Accountable Care Organizations (ACOs) and “bundled payments” are set to play a central role in the Affordable Care Act. Under accountable care, physicians and hospitals would be paid out of a “single payment” from CMS or health insurers for all the care needed to treat a clinically defined “episode of care” like a heart attack. The premise is that bundle payments will incentivize physicians and hospitals to deliver more efficient, high quality care.
Much has been written about the health information technology infrastructure needed to support ACOs. Experts also underscore the need for providers (physicians and hospitals) to get patients with conditions like heart failure more engaged in prevention and self-care. After all, as much as 90% of the “care” for chronic conditions like heart failure is provided by the patient and their care givers at home. But effectively engaging patients has been a difficult nut to crack for health care providers.
What Can ACO Providers Do To Increase Patient Engagement?
Here’s the short answer – improve the quality of communications between physicians and patients. After all, physician-patient communications is how most patients are diagnosed and treated.
The degree to which patients and physicians agree on key aspects of the diagnosis and treatment is said to be an indicator of communication effectiveness. Disagreements such as the nature or severity of a medical condition or the need for a new medication represent a breakdown in physician-patient communications. Such breakdowns are common and are closely associated with patient behavioral issues such as non-compliance, excessive health care use, and decreased satisfaction.
High levels of physician-patient agreement are linked with more desirable patient outcomes and behavior. Physicians that use a patient-centered style of communication tend to report much higher levels of agreement with their patients on critical diagnosis and treatment issues.
The Current State of Physician-Patient Communications
A 2011 study of patients diagnosed with a heart condition, and being seen in a public hospital cardiology clinic, illustrates the scope of the communication problems facing not just ACOs…but all health care providers today.
In the study, 55% of patients diagnosed with heart failure did not recognize (nor agree with their doctor) that they had heart failure. Even more disconcerting was the finding that “only 15% of those with hypertension agreed with their doctor’s diagnosis.”
Physician-Patient Disagreement And A Lack of Patient-Centered Communication Are Greatest Amongst Population Groups That Are The Sickest And Most In Need
African-Americans experience heart failure at a rate this is 20 times higher than their white counterparts. Physicians that treat blacks are less likely, according to researchers, to use a patient-centered communication style.
Numerous studies have revealed that when treating black patients, as opposed to white patients, physicians tend to “provide less health information, are more physician-directed (versus patient-centered), spend less time building a rapport with patients, and are more verbally dominant.“ In other words, the patients that are in greatest need for patient-centered communications, and the benefits it provides, are presently the least likely to receive it. The lack of high quality patient-centered communication is not limited to minority groups. An estimated 60% of practicing physicians use a physician-directed communication style.
The Take Away?
Needless to say, the quality of physician-patient communications in the U.S. does not bode well for the success of ACOs. Health plans, physician groups and hospitals looking to realize the financial benefits of bundled payments and accountable care should give serious consideration to investing in benchmarking tools and communications interventions that will measurably improve the quality of physician-patient communication both in the office and hospital.
That’s my opinion…what’s yours?
Cené, C. et al. The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication. Journal of General Internal Medicine. 2009. 24(9):1057–64
Sarkar, U. et al. Patient-physicians’ information exchange in outpatient cardiac care: time for a heart to heart? Patient Education and Counseling. 2011. Nov;85(2):173-9.
Johnson, R. et al. Patient race/ethnicity and quality of patient-physician communication during medical visits. American Journal of Public Health, 2004. 94(12), 2084-90.