Patient engagement: Strategies, barriers, and quick wins

We're continuing our conversation on patient engagement. In this discussion, Nordic Practice Director Lauren Griessmeyer talks with Nordic Director of Optimization Solutions Rick Shepardson about some effective strategies for patient engagement, some of the barriers to implementing those strategies, and some quick wins you can benefit from right now.

Specifically, Lauren and Rick cover these topics:

Lauren: Hi, I'm Lauren Griessmeyer the Willow and Beaker practice director, and I'm here today with Rick Shepardson. Why don't you go ahead and tell us a little bit about yourself?

Rick: I am the Director of Optimization Solutions here at Nordic. We do a lot of work with strategic optimization opportunities, tying together operations with technology.

Lauren: Okay. What did you do before your time at Nordic?

Rick: Before my time here, I started at Epic, worked from there from '04 to '10, and left to put together a health care platform on the One Laptop Per Child program in South America, trying to target some, giving some remote care to villagers. Came back and done a variety of variety of optimization projects since then, largely focused on rev cycle.

Lauren: We have been talking a lot, lately, about patient engagement and what patient engagement actually means, and how Epic is adding to this patient engagement “thing,” for lack of a better word. Part of patient engagement is being able to meet patients where they're at, and effectively, engage different types of patient populations. What are some of the ways that organizations ... What are some of the patient populations and what are some of the ways that organizations are effectively engaging with them?

Rick: Yeah, so what I think about these, there's a bunch of different patient populations that we can talk about, we can stratify for days. A couple of the key areas to really hit on. We're going to talk about well patients who they really just want to get in and get seen. They don't want it to take a long time to get in and see the doctor. If it takes a long time, you have good choices. You're going to go somewhere else. Right? We want to be able to allow them to get scheduled and be seen as soon as possible after that initial request. That can take place in an office visit if it's an acute visit, that could take place via e-visit if it's less acute and they just want to check in on their flu-like symptoms. Being able to have those long visits or those short visits that are appropriate for the level of acuity, really, is going to allow a couple of things. It allows patients to be seen more rapidly, and they feel like they're more involved or they're getting better service.

But it also means more money for the hospital organizations, the providers, they can increase their panel size because that 30-minute flu-like symptom visit is now a six-minute e-visit. Then you can put a lot more six-minute visits in there and you might get paid less, but for each of the individual visits, but overall, it's going to add up more.

Lauren: Plus it opens up space for the other types of visits that you might be wanting to schedule.

Rick: Exactly. The other population that we're talking about a lot of opportunity is with the chronic care patients, chronically ill patients. They need high touch, right? They're level of engagement is a little bit different. They need to be tracking to a care plan, they need to be constantly outreached to because they're probably not doing a great job. There's a reason why they're chronically ill in the first place, right? They've let themselves go, in many cases. Sometimes, not by choice, obviously, but they've gotten to that point where they need constant outreach.

One of the things that organizations really should be doing is chronic care management. There's the new code in 2015, 94990, you get paid for roughly $42 plus a copay for 20 minutes of non-face-to-face care. That's a really high ROI opportunity for organizations and it also keeps those patients engaged. It's kind of a forced engagement model, not quite forced, but it's more active engagement for these chronically ill patients, and that's another population that you really should be hitting on.

Lauren: We've talked about a lot of different ways that patient engagement can lead to increased ROI, better outcomes, etc. What are some of the barriers that organizations are hitting when they try to accomplish some of the things that we've talked about?

Rick: Yeah. I think that one of the hardest problems with all of this is that a lot of the ROI measures on these patient engagement opportunities are really graying. It's hard to understand if I allow my patients to schedule online, will they? What additional revenue will I get?

Lauren: Yeah. You don't see a firm uptick that you're able to ...

Rick: Right. You absolutely don't see a firm uptick, and then when you compare that to all the must-dos, you must implement ICD-10, you must implement the new cancer center that's coming online, right? What are you, ultimately, going to prioritize, right?

Lauren: Right.

Rick: Those things that have a very clear ROI. Where this is kind of going is the government, coming back to the government and some of the policies, the same people that, then, did the MMA back in the day and now the ACA. Moving forward, as they move into value-based care modeling, they're building incentives to start to move people down that pathway. The chronic care management piece that we talked about earlier, that really is related to some of those value-based care models.

As more and more of these metrics are made available and reimbursement is more closely tied to value and quality, it will become more of a no-brainer to do some of these. Where organizations really, I think, need to focus are on some of the quick wins, the obvious factors.

Obviously, there's a lot of functionality in MyChart. I think you've talked a lot about these in your other series. Yeah, just implement that stuff, right? Make sure, though, that as you implement it, it is really closely tied to your social media and your marketing plans so that the awareness is truly throughout your patient population. Going through and opening your scheduling access so that patients can get in and get seen, that's going to give you more money. You're going to have providers that are better utilized, they're going to be more efficient. Your patients are going to get seen easier, and you're going to make more money.

You also should be really focused on the transparency in terms of price. Patients as consumers, right? They want to know how much stuff's going to cost. You can make that available to them and, at that moment, it's also a great opportunity to say, "Oh, by the way, would you like to pay for this now?" You may give them a small discount, allow them to make a payment via a credit card. As soon as they make those payments up front, guess what? The likelihood of them no-showing for that appointment, yeah, it just went way down. Right?

Lauren: Sure.

Rick: These things all sort of feed in. Implementing e-visits, like we talked about, right? That is a little harder to implement because there's questionability around the assessments and how much doctors are going to want to go by that. But if you can implement them, the reimbursement is there, and it helps to increase your panel sizes, which is a really big deal for physicians.

Then, beyond that, then, it's just being an advocate for your patient. It's really easy to help get patients signed up for Medicaid, right? It's really easy to help them get signed up for payment plans, and then you keep them out of collections and these are things that you can really easily do from a revenue cycle perspective, it's really just a matter of making them available, enforcing and reinforcing the approaches with your operations staff, and then marketing campaigns and making sure that patients are aware of the services that you're providing, and they stay with you. You maintain that market share.

Lauren: Okay. Well, thank you.

Rick: My pleasure.