In January 2019 the Merit-Based Incentive Payment System (MIPS) began adjusting payments based on quality care data. While MIPS is a step in the right direction to further provide value-based care for patients, health systems and clinicians now face new considerations due to these regulation changes.
More than ever before, care teams need to be able to nurture patient relationships and prove patients’ needs are being met in their medical care programs. When faced with increasing patient numbers, care teams often look to tech solutions to improve patient care reporting and to keep patients from slipping through the cracks.
But sometimes these tech solutions prevent teams from proving their results due to breakdowns in data collection and reported patient outcomes.
Here are five signs that signal when patient relationship reporting needs to improve:
1. No Data to Prove that Your Program Works
Without the right metrics, it’s difficult to justify to payers that your program is effective. For instance, health insurance plans want to know that the care they pay for helps patients meet their health goals. Without data to back up the program’s effectiveness, will the health plan continue to pay for it?
Your program needs the right data to prove it works. For example, reports on staff efficiency are important for health care providers but these metrics won’t sell the program to other decision-makers.
Outcome-driven data is the best way to show the ROI of your program. By gathering information for variables including symptom management or weight loss, health staff can demonstrate how your program moves patients toward their health goals.
Consider chronic pain management programs. How do care teams gather reports on pain that’s shifted from being a symptom to an actual illness? While pain levels may be subjective, there are straightforward ways for teams to gather data on chronic discomfort.
Health staff can validate pain management programs by regularly collecting self-reported pain scores and information on the patient’s condition from patients themselves. As they help patients with medical conditions such as fibromyalgia, osteoarthritis and chronic back pain, teams can show the effectiveness of their program through patient care reports that track how their patients’ pain scores improve.
Clinically Validated Research
Patient assessments and surveys are another way to validate patient relationship programs. With these types of reporting methods, patients can describe their quality of life and overall progress.
For instance, in a self-management program for diabetes, questionnaires allow teams to keep medical records up-to-date with patient information such as glucose levels, energy levels and other complications such as depression. While gathering data to improve patient care, care teams can also gain useful metrics to support the continuation of PRM programs.
2. Patients Are Dropping Through the Cracks
If care teams can’t identify when patient drop-off occurs, they need better reporting systems. After all, how can patients receive the quality care and attention needed if no one knows when their condition is becoming more difficult to manage? This needs to go beyond a typical EMR’s record of patient demographics, medical history, and health information because multiple other factors affect a patient’s ability to manage their condition.
For example, drop-off rates in type 2 diabetes management can contribute to worsening symptoms. Around 47 percent of these patients have poor glycemic control, meaning they aren’t fully following through on care plans. If care teams are able to intervene in situations like these, health systems could better control costs and optimize resources.
To address patient drop-off, care teams need a way to view patient engagement each step of the way and adjust their electronic patient care appropriately. By monitoring progress in phases, they’re able to assess and intervene accordingly.
3. Unable to Track Interactions with Patients
Building and maintaining relationships requires meaningful interactions. For health care staff, however, maintaining patient relationships is difficult given the number of patients they care for. Without the right digital tools, care teams may find patient care reporting difficult.
Care teams need methods to record and view their interactions with patients. Some patients, for instance, regularly reach out for help while others prefer to fly under the radar. Since every patient is different, care teams need to know when and where to connect with patients based on their behavior patterns.
Every communication channel should be monitored. While some lend themselves to easier tracking than others, it’s difficult to record all conversations in one place. That’s why Welkin allows for integration with all major channels so healthcare providers can communicate where patients feel the most comfortable and track every single conversation.
Care managers also need to be able to monitor who they haven’t interacted with recently and who receives the bulk of their attention. In this way, teams can reach out to patients who may not normally reach out for help.
4. No Tracking of Expenses Versus Savings
With health tech solutions, there’s a balance between cost per patient and savings per staff member. That’s why PRM software should allow program directors and care teams to analyze staff efficiency while comparing it against patient expenses.
There’s a point at which PRM solutions could cost health care more than they’re worth.
Consider these questions:
- How much does it cost to have patients go through this program? Many health care organizations don’t actually know the cost per patient. PRM software can help provide the big picture so directors and administrators have a clear understanding of what their program costs.
- Is this solution saving health staff time so they can invest in more patients? Often technology solutions promise to save staff time, but many don’t follow through. Your PRM solution should enable your staff to automate simple or repetitive tasks so they can spend more time focused on patients.
- Are patient outcomes improving at a rate that can’t be achieved more cost-effectively? Health care providers may have little insight into how a program has improved patient outcomes. By keeping track of clinically validated patient assessments and patient-reported outcomes, PRM software can help prove that the program does improve patient outcomes.
In an ideal world, per-patient cost would decrease while care team efficiency would increase. And while achieving the perfect balance may never fully happen, patient care reporting should allow care teams to carefully evaluate these factors.
5. Inadequate Tracking of Care Manager Performance
When a program focuses on patient relationship management, there needs to be a sense of consistency. Program directors need to know if patients are receiving the same level of care and attention—regardless of their care team.
On the care team level, managers need to be evaluated based on procedures, efficiency and effectiveness. PRM software should allow directors to evaluate performance not only patient progress but in relation to other coaches.
Relationship reporting impacts patient outcomes and the possibility of scalable health care. By addressing these issues, health care can ensure a stable level of quality care for patients while validating the workflow of care teams.
Read “Why Health Care Companies Struggle to Scale” to learn more about improving ROI while meeting patient needs.