What You Should Know:

– Medical Home Network (MHN), a leading care enablement partner for FQHCs, announced that its partners participating in the NeueHealth Premier ACO achieved $10.1 million in gross savings and a perfect 100% quality score in the 2022 performance year.

– This accomplishment, under the ACO Realizing Equity, Access, and Community Health (REACH) Model, involved 20 FQHCs across Ohio, Missouri, and Illinois serving approximately 10,000 Medicare beneficiaries. The success highlights the effectiveness of MHN’s collaborative approach and its commitment to empowering FQHCs in value-based care.

MHN’s Team-Based Care Model Drives Results

The key to this success lies in MHN’s unique team-based care model. By providing culturally tailored, whole-person care, MHN’s approach empowers FQHCs to:

Hire and train care coordinators and managers: These dedicated professionals provide comprehensive support to patients, addressing both clinical and social needs.

Leverage AI-powered risk assessments: MHN’s proprietary technology identifies patients at risk for adverse events and helps prioritize care interventions.

Utilize performance analytics: Data-driven insights guide care teams in closing care gaps, reducing unnecessary emergency department visits, and optimizing inpatient utilization.

Significance for FQHCs

With over 30.5 million Americans relying on FQHCs for their healthcare, their inclusion in value-based care models is crucial to achieving equitable and efficient healthcare for all. MHN’s success story demonstrates the potential of FQHCs to excel in this domain, paving the way for broader participation and improved health outcomes for underserved communities.

“These nationally leading results are early proof that FQHCs can benefit from our team-based model of care and thrive as they enter value-based care arrangements,” said Cheryl Lulias, president, and CEO of MHN. “This also shows ACOs led by FQHCs can achieve stellar results.”

What You Should Know:

– A new survey by Artera, a leader in patient communication technology, reveals a stark disconnect between how healthcare providers communicate and what patients actually want.

– The findings, based on responses from over 2,000 patients, paint a picture of frustration and missed opportunities, with simple phone calls and one-dimensional text messages falling short of patient expectations.

Communication Breakdown

– Nearly half (45%) of patients have missed or forgotten a bill due to communication difficulties with their provider’s office.

– 43% report negative health impacts from communication challenges, including issues scheduling appointments or sharing crucial information.

– A staggering 79% of patients want providers to offer text-based conversation on any topic, highlighting a desire for more convenient and accessible communication.

Texting: A Double-Edged Sword

– While 77% find automated text exchanges valuable, simplistic “yes/no” interactions dominate, frustrating 69% of patients who long for deeper conversations.

– Two-thirds report incomplete text experiences, with 31% failing to achieve their goals at least half the time, often resorting to phone calls.

– Technical glitches and unanswered messages further exacerbate the problem, with 62% experiencing error messages, invalid responses, or radio silence from providers “half the time” or more.

Financial and Human Costs

– Providers failing to meet communication expectations face financial consequences, as 59% of patients are willing to switch doctors due to poor communication.

– Artera’s research sheds light on the impact on healthcare workers as well, with a December 2022 report finding outdated communication strategies contributing to staff burnout.

Guillaume de Zwirek, CEO and Founder of Artera, emphasizes the importance of patient-centric communication: “As a $4 trillion market, healthcare should offer unmatched customer experience. If patients can’t communicate seamlessly, they won’t engage, leading to a sicker population and more expensive care long term.”

What You Should Know:

– Zocdoc, the healthcare marketplace, has released its inaugural What Patients Want Report, offering valuable insights into what patients seek from their healthcare experience and providers.

– Based on millions of bookings and patient interactions, the report paints a picture of how patients are navigating the healthcare landscape today, and what they expect from their providers and the industry at large.

Key findings of the report include:

• Women driving appointment bookings: Women are more proactive in booking appointments, with Millennial women leading the charge in booking on behalf of others.
• In-person visits and timely access remain crucial: Patients prioritize in-person appointments and prefer to schedule them soon after searching.
• Gen Z leads in mental health bookings: This age group seeks mental health care more than any other, reflecting a growing awareness and prioritization of mental well-being.
• Patient Empowerment Index reveals room for improvement: The inaugural index reveals moderate patient empowerment, with nearly 1 in 5 Americans feeling they have little control over their healthcare and 15% facing access challenges.

Predictions for the Future

• Mental health boom: Mental health bookings are expected to surge in the latter half of 2024, potentially influenced by upcoming elections and increased awareness.
• Convenience triumphs tradition: Patients will prioritize convenience and accessibility for routine care, potentially impacting traditional healthcare models.
• AI to the rescue: AI advancements will free up valuable time for providers, allowing them to focus on personalized patient care.
• Big Tech’s muted impact: Despite heightened noise from tech giants, their actual influence on healthcare delivery is likely to remain limited.
• Digital consolidation: The landscape of patient portals and digital front doors to healthcare will likely see consolidation, offering a more streamlined experience.
• Savvy prescription shoppers: Patients will become increasingly informed and empowered to compare medication prices and make informed decisions about their prescriptions.

The report emphasizes the need for healthcare providers and systems to adapt to evolving patient preferences. By prioritizing patient-centered care, focusing on convenience and access, and leveraging technology for greater efficiency, the industry can empower individuals to take control of their health and wellbeing.

“As the leading healthcare marketplace, we offer patients the ability to search and book with nearly 100,000 providers across every specialty, every state and every segment,” said Zocdoc founder and CEO Oliver Kharraz, MD. “By aggregating a diverse array of providers that patients can choose from, all in one place, we empower them to have more control over their care. We are proud to give voice to what patients really want by highlighting emerging trends and preferences expressed through the millions of bookings made through Zocdoc each year.”

Patient Empowerment Index Survey Methodology

Zocdoc commissioned Censuswide to collect this data via an online survey of 1,000 U.S. consumers aged 18 and up. The survey was fielded November 14 to November 16, 2023. Respondents were assigned scores based on their answers to the three questions. These scores were then averaged to find the Patient Empowerment Index number, ranging from -80 to 120. Censuswide abides by and employs members of the Market Research Society, which is based on the ESOMAR principles.

What You Should Know:

– Clover Health, a physician enablement company committed to bringing access to great healthcare to everyone on Medicare announced that it has delivered notice to the Centers for Medicare and Medicaid Services (“CMS”) that it will exit the CMS ACO REACH Program at the end of the 2023 performance year.

– Written notification will also be sent to all participating physicians in accordance with CMS requirements.

– The decision will have no impact on its ACO REACH beneficiaries, and Clover will continue to fulfill all of its obligations under the ACO REACH Program for the 2023 performance year.

Strategic Decision to Focus on Medicare Advantage

Clover Health’s CEO, Andrew Toy, explained the company’s decision to exit the ACO REACH Program:

“When we entered the ACO REACH business in 2021, we felt that expanding our platform to Original Medicare would have a number of benefits, including increasing the number of lives under Clover Assistant management and enabling us to rapidly increase the number of physicians we worked with directly. And, while we were successful in those goals, we have not seen a clear line to profitability in this business and it has also become quite clear that, over the same period of time, we have made far greater and swifter strides on our path to profitability in our Medicare Advantage insurance business.”

What You Should Know:

• NextGen Healthcare, Inc. a leading provider of innovative, cloud-based healthcare technology solutions, today announced that its clients participating in the Medicare Shared Savings Program (MSSP) leveraged NextGen® Population Health to achieve a cumulative $82 million in total Medicare savings last year.
• The MSSP incentivizes hospitals, associations of physicians, and other healthcare facilities to form accountable care organizations (ACOs) that optimize resources to save costs and better serve Medicare beneficiaries in their communities.

NextGen’s Impact: Transformative Results in MSSP ACOs Across the Nation

In 2022, nine NextGen Healthcare clients across the nation took part in MSSP ACOs, marking the most recent year for available data. Through the implementation of NextGen Population Health, these entities seamlessly incorporated actionable patient insights into electronic health record (EHR) workflows, ultimately enhancing engagement and elevating the quality of care provided to attributed beneficiaries. With an improved capacity to pinpoint and address gaps in care, the MSSP ACOs demonstrated noteworthy advancements in quality performance. The collective outcomes for the 129,000 Medicare beneficiaries served included:

– Total Medicare savings amounting to $82 million

– Shared savings reaching $42 million

– An average shared savings of $27.85 per member per month

– An impressive average quality score of 83.9%

Hutchinson Clinic, a NextGen client catering to South Central Kansas and representing a network comprising over 100 physicians and 600 employees, actively participated in an MSSP ACO during the same period, achieving savings for their Medicare beneficiaries.

“As the healthcare landscape increasingly shifts towards value-based care, NextGen Healthcare is helping ACOs leverage data and actionable insights at the point of care to reach evolving standards of clinical and financial excellence,” said Srinivas (Sri) Velamoor, chief growth & strategy officer for NextGen Healthcare. “We are proud to support our clients’ commitment to providing high-quality and cost-effective care for Medicare patients and manage their transition to risk-based arrangements.” 

It’s no surprise that healthcare is doubling down on software investments for healthcare revenue cycle, including software with an AI component, like predictive analytics. What’s unique is that right-now value from AI in revenue cycle is happening outside the walls of a healthcare facility or medical practice. In fact, it’s originating from the device patients use most: their smartphone.

For specialty groups in particular, the ability to successfully engage patients in their financial responsibility for care can significantly strengthen financial stability and their ability to invest in new services, equipment, staff development and more. That’s especially true for rehabilitative therapy groups, where patients may have two to three visits per week, generating a claim for each appointment.

At a time when many consumers say they pay medical bills faster when they receive payment requests digitally—especially when these requests come by text (49%, according to a recent U.S. Bank survey)—leading specialty groups are exploring mobile payment strategies with an AI component. The best strategies incorporate a data-informed approach that is grounded in predictive analytics.

Applying Data Science to Healthcare Mobile Pay

The value of digital payment for medical expenses extends beyond improved cash flow, although that’s certainly a key consideration. The U.S. Bank survey indicates consumers want mobile options for medical payment. Part of the attraction lies in the convenience of a digital approach, which gives consumers the ability to pay their bill anytime, anywhere, just as they have become accustomed to paying for retail purchases. 

The appeal of mobile goes beyond payment. More than half of consumers (56%) also would be comfortable resolving billing questions via live text chat or video chat. 

But leading specialty groups go beyond a plug-and-play, text notification-based mobile payment approach. They also incorporate predictive analytics, exploring aspects of patient financial engagement such as:

• The patient’s past history of medical payment
• The likelihood that a patient will pay their bill—and the speed with which the patient is likely to do so
• The individual’s communication preferences—critical given that some patients still prefer paper-based payment

They also incorporate behavioral science techniques in crafting the messaging associated with text-to-pay, down to the first words a patient sees on the screen. For example, one specialty practice decreased inbound customer services calls from 15% to 12% when it analyzed consumers’ most frequently asked questions and sought to answer these questions on the first screen patients see when they log onto the payment site.

The easier it is to take action, the faster consumers will pay their bill—sometimes, within seconds. That was the case when Integrated Rehabilitation Group (IRG), a 40-location physical therapy group based in the Northwest, implemented a text-to-pay solution at the start of 2023.

Making the Right Moves for Mobile Pay

At the time, IRG was seeking a way to stay ahead of the cash flow challenges specialty groups typically face at the start of a new year, when healthcare deductibles and out-of-pocket limits reset and most healthcare expenses shift to patient responsibility. It’s a period when patients tend to take more time to pay their medical bills. But the pandemic also had added extra financial stress for IRG. What used to be a 12% no-show rate had grown to 20%. Also distressing: overall volumes had been slow to return to pre-pandemic levels. 

As CFO for IRG, I knew the results other specialty groups had experienced, with 43% of patients who click on a payment link received via text going on to pay their bill. With pent-up demand for therapy, we knew a payment rate like this not only would help us overcome sluggish cash flow at the beginning of the year, but also set us up for success over the long term. 

What we didn’t expect is that we would begin to receive payments within minutes of turning on our digital payment function—or that our rate of payment, at 60%, would surpass the average experience by other groups. It’s a rate of return that helps position us to open new clinics, expanding our footprint to meet the increased demand for rehabilitation services, with four new clinics opened in 2023 alone. It has also empowered us to introduce new services, such as rehabilitation for patients suffering from traumatic brain injuries, concussions, and cognitive challenges.

Within months, IRG’s cash collections doubled—and they’ve remained at this level for the past eight months. We’re seeing patients pay sooner and with fewer questions, freeing staff to focus on more value-added activities, such as patient education.

Establishing the Foundation for a Mobile-Smart Approach

As providers of all types cite revenue cycle management as an area of increased focus, performing due diligence to determine what works—and what works better than most—is essential to capture optimal value. In addition to taking a data-based approach to digital payment, key steps that set the stage for success around mobile pay at IRG include the following.

Sending the right communication at the right time—and in the right format. It’s not good enough to simply have the mechanism to send a text bill. To avoid digital fatigue, specialty groups must be careful not to overload consumers with text reminders around medical payment. Look for a mobile payment provider that uses a Dunning engine to determine when, how and what to communicate to make the greatest impact. 

For example, some physician groups wait seven days to send an electronic reminder. They might also send a paper statement at this point to get a feel for how patients wish to receive communications around payment—and use this data to inform future communications. Engaging patients through their preferred method adds a level of personalization that drives higher conversion rates and patient satisfaction. 

Creating a seamless mobile payment experience. The best mobile payment functionality makes it easy for consumers to navigate from a text to their bill, without having to log onto a portal. This enables them to pay their bill with just a couple clicks. IRG learned the value of seamless navigation from its previous efforts to incorporate online bill pay on the therapy group’s website. While a link for online bill pay existed, it wasn’t easy to find—and consequently, online payment rates were low.

Integrating mobile payment with the specialty group’s electronic medical record system. This is the only way to be sure the amount patients see is accurate—and that’s vital to establishing trust and, ultimately, securing engagement. At IRG, mobile payment integrates with a practice management system that is specially designed for rehabilitative therapy practices.

About Janet Carbary

Janet Carbary is the CFO for Integrated Rehabilitation Group (IRG) and a member of the client advisory board for PatientPay.

What You Should Know:

– Edward-Elmhurst Health (NS-EEH) has announced a significant, long-term partnership with Lumeris, a pioneer in value-based care (VBC). This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018.

– With rising expenses outpacing reimbursement rates, health systems and physician organizations are increasingly turning to value-based care to avoid layoffs and service cuts. NS-EEH, the third largest healthcare delivery system in Illinois, comprises nine hospitals, 25,000 team members, and 300 local offices, serving over 4.2 million residents.

Collaboration aims to drive coordinated care and improve quality while reducing costs

NS-EEH will strengthen its clinically integrated network (CIN) by incorporating Lumeris’ population health data platform into its value-based care strategy. The two organizations also plan to deliver joint services, supporting the CIN’s healthcare providers in care management, pharmacy management, patient engagement and other key areas. NS-EEH’s CIN includes more than 3,000 system-employed physicians, affiliated physicians and advanced practice providers, and nine hospitals across Chicagoland.

In collaboration with Lumeris, the organizations will manage joint risk arrangements, leveraging AI as a central component of their technology and approach. Lumeris stands out as the only value-based care enablement company with experience working across various patient populations, including those covered by Medicare Advantage, CMMI programs, commercial insurance, and Medicaid. This partnership aims to enhance collaboration among patients, physicians, and care teams, ultimately leading to improved clinical outcomes, a better experience for both patients and providers, and more efficient management of healthcare costs.

Formation of New ACO Models

Furthermore, NS-EEH and Lumeris will work together to address healthcare disparities in underserved communities by establishing new models of care under the accountable care organization (ACO) framework. Initially, NS-EEH and Lumeris will focus on the opportunity to participate in the Centers for Medicare & Medicaid Services’ (CMS) ACO Realizing Equity, Access, and Community Health (ACO REACH) model. This advanced value-based care model seeks to streamline care coordination and improve health outcomes for traditional Medicare patients. In the future, the partner organizations will expand their focus to include other types of accountable care and population health models to serve our diverse communities.

What You Should Know: 

– UnitedHealthcare and RUSH Health announced a new relationship that will give UnitedHealthcare Medicare Advantage plan members network access to all RUSH Health locations in Illinois for the first time, effective immediately. 

– The multi-year agreement, effective Oct. 1, provides UnitedHealthcare Medicare Advantage plan members with enhanced access to quality care and provides a new option as they choose which health plan best meets their healthcare needs during the current Medicare Annual Enrollment Period.

– The new agreement covers nearly all UnitedHealthcare Medicare Advantage plan types, with the exception of Medicare Advantage Access plans.

RUSH Health Background

RUSH Health is a clinically integrated network of physicians and hospitals that work together to provide high-quality, efficient health services. The health system covers the spectrum of patient care from wellness and prevention to disease and care management. At the system level, RUSH Health includes RUSH University Medical Center, RUSH Copley Medical Center, RUSH Oak Park Hospital, Riverside Medical Center and more than 140 physician practices.

In Illinois, UnitedHealthcare serves more than 186,000 people enrolled in Medicare Advantage plans with a network of thousands of physicians and other care providers statewide. 

“This new relationship will create greater access to the very best health care for more patients across the Chicago area and Northwest Indiana,” said Lisa Wagamon, president of RUSH Health. “We are pleased to be able to extend the reach of academic medicine to more patients and families, especially those who need care for serious and complex conditions.”

Given Artificial Intelligence’s potential to improve patient care and reduce costs, it’s no surprise that AI applications are gaining momentum in health care. As your organization explores the benefits of AI in your journey towards Value-Based Care, however, you need to carefully assess the implications, for better and worse.

Evaluating AI implications can be tricky. Healthcare AI varies widely, with clinical technology paving the way for advancements in diagnostics and treatment. But pressure on ACOs to achieve savings is spurring consideration of machine assistants for customary clinician services. That’s the message of one recent study suggesting that AI chatbots may outperform physicians in communicating with patients, offering higher-quality responses and displaying greater empathy. The study evaluated how chatbots versus physicians responded to 195 patient questions from Reddit’s r/AskDocs. Surprisingly, healthcare professionals who reviewed the responses favored chatbot answers over those from physicians in terms of quality (78.5 to 22.1 percent) and empathy (45.1 to 4.6 percent). Not a great report card for physicians!

But before planning to use chatbots in patient education, navigation, and coaching – especially given staffing shortages in health care – ACOs should closely examine the underlying assumptions. Consider these very human factors: How do patients feel about discussing treatment plans with chatbots? Was the study validated and reviewed by peers?  What were the study’s limitations and biases? Did physicians couch their responses with caution due to liability or clinical concerns? Either could have negatively affected the tone of physician communications.

The rapid adoption of AI technology risks incorporating human biases into algorithms, perpetuating gender and race biases through AI healthcare recommendations. Before jumping on the AI bandwagon, we need a better understanding of the effects on physicians and patients, as well as a thorough evaluation of potential unintended consequences.

There may be an advantage in time and money to using chatbots to assist in patient education and to support—not replace–human roles in medicine. We still need to preserve essential conversations between patients and physicians to maintain trust. Ceding that direct communication to technology could erode the patient-physician relationship. It would also undermine efforts to recruit talent into the healthcare profession, where shortages of skilled clinicians is already a significant issue, especially in rural and poorer communities.

Under pressure to adapt to Risk, many ACO stakeholders may be eager to deploy AI solutions. To resist being swept up by the momentum, carefully consider your options, support your participating clinicians in their clinical AI applications, and explore how you might collaborate.

Here are three guidelines for leveraging AI to strengthen your organization while recognizing potential weaknesses of machine-based systems:

1. Use AI to analyze complex data for risk identification, patterns, and variations in healthcare services and costs. AI’s ability to efficiently analyze diverse datasets aligns well with Value-Based Care. Personalized treatment plans based on multiple patient data points can be developed using AI analysis. For instance, AI algorithms can drive episodes of care, enabling ACOs to compare procedure costs, reduce variations, target patients for clinical review, and identify opportunities for improvement. However, be sure to exercise caution and scrutinize algorithms for potential biases that may impact population groups and health equity.
   
2. Evaluate the use of AI in creating patient materials for review by clinicians. ACOs have a responsibility to provide patients with factual information, support medical decision-making, promote cost transparency, and engage patients and their families in the process. Chatbot-generated communications, subject to clinical review, can be an efficient way to develop the necessary tools.
3. Defer replacement of direct communications with patients with AI and test the programs first. Pilot AI-driven communication and education tools, such as patient check-ins and self-management programs, with evaluation of changes in outcomes and patient acceptance. The urgency to utilize data wisely will drive ACOs toward AI solutions. Remember that technology is never neutral. Plan carefully for human and non-human resources to ensure that any AI applications benefit your organization and avoid potential, significant harm.
   

About Theresa Hush

As CEO and Co-founder of Roji Health Intelligence, Theresa Hush is a healthcare strategist and change expert with experience across the health care spectrum, including public, non-profit and private sectors. Her accomplishments include leading the transformation of Blue Cross Blue Shield regulations in Illinois, improving access to care as Director of the Illinois Medicaid program, and serving in executive leadership for both private payers and physician organizations. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs.

Today, more than 131 million Americans – 66 percent of all adults in the U.S. – use prescription drugs, and one in four use three or more, according to the Health Policy Institute. Not only are we being prescribed more drugs than ever before, but we’re paying more for them too: the U.S. has the highest per-capita pharmaceutical spending among the developed countries. In 2021, the U.S. healthcare system spent $603 billion on prescription drugs.

But even as we’re being prescribed more drugs, we’re failing to take them. Lapses in medication adherence are worrisomely common, with studies showing that 20%-30% of medication prescriptions are never filled, and a staggering 50% of medications for chronic disease are not taken as prescribed. 

This lack of medication adherence has serious repercussions for both our physical and financial health. Statistics show that each year in the U.S., non-adherence to prescribed treatments can be attributed to at least 125,000 preventable deaths, up to 25 percent of hospitalizations, and $500 billion in preventable medical costs.  

The Causes of Non-Compliance 

Patients themselves are not always the cause of medication non-compliance. People generally want to do what’s best for their health, but there are several potential factors that may keep them from taking their medications as prescribed, including financial limitations and logistical issues. Some patients, especially those from more vulnerable populations, take less medication than prescribed because of the cost. Other patients may face logistical barriers such as lack of transportation, which makes it difficult to stay on track with medications because the patients have no way to pick them up. 

But there are also other, more controllable factors that impact patients’ medication adherence, including:

• Insufficient patient education. Patients may not take medications because they don’t understand the benefits of the therapy or potential consequences of non-adherence, or because they are afraid of the side effects. 
• Health literacy. patients’ health literacy is central to their ability to adhere to their treatments.  Studies show that the risk of non-adherence is very high when patients cannot read and understand basic written medical instructions. Misunderstanding of this type is not as uncommon as one might imagine, with one large study of 2,500 patients finding that nearly one-third had marginal or inadequate health literacy. 
• Complex treatment regimens. Patients may have trouble remembering what their doctor told them and may require extra support to remember what medications to take and when to take them.
• Lack of trust in the healthcare provider. The interpersonal dynamics of the physician–patient relationship play an important role in patient’s adherence to their treatments.  Patients who believe that their physician is someone who can understand their unique experience of being a patient, and can provide them with reliable and honest advice, are more likely to take their medications as prescribed.

Personalized Patient Engagement is Critical to Getting Patients to Adhere to Treatments 

Many of the barriers described above can be overcome with better patient engagement and communication. For example, while clinicians don’t have control over drug pricing, they could offer lower-cost options if they recognize that price is an issue for a particular patient. Clearer patient education about the risks for side effects and the realistic result of therapy is essential for patients who don’t fully understand their treatments.  

But to achieve effective engagement, in which the patient understands and internalizes information, is motivated to act upon it, and provides reciprocal information, requires true personalization. Until recently, personalization in digital communications simply meant adding the recipient’s name in the introduction of an email or calling out a health condition s/he may be managing. Such mass approaches to patient engagement (whether for education or marketing) have proven insufficient. What’s needed is a new approach that leverages patient data to gain insights into what motivates them. Patients provide a significant amount of historical health and other personal information about themselves; finding a way to use this data to create hyper-personalized communications through preferred channels is central to achieving real patient engagement.

Leveraging Psychographics to Create Personalized Communications 

Psychographic segmentation (dividing people into groups using psychological characteristics including personality, lifestyle, social status, activities, interests, opinions, and attitudes) has been used for decades by the world’s most successful consumer products and retail companies to influence decisions, behaviors and user experience. However, psychographic segmentation is relatively new to healthcare and represents a way for consumer science to augment and support the delivery of care, as well as help healthcare providers achieve their business goals.

Healthcare has historically taken a “one size fits all” approach to patient engagement, using the same message and channel mix with every person who shares or seeks to prevent, a given health condition. Patients are people first, who happen to have a health issue but do not define themselves solely by that issue. They have distinct personalities and motivations that influence their choices and behaviors. Psychographic segmentation helps classify people according to their motivations and communication preferences to optimize targeting, messaging and the engagement experience. 

Today, there are advanced patient engagement technologies that leverage psychographic profiles to understand patients’ lifestyles, motivations, and engagement preferences to deliver hyper-relevant messages designed to trigger action. These solutions enable healthcare organizations to provide personalized care without increasing staff workload and serve as a valuable tool in addressing medication non-adherence. 

The reasons patients fail to adhere to their drug treatments are highly personal – engaging these patients in an equally personal way is the key to solving the problem.

About Carrie Kozlowsk
Carrie Kozlowski, OT, MBA, is the COO and co-founder at Upfront Healthcare. Over a career spanning 25 years, Carrie has combined real-world clinical experience with strategic thinking and an entrepreneurial drive to lead strategy, operations, and talent development at forward-thinking organizations focused on population health. Carrie’s clinical background includes providing direct care, training, and management services as a practicing occupational therapist. She holds an MBA in Management and Entrepreneurship from the University of Illinois Chicago, and a bachelor’s degree in occupational therapy from the University of Hartford.

What You Should Know: 

• LG Business Solutions USA launches a new line of “Patient Engagement Boards” that empowers hospitals to outfit patient rooms with crisp high-definition screens for displaying patient information such as their name, schedule, a list of caregivers, native language and more. 
• The new Patient Engagement Boards are now available in a 43-inch UHD model and 32-inch FHD model, featuring Power over Ethernet (PoE) capability, offering optimized solutions and simplified installation for diverse patient room needs.

LG Patient Engagement Board Overview

The LG Patient Engagement Boards (ML5K-B Series) are designed to improve experiences for patients and caregivers while simplifying operations for administrators and IT staff. The 32-inch model can be rapidly deployed utilizing POE without the exhaustive approval process commonly associated with modifying a room’s electrical components. Convenience is further enhanced by each display’s automatic brightness sensor, which ensures viewing comfort by matching ambient light levels throughout the day.

Both models can be wall-mounted vertically or horizontally using 200×200 VESA mounts. And both displays feature LG IPS panels and offer up to 50,000 hours of life, making them ideal for 24/7 use. Integrated stereo speakers further simplify deployment and provide flexibility to host a variety of content. The 43-inch 43ML5K-B offers a typical brightness of 500 nits and has a 25 percent haze treatment that reduces glare, while the 32-inch 32ML5K-B provides 400 nits through standard power and 200 nits through PoE. 

“As hospitals continue to digitize more and more of their operations, in-room displays provide patients and caregivers with greater legibility and infinitely more flexibility than analog white boards,” said Tom Mottlau, LG Business Solutions USA Healthcare Director. “Our patient engagement development partners have utilized the powerful LG webOS 6.0 platform to develop intuitive applications that can allow hospitals to eliminate handwritten notes and the difficulties that can arise from illegible writing or unclear instructions. These enhancements can improve communications and patient trust, resulting in better overall experiences.”

Given Artificial Intelligence’s potential to improve patient care and reduce costs, it’s no surprise that AI applications are gaining momentum in health care. As your organization explores the benefits of AI in your journey towards Value-Based Care, however, you need to carefully assess the implications, for better and worse.

Evaluating AI implications can be tricky. Healthcare AI varies widely, with clinical technology paving the way for advancements in diagnostics and treatment. But pressure on ACOs to achieve savings is spurring consideration of machine assistants for customary clinician services. That’s the message of one recent study suggesting that AI chatbots may outperform physicians in communicating with patients, offering higher-quality responses and displaying greater empathy. The study evaluated how chatbots versus physicians responded to 195 patient questions from Reddit’s r/AskDocs. Surprisingly, healthcare professionals who reviewed the responses favored chatbot answers over those from physicians in terms of quality (78.5 to 22.1 percent) and empathy (45.1 to 4.6 percent). Not a great report card for physicians!

But before planning to use chatbots in patient education, navigation, and coaching – especially given staffing shortages in health care – ACOs should closely examine the underlying assumptions. Consider these very human factors: How do patients feel about discussing treatment plans with chatbots? Was the study validated and reviewed by peers?  What were the study’s limitations and biases? Did physicians couch their responses with caution due to liability or clinical concerns? Either could have negatively affected the tone of physician communications.

The rapid adoption of AI technology risks incorporating human biases into algorithms, perpetuating gender and race biases through AI healthcare recommendations. Before jumping on the AI bandwagon, we need a better understanding of the effects on physicians and patients, as well as a thorough evaluation of potential unintended consequences.

There may be an advantage in time and money to using chatbots to assist in patient education and to support—not replace–human roles in medicine. We still need to preserve essential conversations between patients and physicians to maintain trust. Ceding that direct communication to technology could erode the patient-physician relationship. It would also undermine efforts to recruit talent into the healthcare profession, where shortages of skilled clinicians is already a significant issue, especially in rural and poorer communities.

Under pressure to adapt to Risk, many ACO stakeholders may be eager to deploy AI solutions. To resist being swept up by the momentum, carefully consider your options, support your participating clinicians in their clinical AI applications, and explore how you might collaborate.

Here are three guidelines for leveraging AI to strengthen your organization while recognizing potential weaknesses of machine-based systems:

1. Use AI to analyze complex data for risk identification, patterns, and variations in healthcare services and costs. AI’s ability to efficiently analyze diverse datasets aligns well with Value-Based Care. Personalized treatment plans based on multiple patient data points can be developed using AI analysis. For instance, AI algorithms can drive episodes of care, enabling ACOs to compare procedure costs, reduce variations, target patients for clinical review, and identify opportunities for improvement. However, be sure to exercise caution and scrutinize algorithms for potential biases that may impact population groups and health equity.
   
2. Evaluate the use of AI in creating patient materials for review by clinicians. ACOs have a responsibility to provide patients with factual information, support medical decision-making, promote cost transparency, and engage patients and their families in the process. Chatbot-generated communications, subject to clinical review, can be an efficient way to develop the necessary tools.
3. Defer replacement of direct communications with patients with AI and test the programs first. Pilot AI-driven communication and education tools, such as patient check-ins and self-management programs, with evaluation of changes in outcomes and patient acceptance. The urgency to utilize data wisely will drive ACOs toward AI solutions. Remember that technology is never neutral. Plan carefully for human and non-human resources to ensure that any AI applications benefit your organization and avoid potential, significant harm.
   

About Theresa Hush

As CEO and Co-founder of Roji Health Intelligence, Theresa Hush is a healthcare strategist and change expert with experience across the healthcare spectrum, including public, non-profit and private sectors. Her accomplishments include leading the transformation of Blue Cross Blue Shield regulations in Illinois, improving access to care as Director of the Illinois Medicaid program, and serving in executive leadership for both private payers and physician organizations. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs.

The VBC delivery model encompasses various approaches with the most common being Accountable Care Organisations (ACOs) and Integrated Delivery Networks (IDNs) in the US and  Integrated Care Systems (ICS) in the UK.  Both countries’ approaches are networks of healthcare providers (hospitals and physicians) who work together to deliver high-quality coordinated care to beneficiaries while controlling costs.  The benefits of VBC models include better patient health outcomes at a lower cost, streamline delivery via coordinated care teams, focused preventative care and treatment plans for patients, less physician burnout, lower costs for payers, and a healthier patient population due to better adherence to treatment.  

While there are many benefits to VBC, there are also some significant obstacles that must be overcome for this type of healthcare delivery model to be a success.  This includes dealing with disparate IT and health records systems, outdated workflows, and lack of internal resources which is a consequence of patients seeing multiple physicians, specialists, etc. who are using different data handling platforms throughout the course of treatment.

When it comes to VBC IT solutions, there are six tools that are essential for tracking, monitoring, and measuring patient outcomes.  These include IT tools to identify patient cohorts, segment patients by risk, aid clinical decision-making, manage care coordination, carry out patient activation, and finally, measure performance and report outcomes.  

Over the years, Signify Research has had the opportunity to speak to 100s of VBC decision-makers and buyers from ACOs and IDNs in the US and similar organizations internationally about their healthcare IT needs.  Our conversations with these organizations have provided greater insights into the current drawbacks of utilizing these technologies as well as what needs to change to improve these IT tools for the better. 

Tools to Identify Patient Cohorts

Our research has highlighted that electronic health record (EHR) systems are the main sources of patient information that are used to identify specific patient cohorts to target as part of VBC, coupled with manual data handling processes.  EHR systems can vary across providers’ settings, with some being more basic with limited clinical decision support (CDS) on offer including minimal highlighting of care gaps and no priority ranking of patients or insights on the financial impacts of closing these care gaps.  EHR systems that are more advanced tend to provide modules that have robust CDS that highlight actions to prioritize patients and provide some input on the cost impact of closing care gaps.  

However, gathering this information to identify patient cohorts to target for VBC is not always a straightforward process.  A majority of ACOs and IDNs that leverage EHR systems to identify patients use a mixture of DIY business intelligence tools such as Tableau, PowerBI, and Excel, for example, combined with some form of a dedicated commercial health insights solution drawing on EHR data.  This process is not straightforward and involves interrogating multiple data sources in various locations to develop a fuller patient view that includes manually pulling data from EHRs/Data Warehouses, claims portals (US-only), self-developed DIY tools, and social determinants of health (SDoH) tools.  Having to pull in data from multiple sources manually does not always display in a way that can help these organizations clinically, especially when some of the data is insignificant or inaccurate.    

When identifying patients to target for VBC, key things that care management teams look at include frequency of hospital admissions/readmissions, frequency of ED visits, type and number of chronic conditions, social needs data, medication spending, and screening tests.  As VBC organizations continue to grow and mature, the demand for more data points beyond EHRs is becoming increasingly important to help accurately identify patients to close care gaps.  With this comes growing interest in the need for sophisticated IT tools that automate processes and improve current workflows. 

Tools to Risk Stratify Patient Cohorts

The VBC providers we have spoken to have highlighted a reliance on several off-the-shelf algorithms that are used to segment patient cohorts identified from EHRs into high-risk/low-risk categories as a way of prioritizing who needs immediate interventions and care plans.  The algorithms in use include, for example, Milliman RX, Hierarchical Condition Category (HCC), Charlson Comorbidity Index, QAdmission Risk Algorithm (UK), Electronic Frailty Index (UK), and Kaiser Triangle.

The reliance on these algorithms once again requires care management teams to utilize manual data handling processes that include a mix of self-developed business intelligence tools combined with some health insights software.  As risk stratification is an important part of VBC, most organizations are currently not using sophisticated tools for various reasons related to issues of cost and lack of internal resources.  But the interest and need are there to look at IT tools that can improve workflows and help to focus on high-risk, high-cost patients in a more efficient and less laborious manner.

Clinical Decision Support Tools

Across VBC organizations we have engaged with, there is a wide variety of CDS software tools in use depending on where the ACO, IDN or other organization is based on their IT set-up journey.  Some have minimal or no CDS tools for closing gaps in care and rely entirely on manual processes to find and prioritize patients for care plans.  Other organizations have CDS support in the form of limited actionability that provides some software assistance with identifying cohorts but still requires manual work to input/extract relevant patient data.  The most advanced VBC organizations have developed integrated tools/dashboards that are combined with cohort identification and risk stratification IT tools and CDS modules providing care gap closure recommendations. 

While advanced CDS setup is what most organizations aspire to, the system is still not perfected as many CDS options are not integrated with care coordination team workflows requiring timely manual processes and additional staff resources.  There is a growing demand for the use of mature, integrated tools that mirror the VBC journey and bundle cohort identification, risk stratification, and CDS in health insights into one seamless end-to-end workflow.  

Population Health Management Tools

Another health IT needs includes improvements to current population health management (PHM) tools on the market.  Many organizations currently use broader dedicated PHM tools that enable care management teams to view cohorts based on risk and then drill down into specific patients to receive input and advice on what actions are needed to close gaps in care.  This specialized software allows for data visualization of common actions across cohorts that would lead to the greatest impact from a financial and clinical perspective.  

While dedicated PHM software is mostly used in medium to large-scale VBC organizations, many of the buyers we have spoken to have highlighted the dissatisfaction that cohort ID is mostly from siloed data sources that are not always accurate or up to date which increases the potential for patients to be incorrectly prioritized.  Also, many of the tools are not as user-friendly and require dedicated support from the IT/informatics team to manipulate data.  The demand is for solutions that not only provide a holistic patient view but also can be easily manipulated by care management teams without having to rely on technical or informatics expertise.  

Patient Activation and Outreach Tools

Our conversations with VBC decision-makers and buyers have also illustrated that despite the demand and use of IT tools for PHM, the telephone remains the primary method of contacting patients and enrolling them into VBC.  Enrollment success varies greatly across organizations, with some leveraging additional outreach tools such as texting tools and various patient apps and portals to contact patients.  

Patient communication is initiated and managed via workflows that once again originate from the EHR which houses patient contact information.  Organizations that have smaller, less diverse populations and those who have either invested in specific PHM IT tools to manage the process or who have developed their own in-house IT tend to experience higher patient enrollment in VBC.

However, while not high on the IT improvement wish list, many VBC buyers have expressed a desire to access outreach tools that better integrate with other care coordination workflows to streamline and expedite patient outreach activities and generate engagement.  

Reporting and Performance Tracking Tools 

To judge the eligibility of ACOs and IDNs for reimbursement payments and shared cost-savings, these organizations are required to participate in annual audits that measure performance and track outcomes.  Analyzing data for these audits is extremely valuable, but it tends to be a labor-intensive process and many healthcare organizations lack adequate resources and skill sets to create these reports.

Currently, most organizations use some form of DIY BI tools created by internal staff to track various program success metrics and KPIs around strategy, operational, and process improvements.  Most medium-to-large scale organizations rely on internal data analytics/informatics teams to develop IT tools via Tableau, Excel, Qlik that provide details on specific performance measures. 

This method of reporting again requires an abundance of manual tracking/reporting activities with automated tools used less commonly.  And this reliance on specific data analyst teams creates a backlog of reporting which makes it impossible to monitor performance in real time so strategies can be implemented to correct or improve outcomes before year-end.   

What PHM solutions are truly needed?

In summary, the six types of health insights IT tools that are essential for VBC organizations are not without significant drawbacks.  What is clearly not working is the lack of a holistic 360-degree patient view, and data limitations in terms of latency and access with multiple data feeds leading to missing and outdated patient information.  With the variety of vendor PHM IT tools in use that are falling short and still need to rely on manual processes, there are growing challenges in creating clear, coordinated workflows that share information back and forth between care management teams and frontline providers.  

Our conversations with VBC healthcare leaders have illuminated three key purchase drivers for any PHM IT tool which includes examining how these tools improve patient care, improve clinical staff workflow/efficiency, and reduce data fragmentation/data siloes.  What is needed for VBC are IT tools that ensure actions recommended by dedicated care management teams are visible and front-facing for providers to act upon as they interact with patients.   Also, having real-time data feeds and tools to inform care management would be extremely beneficial to VBC organizations in terms of monitoring and improving healthcare outcomes.

About Rohinee Lal 

Rohinee Lal is the Principal Analyst at Signify Research, a research advisory company providing healthtech marketing intelligence powered by data. Rohinee joined Signify Research’s Custom Research & Consultancy team in early 2022. She brings over 24 years of experience collecting, analyzing, & presenting market intelligence across various industries including pharmaceuticals, medical devices & digital health.

What You Should Know:

– Aledade is continuing its strong momentum today, announcing that Cigna Healthcare Medicare Advantage customers can now receive value-based care from Aledade’s network of independent primary care practices.

– Participating practices can access Aledade’s cutting-edge data analytics, user-friendly guided workflows, and health care policy expertise, as well as integrated care services supported by AledadeCare Solutions.

– This news comes shortly after Aledade announced a 10-year collaboration with Humana, and a partnership with CareFirst Blue Cross and Blue Shield to advance value-based care to more independent physicians. 

Doctors and other healthcare professionals are entrusted with the responsibility of safeguarding the health and well-being of their patients, ensuring they receive the highest quality of care. While healthcare professionals are expected to provide a certain standard of care, any deviation from that standard that results in harm or injury to a patient may leave them exposed to a medical malpractice claim.

The consequences of medical malpractice can be severe, and in some cases, can result in permanent injury, disability, or even death. Patients harmed by medical malpractice may suffer from physical and emotional pain, financial loss, and other damages that severely impact their quality of life. This article will examine some of the causes of medical malpractice and outline steps to prevent its occurrence.

Causes of Medical Malpractice
There are many scenarios that can lead to a medical malpractice claim. Among the most common causes of malpractice are:

– Diagnostic errors: Misdiagnosis occurs when a medical professional fails to correctly identify a patient’s medical condition, resulting in the wrong treatment being administered or no treatment being provided at all. 

– Surgical errors: There are many types of surgical errors, such as damage to internal organs, incorrect incisions, operating on the wrong area, or leaving foreign objects behind after surgery.

– A failure to treat patients: A failure to provide adequate treatment to patients can encompass a range of issues, such as neglecting to administer necessary medical tests or failing to address a medical condition in a timely or appropriate manner.

– Birth injuries: These can result from various causes, such as the misuse of delivery tools, failure to perform a timely cesarean section, or inadequate prenatal care.

Medication errors: This may occur when a medical professional prescribes or administers the wrong medication or dosage.

If you have undergone a failed tubal ligation procedure you may be entitled to compensation for your injuries. You can speak with a specialist attorney such as those at The Tinker Law Firm PLLC to see if you have a claim.

Preventing Medical Malpractice 

The prevention of medical malpractice is critical to ensure patient safety and reduce the risk of injury or harm. The following steps can help in achieving this goal.

Effective Communication 

Medical professionals should communicate clearly with patients about their medical conditions, treatment options, and the potential risks and benefits. Patients should also be encouraged to ask questions and express their concerns about their treatment. 

Electronic Health Records 

Another vital way to prevent medical malpractice is through technology. EHRs can help to reduce the risk of medical errors by providing medical professionals with accurate and up-to-date information about a patient’s medical history, allergies, and medication use. EHRs can also help to ensure that medical professionals are following the correct guidelines and protocols for patient care.

Staying Current

Medical professionals can prevent medical malpractice by staying up to date with the latest research, information, and guidelines in their field. By participating in ongoing education and training programs they can ensure they are providing the most effective and safe treatments to their patients.

The steps outlined above can help to prevent medical errors and ensure that patients receive the appropriate care and treatment.