Readers Write: Transitioning from Fee-for-Service to Fee-for-Value Requires Outcomes-Focused Patient Engagement

Transitioning from Fee-for-Service to Fee-for-Value Requires Outcomes-Focused Patient Engagement
By Richard Ferrans, MD, ScM

Critical to success under new care models is creating the right IT infrastructure to break down walls and foster better partnerships between hospitals, physicians, payers, and patients alike. We can no longer view inpatient and outpatient settings as different businesses. We must share complex clinical data between the “Care Layer” of physician and hospital EHRs and the “Value Layer” of HIT to integrate their disparate records and promote clinical analytics, value decision support (VDS), care coordination, and digital patient engagement.

Presence Health is the largest Catholic health system in Illinois with 12 integrated hospitals, 29 senior care locations, and more than 4,000 providers and 100 primary and specialty care medical practices. In January 2013, our Accountable Care Organization (ACO), Medicare Value Partners, joined the more than 250 other ACOs established through the Centers for Medicare and Medicaid Services’ Shared Savings Program.

A major part of our journey to becoming an ACO was the integration of employees, providers, and systems during the 2011 merger of Provena Health and Resurrection Health Care that created Presence Health. The combined experience and excellence of the two organizations is helping us succeed in the Shared Savings program. Specifically, both Resurrection and Provena, each with significant Medicare and Medicaid patient populations, had undertaken clinical integration and quality improvement pilot programs before the merger.

The proven patient outcome and financial improvement results of these efforts prepared us for the transition from a fee-for-service model to one based on value. Nevertheless, achieving the CMS’s required 33 quality of care measures while controlling costs will be a challenge.

An integral piece of our “Value Layer” is our patient engagement technology platform that allows us to provide patient-centric communication. We chose our partner, Emmi Solutions, because they have been focused on patient engagement for more than a decade. They have a complete solution proven to motivate patients to take preventive action, transition from one care setting to the next, and participate in shared decision making.

The technology supports web, mobile and interactive voice response (IVR) all in a single platform to deliver actionable information to patients. The platform uses language patients can understand and connects with them at their convenience and on devices they already own – both in and outside the hospital or healthcare setting.

Our patient engagement solution was first introduced to the Presence Health system at Presence Saint Joseph Hospital in Chicago. A survey of nearly 200 patients who had accessed the technology on the Web, conducted over a six-month time period, showed that 94 percent of patients said the engagement platform answered questions for which they normally would have called their doctor. In addition, 92 percent said it motivated them to change their lifestyle and all patients indicated it gave them a better understanding of their treatment options.

We do not passively “educate” patients, but rather use our interactive technology to engage patients in a two-way process where they become motivated participants in their care, exchanging information, validating understanding, and sharing concerns. This is more than a discreet intervention. It is a comprehensive set of reminders, calls to action, and tools needed throughout one’s entire healthcare journey.

We are in the process of expanding it across the Presence Health system and ACO to broaden our ability to cost effectively manage the health of populations and improve both clinical and financial outcomes.

Another reason we chose this technology is because its platform tracks the delivery and consumption of information, which enables us to measure the impact of patient engagement down to the individual patient level. With healthcare transitioning from a fee-for-service to a fee-for-value model, being able to quantify the return on IT investments is becoming a business imperative. Not only are we being held accountable, so is our vendor partner.

Richard Ferrans, MD, ScM is system vice president of Presence Health and CEO of Medicare Value Partners.