The economics of health care are in dire need of a reboot — and fortunately for patients, a convergence of factors is finally bringing one about. For one thing, many of the health care services that people rely on have grown increasingly expensive in recent decades, far outpacing economic growth as a whole. In 2010, the total cost of health care in the United States was $2.6 trillion, or $8,402 per person, according to the Centers for Medicare and Medicaid Services — and that was up from about $75 billion in 1970, or $356 per person.
But perhaps even more pressing, the long-accepted economics of health care in the United States have in some ways worked against what should be the central goal of providers, such as hospitals and physicians’ offices: keeping people healthy. For many years, if a patient checked out of the hospital on Friday and came back on Monday with the same condition, that was good news for the hospital’s bottom line — despite the fact that it could also mean the patient had been administered ineffective treatment in that same hospital. Similarly, when a patient contracted an infection in a hospital and had to stick around three extra days, the hospital saw not a financial loss but a financial gain. In other words, any ethical calls to decrease such incidences from doctors, nurses and others were undercut by economics.
Changing laws, as part of the Affordable Care Act (ACA), have started to alter the economic equation in a concerted push from fee-for-service health care to value-based care. In value-based care, providers are paid only when they’ve improved patients’ health outcomes. For example, one provision of the ACA holds that hospitals don’t get paid for readmissions, or patients who return within 30 days of discharge for the same issue that brought them in the first time. Providers are now being economically incentivized to make sure their patients are healthy.
“That’s forcing the providers to be more interested in high-quality care, evidence-based care, and really achieving the health outcomes people want,” says Richard Biehl, an instructor in the online Master of Science in Healthcare Systems Engineering program at the University of Central Florida.
What that enhanced interest among providers leads to, he explains, is an increased focus on patient engagement.
“What we’ve always known is that the way to get people to be healthier is to get them to live a healthier life,” Biehl says. “Hospitals are starting to internalize that if a hospital is doing its jobs, it’s admitting far fewer people than it did in the past. The old system wasn’t set up to reward that type of thinking.”
A growing body of evidence does indeed support the claim that when patients are more involved in their own health care, they tend to be healthier and spend less money on their care. With patient health — as well as new economic incentives — in mind, how can physicians, nurses and other health care providers improve patient engagement efforts?
1. Work harder to “activate” healthy patients.
“Ultimately, it’s the patients who have to decide to get healthy,” Biehl says. “As a philosophy, we’re moving toward the patient making a lot more decisions about their own care and being more actively engaged in their care.”
A research review published in Health Affairs shows that “patients who are ‘activated,’ — that is, have the skills, ability, and willingness to manage their own health and health care — experience better health outcomes at lower costs compared to less activated patients.” One study mentioned in the review found that patients with the fewest skills and least confidence when it came to their health care incurred between 8 and 21 percent more in health care costs than patients with the highest activation levels.
Cultivating patients with high activation scores means educating them about health risks and healthy lifestyle changes, and empowering them to make changes in their own lives.
2. Ensure that health care providers are making decisions with patients, not for them.
Research has shown that another way to encourage healthier behavior, better outcomes, and lower costs through patient engagement is to let patients weigh the pros and cons of different treatment options with their doctors and reach a decision together.
One study found that patients who had received enhanced decision-making support from health coaches in dealing with a health condition incurred medical costs that were 5.3 percent lower than those of the control group, with 12.5 percent fewer hospital admissions.
3. Start making the most of new and fast-developing technologies.
Biehl speculates that the oncoming rise of wearable technology and the “internet of things” will open more and more opportunities for doctors and patients to work together to improve patients’ health rather than just treat symptoms. Today, physicians are being required to ask more questions about the medications a patient takes to avoid unknown contraindications. In the future, patients will be able to share their detailed data about more difficult-to-quantify areas, too: sleep patterns, exercise and diet, to name a few.
“It’s much easier to engage patients if I already have data on them [via wearables],” Biehl says. “I can call you up if I know there’s a change that’s indicative of cardiac enzymes being produced — the leading indicator that tells me you’re going to have a heart attack within 48 hours, for example.” If patients can become more involved in staying healthy (rather than only managing symptoms when they’re sick) and catching problems quickly, they can do more to avoid unnecessary hospital visits and invasive treatments.
As new systems evolve to meet these technological and policy changes, hiccups are inevitable, but there’s a chance they will lead to lower health care costs and all-around stronger economics in the long term. And that, overall, is a healthy change.
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