PATIENT RELATIONSHIP MANAGEMENT : PATIENT CARE WITH CRM APPROACH
To ensure actual benefit of the patient
Patients often demand things they don’t need, like expensive antibiotics for a cold or an MRI for low back pain, and providers may be confronted with requests for items that they don’t know the value of, such as back stretchers for cervical radiculopathy. Physicians will need access to the best evidence on therapies and technologies, and must also become skilled at explaining to patients why they will not benefit from things that are unlikely to help them (Poku et.al., 2017). Clearly, this will be a delicate balance. Health care system is characterized by high and rising healthcare costs as well as gaps in quality, safety, equity, and access. With limited healthcare budgets, it is important that resources are used in a way that provides the most value for patients. US healthcare system faces daunting challenges in the years ahead. Increasing costs, limitations in access to care, and variability in the quality of care delivered threaten the long-term viability of the system. According to the MedPAC, Medicare enrollment is projected to increase by more than 50% over the next 15 years from 54 million beneficiaries today to more than 80 million in 2030 (Landers et.al., 2016). Among the oldest Americans, the Census predicts that the population age 85 and above will double by 2036 and triple by 2049. Benefits in healthcare include both the quality and patient experience associated with the provision of healthcare services. While value-based purchasing (VBP) can refer to a wide variety of payment strategies that link provider performance and reimbursement (Damberg et.al., 2014), this paper will focus on VBP programs where providers are paid fee-for-service with payment adjustments up or down based on value metrics, a structure also known as pay-for-performance. This trend has led to calls for multi-stakeholder collaboration to improve quality and reduce the cost of healthcare, and to increase transparency regarding the cost and quality of healthcare services (Mannion et.al., 2008). As a result, a number of payment and delivery reforms have recently emerged, which attempt to promote higher value healthcare (Chee et.al., 2016). Long-term success is predicated on the creation of patient-centric value creation (eg, higher quality, patient-centered care at a lower cost). The Institute of Medicine has emphasized value as an important part of improving health care systems, and the American College of Physicians has launched the High Value Care Initiative. It is an increasingly important concept in medicine and rehabilitation, home care, long term care, hospice and other similar HCEs. The value-based system refers to a personalized care, where patient’ expectations and needs are included in a holistic approach of medicine that considers physical, mental, and spiritual well-being (Mor et.al., 2005). Providers should also assess their risk tolerances and organizational cultures. At the micro level, the quality-cost relationship is focused on the impact of health care service delivery on individual patients, as well as on the decisions of individual providers and organizations that manage the care. At the macro level, this relationship is evaluated based on population impact and the costs to society to achieve a positive health status for large cohorts of people (Institute of Medicine US, 2002; Carvalho et.al., 2018). Achieving success in value-based payment and delivery requires an organizational culture that emphasizes and facilitates high-quality, safe, patient-centered, cost-effective care. It also requires strong physician leadership and a willingness to change often longstanding practice patterns and systems of care (Bozic, 2013). Finally, organizations should define in advance the metrics they will use to evaluate and monitor successes or failures. Thus, aligning PRM with an appropriate reimbursement model is essential—in a fee-for-service reimbursement environment, utilizing PRM to deliver an ever-growing set of unnecessary services would be a real risk (Skempes et.al., 2018). As emerging reimbursement schemes increasingly reward true healthcare value creation, provider organizations will find incorporating PRM to be a key element of a winning strategy.
Reflecting on the future state of our healthcare delivery system, it is important to note that high levels of satisfaction and high care quality do not always align. A national study demonstrated that higher patient satisfaction was correlated with higher total healthcare expenditure and increased mortality. Patients often demand things they don’t need, like expensive antibiotics for a cold or an MRI for low back pain, and providers may be confronted with requests for items that they don’t know the value of, such as back stretchers for cervical radiculopathy. Physicians will need access to the best evidence on therapies and technologies, and must also become skilled at explaining to patients why they will not benefit from things that are unlikely to help them. Clearly, this will be a delicate balance. Furthermore, while the takeaways described by the three companies are important lessons for healthcare leaders to internalize, they must do so in a measured way that acknowledges the inherent differences between operating a healthcare delivery enterprise and operating a service enterprise outside the healthcare domain. In the latter, the primary goal is to deliver service excellence in order to increase customers’ willingness to pay and/or to increase the rate of return customers. Healthcare, of course, is different. Maximizing value delivery in healthcare services will mean improving the health of patients in part by avoiding costly acute care services. It may also be hard for patients to fully judge the value of a healthcare service even after that service is provided. Thus, aligning PRM with an appropriate reimbursement model is essential—in a fee-for-service reimbursement environment, utilizing PRM to deliver an ever-growing set of unnecessary services would be a real risk. As emerging reimbursement schemes increasingly reward true healthcare value creation, provider organizations will find incorporating PRM to be a key element of a winning strategy.
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