Implementing strategies to encourage patient accountability

While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved in their own health is critical to improving outcomes and reducing costs as part of any accountable care environment.

Currently, patients navigate the medical system to achieve the best outcome in the shortest amount of time, but physicians are incentivized to provide more services. If the decision-making process of the physician and patient are not fully aligned, then it is not reasonable to deploy a strategy focused solely on stimulating greater accountability in the patient. An alignment of goals for the highest quality and most financially efficient care can help to ensure patients are never in a position to make a health decision against the advice of their physician. The burden of responsibility has to be directed equally at all stakeholders. Once alignment is established, strategies to stimulate greater patient accountability can be deployed.

Establishing a primary care relationship is key for patients because it provides them with the opportunity to view care more holistically, gain a better understanding of medical alternatives, and feel supported by an advocate for better personal health. Group visits can also encourage patient accountability by allowing patients to connect with others who have similar conditions, and providing physicians with an opportunity to educate and promote better overall patient health. In addition these strategies, tools to enable patient engagement are paramount. I’ve bucketed these accountability enablers into three categories:

  • Demand management: Stakeholders too often demand a greater intensity or frequency of service than necessary to achieve clinical success—experiencing more readmissions, ER visits, and MRI or CT scans than needed for example. It may sound simple, but asking discharged patients questions such as “Where will you go post discharge?”, “Are you certain any equipment or physical therapy has been arranged?” and “How can we reach you?” counters some of the system inefficiencies and better moderates unnecessary demand in the medical system. In fact, such efforts can cut in half the readmit rates.
  • Population management: According to a commercial insured 2010 population analysis, half of high cost claimants had minimal to no engagement with the delivery system in the prior year, indicating that providers need to better engage with individuals who are not active in the system, not just at the point of care. This is a significant challenge that can be overcome by partnering with organizations that specialize in identifying and engaging individuals who will become future sources of medical costs. It is particularly important for providers to reach out to individuals with a low intensity of need that don’t consider themselves patients and individuals with immobility or lack of access to care.
  • Network management: Oftentimes, individuals choose to access care at the wrong place. Transparency of information on physicians and specialists ensures that patients are receiving the best care at the lowest cost. By facilitating transparency providers can influence patients’ decisions, increase patient involvement and open the door for better communication across the care continuum.

All patients across the care continuum need to be participants in their own care, and providers should be implementing strategies to encourage this accountability both at the point of care and, more importantly, once the patient goes home. The focus should not be directly on changing a physician’s practice or reducing a hospital’s patient load, but instead on implementing an accountability model that aligns both physician and patient expectations to improve the health care system as a whole.

Miles Snowden is Chief Medical Officer of OptumHealth.

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  • Dr. Douglas Curtiss

    It seems to me that part of the “demand management” should involve the shifting of the cost to the patient.  In all other industries, cost is controlled by supply and demand.  While a purely supply and demand type system may not work in medicine, there needs to be some change.

    • Payne Hertz

      Yeah, because the $2.7 trillion we spend every year in this country on
      medical care comes from the Magical Money Mine. Patients don’t bear the
      cost of any of this, even though medical bills are the number one cause
      of bankruptcy in this country and medical care is considered by some to
      be the 3rd leading cause of death. Patients are magically insulated from the consequences of their medical choices…to the extent they have a choice.

      Solution: makes patients suffer and pay more.