24 Jun ACOs Find Engaging Chronically Ill Patients is Challenging Work

MedicalResearch.com Interview with:
Stephen M. Shortell, PhD, MPH, MBA
Blue Cross of California Distinguished Professor of Health Policy and Management and
Director, Center for Healthcare Organizational and Innovation Research (CHOIR)
School of Public Health
UC-Berkeley

Medical Research: What is the background for this study? What are the main findings?

Dr. Shortell: To meet quality and expenditure targets, Accountable Care Organization (ACOs) need to change how care is delivered to patients to reduce preventable hospitalizations, readmissions, emergency department visits, and unnecessary tests. To do this they need to increase their engagement with patients and patient families. With support from the Gordon and Betty Moore Foundation, we undertook the study to assess the extent to which ACOs are engaging their patients and patient families and to identify some of the barriers and facilitators of such engagement. We did a survey of 101 ACOs, in-depth phone interviews with eleven ACOs and two on site visits.
Among our key findings are:

1) There are some “early adopters” of patient engagement activities with, for example, respondents reporting an average of 62 percent of primary care physicians working with patients/families to set treatment goals and 61 percent of high risk chronic illness patients participating in formal care transition programs; but

2) Only 18 percent of ACO high risk chronic illness patients participate in peer support groups or group visits, and only 24 percent of patients have access to both medical records and clinical notes in the record;

3) ACO leaders strongly believe patient activation and engagement is critical to ACO success and those who have such beliefs do have greater patient engagement at the actual point of care;

4) Engaging patients is very difficult challenging work as it often involves a total re-organization of workflow within physician practices including the re-allocation of tasks to other healthcare professionals, reorganization of time commitments, adjustment to use of electronic health records and training in communication methods.

Medical Research: What should clinicians and patients take away from your report?

Dr. Shortell: For clinicians, the key takeaways are:

1) To recognize the need to work on patient engagement within the context of competing priorities within the practice;

2) lack of time;

3) work flow disruption; and

4) resource constraints.

The more successful ACOs prioritized patient engagement and embedded it within related priorities of the practice; provided the time, training, and resources to re-organize how care was going to be delivered and, in particular, worked on developing teams that included medical assistants, nurses, health educators, social workers and others who worked on helping patients achieve their health goals.

For patients, the key takeaways are to recognize that they have the most important role as the center of the team since it is all about them and, therefore, they need to take an informed active role in their care. They need to ask questions that matter to them, to follow up on any communication that is not clear, and make sure they have the knowledge and skills to mange their care. They also need to recognize that they are not in it alone and to make use of support groups and fellow patients for advice.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Shortell: Future research needs to generate more knowledge of what is actually occurring on the frontline of actual care delivery and not just what is reported on surveys. We are currently engaging in such research with support from the Patient-Centered Outcomes Research Institute (PCORI). Research is also needed to assess the impact of new payment models on patient engagement. In particular, greater attention needs to be given to assessing the impact of “packaged innovations” such as the use of motivational interviewing combined with peer or group visits and access to patient portals since it is unlikely that any single innovation or intervention will have much impact.

Finally, and most importantly, there is need to continue to examine the relationship between patient activation and engagement and patient clinical and reported outcomes of care. We, and others, are currently undertaking some of this research.

Citation:

Shortell SM, Sehgal NJ, Bibi S, Ramsay PP, Neuhauser L, Colla CH, and Lewis VA. “An Early Assessment of Accountable Care Organization’s Efforts to Engage patients and Their Families.” Medical Care Research and Review.
DOI: 10.1177/1077558715588874. [e-pub ahead of print].

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Stephen M. Shortell, PhD, MPH, MBA Blue Cross of California Distinguished Professor of Health Policy and Management and, Director, Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, & UC-Berkeley (2015). ACOs Find Engaging Chronically Patients is Challenging Work 

Last Updated on June 25, 2015 by Marie Benz MD FAAD