The Robert Wood Johnson Foundation (RWJF) defines "care management" as follows: "Care management is a set of activities intended to improve patient care and reduce the need for medical services by enhancing coordination of care, eliminate duplication (of services), and helping patients and caregivers more effectively manage health conditions."
Such efforts, as part of a care management program, can deliver significant benefits to an organization that include improvements in quality and safety, reduced costs, and enhanced patient, physician, and staff satisfaction.
One could argue that effective patient engagement is vital to a successful care management program. The activities referenced by RWJF will be vastly improved when patients are more active participants in their care.
The Role of Patient Engagement in Care Management
Let's examine how patient engagement can help achieve those essential care management activities identified by RWJF.
1. Enhancing Coordination of Care
Effective care coordination doesn't come easy. It requires a great deal of time, work, and consideration from caregivers. As the Agency for Healthcare Research and Quality (AHRQ) notes, "Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. This means that the patient's needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient."
While care coordination is largely the caregiver’s responsibility, the patient’s role can be just as vital and must not be overlooked. As the saying goes, "You can lead a horse to water, but you can't make it drink." Despite caregivers' best efforts to achieve the objectives identified by AHRQ, care coordination will likely come up short if patients are not fully engaged and educated throughout their treatment. For example, care coordination problems can arise if patients:
- do not understand why they are being referred for a service;
- are unclear about how to schedule appointments;
- do not fully appreciate the importance of completing each stage of their treatment (i.e., ignore treatment plans); and
- are unsure what to do after completing a stage.
Effective patient engagement can help avoid these and other care coordination downfalls.
2. Eliminate Duplication
Every duplication of services has several potential negative ramifications. It can delay advancement of a patient's treatment. If the service is not covered, it will cost the patient money. Duplicate services waste resources, unnecessarily consume provider time and may delay another patient from receiving the service. And if duplication becomes routine, it could prompt investigations of fraud.
Effective patient engagement provides patients with opportunities to share their thoughts and ask questions about treatment options and decisions. Efforts should be made by caregivers to remove any barriers to patients speaking up, such as those created by culture, language, and educational differences. When patients feel comfortable sharing thoughts and asking questions throughout their treatment, they are more likely to inform caregivers that they already received a recommended or scheduled service. To better ensure duplication of services is avoided, caregivers should ask patients whether they have already received a particular service(s) when discussing treatment plans.
3. Help Patients More Effectively Manage Health Conditions
As Partners Healthcare notes, "Evidence has shown that patients engaged in their health demonstrate improvements in their ability to self-manage their care, better outcomes and experiences in hospitals, and lower costs of care."
Here are a few tips on how to improve patient engagement and patient self-management of health conditions in the process:
- Give patients more control, recommends an HIT Consultant article, citing the value of teaching patients to "do what they can" and referencing two success stories out of Dallas and Sweden.
- Strive to offer education and support "at the right time, at the right cadence, and via the preferred communication channel to be effectively absorbed," a Becker's Hospital Review article notes. Consider a patient's comfort level with and access to technologies and how to leverage these tools, such using email, text messages, and web portals to share information about care management.
- Take health literacy into consideration. You may want to assume that "all patients are at risk of not understanding their health conditions or how to deal with them," as a Health Affairs article advises, and approach education and support efforts accordingly.
- Focus on moderation, advises Douglas Hough, an associate scientist and professor at Johns Hopkins Bloomberg School of Public Health, in a Healthcare IT News article. "To Hough, keeping patients engaged means interacting with them in targeted doses that lightly prod the patient forward. Bombarding them with reminders or information won't do the trick; nor will shaming them or blaming them."
A key takeaway: When patients gain a better understanding of what's required for their successful treatment and where their involvement is essential, care management efforts are more likely to deliver meaningful results.