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Co-authored with Rohinee Lal
Cranfield, UK, [12/06/2023] –
Value-Based Care and Key IT Solutions
Over the last decade, the healthcare landscape has been undergoing a significant transformation, with an increasing focus on Value-Based Care (VBC). The VBC model is a replacement for traditional fee-for-service in which providers are reimbursed based on patient health outcomes and the quality of care provided, rather than the quantity. It places a greater emphasis on preventative care, care coordination, and patient engagement, aiming to reduce healthcare costs and improve overall population health. This transformation has gained momentum in Accountable Care Organisations (ACOs) and Integrated Delivery Networks (IDNs) across the US.
Care management processes in a VBC environment are supported by six types of key IT tools. These include tools to report and monitor performance, identify patient cohorts, risk stratify cohorts, support clinical decision-making, manage care coordination, and lastly, carry out patient activation and engage patients in care delivery.
Patient Activation and Engagement
Patient activation is an individual’s competence and motivation to participate in care decisions and processes, leading to their active participation in decision-making and self-care. Patient engagement, on the other hand, focuses on communication and collaboration between patients and healthcare providers to achieve optimal health outcomes. Both these concepts being interlinked, are essential to the success of VBC. However, among the VBC decision-makers and buyers, executing patient activation and engagement remains a challenge and the IT tools developed to support this fall short.
After speaking with 100s of VBC decision-makers and buyers from ACOs and IDNs across the US about their healthcare IT needs, Signify Research has been able to gain valuable insights into the current processes and challenges faced when using digital patient engagement technology as well as what needs to be improved to alleviate pain points.
Digital Tools to Identify Patient Cohorts for Engagement and their Shortcomings
Across ACOs and IDNs in the US, patient identification is primarily carried out in-house using a mix of automated and manual workflows to extract data from multiple software platforms. While most healthcare providers rely extensively on data to identify and prioritise patient cohorts for VBC, they lack a holistic view of the population due to between systems. The data pulled from these systems is siloed and tends to lack comprehensive information, such as social determinants of health (SDoH) and up-to-date claims data, which is important to understand patients’ health conditions and risk factors. These data gaps make it challenging for organisations to accurately identify patients who will benefit from added support via engagement technology.
Many VBC organisations use a range of risk stratification tools to identify the largest cohorts who will benefit the most from interventions. Some of these tools are incorporated within EHR systems and others are provided through PHM platforms that may incorporate predictive analytics functionality. Despite implementation of these IT tools, many VBC providers need to incorporate manual processes that extract this data into DIY BI tools such as Tableau and Power BI, to run analytics that can be used to identify high-risk patients. Some ACOs have even built their own in-house, analytic tools that help them identify specific patient groups that require targeted care management engagement.
Once these high-risk patients are identified for engagement, telephone communication remains the primary mode of contact, requiring additional manual processes to be carried out by care staff. Alongside telephone calling, some organisations leverage alternative bulk outreach methods such as text messaging, email tools, patient portals, and apps. These outreach tools also require staff intervention in the form of manual administrative tasks and have varied success rates.
Pain Points in Patient Engagement
Providers face significant challenges with engaging patients into care plans, primarily due to patient behaviours and attitudes towards self-care, outdated communication methods, data limitations, and social and environmental situations of the patients.
There is a lack of connectivity with some patients after hospital discharge, attributable to limited awareness about ongoing self-care. Patients often ignore follow-up phone calls from care management teams, do not show up for scheduled appointments, and have an overall disengaging attitude.
Despite hospitals having invested in patient engagement IT, VBC providers continue to face challenges in utilising these tools. They rely on multiple software solutions to locate patient engagement and activation data. Furthermore, patient contact information is often incomplete or inaccurate, making it difficult to connect with individuals. There is also a lack of user-friendly, front-facing care management workflow tools such as dashboards.
Relying solely on patient portals or appointment booking tools is not enough. Many of these portals have complex user interfaces and low usability, making it challenging for patients to navigate effectively. Some patients also lack the necessary IT skills to operate these platforms, requiring additional staff intervention to keep them engaged in care plans.
Furthermore, data limitations such as outdated EHR data, delays in receiving claims data, and the lack of SDoH data hinder efforts to effectively identify and engage high-risk patients from resource-poor communities.
Patient engagement is heavily influenced by social and environmental factors such as socio-economic status, lifestyle, housing conditions, and access to transportation. These factors are crucial as they determine the accessibility to healthcare services. Existing patient engagement tools lack data and solutions to address these factors, posing challenges for VBC teams to effectively outreach and engage with these vulnerable populations.
Improving Patient Engagement from an IT Perspective and its Benefits to VBC
Our conversations with VBC decision-makers and buyers have shed light on their expectations from a patient engagement IT platform. Here are the key insights:
Developing Multi-Channel User-Friendly Patient Engagement Tools: Developing user-friendly solutions that enable patient/provider communication across multiple channels (such as phone, SMS, WhatsApp, email, etc.) and that feature a seamless interface is essential to create a satisfying experience for patients to improve their adherence to care plans. Messaging-based platforms that provide simple call-to-action links that allow patients to easily make bookings, change appointments, access their care plan, and start a virtual consultation tend to have much higher success rates compared to those solutions that do not offer a variety of communication methods and tools.
AI Tools that Provide Intelligence on Patient Behaviour: VBC providers would find it beneficial if their patient engagement tool could offer guidance on the most effective ways to connect with specific patients. This includes determining the optimal time of the day or day of the week to conduct outreach activities per patient to ensure success, and whether communication directly with the patients themselves or via their support system upon hospital discharge is most effective. Digital engagement tools that use aggregated data, advanced predictive analytics, and AI/ML could then automatically adjust message content and delivery based on individual responses.
While some tools may already offer this level of insight, there are concerns from both VBC providers and patients regarding confidential data being housed on third-party servers via these digital engagement IT tools. Moreover, many patients are reluctant to share their personal health information on these IT portals. But if general day to day behavioural data can be captured and stored securely, it could be used to provide recommendations on the most successful strategies for patient engagement, leading to broader benefits.
Automated Voice-Based Tools: There have been concerns around the reliability of tools such as chatbots and automated voice-based solutions. This is still work in progress and patients are rather uncomfortable using these tools due to the lack of human interaction. However, the emergence of Large Language Models (LLMs) like ChatGPT and Google Med-PaLM have the potential to change this by improving the quality of the software, ensuring accuracy, and offering a more ‚Äòhuman touch’ experience.
Solutions that Support Holistic Care Management: There is a demand to build more holistic solutions that not only help identify care gaps by providing a complete view of the patient but also engage the identified patients into care management plans. Automated personalised digital outreach that is embedded within EHRs and workflows would be able to highlight missed screenings and vaccinations for patients and enable care teams to act on these insights and deliver more efficient and reliable care.
Automation of Processes: Many existing patient appointment scheduling tools and platforms still rely on staff to repeatedly call patients. Moreover, patients tend to ignore phone calls from unknown numbers, with some staff having to attempt an average of eight phone calls to successfully reach one patient. These administrative tasks are burdensome and time-consuming and divert providers’ attention away from delivering quality care. Developing automated solutions that eliminate the need for manual operations would alleviate the burden placed on providers and decrease care staff burnout.
Interoperable IT Tools: There is a lack of interoperability between platforms utilised for patient identification and care gap closure. When systems don’t communicate with each other, it becomes harder to exchange information and to find unstructured data such as clinical notes. This can lead to providers not focusing on the right patients to target for care plans, impeding patient engagement.
Data Security: Data security is a non-negotiable consideration when it comes to making purchasing decisions for IT platforms. Decision-makers and buyers have emphasised that their topmost priority is to protect patient information and that they would not consider any software unless they are most certain about data security.
Addressing RAF (Risk Adjustment Factor) Gaps: Identifying RAF gaps is essential for accurately representing a patient’s health profile and understanding their overall health status. Developing IT solutions that alert providers at the point of care to address RAF gaps directly with patients attending appointments will help improve the quality of care delivered, the accuracy of treatment plans, and encourage patient engagement in decision-making.
So, what do VBC Buyers Need from Digital Patient Engagement Tools?
Based on our discussions with VBC buyers, there is strong demand for patient engagement technology that offers effective communication channels and insights into patient behaviour. Solutions with a more strategic and intelligent approach to patient activation and engagement are paramount to the success of VBC. It is vital to create tools that improve patients’ attitudes and encourage positive behaviours towards managing self-care while also ensuring ease in accessing portals and apps that enable engagement with VBC providers.
From a technical standpoint, it is essential to develop tools that offer a comprehensive patient overview, are automated, and that integrate smoothly with other care management IT systems to efficiently handle both structured and unstructured data, and most importantly, keep patient data secure.
Software vendors will need to tactically address the above pain points while keeping the needs of both patients and VBC providers central to product development. Focusing on these aspects is key to increasing the rate of patient engagement and, in turn, improving the overall health outcomes of the populations that VBC providers serve.
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Integrated Care and Value-Based Care IT
Signify Research’s 2023 report on the Integrated Care and Value-Based Care Market is due to be published in June 2023.
Key issues to be addressed:
- How has the political landscape, slower than expected move to VBC and CMS changes to ACO risk contacts impacted the US population health management market in 2023?
- What are the prospects for 2023 and beyond?
- To what extent is the integrated care agenda driving demand for PHM products globally and which countries are most advanced?
- How is the US PHM competitive environment evolving Is it EHR vendors, payer-owned vendors or PHM specialists that are having the greatest success in terms of value-based care IT business?
- How is the competitive environment evolving internationally? Are the successful US PHM vendors seeing success, or are regional health IT vendors winning local contracts?
- What will a PHM solution look like in three years’ time? Will product development focus on data aggregation, longitudinal records, financial tools, risk stratification, care management/coordination or patient relationship management?
About Mohita Deshpande
Mohita joined Signify Research in 2023 as a Market Analyst. She has an undergraduate degree in Dentistry from India and a master’s degree in Public Health from the University of Warwick.
About Rohinee Lal
Rohinee joined Signify Research’s Custom Research & Consultancy team early 2022. She brings over 24 years’ experience collecting, analysing, & presenting market intelligence across various industries including pharmaceuticals, medical devices & digital health. She has a master’s in medical Anthropology from the University of British Columbia (Canada).
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