Patient-centered approaches reduce waste + improve care, CEOs advise

Patient-centered care has become a business imperative, and patient-centered strategies to reduce waste while improving care will benefit both healthcare organizations and patients, according to an article published in the February issue of Health Affairs.

The article was written by 11 CEOs or executives from healthcare systems across the country, including Delos M. Cosgrove, president and CEO of Cleveland Clinic; Gary Gottlieb, president and CEO of Partners HealthCare in Boston; and George C. Halvorson, chair and CEO of Kaiser Permanente in Oakland, Calif.

“For CEOs of health care organizations, the move toward engaging patients in their own care is not simply the right thing to do. It is quickly becoming the norm amid growing evidence that patient-engaged care is associated with better health outcomes, better care experience for patients, and lower health care costs,” wrote the authors.

Patients want healthcare providers to coordinate care across settings, give them tools to manage their own health and take a holistic approach to care, according to National Partnership for Women and Families surveys cited by Cosgrove and colleagues. To aid in the delivery of high-quality care that better engages patients, the authors provided a CEO Checklist for high-value care:

  • Governance priority: visible and determined leadership by CEO and board
  • Culture of continuous improvement: commitment to ongoing, real-time learning           
  • IT best practices: automated, reliable information to and from the point of care
  • Evidence protocols: effective, efficient, and consistent care
  • Resource use: optimized use of personnel, physical space, and other resources
  • Integrated care: right care, right setting, right providers, right teamwork
  • Shared decision making: patient-clinician collaboration on care plans
  • Targeted services: tailored community and clinic interventions for resource-intensive patients 
  • Embedded safeguards: supports and prompts to reduce injury and infection
  • Internal transparency: visible progress in performance, outcomes, and costs

“One theme present in many of the points in our Checklist is that patient-engaged care is often also high-value care,” wrote the authors.

They then shared examples of changes made in their organizations to improve care. These fell into five broad categories:

Delivering evidence-based care: Evidence-based protocols ensure safe, efficient and consistent care delivery, according to the authors. At Kaiser Permanente, the Healthy Bones Program identifies and proactively treats patients at risk for osteoporosis and hip fractures. The program standardized practice guidelines for osteoprorosis management and included patient education and home health components. It has resulted in a 30 percent reduction in hip fracture rates for at-risk patients over five years.

Team-based approaches/shared decision making: One example of a team-focused change provided by the authors came from Cleveland Clinic, where a care enhancement program for lung transplant patients added daily huddles between patients and caregivers. Keeping patients informed and engaged in the development of a plan improved patient satisfaction with clinicians’ communication by nearly 30 percent.

More efficient care delivery: Cincinnati Children’s Hospital Medical Center improved surgical scheduling practices and cut delays, lower the number of cancellation of elective surgeries because beds were not available and ultimately save the facility $100 million in capital costs by eliminating the need for 75 new beds, according to the authors.

Provide care in new ways: Patients may need care outside the hospital, so the authors pointed to examples of programs that delivered care to patients where they needed it. One example was the Connected Cardiac Care Program from Partners HealthCare, a self-management and telemonitoring program that helps patients with heart failure manage their health at home. Telemonitoring nurses can check patients’ weight, blood pressure heart rate and symptoms daily, resulting in $10 million in savings and hospital readmission rates that have been cut in half.

Targeting care to patient/community needs: Denver Health was able to increase breast cancer screening 20 percent, colorectal cancer screening rates by 50 percent and the rate of hypertension control by 12 percent among its patients by assigning medical homes and primary care providers, according to the authors. These providers helped manage care between clinic visits.

The authors concluded by writing that no one approach will suit every organization’s needs. “Each organization must take stock of its unique culture, patient population’s needs, and other elements that will contribute to the ultimate success of any intervention aimed at improving patients’ engagement in their health care.”