As the healthcare industry continues a positive shift toward value-based care and away from the fee-for-service model, payers and providers are starting to look at patient engagement and chronic care management conditions very differently. Previously, disease management was measured more by associated cost such as procedures ordered, in-patient stays and re-admissions, and patient engagement typically consisted of generalized letters that described their disease and standard therapies. These letters were a one-way communication and hardly fulfilled the notion of “engagement.”
There have been great strides made recently in developing patient-centric, IT solutions such as electronic health records, personal health records, health information exchanges and clinical decision support platforms. These platforms are finally enabling physicians, providers and payers to improve their care coordination and communications, while increasing the quality of care for patients. While this is definitely a welcome advancement for healthcare IT, a very important group is conspicuously left out of the conversation — actual patients. But that too is starting to change.
With ubiquitous use of mobile devices and more people opting for home healthcare, many patients want to take a more active role in managing their own health, so why not invite them into the conversation? As technology companies work to develop cutting-edge, patient-centric solutions, it will become increasingly more important to actually involve the patient in the process of developing their individualized treatment plan. Empowering patients in managing their own care becomes even more important with the prevalence of chronic conditions.
Recent data shows that more than 145 million people, or almost half of all Americans, live with a chronic condition. That number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. Today, chronic diseases such as diabetes, cardiovascular disease, COPD, and hypertension are among the most prevalent, costly, and preventable of all health problems. Seven out of every 10 Americans who die each year (more than 1.7 million people) have one or more chronic diseases and 80% of chronic diseases are preventable with appropriately tailored treatment and wellness plans.
Chronic Care Management and CMS
As of January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) started paying physicians for delivering care management to their Medicare patients with two or more chronic conditions. The newly created CPT code, (99490) reimburses providers for spending at least 20 minutes per month on care, including non-face-to-face interactions, with their patients. Eligible providers and qualifying clinicians will be reimbursed at approximately $42 per patient, per month.
With new regulations pushing the healthcare industry forward to ensure better patient engagement and care, it’s clear that changing the way care is currently delivered in the hospital and beyond is starting to become a necessity. The vision is clear: identify efficiencies, while maintaining high clinical quality to ensure delivery of the right care, at the right place and time. However, the execution seems to be elusive, and most providers and payers do not know where to even start.
This requires collecting, analyzing and sharing information, working across silos and engaging patients in an unprecedented and innovative manner. Data needs to be recorded from all sources, from the EHR to the Apple watch. And this data needs to be bi-directional, enabling real engagement between patients and clinicians. In turn, it is our responsibility as technology providers to develop solutions that work together to enable transparency, collaboration and information-sharing. Like many shifts in healthcare, changes won’t occur overnight. It will take time. However, by making efforts today to move treatment closer to the individual, and involving patients in the development of technologies enabling this shift, we as an industry can accelerate decisions that can lead to better outcomes.
About Dr. Fauzia Khan
Fauzia Khan, MD, FCAP is chief medical officer and co-founder of Alere Analytics. Dr. Khan provides direction and leadership to develop practical and scalable technologies that allow clinical decision support and analytic capabilities to be seamlessly incorporated into clinical workflows. She has expertise and passion for algorithm design, knowledge acquisition and engineering as well as data mining and leveraging these capabilities to improve outcomes. Prior to forming DiagnosisOne, Dr. Khan was the director of informatics at UMass Memorial Medical Center with ten years of experience in the hospital practicing pathology. She is the author, editor and primary visionary of the “Guide to Diagnostic Medicine” (Lippincott Williams & Wilkins, 2002).