Patient engagement: No longer optional, Part 2
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Focus on: Digital Transformation in Health |
Part 2: Unbounded ways to collaborate with and empower patients
If you missed Part 1, you can find it here: Part 1: It takes engaged clinicians to engage patients
In Part 1, I proposed we upgrade our aging definition of patient engagement to one that makes more sense in the emerging fee-for-value practice model: The unbounded ways that organizations and clinicians collaborate with and empower individuals to take actions to maximize their health and realize the greatest value from care. Part 2, below, is my interview with Elan Hekier, MD, Chief Medical Information and Innovation Officer of San Diego-based Sharp Rees-Stealy Medical Group where it didn’t take long for me to realize that they were taking an exceptionally effective, “road less traveled” approach to patient engagement. The following is a transcript of my conversation with him.
A bright spot: Sharp Rees-Stealy Medical Group
Schmuland: Before we get started, could you just give me an overview of your role and the scope of services and footprint of Sharp Rees-Stealy Medical Group?
Hekier: I’m a pulmonary-critical care physician for Sharp Rees-Stealy Medical Group which is part of Sharp HealthCare, San Diego’s largest integrated healthcare system. We have 22 sites of care that offer primary and specialty care, laboratory, physical therapy, radiology, pharmacy and urgent care. We have 500 physicians and 2,800 staff members who are dedicated to delivering the extraordinary level of caring called The Sharp Experience, which combines clinical excellence, advanced technology and patient- and family-centered care.
The road to empowering patient engagement
To really reap the benefits of patient engagement–improved care outcomes, healthier lifestyles, and faster recovery, you need an empowerment platform that empowers consumers and the clinicians they trust to stay connected and communicate about the things that matter most to them during the 5000 hours between office visits.
– Elan Hekier MD, Chief Medical Information & Innovation Officer, Sharp Rees-Steely Medical Group
Schmuland: Tell me a bit about your journey from fee-for-service to fee-for-value and the challenges and trends related to the current and changing payment models?
Hekier: It was 36 years ago that we took on our first risk-based contract and, since that time, have never looked back. About 70% of our revenue today is prepaid, which represents about half the 400,000 patients we currently provide care for, and that percentage grows almost every week.
Schmuland: I’m especially interested in the evolution of your thinking and strategy around patient engagement. How did it start out and how did it evolve to what it is today – because it’s clear to me that, unlike most health systems that are still dabbling with patient engagement, SRSMG is all in. What’s your story and strategy?
Hekier: We first built our own in-house portal back in 2008—messaging and appointment scheduling that was integrated with four unique practice management systems. But by the time Meaningful use stage 2 under ARRA and the attestation program under the HITECH Act of 2009 came along, we realized that we would need to invest in a certified third-party portal platform – because when we did the math, we realized that the cost certifying our own portal would have been prohibitive.
We had a portal but we realized that we needed to reframe patient engagement as a strategy rather than a portal – because a patient portal wasn’t really a patient engagement strategy. Portals are certainly necessary, but they’re also insufficient to drive engagement. We knew had to think much bigger about patient engagement than our portal.
Schmuland: What exactly do you mean when you say, “thinking bigger about patient engagement?”
Hekier: The way we do patient engagement today, as you’ve aptly defined it—”the unbounded ways that we collaborate with and empower our patients”–is extremely labor intense and time consuming. So we had to find the right technology partner and solution that could amplify human efforts around empowerment, collaboration, and goal reaching without the usual one-size-fits-all design that we see with most HIT solutions.
Most health systems think of patient engagement as a program, a portal, or an app. But for us it’s a strategy and culture of empowerment that’s woven into the way we practice medicine every day. The portal isn’t an afterthought, but a core channel for our care.
We believe that patient engagement starts with leadership, ends with the patient, with every physician and care team engaged between the two. To really reap the benefits of patient engagement–improved care outcomes, healthier lifestyles, and faster recovery, you need an empowerment platform that empowers consumers and the clinicians they trust to stay connected and communicate about the things that matter most to them during the 5000 hours between office visits. For us that empowerment platform is Allscripts® FollowMyHealth.
FollowMyHealth empowers our patients and their families to continuously communicate with their physicians and be active members of their own care team without having to log into and out of multiple portals tethered to each of our four different EHRs. It empowers our clinicians to track how well patients are sticking with their care plans and offer a helping hand to help them get back on track when it looks like the patient is struggling or stuck. It also supports e-visits, including asynchronous messaging and virtual visits.
Engaged physicians engage patients
I don’t have to order records, wait days to get them, and then sift through them. I also now have the peace of mind that, when a patient is under the care of three or four specialists, that their care is being coordinated because they’re all interacting with the patient between office visits and everyone is on the same page regarding next steps.
– Elan Hekier MD, Chief Medical Information & Innovation Officer, Sharp Rees-Steely Medical Group
Schmuland: Can you give me some examples of how FollowMyHealth has changed the way your clinicians practice?
Hekier: Our clinicians are very mindful that, in the fee-for-value model, what happens with patients outside the four walls of the clinic or hospital is more important than what happens inside the four walls. So they’re constantly using FollowMyHealth to digitally coordinate care and communicate, not just with the patients, but also among themselves. Patients love the fact that our clinicians can address so many problems or concerns through FollowMyHealth or a virtual visit because they can avoid waiting in traffic, lost wages, waiting time, and the inconvenience of an in-person visit.
What’s changed in my own practice is that caring for patients is easier now than ever before because I know so much more about them as they’re being seen by my colleagues and I have all that information at my fingertips. I don’t have to order records, wait days to get them, and then sift through them. I also now have the peace of mind that, when a patient is under the care of three or four specialists, that their care is being coordinated because they’re all interacting with the patient between office visits and everyone is on the same page regarding next steps. For a patient with diabetes that also has tuberculosis, for example, I’m just the one physician handling their tuberculosis but FollowMyHealth enables me to see that those patients are also getting their foot exams, retinal screening exams, and blood sugars under control. The left hand not only knows what the right hand is doing, but the motions of each hand are intentionally coordinated.
While physician burnout rates are the highest on record, our burnout rate is much lower, mostly, I believe, because it’s the small wins that patients report back to their physicians that are the most rewarding and can bring the joy back to the practice of medicine. Like when the patient reports back that they’ve followed their care plan and lost 10 pounds or brought their blood sugar, cholesterol, or blood pressure into the normal range when nothing else previously had worked.
Schmuland: Can you give me an example or two of how the patient experience has changed with FollowMyHealth?
Hekier: We’ve taking the pain out of scheduling for patients by self-scheduling their appointments, especially same-day visits. But even more complex ones. This one really happened. While at his wellness visit a 65-year-old gentleman’s primary care physician reminded him he was due for a colonoscopy. Ordinarily, the physician would have handed the patient a paper referral and instructed him to call and schedule procedure – which could take weeks or never happen at all. Instead, the patient gets an email the next day from the gastroenterologist with instructions for the procedure and options to self-schedule. The patient immediately scheduled the procedure himself.
Schmuland: What would you say sets SRSMG apart from the competition?
Hekier: Without question, one of our greatest differentiators is how we’ve made patient engagement a strategy and a culture of empowerment – for both clinicians and patients. The reason we know it empowers our clinicians is the fact that 100% of our 500+ physicians and 100+ advanced practitioners use it. It’s the way they practice medicine. To get to this point we continuously train our staff and patients – and we’ve now reached the 50% mark on patient enrollments and at least one of our facilities has reach the 25% point for self-scheduling. Which brings up another key differentiator. Our physicians are the “influencers in chief” in asking their patients to enroll. Their influence is so much more powerful than phone calls or letters in the mail–which reflects the power of the patient-physician relationship. When your personal physicians say, “If you use FollowMyHealth, I can provide better care for you and communicate with you between office visits – and maybe avoid some,” why wouldn’t a patient enroll?
Parting advice
Schmuland: What advice would you offer to your peers who may be a bit earlier in their journey toward fee-for-value payment models and looking for the best way to partner with their patients to maximize their health and realize the greatest value from care and reduce waste, inefficiencies, and costs?
Hekier: The advice I’d offer to our peers is to ask the question, “Does the technology empower and amplify the efforts of patients and the physicians they trust and does it strengthen the trusted patient-physician relationship that every patient and physician values and fights for?” If it doesn’t do both, keep looking.
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