Why Professionals Go into Healthcare

SUCCESS IN TODAY’S HEALTHCARE MARKET Healthcare is quickly moving to a value-based system. The Center for Medicare and Medicaid Services (CMS) is no longer paying for beds; it’s paying—or penalizing—for stays and satisfaction. It’s looking at the patient experience, both in terms of the care patients receive and how they feel about that care. Patients are now a critical part of the equation. They need to be engaged and educated in order for hospitals and healthcare systems to succeed. But how is this most effectively done? Most hospitals today have websites, web-based health libraries, some videos and information sheets, as well as printed handouts and discharge instructions. The problem with this “standard approach” to patient education is that it has not affected the cost or quality of care. Hospitals relying on standard patient education are still hemorrhaging. A new model is needed! To be successful in today’s healthcare environment, a hospital must be a leader in patient engagement. Why? Because, as evidence has already shown, it will provide the highest return on investment (ROI) in quality of care, patient satisfaction, hospital reputation, revenue retention and cost savings. To do this, hospitals need to extend care beyond patient appointments and inpatient stays. Providing timely, relevant information that keeps patients engaged and aligned with their healthcare has been shown to reduce a hospital’s cost of unnecessary care by 30%1. Translated into ROI, the investment in this “new model” of patient engagement should be paid back within 60–90 days, after which the hospital is saving money—that’s money in the bank! These figures are derived from research about improving patient engagement and experience. They are calculated based on hospitals delivering this new model for all of their in-patient stays. These are the hospitals that, rather than relying on the standard approach of simply putting out information with the hope that patients find and use it, are proactively engaging patients and delivering the information they need at the right time in useful, in actionable pieces. 2

Providing timely, relevant information that keeps patients engaged and aligned with their healthcare has been shown to reduce a hospital’s cost of unnecessary care by 30%1.

The standard approach to patient education has certainly been tried and it’s quite clear that it has not done the trick. If it had, we would have seen its impact in terms of improved care and outcomes and reduced costs associated with unnecessary care. This has not happened. But it does when we leverage what is known (the research about patient education and reduced costs) and the technologies that now exist (patient engagement solutions).

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Annals of Internal Medicine. 2009;150:178-187 ibid.

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The most effective patient engagement programs provide a means of tracking and substantiating—in real time—their efficacy and impact, while allowing the hospital to easily make iterative changes to improve results. And the results should be improvements in: • Quality of care • Satisfaction, reputation and new business • Cost savings and revenue retention When connected to patients’ electronic medical records (EMR), effective engagement programs also provide documentation of patient-specific education and the positive changes, which can be helpful in terms of meeting “meaningful use” and other requirements.

THE

NUMBERS The New Model vs. Standard Approach So how does this new model of patient engagement and education work in the real world? What does it look like in a typical hospital or hospital system? Let’s take a look at what’s happening at Altapark Medical Center (a fictitious compilation of what we’ve seen at four medium to large-size hospital systems). Altapark comprises three hospitals and primary care practices.! Altapark enlists both the standard approach to patient education, including a web health library, printed hand-outs and a general health e-newsletter. But Altapark’s surgical director of orthopedics, Dr. Kate Masters (we’ll call her Kate), decided to use a new model of patient engagement. She chose one she had seen in use at two of the nation’s top 50 orthopedic programs (according to U.S. News & World Reports’ ratings). The new model strategy begins pre-surgery and stays connected to patients—during their hospital stay and post discharge. Kate understands that “e-patient” means an “engaged patient”3 and that when patients “get it” they are better partners in their own care. The surgeons reviewed this program too, and they thought it would save them time and effort, and might even contribute to better results. We’ll call this new model of patient engagement at Altapark “Kate’s Joint Replacement Engagement Solution.” Altapark patients receive information, instructions, support and FAQs 3

• Altapark Medical Center performs 324 joint replacement surgeries (knee or hip) annually. • All joint replacement patients have access to Altapark’s standard web content, print packets and printed discharge instructions. • 198 of these patients receive the weekly care-plan messages from Kate with timely, understandable, evidence-based instructions, information and resources. • 126 do not receive these messages. • As suggested, these 126 patients without specific support and guidance are likely costing Altapark $51,912, while those 198 with Kate’s support could actively be saving Altapark $81,576. • These numbers do not account for the additional CMS penalties for readmissions that could apply.

Pew, “The e is for Engagement”

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weekly via Kate’s Joint Replacement Engagement Solution. These help patients fully understand their care plans and enable Kate to connect with patients (and their family members, too) before, during and after surgery—even staying with them well into their recovery. As the research referenced above suggests, standard patient care, education and support costs Altapark an additional $412 per patient. However, providing those same patients with timely instructions and delivering them in a way that patients can understand and find actionable, as Kate does for joint replacement surgery, could save Altapark the $412 per patient and this could translate into a 30% reduction in unnecessary costs of care.

A Caveat This research study4 was conducted in an urban area with patients who were admitted and is not based on scheduled surgeries, such as a hip or knee replacement. What is parallel though, are the specifics of standard patient-care education and the intervention, which saved the $412 per patient. In this case, the intervention was more labor intensive and only began once the patient was admitted. Furthermore, all sites are different, of course, so this extrapolation may not be 100% comparable in every situation. Nevertheless, even viewed conservatively with, for example, only 50% of the savings realized, the cost of Kate’s Joint Replacement Patient Engagement Solution is covered more than 200%:

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If all of Altapark Medical Center’s joint replacement patients were to receive this specific support, Altapark would break even in less than 2 months and have a substantial ROI each month thereafter, with an annual savings in unnecessary care costs alone greater than $100,000—not including additional penalty savings from avoiding unnecessary readmissions and increasing patient satisfaction.

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This calculated ROI is based on only one service area, joint replacement surgery, but it can easily be multiplied across many areas, as other top hospitals are doing. Imagine if the 126 were 1,260 stays, the savings might be $519,120.

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Using the study’s numbers5 is a means of comparing something standard, which has not worked, to a new model approach, which electronically replicates what was done with nurses in hospitals one to one with each patient (a significant cost in itself), as well as pharmacy calls, information to the primary care physician and follow-up interviews. In fact, Kate’s program connects with the patient in a way that extends the care from before they come in for surgery through well into their recovery. And it provides four times the number of communications with regular feedback to assure that patients “get it.” 6

Annals of Internal Medicine. 2009;150:178-187 Annals of Internal Medicine, 2009; 150:178-187 Becker’s Hospital Review, Aug. 31, 2012

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The Experience: How It Works To fully understand the difference between standard patient education and Kate’s Joint Replacement Engagement Solution, we provide below an illustration of the experience of care for patients and providers. The difference is substantial in terms of ease of use, accessibility, relevance and, therefore, impact and ROI.

Kate’s Joint Replacement Engagement Solution at Altapark •

Patients are enrolled to receive HIPAA-compliant messages from Altapark Medical Center. The information and guidance they need comes to them automatically in manageable, actionable emails. The messages are geared specifically to where they are in their care path. The messages are relevant, interactive and engaging, plus they address only the issues patients are facing—and the questions they have—right now. Many studies7 show that, often, 80% of what patients hear from their healthcare provider is forgotten— sometimes by the next day. In addition, adult education teaches us that in most cases adults need to hear something about seven times for it to really be learned. So planned redundancy (through electronic messaging that reinforces a healthcare provider’s instructions or information) is not really redundant, it’s crucial to activating patients—a key to making them savvy costsaving partners in their care.

How Effective Is This New Model? Surveys say: • 87% of joint replacement patients receiving the new model of patient engagement solution said the messages were “extremely/very helpful” in preparing for surgery or during rehab. • 82% said the joint replacement messages would be a factor in recommending the hospital to friends and family. • 85% said they would be very/somewhat likely to want the messaging series for future joint replacement surgeries. • 77% said they are interested in receiving future education by email.

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Patients have access to Kate and the Altapark care team 24/7. Because the messages are mobile optimized, patients can access the information anywhere at any time on their mobile phones, tablets, laptops or desktops.

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Patients can interact with Altapark, ask and respond to questions, click on links to see recommended resources, and keep the information for easy referral at any time. In essence, they always have Altapark and Kate with them. And their family members/caregivers can, too.

The Value Added with Kate’s Joint Replacement Engagement Solution •

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Patients have understandable, easy-to-use help, support and clarification 24/7, making them more knowledgeable partners in their care.

Forbes Magazine, “Doctors Are a Broken Record We Don’t Comprehend 80% of the Time,” Oct. 14, 2012

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Patients do not need to search for answers to their questions. Altapark Medical Center is proactively providing the answers.

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Kate’s solution integrates targeted, evidence-based content tailored to Altapark Medical Center with Altapark’s resources and referrals.

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Kate and Altapark receive real-time analytics to understand their specific patient

engagement. •

Kate and Altapark are fully in control of the messaging. o They can customize the messages at any time—for example, modifying the care path or noting changes in policies. o They can send additional, targeted communications—for example, reminding patients to use special soap before their surgeries or highlighting a relevant hospital class offering. o They can survey patients to gain critical feedback in real-time—for example, running an ongoing satisfaction survey to understand where improvements can be made to the patient journey.

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Kate and Altapark receive trustworthy health content that is reviewed regularly and updated as needed.

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Kate and Altapark also receive messaging tools that enable private, secure communications with patients.

The Standard Patient Education and Support at Altapark •

Patients are given printed copies of information and discharge packets one time at appointments. They put this information in their bags to “go back to later.”

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Patients have 24/7 access to joint replacement information on Altapark Medical Center’s website. But here’s what happens when they attempt to access patient information about their hip or knee replacement. 1. They go to the Altpark website. 2. They click on a button asking: “How can we help you today?” They are disappointed to discover that “Knee/Hip Surgery” is not one of the options listed. 3. They use the website’s search function, but find no matches for “knee/hip replacement surgery.” 4. They go back to the homepage and notice the “I am a …” text entry field. So they type in: “patient.” Lots of other options pop up, but nothing about knee/hip replacement or joint replacement surgery. 5. At this point, they either decide to try again later, search elsewhere or struggle through to find the site’s “Health Library.” 6

6. When they click on Health Library … there it is. 7. They click on “H” where they finally find the information they are seeking. 8. They read that “their hospital stay will be several days.” But their surgeon told them to expect to stay in the hospital for 3–4 days. Is that several days? They are not sure. 9. At the bottom of the page, they see that a doctor reviewed the online information, so they try to call their doctor and/or this other doctor for clarification. Only this doctor does not work for Altapark Medical Center, which leads to more confusion.

The Value Added with the Standard Patient Education and Support •

Patients get printed copies of instructions to refer to. Do they?

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Patients spend more time on the hospital’s website, but is it a positive experience?

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Patients can come back to the hospital’s website at any time for more information. Do they?

Why Professionals Go into Healthcare The why is what really matters. Most healthcare professionals got into this to help make us all better. It is from this motivation—and a direct, personal touch—that care improves; that we heal and get better. But with new and increasing demands—and often fewer resources—this is all too easily lost on the clinical level. We know that improved care outcomes and higher patient satisfaction come from establishing and sustaining relationships with patients. While standard patient education provides something of value, it does not regularly—or necessarily meaningfully— connect with each patient. We know what works to improve care and empower patients; technology facilitates the ability to do it efficiently and effectively. All of this is even more important now that CMS is no longer paying for beds; it’s paying—or penalizing—for stays and satisfaction. To a great extent, patients themselves play a role in this. So how perfect is it that the new model of patient engagement makes care the ongoing focus while also directly attending to the new economic realities? Let’s conclude by doing a little math.

The Final Tally Again, we use as our currency the $412 per patient lost on unnecessary care that we referenced earlier. The average U.S. hospital has 162 beds and approximately 6,388 in-hospital stays each year.

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Each of these stays by a patient who does not understand his or her care plan, costs an additional $412 at a minimum. That’s 6,388 patients x $412 = $2,631,856 This is before including any penalties for readmissions or decreased satisfaction, which are similarly impacted by patients not having clear, actionable guidance and an understanding of their care plans. Penalties for just two knee or hip replacement surgery readmissions beyond the national average may add an additional $530,000 to a hospital’s cost of care. The tally for these avoidable costs of care? $2,631,856 + $530,000 = $ 3,161,856 Even if we choose to be more conservative, and estimate that only 50% of a hospital’s patients do not “get it” and the hospital has no readmission or satisfaction penalties, the unnecessary costs of care come to $1,315,928. About the Authors: Debra Zalvan, MBA, focuses on expanding business scope for engagement in healthcare. As UbiCare’s Executive Vice President she works to leverage new research and technologies to develop solutions that build effective relationships between healthcare providers and their patients. She provides project governance for UbiCare’s new projects, as well as our work with the Department of Defense. She has 18 years of experience in project management, with a distinct focus on educating and communicating through non-traditional media. She has extensive experience in marketing, design and account management with emphasis on strategic planning, cross-functional team collaboration and financial considerations. Bill Lindsay, UbiCare’s Vice President of Content, has 28 year of experience leading content operations for targeted, multi-platform media ventures, creating award-winning content on health, education, parenting and life-stage issues. He has been a featured speaker at national publishing and social media events and is a former fellow at the American Press Institute and the Casey Journalism Center for Children and Families at the University of Maryland. Betsy Weaver, Ed.D., is a nationally recognized innovator in patient education and healthcare communication. With the formation of TPR Media (d.b.a. UbiCare) in 2002, Weaver created the first email services designed to enhance hospitals’ care connections with patients and streamline processes for staff. Building on this success, in 2010 Weaver created the first hub platform for healthcare, incorporating email, social media, text messaging and web services.

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About UbiCare UbiCare is a leader in patient engagement, extending high-quality care through technology. UbiCare’s patient engagement solutions are customizable in real-time, delivering the right information at the right time to create and sustain effective patient/provider relationships UbiCare has enabled hospitals and private practices—including the U.S. Department of Defense and 400 others—to be patient engagement innovators at the forefront of enhancing their patients’ experience and outcomes. •

All of UbiCare’s patient engagement solutions function from a single hospital database, allowing clients the ability to connect information and gain a deeper understanding of their patients through the full range of content they access and engage with.

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UbiCare offers solutions in more than 50 service areas.

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UbiCare also works with clients to create custom solutions tailored to specific needs.

UbiCare is GSA approved, Small Business Certified, Women’s Business Enterprise Certified (WBENC) and Women-Owned Small Business Certified (WOSB) with a Dun & Bradstreet customer-service rating of 93%.

End Notes, Sources and Relevant References • Annals of Emergency Medicine, 2013, “Physician E-mail and Telephone Contact After Emergency Department Visit Improves Patient Satisfaction: A Crossover Trial,” by Pankaj B. Patel, MD; David R. Vinson, MD. http://www.annemergmed.com/webfiles/images/journals/ymem/FA-5365.pdf “Results: The mean patient satisfaction score was 79.4% for the 1,002 patients in the noncontact group and 87.7% for the 348 patients in the contact group (difference 8.3%; 95% confidence interval 4% to 12.6%). Patient satisfaction scores were similar for e-mail and telephone contact: 89.3% for the e-mail group and 85.2% for the telephone group (difference 4.1%; 95% confidence interval 2.3% to 10.5%).” • Annals of Internal Medicine, Vol. 150, No. 3, pp178-187; Feb. 3, 2009: “A Reengineered Hospital Discharge Program to Decrease Rehospitalization A Randomized Trial,” by Brian W. Jack, MD; Veerappa K. Chetty, PhD; David Anthony, MD, MSc; Jeffrey L. Greenwald, MD; Gail M. Sanchez, PharmD, BCPS; Anna E. Johnson, RN; Shaula R. Forsythe, MA, MPH; Julie K. O’Donnell, MPH; Michael K. PaascheOrlow, MD, MA, MPH; Christopher Manasseh, MD; Stephen Martin, MD, MEd; and Larry Culpepper, MD, MPH. http://annals.org/article.aspx?articleid=744252 “The difference between study groups in total cost (combining actual hospital utilization cost and estimated outpatient cost) for 738 participants was $149,995—an average of $412 per person who received the intervention. This represents a 33.9% lower observed cost for the intervention group.” (p184) • Archives of Internal Medicine 2000;160(8):1074-1081. “Hospital Readmissions as a Measure of Quality of Health Care,” by Jochanan Benbassat, MD; and Mark Taragin, MD, MPH. http://archinte.jamanetwork.com/article.aspx?articleid=415392 “Furthermore, randomized prospective trials have shown that 12% to 75% of all readmissions can be prevented by patient education, predischarge assessment and domiciliary aftercare.”

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• Becker’s Hospital Review, Aug. 31, 2012. “Interactive Patient Education Reduces Readmissions, Increases Satisfaction: Kaiser Permanente Panorama Hospital Case Study,” by Kathleen Roney. http://www.beckershospitalreview.com/healthcare-information-technology/interactive-patient-educationreduces-readmissions-increases-satisfaction-kaiser-permanente-panorama-hospital-case-study.html • Forbes, Oct. 14, 2012, “Doctors Are a Broken Record We Don't Comprehend >80% of the Time,” by Dave Chase. http://www.forbes.com/sites/davechase/2012/10/14/doctors-success-hinges-on-transactorto-teacher-transition/ “As both the private and public sector aggressively shift healthcare incentives from a “do more, bill more” to a value and outcome based model, healthcare providers ignore patients role in driving outcomes at their own peril. It is generally understood that patients forget 80-90% of what they are told at the doctor’s office.” “78% of patients don’t understand discharge instructions” • Health Affairs, Vol. 32, No. 2, pp 216-222; Feb. 2013. “Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’,” by Judith H. Hibbard, Jessica Greene and Valerie Overton. http://content.healthaffairs.org/content/32/2/216.abstract?=right “8% higher cost for those least activated in base year and 21% higher cost in the following year.” • Mayo Clinic Proceedings, January 2010; 85(1): 47–52. “Hospitalized Patients’ Understanding of Their Plan of Care,” by Kevin J. O’Leary, MD, MS; Nita Kulkarni, MD; Matthew P. Landler, MD; Jiyeon Jeon, MPH; Katherine J. Hahn, BS; Katherine M. Englert; and Mark V. Williams, MD. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800283/ “CONCLUSION: A substantial portion of hospitalized patients do not understand their plan of care. Patients’ limited understanding of their plan of care may adversely affect their ability to provide informed consent for hospital treatments and to assume their own care after discharge.” • Pew Internet & American Life Project, “The e is for Engagement,” by Susannah Fox. Presentation at Stanford MedicineX and Partners Connected Health Symposium, October 2012. http://www.youtube.com/watch?v=XA4hqhSk4hM “Tom Ferguson was an M.D. who believed he saved more lives by not practicing medicine in the traditional sense, but by forging a path we have come to call participatory medicine. He was my mentor for the six years I knew him before he died, in 2006, and he continues to teach me as I review what he shared with me. … He coined the term “e-patient,” which many of us use today to describe people who are engaged in their health.” • Pew Research Center, “Health and Technology in the U.S.” fifth (and final) 2012 national survey, September 2012.

© UbiCare 2014

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