Value-based Policy Changes to Drive Patient Engagement

Melina Ward MS — October 20, 2015

The other day a friend asked me, “Do more engaged patients actually result in improved outcomes?” My answer to him? Well, it depends on how you define engagement.

Many argue that people engaged in their health and health care results in better outcomes and lower costs. With the range of definitions of “patient engagement” it is important to note that an improved patient experience alone is not the sole driver that improves health outcomes. Rather, a growing body of literature suggests that an individual’s active participation in his or her care is a key component of successful patient engagement. Active and informed participation is critical to drive care plan adherence and, consequently, the improved outcomes (and ideally lower costs) that are so sought after. Bottom line: a physician who “engages” a patient in her care by providing her with information about a condition or letting her express treatment preferences is different than a care team who become partners in care with accountability and on-going follow-up. 

The challenge, however, is our health care system still doesn’t make engagement easy – for the health care providers or the patients. Our experience at Wellframe continues to reinforce for us that almost all patients want to do the right thing to better their health, but it’s not always clear what they need to do once they are outside of the clinical setting or between doctor visits. Hospital discharge instructions and care plans are complicated and hard to remember even for the most motivated patients. Nevertheless, in the traditional fee-for-service (FFS) system, providers are not paid for – and therefore not incentivized – to coordinate and support the care that happens in between doctor visits, which is when it’s also hardest for patients to stay engaged and more likely to deviate from their care plans.

At the US health policy-level, change is on the horizon with respect to how care is paid for and delivered in order to support active patient engagement for improved outcomes. Last month, Health and Human Services (HHS) Secretary Sylvia Burwell announced HHS’ intent to reform our system’s costly traditional Medicare FFS system by linking it more to quality and value. Of particular note is HHS’ goal to have 85% of all Medicare FFS payments tied to quality or value (e.g., bonuses on top of FFS payments) by 2016, and 90% by 2018. Moreover, HHS wants to encourage adoption of the alphabet soup of new payment models like ACOs and PCMHs. Its goal is to have 30% of Medicare payments tied to alternative payment models by 2016, and 50% of payments by the end of 2018. These value-based goals have significant implications for traditional FFS providers and when they will choose to jump on the bandwagon to engage in the care that happens outside of the walls of the doctor’s office.

One change already in motion is that, as of January 1, 2015, the Centers for Medicare and Medicaid (CMS) will pay for Chronic Care Management (CCM) services. CCM payments will reimburse providers for delivering specified non-face-to-face services over a 30-day period to individuals with two or more chronic conditions. For context, as of 2012, over two-thirds of FFS Medicare beneficiaries had two or more chronic diseases. Fourteen percent (14%) had six or more.

This reimbursement change represents an enormous opportunity for health care providers who have not embraced the value-based reimbursement to begin the transition to new models of care delivery designed to improve clinical outcomes and support patient engagement. It is an important stepping-stone in order to move towards a US health system that holds providers accountable for value and quality, such as the one Secretary Burwell describes.

While many providers are already delivering some of these non-face-to-face services to their patients, the emerging challenge is how to sufficiently deliver these services at scale in order to meet reimbursement criteria. The world of how care is paid for is changing, and thus the ways in which we keep our patients actively engaged in their care must follow suit in order to consistently promote higher-value care in the US.

Melina Ward MS

Melina Ward MS

Implementation Manager

Melina is a public health professional committed to improving health and health care in the US and internationally.