Tuesday, January 20, 2015

Patient-Centered Care: Health Literacy, HIT and Shared Decision-making

By Nalini K Pande, JD

“When we want your opinion…”

When we talk about patient engagement, a cartoon comes to mind that I often used when I was teaching at Georgetown.  The cartoon depicts a group of doctors conferring amongst themselves while they lean over a patient who is sick in a hospital bed.  The patient is trying to speak and a doctor interrupts and says, “When we want your opinion, we’ll let you know!”

That, in a nutshell, depicts how many patients feel when it comes to interacting with the healthcare system.  Ironically, on the flip side, many healthcare delivery executives are trying to determine how they can increase the value of the care they provide, and as a result, produce better outcomes for their patients.  Increasingly, organizations are recognizing that meaningfully engaging patients and families is the answer to this question. In fact, these organizations are focusing on more than engaging patients in making choices about their care. Health systems are focusing on engaging and supporting patients in self-care for chronic disease management, and asking for patient input on how healthcare organizations can better engage patients.

Payment Reform and Patient Engagement Go Hand-in-Hand

With payment reform leaving providers with increased risk-sharing and accountability, patient engagement may be seen as the Holy Grail to tap into improved patient outcomes and contain costs.  Yet, many patients lack the health literacy to effectively navigate what is now an increasingly complex and confusing health system.  Koh et al propose a Health Literate Care Model that would “weave” health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model).  In this way, health literacy would become an “organizational value infused into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources.” [1] 

Further, the HIT infrastructure can help providers keep patients and caregivers informed, educated and literate about their personal health and medical conditions. It can support on-going self-care and wellness management, including coaching from healthcare providers and ongoing dialogue between those providers and patients.  Additionally, patient portals (available online and via kiosks)  can be effective tools in providing access to electronic health records, appointment scheduling as well as clinical support such as secure provider messaging, patient reminders, alerts, test result views and prescription refill requests. 

Perhaps, most importantly, taking a population health approach to patient engagement is essential.  Bending the cost curve and improving quality requires the management of patients in lower-acuity, primary care settings with diverse access points, education of treatment plans and adherence through clinical care and community partnerships as well as strong patient activation.

Policy makers, payors, providers, patients and caregivers should work together to develop strategies to implement:
 • The health literate care model
 • Provider, patient and system competencies needed for patient-centered care
 • HIT infrastructure & population health approaches to patient/family engagement.

Changing the healthcare culture and allowing for stronger shared-decision-making may not be the top agenda item for many health system executives.  However, given the costs of maintaining the current status quo, health system executives would do well to re-think their priorities.

Nalini Pande, Managing Director, Sappho Health Strategies has nearly 20 years of experience in healthcare policy and reform.  She has considerable experience in Medicare and Medicaid, prevention, population health, patient engagement, and emerging payment models including accountable care organizations and patient-centered medical homes. Ms. Pande also has strong expertise in dual eligibles and the specific issues facing this unique population.  She previously taught a graduate health quality course at Georgetown University as an Adjunct Professor. Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.


[1] Koh et al. “Analysis and Commentary: A Proposed ‘Health Literate Care Model’ Would Constitute A Systems Approach To Improving Patients’ Engagement In Care.” Health Aff. February 2013, 32:357-367. 

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