With the number of medical practices transitioning to accountable care organizations (ACO), experts say the need for patient engagement has never been greater. Groups are increasingly looking to mobile health, or mHealth, technologies to achieve this kind of engagement.
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Speaking at the mHealth World Congress in July, Tricia Nguyen, M.D., chief medical officer at Banner Health -- one of the organizations chosen to participate in the CMS' Pioneer ACO program -- said helping patients become more engaged can support wellness, which is a top priority for ACOs. Most ACOs derive profits based on how much money they are able to save during the course of treating patients. In this system, it makes more financial sense for a provider to encourage patients to seek annual well visits or manage a chronic disease than to treat them for major medical events, such as heart attacks.
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The use of mobile applications can drive more appropriate utilization of health services, Nguyen said, which ensures patients receive services at the right time. This is particularly important for ACOs, as eliminating the delivery of wasteful and unnecessary care plays a major role in the profitability of providers who have adopted the care model.
Banner Health is currently looking for ways to use mobile devices to engage healthy patients -- not just sick ones -- in their care to ensure they receive preventive services, Nguyen said.
To accomplish the goal of patient engagement and ensure patients receive only the most necessary treatments, ACOs will have to develop new types of applications, according to Ibrahim Eid, M.D., chief medical officer at Providence, R.I.-based Expert Medical Navigation, and who also spoke at the mHealth World Congress.
He pointed out that there are a number of applications available now that educate patients about certain health conditions and procedures, but these generally do not include information on specific doctors. While a patient may be able to learn whether a certain procedure is right for their health problem, they have no way of knowing if their doctor is the right person to perform it.
Until applications are developed that give patients all the information they need, meaningful engagement will be limited, Eid said. "We are actually putting in lots of effort to keep the patients blinded; to keep them where we want them to be."
This could soon change. Both experts agreed the growing use of mobile technology is putting more information in the hands of patients than ever before. This will likely empower them to make smart health decisions. Engaged patients are a necessary component of successful ACOs, the speakers said.
Banner Health has launched several initiatives over the last few years to incorporate mHealth tools into the delivery of care. Nguyen said the health system started out using mobile devices for things like remote monitoring of patients in intensive care units. Next, the provider set up systems in emergency rooms that decreased the length of time it takes to find a bed for a patient who needs to be admitted to the hospital. Chronic disease management is the latest realm into which Banner has extended its use of mobile systems, deploying tools to help patients manage their blood pressure and weight.
Still, Nguyen pointed out the majority of health care applications available currently are focused on helping sick patients interact with their providers. This will have to change in order for ACOs to deliver the best care more efficiently. Developers are increasingly looking for ways to put applications in the hands of healthy individuals to engage them and encourage them to seek preventive services in a timely manner, Nguyen said.
Health care providers will need to find ways to solve the patient engagement problem in order for ACO initiatives to be successful, Eid said. This could play an important role in getting the health care system away from the current fee-for-service models, which Eid said are outdated and can no longer support the kind of care patients need. Furthermore, they are contributing to high spending.
"The bottom line is the fee-for-service model in the U.S. is dead," he said. "It's not coming back no matter what we do. What we have now is large-scale capitation. Physicians are terrified of that, but every other industry on the plant is familiar with the concept, which is to stick to a budget."
He pointed to recent studies showing that upwards of 30% of all health care spending may not be necessary. In order to eliminate this spending and help providers stick to a budget, as required in an ACO model, Eid said he believes patients need to be better educated. Some evidence has connected a lack of knowledge among patients to high health care spending.