Surfing the patient tidal wave

Consider this: From 2008 through 2014, Massachusetts was the only state with an uninsured rate lower than 5 percent. Today, at least seven states boast uninsured rates at 5 percent or below: Rhode Island, Massachusetts, Vermont, Minnesota, Iowa, Connecticut and Hawaii. Nationwide, the uninsured rate is less than 12 percent – and this will continue to decrease in the months ahead, thanks to an initiative by The U.S. Department of Health & Human Services (HHS) targeting several states for increased healthcare exchange enrollment in 2016. Texas tops HHS’ list with the highest uninsured rate in the country at 20 percent.[1]

Shrinking uninsured rates have significant implications for provider organizations as they move to a value-based care model. These organizations can expect a tidal wave of new patients coming to their facilities. They must find a way to improve quality and reduce costs while, at the same time, preparing for an influx of chronic patients with significant and lengthy gaps in care.

Newly insured patients, many of whom had forgone preventive and chronic care prior to gaining insurance, require outreach – for routine care, such as immunizations, screenings and wellness visits – as well as systems of management for those suffering from one or more chronic conditions. Providers in Texas, and any state where HHS’ efforts to increase healthcare exchange enrollment bring on a sudden surge of new patients, will need to quickly build scale and capacity so as not to disrupt their practice and burn out staff. 

High tech + high touch

Most organizations do not have enough licensed staff on hand to provide quality outreach and care management to this influx of patients. These organizations can benefit by supplementing their existing efforts with a combination of automated communication technologies and human-touch clinical services so they can more effectively manage new patients while maintaining quality of care for existing patients.

Intelligent, automated communications combined with clinical services enable organizations to take a proactive, scalable and patient-centered approach to engagement. Some advanced solutions align automated communications with clinical guidelines or the patient’s plan of care, giving those who manage patients a more productive, contextual and consistent way to engage with patients on any issue and at any point within the continuum of care.

For example, newer solutions on the market today enable population health managers or care coordinators to prescribe a communication pathway for each diabetic patient in their panel. Such a pathway leverages a series of pre-scheduled automated communication interventions including:

• Text reminders when it’s time for the patient to make an appointment for foot and eye exams or A1c draws
• Automated calls to collect blood sugar readings
• Surveys about how the patient is doing with medications
• An automated flu shot reminder

These automated communication pathways deliver significant efficiencies over the traditional process of managing care through periodic manual phone calls and even traditional approaches to ad hoc automated outreach. To care for patients effectively, coordinators need to remind, manage and coach them through a number of interventions over a long period of time. They must also keep an eye on patients’ general wellness and prevent other gaps in care around immunizations and screenings not related to a diabetes diagnosis. Advanced automated technologies enable them to perform these tasks accurately and at scale. 

Patient engagement visualized

Automation frees clinical staff to focus on issues that truly require the human touch, particularly among higher-risk patient populations. Intelligent communications capture patients’ input about their conditions and escalate any problems to the care coordinator for a live intervention. 

Through this approach, patients enjoy a seamless, unified communication experience with the provider in their communication channel of choice – and each interaction builds intelligence for future interactions. When individual care coordinators and the organization as a whole can visualize the effectiveness of all of the communication interventions over time, they’re able to determine which patients have been engaging with each intervention as expected and which require additional intervention. This steady stream of valuable patient data enables organizations to continuously enhance and optimize the way they engage with patients between visits.

Health reform is bringing much needed care for millions of people. When they show up at healthcare organizations’ front door, those with an automated strategy in place will be ready for them.

[1] http://www.gallup.com/poll/184514/uninsured-rates-continue-drop-states.aspx