Even though health and illness are considered some of the most personal aspects of anyone's life, visiting a physician's office or a hospital can be one of the most impersonal, conveyer belt-like experiences for many patients.
"I often use the example of the DMV experience when going to an acute-care facility for an episode of care," says Damon Auer, vice president of healthcare for Tribridge, a technology services firm. Between completing forms and waiting in lines or waiting rooms, the entire process becomes scientific and impersonal.
As the healthcare industry begins to transition from a fee-for-service reimbursement structure to pay-for-performance or capitated payment structures, it is becoming obvious that healthcare organizations will be successful in the future only if they move toward population health management.
While the term "population health management" itself also sounds impersonal — emphasizing the population instead of the people who define it — providers that utilize the method successfully are providing personalized care on a patient-by-patient basis. "Healthcare providers have to effectively, proactively and collaboratively engage with patients, even when they're not in the healthcare facilities, and certainly when they are," Mr. Auer says.
Many hospitals and health systems are taking the steps to make their environments more patient-centered. Several larger systems have added positions like chief customer officers to their C-suites. Organizations have also made changes to their facilities based on patient experience survey data, such as quieting recovery rooms, as many patients indicate having a quiet area positively impacts their recovery.
Gathering necessary data
Those are important steps to take, but provider organizations that want to function as accountable care organizations and truly manage the health of a specific population need to do more to personalize care. "[It] requires that we're able to engage [with patients] at a very individual level and plan and manage a relationship with them that is based on their situation," Mr. Auer explains. For ACOs to tailor services directly to the individual, they need data.
A lot of necessary information comes from clinical and claims data, gathered from electronic health records and payers. However, a patient's health is influenced by a lot more than what can be seen on an EHR or through claims data.
"The challenge for providers becomes planning care services around more than just clinical data," Mr. Auer says. "A patient's socioeconomic status, family information and care preferences become important for ACOs to consider when making patient care plans. For example, providers in an ACO need to know if a patient will have trouble paying for a prescription or has no way of getting to an appointment across town."
Borrowing from other industries
Gathering and organizing this kind of nonclinal data on patients has not historically been the norm in the healthcare industry. Other industries, especially in the commercial space, however, have been doing so for years.
Since ACOs need to know more about their patients than ever before, they can borrow this approach from industries that have nearly perfected it through utilizing customer relationship management software. Tribridge adapted a Microsoft product, Dynamics CRM, for the healthcare space, creating the Tribridge Care Coordination solution. "It's targeted to enable ACO operations, workflow and effectiveness of care managers and the patients with whom they need to personally engage," Mr. Auer says.
When ACO care managers are equipped with CRM software, care coordination becomes much easier. It's their job to interact directly with and better coordinate, plan and care for specific individuals, and CRM software can be their "toolbox," he says.
How it helps
The technology can stratify a population that the ACO may want to target for a specific care program, such as those at risk for type-2 diabetes. Once the population is identified, it enables care managers or navigators to reach out to individual patients and work with them personally, developing a care plan based on their preferences. Information about the patient's preferences, living and family situations can be captured and at the navigator's fingertips.
Once the care plan is developed through patient and care navigator collaboration, ACOs can make it visible to the patient through a patient portal or personal health record. Care managers can also receive alerts if a patient misses an appointment, for example, or did not record that he or she took medication. This enables the care manager to contact the patient and take action.
By gathering and organizing data on individuals and attempting to coordinate care tailored to the patient, ACOs have the ability to greatly impact patients' lives for the better. "They have the opportunity to go beyond what people traditionally think of in the healthcare continuum," Mr. Auer says.
For example, a healthcare provider's CRM system in a warm state like Florida could keep tabs on patients without air conditioning. With that information, ACOs could establish a funding mechanism that could help those patients obtain air conditioning, or direct them where to go to stay cool when temperatures peak, thus keeping them safe and healthy by addressing their individual needs. In this way, the organizations are managing the health of the population through personalized care in a way likely not available before.
That is just one instance of how care coordination can help ACOs begin to truly personalize care, and innovative organizations can tailor care to the individual in even more ways in the future. But for now, "the good news is that's it's starting to happen," Mr. Auer says. "Every person in the world is a patient, and this is good news for us as patients in the U.S."