By: Mr. Harish Kapoor
Founder Director at Quantum Therapeutics (a div. of Dr. I-Net Corporation)
June 20, 2014
Patient empowerment and engagement are the new healthcare models that will improve quality and bring cost saving, by removing the waste and un-necessary care. This will also barricade the fraud which amount over $65 billion a year.
Experts, wholeheartedly concur and believe that the medical patient population is very receptive to cost effective, non-invasive, less pharmaceutical based and alternative approaches to prevent systemic diseases such as diabetes and hypertension.
· Telemedicine – Half a day wait for doctor’s appointment can be very well saved by telehealth.
· Day-to-day and chronic disease care: Patient Centered Medical Homes are a step in the right direction.
· Employees are thrilled to avoid risky and expensive procedures. It also sent a great message to employees that their employer valued them enough to send them to the best medical centers in the world for second opinions.
· Wellness & Data analytics – provides structured clinical intelligence to predict disease and patient behavior
Patient Engagement, Is the therapeutic Drug of the Century
Rather than denying claims and building up a mountain of ill will, insurance companies should invest resources in helping their customers get engaged in their health. Their customers would, in effect, “self-deny” their own claims.
Patient engagement, also include family members and caregivers. For more than our total spending on Medicare! Having more resources/tools as a caregiver would be welcomed as most of us have no clinical background and are thrown into a care giving role virtually overnight.
Patient Engagement can be in the best interest of Health Plans’
Doctors and even nurses can be less effective at effecting behavioral change in patients than non-typical care team members. Whereas health coaches play a vital role in the successful models. Once again, while the goal is an improve health outcome, there is a second order benefit that being more effective lowers costs by avoiding complications and the medical assistants and health coaches are generally paid less than doctors and nurses.
Any system that profits more from people with “problems” than those without is destined to collapse. Our system is opposed to the goal of every person I see: to stay healthy and stay on as few drugs, have as few procedures, and avoid as many doctors (and drug companies) as possible.
Health insurers have implicitly viewed their customers as adversaries by creating a claim-denying framework as the default. The smart health plans will figure out how to harness the consumer goal that to stay healthy and generally avoid doctors, drugs and procedures as much as possible.
While financial rewards are important, most physicians are not motivated primarily by money but by autonomy, mastery and purpose. In the aforementioned successful models, the physician-entrepreneurs created their own autonomy and recognized the focus of their mastery and purpose had to fundamentally shift. A nice outcome is the empowered and educated patients better understood the significant risks of over treatment and errors.
Frequently, health plans have tried to micro manage clinical processes. With proper financial incentives combined with move towards enabling clinical teams to become masters at driving patient engagement, the health plan is much more likely to achieve the outcomes they desire. As the Stephen Wilkins pieces linked to above illustrate, clinicians haven’t been trained or rewarded directly or indirectly for encouraging patient engagement. It should be no surprise that most haven’t achieved mastery in helping their patients achieve patient engagement. Instead, the language of medicine has been punitive and demeaning talking about “non-compliant” patients as though they were petulant juvenile delinquents. That doesn’t further the partnership between patients and their care teams which is necessary for optimal outcomes.
Patient engagement can be the best case of post ACA era. It’s clear that past efforts by health plans to reduce claims have fallen short and created ill will and sub-optimal health outcomes. Putting the patient/member at the center, need not be a marketing gimmick. Rather, it’s central to a winning strategy in the fee-for-value era.