Exclusive Book Excerpt: Engage! Transforming Healthcare Through Digital Patient Engagement
Patient Engagement has been referred to as the “Blockbuster Drug of the Century” for its tremendous impact on health outcomes. Recognizing its importance, HIMSS (the professional association for healthIT) commissioned the seminal book on Patient Engagement –Engage! Transforming Healthcare Through Digital Patient Engagement. The book project was led by Jan Oldenburg who oversees patient engagement programs for Aetna. I was part of the team to pull together the book along with Brad Tritle and Kate Christensen, MD. There were also numerous industry contributors.
Forbes received permission to exclusively publish a chapter of the book. The chapter is on the importance of communications between patient and provider. I was asked to write that chapter since I write frequently on that topic and my software company, Avado, is focused on that area.
Referenced below is a new model for receiving and paying for primary care called Direct Primary Care. If you’d like a copy of the seminal whitepaper on Direct Primary Care, contact me via LinkedIn so I can send you a copy.
Patient-Provider Communications: Communication is the Most Important Medical Instrument
Written by Dave Chase
“A good scalpel makes a better surgeon. Good communication makes a better doctor.”
– Dr. Josh Umbehr
“I don’t think you can overstate the importance of communication in clinical care. Even with devices, robotics, genomics and personalized care, it all rests, and depends on, clear communication.”
The Patient is the Most Important Member of the Care Team
It has long been said that the most important member of the care team is the patient (or the patient’s family members). Quite simply, in a world where providers are compensated on quality and outcome, it’s nearly impossible to run a successful practice without building it around a patient-centered approach. Clinicians can provide guidance and coaching, but ultimately it is the patient who navigates the way back to full health. Unfortunately, too often, the patient gets “lost” on that journey back to health.
Consider the diagram below. Healthcare providers control most decisions that drive outcomes in emergency or high acuity cases, the most obvious example being caring for an unconscious patient in the hospital. In contrast, in low acuity situations such as managing a chronic condition, the patient and/or the family is clearly in control of the actions that will drive the ultimate outcome. Whether adhering to an exercise, diet, or prescription plan, or recognizing and acting promptly on symptoms of relapse or adverse drug effects, the patient/family plays the central role in determining the results. (Note: While it is true that in acute or emergency situations there often is not sufficient time to take the family into account, this is not intended to suggest that there is no role for patient and family decision-making in high-acuity cases.)
Graphic adapted from the Nuka System of Care developed by the South Central Foundation of Alaska
The importance of the patient’s role is clear, given that 75% of healthcare spending results from chronic conditions. Poor decisions made while a condition is in a low acuity state can rapidly lead to high acuity flare-ups that drive large medical bills. As Dr. Wendy Sue Swanson states, “The steering wheel should be attended by the patient.” After all, 99+% of a patient’s life is spent away from healthcare providers and it is the patient who is in the driver’s seat.
The need for a “Healthcare GPS”
Today, too much of a patient’s experience in the healthcare system resembles sending the person to a foreign land, giving him or her directions scrawled in a second language, and pushing him or her out the door to find a destination we call “health.” We tell patients that if they get lost, they should come back and we’ll give them directions again for the price and time of another appointment. Most patients just muddle through on their own, not wanting to appear ignorant, not wanting to “bother” the provider, or finding communication with their provider a troublesome task.
It’s well understood that patients forget or misunderstand more than 80% of what a doctor tells them during a visit. Using their own employees, IBM studied patient retention of instructions given by their physicians. The employees forgot more than 60% of what they were told within one day despite being healthier and smarter than the average citizen. What is needed instead is the equivalent of a GPS for healthcare. Like a GPS, it would know where a patient is on the journey back to full health. The “GPS” in this analogy represents a variety of personal health communication and tracking tools. For example, a congestive heart failure (CHR) patient might step on a scale daily and send that information wirelessly back to his or her provider. If the recorded weight indicates that they are off-track and a problem is developing, the person might receive suggestions via email or text, or a phone call from a care manager. Effective, timely communication can act like a GPS device to get the patient back on course.
In the current system, many factors conspire to create the reality of patients who feel disconnected from their doctors, unsure what actions they should take for their own health, seeing individual providers who don’t talk to one another or act in a coherent, coordinated manner. Historical reimbursement models have contributed to this dynamic both by rewarding piece-work and because there are no incentives for coordinating care. Patients haven’t had clear ways to determine which providers will do a better job of communicating with them or building relationships, and have few ways to ask questions or build relationship between office visits. Considering that people retain less than 20% of what a doctor tells them, this lack of communication and patient retention is a brutal combination driving sub-optimal outcomes and “lost” patients.
Email is Where it Begins
Secure email remains the “killer app” that is the starting point for most patient portals. Though it is an old technology, it can make a significant difference in building trusted relationships between provider and patient in any setting—and may be even more important for establishing a sense of direct connection in larger settings, where more layers of process inevitably make it harder to feel a direct connection with your doctor.
In a study of 35,423 people with diabetes, hypertension, or both, the use of secure patient-physician e-mail within a two-month period was associated with a statistically significant improvement in effectiveness of care as measured by the Healthcare Effectiveness Data and Information Set (HEDIS). In addition, the use of e-mail was associated with an improvement of 2.0–6.5 percentage points in performance on other HEDIS measures such as glycemic (HbA1c),
cholesterol, and blood pressure screening and control.
Recently published data indicate that Kaiser patients enrolled in their patient portal, which includes secure messaging with doctors, access to clinical data, and self-service transactions, are 2.6 times more likely to stay with the organization than those who are do not participate online (see more on Avoiding System Leakage below). Countries such as Denmark provide incentives for doctors to communicate electronically. The result: 80% of physician/patient communication in Denmark is asynchronous (i.e., people talking to each other serially rather than simultaneously). At first, that can sound high until we think about the rest of our lives whether it is conducting business or communicating with friends, where asynchronous communications (e.g., such as email, voicemail, or texting) are the norm.
Email can be one way to address the problem that patients remember so little of what they are told in the provider’s office. Other options include providing a clinical summary to patients after the visit (as recommended by Meaningful Use measures) and providing documentation of a care plan online for patients to refer to later.
Organizations such as Kaiser Permanente and the Cleveland Clinic rightfully are held up as leaders in physician-patient communication because of the way they have incorporated secure messaging and other online tools into their practice environments. However, not every organization has the resources of a Kaiser Permanente or Cleveland Clinic. This section focuses on low cost ways to enhance communication between providers and patients, and highlights two types of examples:
- Individual physicians who have used low cost and free tools to improve communications
- Low price primary care practices built on strong communications that have been successful in achieving the Triple Aim: improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.
Individual Doctors Use Low Cost, High Impact Communications
[Note: Examples of the videos referenced below can be seen in the article sidebar on the Khan Academy]
Even before new financial models fully take hold, many passionate doctors want the best possible outcomes for their patients. Some have created their own content — frequently using YouTube—in order to provide education that really fits their needs. What may seem like a one-way communication tool becomes two-way if covering the basics in the video enables the patient and provider to have a deeper conversation in the office or via email. Some patients even ask general questions in the comments on the video. In the process, the doctors who produce the videos also get the residual benefit of marketing since some of these doctors get 20% of their new patients from social media and videos. Each of the examples below was created using a free tool without any special technology.
Perhaps because Dr. Wendy Sue Swanson was a teacher before she was a pediatrician, she was naturally drawn to using videos and blogs to educate her patients’ and their families. Topics range from “Understanding Growth Charts” to “Vaccines” as well as other topics that she’s frequently asked about. Dr. Swanson shared in an email exchange the reaction she gets from patients. “I’ll launch into something in clinic and a family will say, ‘Dr. Swanson, you don’t have to explain that, I read your blog post/saw your video, etc!’ As a result, we start at a different place. A place that feels easier to connect, more informed, and one with more respect for our mutual vantage points.”
Dr. Ryan Neuhofel (Dr. Neu) uses video to explain the Hemoglobin A1c lab test using an M&M’s metaphor, highlighting why the test is so important when monitoring diabetes. Many physician-created videos are simply talking heads replicating what the doctor would otherwise say in a face-to-face encounter. In this example, Dr. l has simply recorded what he might otherwise sketch on a piece of paper during an office visit. Despite the fact that the video doesn’t use special effects, the patient has the sense of a personal encounter with the doctor. The benefit for Dr. Neu is that instead of taking valuable time in each office visit to explain this test, he can record it once and direct patients to it. Patients are able to consume the video on their terms even if means playing it a few times to fully understand it without feeling uncomfortable about making the doctor repeat his explanation.
Dr. Natasha Burgert describes the benefit to her practice and patients of using video as follows:
Investing time in relevant and complete posts actually saves me time in the long run. Questions I am repeatedly asked, like “How do I start solid foods?“ can be answered quickly and completely by directing them to my site. This saves face-to-face clinic time for more specific concerns for their child. I can actively communicate, acknowledge, and positively influence the choices that my families make for their children between checkups. My anticipatory guidance can be repeated, reinforced, and repeated again.
The benefits of doctor-created videos aren’t limited to primary care. Doctors such as Orthopedic Surgeon Howards Luks also have been realizing the benefit of videos. As Dr. Luks states, “Every patient who sees my videos prior to their visit says. ‘OMG it’s you, you’re just like you are in the videos.’ Very powerful. It humanizes your practice.” One example of the type of thing that might otherwise consume valuable time during an appointment that can be addressed via video is the question of why patients need to undress for part of the exam he conducts. He created a video that explains the medical need and puts his patients at ease for what might otherwise be an uncomfortable conversation.
Low cost primary care
Beyond individual physicians, new practice models have emerged that have patient communication as a centerpiece. One high growth practice model included in the PPACA is called Direct Primary Care Medical Homes (or DPC for short). DPC practices are very similar to the Patient Centered Medical Home (PCMH) model, but they use a straight flat fee per month that is paid directly by the patient and avoids insurance bureaucracy for day-to-day healthcare. DPC practices use the “GPS for healthcare” approach (i.e., regular asynchronous communication via email, remote monitoring, etc.) and have achieved the highest patient satisfaction scores (e.g., scores higher than Apple or Google) in very low overhead practices. DPC practices that have been around long enough to publish outcomes have patient populations with greater than average populations of people with chronic conditions. Like a micro Accountable Care Organization, DPC practices get a fixed amount to keep their patients as healthy as possible. A few examples of documented results include:
- 20.3% improvement of hypertensive patients with blood pressure under control.
- Average drop of 42 points in Systolic Blood Pressure (SBP) for patients who enter with Systolic Blood Pressure greater than 160
- 47-63% smoking quit rates for patients with diabetes, COPD and Coronary Disease
- 19% reduction in sick days and 50% reduction in days not productive at work (aka presenteeism)
- 40-80% reduction in hospitalizations, specialist referrals, and emergency department visits
DPC practices are just one example of practices that put a premium on communication even if that simply means direct access on the phone. One advantage newer practices have is a clean slate approach to technology. In contrast to large providers spending millions of dollars deploying patient portals, many newer practices use flexible and low-cost cloud-based software. Some have deployed their systems in just a day but then evolve and expand the use of their systems. These small start with the basics of a patient portal and progressively use more as they advance their patient communications practices use an array of tools including the following:
- Secure messaging between patient and providers.
- Send patient labs results
- Allow for medication refill requests
- Appointment requests
- 2-way Patient-provider mobile health tracking
- Multi-provider patient portal that allows the patient to keep all of their health information in one place rather than spread across multiple silos
- Biometric device connection (e.g., wireless scales, activity monitors, blood pressure cuffs, etc.)
- Family/Proxy capabilities so pre-approved family members can gain access
- Patient-enabled scheduling – more than just a request, they can reserve an appointment – just like one can reserve a table at a restaurant
- Practice/doctor website that isn’t an obvious templated site but one that provides valuable text and video content
- One-to-many publishing of patient education information to cohorts of patients (e.g., COPD patients receive a stream of content related to treatment options and self-management tips)
- Intake forms and condition diaries no longer have to be repeatedly filled out manually and then keyed in by a provider’s staff. Patients can electronically fill out forms on their own schedule, eliminating a redundant task for staff.
Future EHR requirements
In an article entitled “9 ways future EHRs need to support ACOs” in Healthcare IT News, one of the leading thinkers on the future of health IT, Shahid Shah, was interviewed about future health IT needs the match up with the requirements outlined in the bulleted list above.
“The EHR systems and IT required for Meaningful Use (MU) is a quite different from what will be required for ACOs,” Shah continued. “It will be nowhere as easy for existing legacy EHRs to simply retool their current platforms, like they did for MU.”
Shah went on to outline nine ways future EHRs need to support value/outcome based models beginning with a focus on patient-provider communications which he listed as the #1 priority.
1. Sophisticated patient relationship management (PRM). According to Shah, today’s EHRs are more document management systems, rather than sophisticated, customer/patient relationship management systems. “For them to be really useful in ACOenvironments, they will need to support outreach, communication, patient engagement, and similar features we’re more accustomed to seeing, from marketing automation systems than transactional systems.”
Advantages of Improved Communication
Increased Adherence to Care Plans
As stated earlier, patients (and their families) are central to determining the outcomes for people with chronic conditions. Tools such as the videos mentioned earlier help to ensure comprehension of one’s diagnosis or care plan. This can be followed up by email and automated communication to track patients and remind them of things they should do. Ted Epperly, MD, FAAFP explains the value of communication in adherence to care plans.
“A patient does not care how much his or her physician knows until they know how much the physician cares. Only after a trusted relationship is established and the patient knows that the physician is there for them in a caring, non-judgmental manner will they believe them and follow their advice, guidance, and recommendations. It is in this relationship that shared plans and mutual responsibilities occur, leading to a patient’s compliance with his or her health care plan.“
Improve Provider Efficiency and Coordination
If one were to observe a doctor for a month, you could find that they have their own FAQ for various conditions, diseases, prescriptions, etc. They are essentially hitting the replay button hundreds of times a month. Smart doctors are recognizing that there is a better way. The patient and family benefits greatly when the doctor has a mini package of curated content (video, articles, etc.) that is developed for groups of patients (diabetics, parents of infants, etc.). This is predominantly a manual process today (e.g., writing down web addresses in an appointment or emailing them afterwards). Modern Patient Relationship Management systems automate this process and allow patients to digest the content on their terms. For example, many patients are embarrassed to ask the doctor to repeat something they didn’t understand, so they walk away confused. This has been a boon to sites such as WebMD — patients fill gaps of information by going to “Dr. Google. “Most clinicians realize that communications is the most important “medical instrument,” yet time pressures don’t allow them to spend a great deal of time with patients. Thus, they must come up with other ways to enable effective communications.
Some doctors identify content for their patients on their own but there are low and no cost services that take less than 2 hours of the physician’s time to record a series of 1-3 minute video vignettes for the most commonly discussed items. While initially daunted by this, doctors quickly recognize that all they are doing is simply recording what they are already saying every day. Larger systems handle this with embedded connections to health encyclopedias that provide consistent and reliable content if they don’t want to personalize their content.
Virtually Extend Physician Time
Even though it is virtual, when doctors record short video vignettes, their patients feel like they have interacted with them. Further, they can digest the information on their terms. It essentially extends the appointment without costing the doctor more of her time. This new way for doctors to connect with patients enables them to change the nature of the face-to-face encounter, focusing more on individual care than repeating rote information hundreds of times.
Email systems are also ways for doctors to virtually extend their time. Lower-level staff may be able to triage emails and handle them without the physician’s intervention. Doctors also may be able to move some activities from in-person visits to email—enabling them to focus on hands-on care for more acutely ill or difficult patients.
Avoid the cost of face-to-face appointments
Employers and patients are beginning to appreciate the high cost of face-to-face visits that are often unnecessary. In the traditional fee-for-service reimbursement model, the only way a provider gets paid is if they have a face-to-face appointment. Doctors consistently state that two-thirds of their patient interactions don’t require a face-to-face interaction, however the reimbursement model forces them to do office appointments if they want to be paid. Dr. Don Berwick outlined the burden of face-to-face appointments in a visionary paper The Commonwealth Fund published entitled Escape Fire: Lessons for the Future of Health Care.
I believe that this new framework will gradually reveal that half or more of our encounters—maybe as many as 80 percent of them—are neither wanted by patients nor deeply believed in by professionals. The health care encounter as a face-to-face visit is a dinosaur. More exactly, it is a form of relationship of immense and irreplaceable value to a few of the people we seek to help, and these few have their access severely curtailed by the use of visits to meet the needs of many, whose needs could be better met through other kinds of encounters.
Let’s do a simple calculation of the cost to the workforce in the U.S. to illustrate the point:
- In a Health Affairs study, 86.3 minutes of the 102.7 minutes involved in having a doctor’s appointment is all about getting to and from a clinic and the accompanying waiting and hassles.
- Just over 150 million people are in the workforce and the average wage equates to $22/hour
- On average there are 956 million medical appointments per year. We’ll assume half of those are for people in the workforce, which would equate to 478 million medical appointments. Even if we assumed only half of those face-to-face appointments could be replaced, that is still 239 million appointments.
- The calculation would 86.3/60 x 239 million appointments x $22/hour = $7.6 billion of avoidable lost productivity per year if people didn’t have to waste time driving and in waiting rooms.
- There are additional costs such as gas, parking and tolls as well not included in that calculation.
Avoiding System Leakage
In an Accountable Care organization (ACO) as well as any capitated model of care that doesn’t force people to receive care from one system, a top concern is leakage– when a patient within an ACO receives care outside of the system running the ACO.
Those in the field of consumer marketing know that it is critical that their brand is top-of-mind status when a consumer is in the market to buy goods or services they can supply. In healthcare, the moment-of-truth is when a health event occurs. If the ACO provider hasn’t established a trusted personal relationship with the patient and made it relatively simple to receive care, it’s highly unlikely they will be top-of-mind when the patient needs help. If some other provider is top-of-mind, patients are significantly more likely to go outside the ACO system for care. To inoculate against this kind of leakage, a consumer marketing mindset is critical but remains a foreign concept to most healthcare providers. Key aspects of a consumer marketing mindset applied to healthcare include:
- Building a trusted personal relationship
- Making it easy for patients to communicate with physicians
- Reaching out to patients when they are not sick with touchpoints or health reminders
- Building convenient self-service capabilities into the physician portal
- Making it easier for the patient to get an appointment with a provider inside the ACO than outside of it.
The traditional approach to healthcare largely ignores the central role patients (or families) play in driving outcomes and if continued, could prove to be a fatal flaw in the new reimbursement models. Throwing resources such as care coordinators at the problem can help, but it would be better to combine the best of human and technology driven communication methods to involve the patient in the process.
The following statement is from a “Pioneer ACO” describing the importance of weaving the patient into the process:
“With our finite resources, we must figure out ways to offload what we have thought as tasks that needed to be done by our staff. In most cases, it’s the patient who can do it more effectively. In the process, the patient is more engaged and it’s more efficient for everyone.”
|SIDEBAR Myth and Reality of Physicians Getting Overwhelmed by EmailsPhysicians are understandably concerned about being overwhelmed by emails if they provide an option for secure messaging. As mentioned above, financial incentives have a big effect on the willingness to take on what many perceive to be “more unpaid work.” Interestingly, the physicians who have given out their phone number or enabled secure email (without remuneration) haven’t found they are overwhelmed by any means. In fact, they have experienced a number of benefits.Dr. Ted Epperly has been a family doctor for decades and describes his experience as follows:
“I give them both my phone number and a way to contact me via email. In 32 years of being a family physician I have had this privilege abused less than 5 times. On the flip side it has led to many occasions where I have been able to expedite care and save countless number of office visits, ER visits and hospitalizations. That is patient-centered care and I personally feel better for it.”Dr. Howard Luks is an orthopedic surgeon also has experienced similar benefits.
“Physicians underestimate the fact that opening up a digital channel to facilitate post visit, post-surgery, etc. comments and questions can and does provide a very real ROI if you dive into the typical workflow pattern that evolves when a patient calls with questions. If my assistant or nurse is tracking me down after fielding a phone call, they are not available to perform work that will lead to income. If I can answer a question with a brief email it saves everyone time and enables him or her to remain active in meaningful tasks. So… there are tangible reasons why the use of digital communications in this day and age are worthwhile, but many are not savvy enough to realize the upsides and fear that they will be inundated with an enormous number of useless emails. I can tell you that it never happens and patients start most every email with ” sorry, but I …”. They are very respectful of the opportunity to engage in this format and they are very cognizant of the fact that it does take away from my other clinical related activities.
It is clear that providers can impact how their patients use secure messaging. Those providers who suggest that their patients follow up digitally, “After you’ve taken these new medicines for a couple of weeks, please send me a secure message and tell me how you are doing” and who advertise their willingness and ability to engage with patients via secure messaging will have more digital encounters than their counterparts who mention it rarely or not at all.
As providers do more of their visits via secure messaging, however, systems will need to think about new models for compensating providers that acknowledge writing a thoughtful message to a patient does take time and needs to be balanced with other work. Some organizations expect over a quarter of their doctors’ time will be spent responding to email.
Importance of Aligned Financial incentives
Importantly, the results highlighted in the DPC model above and the case studies of Kaiser Permanente and Denmark use an economic model that aligns financial incentives with providing effective and efficient care, regardless of how that care is delivered. As a Congressional Budget Office analysis notes, “How well health IT lives up to its potential depends in part on how effectively financial incentives can be realigned to encourage the optimal use of the technology’s capabilities.” Instead, the U.S. has a system that doesn’t align financial incentives with health outcomes and the results are sub-optimal. The quote below is from Dr. Ted Epperly.
It’s like having the five best basketball players on the planet. According to our system of payment, we give each of them a basketball and tell them to dribble around and shoot at will. We tell them that every time they shoot the ball they will be paid. They don’t even have to make the basket to get paid; they just need to shoot the ball. And so we have these five superstar basketball players dribbling and shooting constantly in a fragmented, non-integrated, non-coordinated fashion. And to make matters worse, they don’t communicate with each other in any effective way to modify their behavior for each other’s aid, let alone their patient’s. We then play a team from Spain, England, Canada, France, or Germany, and we get beat. Why? Not because we don’t have the best basketball players on this planet; it is because we do not pass the ball and play as a team. When you step back and look at how our nation performs health care, we stack up poorly against the other industrialized nations in terms of outcomes. Not because we don’t have talented people, but because we care for our patients using a fragmented, non-integrated, unaccountable, non-functioning system of record-keeping and communication. It is not connected well with information sharing.
Communication is the driver of satisfaction in any relationship, whether it’s personal or professional. It becomes all the more important as Medicare is including patient satisfaction as a factor in reimbursement# as highlighted in a recent NY Times article.
“The ratings are based on Medicare-approved surveys, which hospitals hire companies to give to a random selection of patients after they are discharged. Some surveys are given by phone, others by mail. All ask the same questions: Did the doctors and nurses communicate well? Was pain well controlled? Was the room clean and the hospital quiet at night? The surveys go to younger patients as well as Medicare beneficiaries.”
The first two questions on Patient Experience address communication
- How well nurses communicated with patients
- How well doctors communicated with patients
Whether out of desire or necessity, consumers are ready for improved communication so they can save on their healthcare costs. It’s expected that roughly one-third of the workforce will be permanent freelancers, contractors, consultants, etc. with little expectation of employer-provided insurance. Even for those with employer-provided insurance, employees today are responsible for an ever-growing percentage of the premium and cost of care. The current average is that employees pay 30% of the insurance premium costs (up from 10% in the recent past) and may also be responsible for significant deductibles. Some speculate that 50% of the workforce will directly purchase their own healthcare via the health insurance exchanges (to be implemented in 2014 as a result of the federal health reform).
This increased onus on individuals coincides with the rise of consumer empowerment that has happened in virtually every other sector. In a fourth-party payment system (i.e., employer pays an insurance company which in turn pays the provider), the consumer is shielded from the true costs. When that shield is removed, one can expect them to have a higher expectation of communication with their providers.
The good news is there is a tremendous competitive advantage that healthcare providers can realize if they choose to focus on improved communications for the 99+% of the time when a patient isn’t in their offices. Not only can this opportunity provide a competitive advantage, it is imperative in the new reimbursement models.
Fortunately, various studies referenced in this book demonstrate improved communication positively affects the goals of the Triple Aim. Improved communication leads to better outcomes while the empowered patient is also much more satisfied with the experience. At the same time, this has the effect of lowering healthcare costs. On top of all of that, clinicians express how they are more fulfilled in their roles. The root of the word ‘doctor’ is teacher. Doctors, as well as all other clinicians, went into the profession to improve the health of their patients and community and nothing is more fulfilling than guiding a patient back to greatly improved health.
Why communication is good for patients
- Improved communications with providers has been correlated to improved health outcomes for patients.
- Patient/family satisfaction is improved and anxiety reduced with strong communication with the healthcare team.
- Better understanding of one’s health situation leads to greater empowerment.
Why communication is good for providers
- Improved communication capability increases operational efficiency.
- Providers express greater professional fulfillment.
- Enhanced communication leads to improved outcomes.
- Reduced network leakage of patients enabled by top-of-mind status.
- Increased patient satisfaction leads to greater reimbursement (due to new Medicare requirements).
Why communication matters for the health care system as a whole
- Payment reform is radically transforming the clinical delivery model. The change management that accompanies can be improved through strong communication.
- Improved health outcomes can slow or reverse overall costs.
- New communication requirements drive new and innovative technology solutions
- With 75% of healthcare spend going to chronic disease, communication is the best method of helping patients self-manage their conditions.
 Yi Yvonne Zhou, Michael H. Kanter, Jian J. Wang and Terhilda Garrido. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients.Health Affairs, 29, no.7 (2010):1370-1375 doi: 10.1377/hlthaff.2010.0048
 Kaiser Permanente. Power and convenience of Kaiser Permanente electronic health record drives member retention http://thelundreport.org/resource/power_and_convenience_of_kaiser_permanente_electronic_health_record_drives_member_retenti_0The Lund Report. Accessed August 25, 2012
 “Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study” March 2010 Issues in International Health Policy, The Commonwealth Fund.
 Patient Protection and Affordable Care Action, Section 1301(a)(3)
 Net Promoter Study by Qliance: While health insurance had the lowest average NPS (-5%), Qliance had 79% compared to Google and Apple which were 53% and 72% respectively
 Dave Chase. CalPERS $7.0 Billion Potential Health Insurance Bunker Buster.http://www.forbes.com/sites/davechase/2012/07/05/calpers-7-0-health-insurance-billion-bunker-buster/. Forbes. Accessed August 25, 2012.,Note: The patient populations had an average or above average percentage of patients with chronic conditions
 Michelle McNickle. 9 ways future EHRs need to support ACOshttp://www.healthcareitnews.com/news/9-ways-future-ehrs-need-support-acos.Healthcare IT News. Accessed August 25, 2012
 Ted Epperly, MD, FAAFP. Fractured, , , New York; Sterling & Ross Publishers; 2012
 National Ambulatory Medical Care Survey: 2008 Summary Tables, tables 1, 9, 13
 Yi Yvonne Zhou, Michael H. Kanter, Jian J. Wang and Terhilda Garrido. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients.Health Affairs: 29, no.7 (2010):1370-1375 doi: 10.1377/hlthaff.2010.0048.
 Dave Chase, Pioneer ACOs Share Lessons Learned and Challenges Aheadhttp://www.forbes.com/sites/davechase/2012/06/12/pioneer-health-care-organizations-share-lessons-learned-and-challenges-ahead/. Forbes. Accessed August 25, 2012
 Congressional Budget Office titled, Evidence on the Costs and Benefits of Health Information Technology, May 20, 2008
 Ted Epperly, MD, FAAFP. Fractured, , , New York; Sterling & Ross Publishers; 2012
 Jordan Rau. Patient Grades to Affect Hospital Medicare Reimbursementhttp://www.nytimes.com/2011/11/08/health/patients-grades-to-affect-hospitals-medicare-reimbursements.html?pagewanted=all. NY Times. Accessed August 25, 2012, Accessed August 25, 2012
 “The Emerging New Workforce”http://www.littler.com/files/press/pdf/Emerging-New-Workforce-May-2009-Employer.pdf. Accessed August 25, 2012