Two of the more significant components of the Affordable Care Act are (1) the penalty against hospitals for patients readmitted within a month for something that should have been dealt with on the initial visit and (2) the redistribution of higher Medicare payments (in effect, a raise) to the hospitals that are delivering better care. The independent Medicare Payment Advisory Commission estimates that 15.3 percent of hospital admissions result in a re-admission. In 2010 alone, this happened 1.9 million times at an estimated cost of $17.5 billion. This has created an immediate and urgent need for hospitals to develop more personalized and effective patient discharge information and education about disease management. Hospitals that figure out how to do this soon will disproportionately benefit, and those that don’t will take a sizable financial hit.
There have long been tremendous costs to the American healthcare system due to readmission rates for chronic diseases. The primary triggers that drive hospital preventable readmissions are: (1) patient compliance with their medication, (2) coordination across the entire care team to ensure that a patient is handed off properly to their primary care physician, and 3) early warnings that would prevent a potential problem. In many cases, these triggers could have been effectively managed in an outpatient setting. So where should hospitals start?
A recent report from the National Community Pharmacists Association gave the average American a C+ for medication adherence. We’ve studied adherence rates for nearly 9,000 patients across six different therapeutic areas, from oncology to heart disease, and five different countries around the world. And in every single segmentation study we’ve completed, we’ve found that a patient’s personality profile and outlook on his/her own health are the key factors in adherence rates. The core adherence drivers are Predisposition (health proactivity, general medical attitudes and concerns about side effects, etc.), Motivation (physician relationship, attitudes toward medication, interest in adherence programs, etc.), and Situation (health, lifestyle and demographics).
Our research reveals four core segments of patients, regardless of disease or geographic location, and significant variation in adherence rates between each segment. A one-size-fits-all approach to patient adherence doesn’t work because the variance between patient segments is so great. Communicating in a more personalized way to these segments is the key to reducing readmission rates.
In order to achieve this at scale, a hospital’s discharge process should include a typing tool or algorithm to identify the correct segment for every patient. To do this effectively, and it’s already been done numerous times in an outpatient setting, a hospital discharge counselor would ask patients a handful of questions and enter the answers into the algorithm tool, which would automatically segment the patients.
A content generation system would then customize education and discharge instructions for a patient’s disease with a plan tailored to his/her personality type.
For a proactive patient who wants to be an active manager of their health, a hospital might use content that is encouraging and geared toward those who want to learn on their own. Hospitals should be ready to provide additional resources for the proactive patient to conduct searches on their own and ensure that discharge instructions speak to the patient’s need to be in control.
For patients who are overwhelmed and pessimistic about their health, communications must be much more personal and reassuring. For example, hospitals might use more frequent check-ins and better access to nurses or other healthcare providers to provide individualized support. That way, the patient knows that the doctor is available to help and clearly understands the step-by-step follow-up process.
This ensures that patients receive information in a message and channel that’s persuasive and compelling to them. We’ve successfully done this for a major pharmaceutical company in the cardiovascular space, and we’re currently doing it for a major pharmaceutical company in oncology.
Hospitals are on the threshold of a new era as these ACA regulations begin to take effect. Personalized care is the future of healthcare, and leaders who embrace the latest tools and technology will provide superior patient education, ensuring the highest level of patient care.