By Martin Entwistle, CEO and President, Ares Health Systems
Today, digital health technologies are offering new ways for providers to personalize and improve care management, especially for patients with complex issues and chronic conditions. Leveraging these digital health technologies, remote care initiatives, specifically, provide new opportunities for patients and providers alike.
While there are significant opportunities, many providers today face challenges finding the best ways to effectively integrate new data sources – like patient-generated health data (PGHD) – into a program of care that will not add additional stress and work for the clinician. However, today we’re seeing that technological advancements along with financial models directly supporting remote patient care are presenting new avenues to successful program implementation.
How technology can solve the problem
Electronic health record (EHR) integration can definitely be a challenge and will remain so until EHRs further advance the capabilities of their APIs to facilitate the delivery of PGHD into the clinical workflow. However, there are already some methods that are making this possible. For example, most EHRs today will allow the writing of PGHD into a patient-entered data flowsheet. And, this can be made available to clinicians inside the EHR. As we see moves to further advance the interoperability of existing clinical systems and workflows, we’ll likely have more opportunities to effectively integrate PGHD.
How to incentivize the use of technology from an operational and financial perspective
A key step for effective program implementation and use is to set expectations, for both patients and providers, up front. Make sure patients understand that their willingness to provide PGHD is going to help their physician provide the best care for them. Make sure that appropriate technical support is provided to help patients get up and running with collecting and uploading PGHD, so this is a positive experience. Don’t make front-line clinical staff carry this responsibility – it will be a frustrating distraction for them. Lastly, make sure the PGHD is viewed and used by clinicians and that patients receive feedback based on the PGHD they have provided, so they know their data is of value to their care team. Experience has shown that one of the biggest incentives for patients is demonstrating that the data they provide directly contributes to their care.
Financially, the “low-hanging fruit” to achieving returns from the use of PGHD is its use to support reimbursable value-based care programs that directly generate revenue. Organizations can see success in leveraging PGHD to meet quality reporting requirements (for MIPS, MACRA, or Meaningful Use), as many reporting metrics now require use of PGHD. In addition, CMS is also continuing to offer more opportunities for reimbursement for the use of remote monitoring. Existing CPT codes, as well as three new codes in the Proposed Physician Fee Schedule 2019 Rule, support the intake and management of physiologic data in remote monitoring – giving providers more financial support for such programs. When leveraging the data in these types of models, the return on investment is easier to define, and providers will be more willing to initiate such programs as a result.
Organizing and orchestrating successful workflow processes
Effective use of PGHD for patient care requires it to become a direct part of the care delivery process. EHRs are now the central tool clinicians use to support his or her process, particularly in handling care management workflows; but, they do not necessarily have all the functionality required to make full use of PGHD. EHRs are challenged to support the wide range of devices and remote data already of value to patient care. They also struggle to handle some of the technical issues around scrubbing and normalizing PGHD.
However, this is one key role Validic supports. Increasingly, people are realizing that it’s not the raw PGHD that’s of value in clinical care, but an analysis of the data – understanding the relationship to normal ranges, to trends, and other themes that can be gleaned. Validic and Ares address this need.
Finally, the analyzed data needs to be further interpreted in the context of the care plan for an individual patient. Clinically meaningful outputs must be provided to both the patient and care team, presented in way that drives understanding and action. To be impactful, these outputs need to be fed into clinical workflows through the EHR and to patients through apps and portals.
Work recently undertaken with a provider with a growing patient base and a need to increase efficiency and impact in care for their patients with diabetes, illustrates this approach. Critical requirements were to handle the growing patient population by increasing the level of responsibility for day-to-day clinical management by nurse care managers, freeing physicians to focus on more complex cases. And, all of this was only possible if the approach made greater use of dynamic remote patient management to drive patient engagement and self-management, while at the same time identifying those individuals needing additional support or more active clinical intervention.
Workflow improvement targets automated the collection of the limited range of PGHD that directly supports the tracking of progress against each patient’s personal care plan goals. Then, the derived clinical performance information is interpreted – in the context of local clinical protocols – and delivered back to the patient through a single, common app. The capture and interpretation of data are irrespective of the devices patients are using and delivered in a standardized manner to the care team though the EHR. This turns disparate data into a common language readily accessible for patients and clinicians to explore together how best to make changes that directly impact outcomes. The ability of the collected data to assist performance reporting, and in the case of some patients, to access revenues for value-based care services, has served to increase the support from leadership. This latter process is the focus of Ares Health Systems.
Martin Entwistle is the CEO and president of Ares Health Systems. Connect with Martin on Twitter.