagement lies with providing patients with a choice in their own personal healthcare decisions. Patients should be given the comfort of making their own health-related choices.
  • Additionally, caregivers should also be given the freedom to exercise choices and be a part of administrative decision-making as they deem appropriate, rather that pre mandated processes, which bring on reluctance toward adoption.
  • A clear indication of roles and responsibilities of each of the entities involved in the healthcare process avoids confusion and misunderstandings and build mutual trust and acceptance.

Lesson # 5 – Interoperability Continues to Play Out

Interoperability in healthcare is the provision to exchange and share information across various different channels. Within healthcare this information exchange is of primary importance as it can greatly contribute to the benefits of a patient. Mohannad Hammadeh, product owner, APIs & ecosystem, Orion Health; part of the HIMSS Interoperability Showcase™ initiative points out, “Think about every time you visit your primary care provider (PCP) and he/she records notes into their own electronic health record (EHR). Where does that information go? The answer is nowhere, unless it is transcribed into a referral and sent to a specialist. And even then, it’s only partial information that is included – not the entire medical record. So, what happens if you go out of state and visit a different PCP, or get sent to the emergency department of your local hospital? What information is readily accessible for practitioners there to understand you, your conditions, and your medical or family history?”

Listed below are the challenges towards interoperability in healthcare:

  1. In the current scenario, no patient records are shared. Electronic Health Records (EHRs) are scattered, unstructured and rarely shared, which makes it impossible for multiple caregivers to receive holistic patient information.
  2. Overall, technology adoption in the healthcare industry has been slow. Paper work is still a common procedure in hospitals, which falls far behind in the information sharing technologies out there.
  3. A lack of interoperability is a risk toward the safety of patients because it provides partial information to the caregiver. Therefore, insufficient or inaccurate healthcare is serving as a huge hindrance toward quality patient service.
  4. Further, this lack of information exchange in a holistic fashion causes a huge financial wastage on the healthcare industry.

(Please create an image titled, “Challenges toward Healthcare Interoperability”, with the below pointers – Scattered, Unstructured Data, Slow Adoption of Technology, Partial Information Access, Financial Wastage.)

The Way Forward:

  • The key towards successful interoperability is through the process of plug-and-play interoperability that can be undertaken by merging healthcare organizations, such as, clinics, managers, hospitals, emergency rooms, insurance companies, etc.
  • To provide holistic information exchange between different entities across the healthcare, data needs to be structured and prioritized based on the context of the data. This can prioritize data based on the healthcare professional involved.
  • Adoption of Application Programming Interfaces allows sophisticated data sharing with multiple benefits for healthcare professionals and patients alike. Healthcare organizations and developers need to make this a priority to bridge the interoperability gap.

Lesson # 6 – Increased Healthcare Transparency for Consumers

Over the years, we have consistently heard consumers demand higher levels of transparency in healthcare. In essence, this is a call by consumers to provide easy access to information that is related to the cost and quality of healthcare services that are accessible, so as to allow consumers to make a conscious choice. Unfortunately, the practice that has prevailed for decades is that a patient only becomes aware of the cost of his/ her treatment, after having received it.

This demand of the consumer is the underlying factor behind the shift from the fee-for-service model to value-based care. As the priorities shift to providing quality care to consumers, “Those hospitals are rewarded for those outcomes,” says Blain Newton, executive vice president at HIMSS Analytics. “So they’re looking to different technologies to help manage that process. The key is that outcomes are influenced by patient behavior and care plan compliance. Those factors are more important than ever. Bringing solutions to market that can enable engagement is more than a nice-to-have. It’s a have-to-have.”

Listed below are the reasons toward an increased demand for healthcare transparency:

  1. Highly deductible health plans and increasing healthcare expenses have made consumers more demanding toward cost and quality transparency.
  2. The traditional fee-for-service model had created a culture more patients means more money and therefore, shifted the focus away from quality care to quantity care. This has now changed to caregivers looking to provide higher quality care.
  3. With easier access to health information on the Internet, the consumer is more informed and needs to be given the information requested.

(Please create an image titled, “Reasons toward an Increased Demand for Transparency” and add in the following pointers: Deductible Health Plans, Increased Healthcare Expenses, Shift from fee-for-service to Value-based Care, Easier Access to Health Information, and More Informed Consumers)

The Way Forward:

  • The healthcare industry is adopting the approach of providing an increased amount of transparency to patients on the costs involved in the process of caregiving, through different technologies, such as a cost estimator application.
  • Further, the responsibility of a physician toward providing quality care has increased tremendously through the value-based care model. Accountability is now a dominating factor for caregivers, which automatically works to the benefit of the consumer, even in the case of referrals.
  • Payers and providers are working in tandem to increase the quality output provided to the consumer. This transparency between the provider and the payer is unprecedented in healthcare history. Several innovative technologies are being developed to be able to increase the collaboration between caregivers.

Lesson # 7 – More Regulatory Guidance from CMS and HHS

According to the Medicare Access and CHIP Reauthorization Act (MACRA) rules, which came into effect on April 16, 2015, the sustainable growth rate formula has been repealed. This act has transformed the manner in which Medicare rewards clinics for value as opposed to volume. It provides incentives and merits and bonus payments through Alternative Payment Models (APMs).

According to a recent report by HIMSS, dated 8th November, 2018, “Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), all eligible clinicians (ECs) who receive over a minimum threshold of Medicare Part B reimbursement must participate in an approved Advanced Alternative Payment Model (AAPM) or the Merit-Based Incentive Payment System (MIPS). ECs who do not participate in either option will receive a negative payment adjustment to their Medicare reimbursement. In 2019, ECs (which will include a physician assistants, nurse practitioners and clinical nurse specialists in 2019) who charge more than or equal to $90,000 or provides care for 200 or fewer Part B–enrolled Medicare beneficiaries and are not part of an approved AAPM must participate in MIPS. Physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists, registered dieticians, or nutrition professionals, and a group that includes such clinicians will be eligible for MIPS beginning in 2020.”

Challenges with the Traditional Billing Practices:

  1. The burden of the providers has proved to be a considerable challenge for clinicians with regard to healthcare billing practices.
  2. Heavy and complex documentation requirements have been consistently tied to healthcare billing practices.

 

 

The Way Forward:

  • The Centers for Medicare and Medicaid Services (CMS) has examined the different ways to address the challenges toward traditional billing practices. The recent changes to the Physician Free Schedule (PFS) include beneficial updates to payment programs and policies, including convenient interoperability.
  • Further, various IT-related provisions have been included in the updates that allow separate payments to individual physicians through innovative technology, correspondence between clinics and Medicare beneficiaries through virtual check-ins.
  • The modifications by CMS and HHS are intended to put the patients at the forefront of all healthcare programs. These include providing meaningful information about the quality and costs related to healthcare, while encouraging innovative approaches that improve the quality, accessibility and affordability of healthcare.

 

Conclusion:

The healthcare industry is ripe for grabbing technological innovations and developers are working toward creating solutions that are poised to significantly boost the quality of caregiving over the years. At the core of this development lies the understanding of the sensitivity of providing healthcare and the implications thereof. Keeping the need for privacy in mind, technological advancements need to factor in measures for heightened cybersecurity.

Artificial Intelligence is the key to boosting the healthcare industry to never-seen-before heights of providing holistic and all-rounded quality care to consumers, causing the various organizations of the industry to work collaboratively for the greater good.

References:

https://www.himss.org/sites/himssorg/files/Patient_Portal_Identity_Proofing_and_Authentication_Final.pdf

https://www.himss.org/news/2017-year-review-cybersecurity-developments-lessons-learned-healthcare-and-beyond

https://www.himss.org/event/machine-learning-ai-healthcare

https://www.healthcarefinancenews.com/news/why-artificial-intelligence-wont-replace-doctors

https://www.himss.org/news/ai-explained-280-characters-or-less

https://intermountainhealthcare.org/blogs/topics/transforming-healthcare/2017/02/patient-engagement-vs-patient-experience/

https://www.himss.org/news/current-state-interoperability

https://www.himssanalytics.org/news/understanding-patient-satisfaction

 

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