How to engage patients and reduce ACO costs

Image of children with their mother in a hospital room from Flickr.

A 2014 report by the Brookings Institution called patient engagement the “key to improved health outcomes and lower costs.” It claimed well-designed patient engagement strategies could “improve patient experience by allowing individuals to become active participants in their care.”

Bold claims, but Judith Hibbard, professor emerita at the Institute for Policy Research and Innovation at the University of Oregon, concurs. “There’s a ton of research that active, engaged patients result in better health outcomes. Better health results in better costs,” said Hibbard, co-author of “Patient Activation and 30-Day Post-Discharge Hospital Utilization,” a Journal of General Internal Medicine article that found an association between engaged patients and improved outcomes and lower service rates.

According to Jennifer Sweeney, vice president at the National Partnership for Women and Families, true patient engagement not only serves as the most successful strategy for ensuring the delivery of patient- and family-centered care, it bolsters the ability of accountable care organizations (ACOs) to meet quality and savings goals.

If you give clinicians the right tools, you’ll see less provider burnout and dissatisfaction.

Partnering with patients and families to establish priorities and develop care plans lowers cost of care and readmission rates, while improving patient experience scores, which are tied to hospital reimbursement. Engagement also optimizes hospital resources, resulting in lower staff turnover, malpractice rates and rework, she said.

“Understanding patient and family needs, values and preferences is critical to designing care and implementing changes that improve outcomes and the experience of care and reduce costs,” Sweeney said. “Working with patients and families supports the direction of resources toward strategies likely to improve outcomes and away from duplicative, low-value or harmful activities.”

[Also: Patient engagement and revenue cycle]

She said patient and family engagement is a partnership, and it's just as important to know what it is not. It's not about creating financial incentives to steer patient choices, convince them to adopt healthy behaviors or to manage their chronic conditions, she said.

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“Patient and family engagement is collaborative,” Sweeney said. “They’re equal partners in defining, designing and assessing care practices and the systems that serve them. They partner with stakeholders at all levels of the healthcare system—from policy to governance.” She advises hospital chief financial officers to “frame partnerships with patients and families as a strategy for achieving overall ACO goals and partner with leaders to develop metrics to track the impact of these partnerships. Designate a leader, accountable for developing meaningful partnerships at all levels in the ACO.”

A good patient engagement strategy can have a positive impact on financial competitiveness, Hibbard said. “If you give clinicians the right tools, you’ll see less provider burnout and dissatisfaction,” she said.

Working with patients and families supports the direction of resources toward strategies likely to improve outcomes.

Hibbard, who developed the Patient Activation Measure, a self-assessment tool that monitors knowledge, skills and confidence in health management, said patient behavior is important to determining outcomes. “If they’re not up to it, how do we get them to become up to it?” she asked.

According to a 2015 Health Affairs article Hibbard co-authored, higher levels of patient activation can be associated with better health outcomes, including better clinical indicators, healthy behaviors and preventive screening, and might even help achieve the key goals of health reform.

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