The missing link: Non-clinical staff and value-based healthcare delivery

“While risk stratification has helped providers deliver more focused medicine, the healthcare industry still has a long way to go.”

-Jim Bowling, co-founder, Premedex

(Reposted from www.rtmd.org) Peel back the layers of what patient satisfaction really means, and you’ll find there’s much more to it than the doctor’s bedside manner.

While a physician’s empathy, likability and listening skills remain vital, these qualities are no longer the end all be all stamp of patient approval they once were.

Instead, patients desire the seemingly simple – for their doctors to communicate with them, clearly and consistently.

But wait. Isn’t that already happening?

Not like it should, says Premedex cofounder Jim Bowling.

“There is a black hole in communications, particularly with regard to patients who are in the post-discharge follow up stage of care,” he said. “This is that critical window of time when patients can relapse and wind up back in the hospital.”

And that, adds Bowling, is why the Centers for Medicare and Medicaid Services (CMS) has levied a series of increasingly progressive penalties for providers deemed ineffective in healthcare population management.

The government’s punitive measures, part of the Readmission Reduction Program, began Oct. 1, 2012, which was the start of the 2013 fiscal year for CMS.

Bowling predicts that these penalties will increase until hospitals change the way they define and treat coordination of care.

“You hear a lot about coordination of care,” said Bowling. “But you have to communicate to coordinate care. If a patient is not recovering well, if their condition is the same or worsening, if they are not taking their medications or otherwise confused on their discharge instructions, they will likely end up right back in the hospital. There’s no reason to invite this kind of over-utilization by under-communicating, especially when in many cases, avoidable readmissions can be prevented by something as simple as a phone call.”

Ok, so it sounds nice in theory. But in an already overburdened healthcare system, where the goal is to find savings at every turn without compromising care, where is the human capital to make these calls? Moreover, doesn’t this add yet another layer of expense?

Enter the non-clinical healthcare workforce.

It’s a model already in practice at the Atlanta-based Premedex, a healthcare provider consultancy firm specializing in healthcare population management.

Premedex employs 20 care coordinators – non-clinical staff consisting primarily of four-year degree holding professionals, who field a large volume of direct patient communication – more than 125,000 patients daily. It’s accomplished through a hybrid system including live calls, automated calls, and even text messages, with call findings tracked in the secure cloud-based platform, all for a fraction of what providers would spend treating these patients in a traditional clinical setting.

“This team focuses on the transition of care, during that time from an acute care setting to home health or an alternate setting,” said Bowling. “The model is a complex web of communication with a very simple end goal – to empower the patient during their most vulnerable point of care.”

For higher risk patient cases, Premedex maintains a small clinical staff of triage nurses.

The findings from these patient touch points are logged into the Premedex portal, the company’s cloud-based patient management platform. Each patient is profiled by disease pathway. Patients also receive an individualized risk score.

Based on this information, specific communication protocols are activated to connect the patient with the right care in the right place at the right time.

If that language sounds familiar, it should. It’s a key component of the Affordable Care Act.

In essence, Bowling and his team are providing a fail-safe in an industry that is still trying to get out of its own way.

“There is a significant issue in many communities where the primary care physician and home health agencies are not kept in the loop when their patients are admitted or discharged,” said Bowling. “Our role is to keep a patient’s entire care team updated on changes in that patient’s health status. If we are serious about changing our healthcare delivery system, and achieving the best possible patient outcomes, we cannot simply assume this knowledge transfer is taking place.”