Innovative strategies and creative solutions are being utilized by health care providers across the country to improve the quality of care and reduce costs, as well as to respond to initiatives by payors to do the same. In general, these strategies are focused on the providers’ actions and performance – “what can we do better.” However, as many providers already recognize, patients are essential partners in improving the outcome of their care. To approach improving outcomes in a comprehensive manner, providers must incorporate additional solutions centered on patient behavior and post-discharge compliance with medical instructions.
Given the pressures on shortening the time practitioners spend with patients and the challenges of discerning patients’ key characteristics and circumstances in brief interactions, a comprehensive, easy to administer test of these non-medical factors in self-management is an essential tool for today’s health care providers. PPI’s Patient Performance Enhancement Test (PET) provides that tool.
Why Invest in Patient-Centered Solutions for Better Outcomes
Improving patient outcomes has moved from an aspirational goal to an absolute necessity in today’s health care industry. Commercial payors are increasingly pushing providers to go “at risk” for patient outcomes using an “accountable care,” “pay for performance” or “gainsharing” approach. Government payors (Medicare and Medicaid) are moving towards this same approach, as evidenced in the Medicare Accountable Care Organization (“ACO”) and Pioneer initiatives, among others. Providers who do not have a vision for responding to the focus on outcomes will fall behind not only in terms of quality and reputation, but also receivables from payors.
A specific area of continued focus is reducing the number of unnecessary readmissions to hospitals, as a proxy for demonstrating better outcomes. Not only is the quality and efficacy of the patient’s care at stake, but so is the hospital’s bottom line. The Medicare program has instituted penalties for hospitals with higher than expected readmission rates starting in FY2013, affecting over 2,000 hospitals nationally. Beyond the Medicare considerations, cutting excess readmissions can save the average hospital 9.6% of the average budget, according to one study. And many of the commercial payors and government health programs are using readmissions as a measurement factor in their incentive programs for providers. Thus, ridding the system of unnecessary readmissions is good for everyone.
At the same time that these quality and reimbursement reform initiatives are being instituted, various trends have transferred a larger role to patients in ensuring they reach the best outcome possible. Advances in surgical and other inpatient treatments have led to earlier discharges with more responsibilities for self-care at the home. (Indeed, decreasing “length of stay” is a common methodology that payors are using to assess whether providers are entitled to the pay for performance/gainsharing payments – thereby directly incentivizing transferring the patients to self-care earlier.) Similarly, better drugs have resulted in expectations that individuals with chronic conditions – diabetes, heart disease, cancer, HIV/AIDS, etc. – manage their drug regimens and other care instructions (pain management, exercise, diet) largely on their own from a day to day perspective.
Thus, investing in improvements to patients’ abilities to appreciate and execute on their health professionals’ instructions for self care benefits the entire health care system. Not surprisingly, a number of sources have called for better tools to test individual patients’ capabilities in this area. PPI has developed the PET to provide this tool.