What's in the Broth of Health Care Reform?

Health care reform brings with it an alphabet soup of programs aimed at pushing medical group practices to provide more patient-centered care. Acronyms such as PQRI and ACO are now common parlance at health policy gatherings, but for patients – and, indeed, most providers – they are a foreign language. It’s hard to see how they will blend to help a practice meet the overarching goal of providing the best possible outcome and experience for the patient.

Broadly, the Physician Quality Reporting Initiative (PQRI) and accountable care organization (ACO) are supposed to apply a new process to the existing health care system for the purpose of achieving better outcomes while reducing costs. Rather than explaining these specific efforts, I will indulge myself by speculating on how they could have a positive effect on a single patient and one health care challenge: patient engagement.

The value of patient engagement can be measured in terms of the desired outcomes sought by both the provider and the patient. When the patient engages with the provider and the provider engages with the customer, both will find the experience of care more satisfying as measured by patient satisfaction and physician satisfaction. When patients feel they are receiving the full attention of an expert provider, their likelihood of following treatment suggestions (taking meds, doing self-care, etc.) will increase, which leads to improved health. The net benefit of patient engagement to the provider is reduced re-admissions, fewer follow-up treatments, fewer missed appointments and a greater sense of loyalty to the health care provider who has engaged with them. (Press Ganey has in development a survey tool that will evaluate patient behavior related to treatment recommendations and protocols, which should give providers a window into their effectiveness in engaging patients as full participants in their care.)

So let’s take one diabetic patient, JoAnn, through our alphabet soup prescription. When a practice begins managing its entire patient population for high blood pressure control in diabetes mellitus (one PQRI measure), a couple of things can occur. The simple act of tracking the population (and sharing with the team of caregivers) brings light to those patients who are not meeting the control goal. The enlightened provider can create a new dialogue with the patient at a regular visit about the importance of blood pressure control. For example, JoAnn can be introduced to the National Committee for Quality Assurance standard without requiring any deep standards education. The practice team member engages JoAnn by sharing a simple goal such as, “Our practice’s goal for this year is to get 90% of our diabetic patients to less than 140/80 readings. We want you to be in the 90% group. What can we do to get there together?”

An ACO reimbursement model takes JoAnn, whose blood pressure is now in control, and extends the practice’s engagement activities to include her full team of health care providers. Through paying for value rather than paying for delivering services and procedures, this community of caregivers now wraps its arms around JoAnn with the collective goal of keeping her well. After a full year with no emergent care events, JoAnn decides she’s healthy enough to start taking those walks with her neighbor friend again. Soup anyone