17 Aug How to re-imagine patient compliance to improve patient health and your bottom line
Patient compliance is a topic that has been discussed, examined, debated, chatted about, strategized over, and written about for decades. Never before has the topic been as prevalent in a time of rising healthcare costs, which are projected to hit $6.2T in 2028. To be fair, every topic is relevant and prevalent when discussing this astounding figure. Insurance, premiums, hospital charges, drug pricing; its all fair game.
Why then, with so much on the table, is patient compliance so critical?
The primary reason is because, if a patient is “non-compliant,” all the treatment, all the money, all the resources are for naught. When a patient has a heart attack and then goes right on eating burgers, fries, milkshakes, and smoking cigarettes every day, the likelihood of a repeat event is high. This has an incredible impact on the cost of care, which may have been avoided in the first, or second place.
With the value of prevention established, it is no profound leap in logic to see why patients doing what their doctors tell them, is so important. It is important to the ballooning cost of healthcare, to the health of the patient, and often to the bottom line of their care provider.
Here is the rub. When you were younger, or older for that matter, and your mother told you that you shouldn’t be so stressed and to get more rest, how many times did you take her advice? What about when your physical therapist told you to stretch three times a day? Did you do it? Or when your doctor told you to cut out the bacon? How much bacon did you eat the next week?
The rub is, we don’t just unilaterally listen to advice people give us, regardless of their perceived or real authority. Its why people don’t get in shape until they want to get in shape.
Even the simple act of using the word “compliance” is the wrong way to think about the topic. Compliance is taking orders. It is accepting what someone tells us and then carrying out their directive. We should listen to our doctors, those with more knowledge and experience than us, but we don’t. Because we are human.
So instead of focusing on telling patients what to do and thinking in terms of compliance, we need to think in terms of Patient Engagement.
We have all heard it. We have all read about it. But that doesn’t mean that healthcare providers have whole heartedly adopted the approach. Why? Probably because we don’t take advice or direction well. And we will not be poised to promulgate patient engagement until we are ready to do so.
Herein lies the transformation, from compliance to engagement. While engagement seems a bit touchy-feely, it is a very pragmatic approach to get patients involved in their healthcare so that they will get healthy and hopefully stay healthy.
Patient Engagement impact
No matter what care setting you are in, there is a benefit to lowering cost of care. In a hospital setting, reducing readmissions improves CMS reimbursement by avoiding penalties. In most post-acute settings, which use capitated payment models, lowering cost is always critical. In bundled payment procedures, lowering cost leads to higher profitability.
One thing that will always have an impact on cost, is whether a patient listens to their care provider and does what they say. If not, it could lead to longer hospital stays, which lowers opportunity costs for new patients and procedures due to capacity and resource constraints. It could lead to more care being needed to provide for a Medicare payment in a capitated setting leading to lower profit margins. It certainly leads to the entire healthcare cost balloon continuing to inflate.
Obviously, it is challenging to suggest that the impact in one care setting is the same as any other care setting. Orthopedic surgeons in Physician owned ASCs are going to be impacted differently than a Critical Access Hospital. The reality for hospitals, is that the less patients that come through the doors, the less revenue they can generate.
What then, is the upside for patient engagement in the hospital?
Altruism aside, hospitals are in the business of treating illness. The more illness there is, the more revenue opportunities there are. But two things are at play in exploring how to capitalize on patient engagement improvement.
The first, we already mentioned: opportunity costs. Patients who are more engaged tend to have shorter hospital stays and fewer complications. On top of what a hospital can realize from the opportunity costs, it can also avoid penalties from complications, see better patient outcomes, and avoid litigation from malpractice claims. Further, hospitals with higher engagement levels tend to have better financial performance measures including higher EBITA and net revenue. Here is a great resource from the Agency for Healthcare Research and Quality (AHRQ) on the topic with a helpful guide.
Secondly, there is another softer cost side related to patient engagement. When a patient is engaged, they usually like you. They like their nurse or doctor and likely have a good overall impression of the hospital. As a result, they are likely to provide high ratings and promote the hospital, doctors, nurses, services, etc. It can also improve CAHPS ratings.
Bundled payments, capitated payments, and value-based payments
In these models it is a little easier to see the value of engagement. The critical component here is improved outcomes and less complications. An orthopedic surgeon that does not have to perform a revision or manage an infection is going to realize greater profitability for the procedure than if there are complications. That is of course, if that surgeon is independent or part of a physician owned ASC. The profitability of the procedure translates to a hospital as well since both will receive a flat bundled payment for the procedure and may incur penalties as the result of complications.
Value-based models are also clear in terms of the upside for improved patient engagement. Reducing any amount of care and costs associated with that care, improves profitability in the model. The same would then apply to insurance companies. Insurers should be all over patient engagement. Truer even for large hospital networks that also insure their populations.
5 Ways to Improve Patient Engagement
With the value established, here are some ways that you can improve patient engagement.
- Know your patients
Patient engagement is not easy. It is more than sending email or text reminders. More than providing online resources for patients or spending 10 extra minutes during an appointment to answer questions.
Think of that frustrating patient that is not doing a good job of controlling their blood sugar. Did you know that they had a neighbor who was helping with meals and accountability, but that neighbor recently had to move away?
Really knowing your patient, is the key to everything in terms of patient engagement. Maybe all it would take is email reminders because your patient is a workaholic who is constantly checking emails on their phone. A twice a day reminder to stand up and stretch would do wonders for their degenerative disc disease.
It’s a hard proposition, especially with physicians spend only 16 minutes with each patient. But if there is a way to engage and know patients, it can make supporting their recovery that much easier. It also leads to the next strategy.
- Leverage technology appropriately
Every one of these strategies is predicated on the effective leveraging of the first one. Technology can be a powerful tool, allowing you to scale education and communication to you patients. But what if your patient population primarily lives in a rural, low-income area and does not have access to the internet regularly? If that is the case, an email appointment reminder service with educational information for follow-up probably would not be the most effective way to engage patients.
That’s why it is always important to first understand patients and then appropriately leverage technology. There are a myriad of tools to help with patient engagement. Here is a list of some that could help:
- Text – simple but even reminders for appointments can make a difference
- Email – Similar to text, this is another personal, 1:1 communication outlet that allows for more robust communication including, education and information
- Patient portals – As above, only patients will have to act to communicate. Can be beneficial when HIPAA compliance is a consideration.
- eCharts – I use the term broadly to mean any portal where health information can be stored and access. Not only used for communication but also as a source of information.
- Patient engagement platforms – there are engagement platforms that are specifically designed to help with patient engagement. They go above and beyond eCharts because the technology is designed in such a way that promotes engagement, not just passively facilitates it.
- Include the patient in decision making and accountability
If you told me you wanted to read more, and I suggested you read at least 10 pages a day, have I helped much? You have probably said that to yourself a million times.
What if you tell an overweight patient who is having trouble managing their diabetes: “eat healthier and lose 15 pounds.” They probably are not going to get very far.
The problem is they are not included in the decision making and there are no accountability strategies. Instead what if you said to the same patient, “I agree that it is a good idea for you to take steps to manage your diabetes better. Generally, I would recommend losing some weight and improving diet. What do you think would make sense for your lifestyle to eat better and lose weight? How would you go about losing 5 pounds over the next month?”
The second instance puts both accountability and decision making into the patient’s hands. They make the plan for themselves, based on their ability and what they can commit to. You are facilitating the plan and the action. Improve the accountability with the technology you have leveraged, whether that is through reminders or through a tracking mechanism. It is not a silver bullet, but a patient is much more likely to follow a plan they made instead of a vague one you told them.
- Set patients up for success
This seems pretty straightforward. You may even be slightly indignant at the suggestion, because after all, everything you do is trying to set patients up for success. But consider the two different places you and your patient are coming from.
Have you used simple enough language so that your patient understands their condition and the steps it takes to manage it? Have you made sure that the tools and resources are available to your patient so they can leverage them as needed? Have you set up a plan that your patient can follow simply and effectively?
We so often take for granted that others know as much as we do or understand the impact the same way that we do. Even the simple language shift we introduced in the beginning of this article, engagement vs. compliance, is important when speaking to patients.
- Make it about family engagement, not just patient engagement
The strategy itself says it all. It can be hard for an individual to stay motivated or disciplined. We all “know” what we should do, but it never seems to be so simple. When family gets involved and engaged, it can be a game changer. A wife and husband both being engaged in the husband’s weight loss will probably yield a better result than if left up to the husband alone.
It may seem inconvenient or difficult, again it boils down to some simple questions and a little extra time. Ask which family members would be able to help best with the care plan. Ask if they are at the appointment and if you could speak with them. Or have a patient include their family in some way. It will help with accountability and motivation to remain engaged.
These 5 strategies may seem deceptively simple, but in the whirlwind of treating so many patients and running a successful organization, they can be easy to overlook. Taking the time to address each and really get to know patients can improve business and your patients’ health.