In her presentation at the HIMSS Texas Regional Conference (Patients as Partners: Leveraging HIT in a Consumer-Centric Era), Get Real Health Vice President of Healthcare Strategies, Cortney Nicolato, CPHIT, revealed insightful perspectives on Health IT return on investment (ROI).
Maximizing ROI from patient engagement applications is a threefold proposition, she explained:
- Understanding what makes patient engagement truly meaningful
- Recognizing how meaningful patient engagement improves outcomes, service delivery and patient experience
- Understanding the total financial picture of HIT-enabled patient engagement
Healthcare consumers respond very positively to the participation and empowerment enabled by robust use of HIT tools. ROI for HIT calculations are evolving, however, and differ from traditional methods. HIMSS recommends that health providers evaluate ROI based on:
- Efficiency savings
- Improved outcomes of care
- Additional revenue generated
- Non-financial gains (e.g., increased patient satisfaction, decreased provider time at work, increased employee satisfaction) –
- Increased knowledge of the patient population
As HIMSS Executive Vice President, Carla Smith, has said, “The traditional definition of ROI as used in other industries isn’t necessarily a good fit for the healthcare industry; successfully demonstrating ROI in healthcare involves more than simply looking at how much money is saved or earned.”
Key facts to know about ROI:
- Data sharing has reduced costs per discharge in acute care settings.1
- Patient engagement can deliver positive ROI in Accountable Care Organization settings2 and this ROI increases with length of members’ exposure to the program3.
- ROI can be 20:1 or higher when replacing paper-based systems with a modern patient relationship management system.4
- Commercial interest in patient engagement suggests it’s good business. Walgreen’s has emerged as an innovator among pharmaceutical chains. Employers are increasingly implementing HIT-enabled wellness and disease management programs in order to increase productivity and reduce healthcare costs. Insurers in nearly every state in the country have created medical homes and accountable care arrangements. All of these initiatives rely heavily on HIT investment for patient engagement, communication, record sharing, and care management tools and none are a direct result of regulatory requirements. Businesses increasingly understand the commercial benefits of engaged consumers and employees.
Providers can maximize ROI by:
- Using data aggregation and mining to effectively target patient populations who will most benefit from care management programs
- Leveraging HIT systems to meet multiple needs:
- ACO, PCMH, HIE participation (PriceWaterhouseCoopers found a 58% overlap between the IT requirements for meaningful use and the IT requirements for an ACO.)
- Marketing tool
- Research
To calculate Health IT ROI, healthcare providers need to consider:
- Net cost of patient engagement and care management solutions
- Net cost of additional interventions
- Savings from not being penalized
- Bonus payments and grants received for IPO participation
- Realized savings resulting from less costly treatment
- Additional revenue derived from increasing the number and satisfaction levels of patients served
Meaningful Patient Engagement
“Don’t just do meaningful use,” Nicolato urged, “do meaningful patient engagement. Meaningful use is a moving target, so it’s important to stay ahead of the curve. Meaningful patient engagement is what generates ROI, efficiencies in care, and is what patients are looking for. View patients (especially those with chronic conditions) as not just consumers of, but partners in, healthcare services. Patients want and benefit from action-oriented care plans and healthcare information.”
Patient engagement is truly meaningful when it:
- Increases patient and provider satisfaction
- Improves efficiencies in service delivery
- Aligns with not just today’s, but tomorrow’s requirements
- Improves clinical outcomes
Higher patient engagement is associated with numerous improvements across various aspects of health delivery, showing reductions in diagnostic testing and expenditures, referrals and elective surgeries, while delivering improvements in adherence to prescribed medical treatments, functional status and faster recovery, and satisfaction. Moreover, well-informed and engaged patients carry out more health-related behavior changes.
More-activated patients have better metrics than less-activated ones:
| More Activated Patient | Less Activated Patient | |
| Be readmitted to a hospital within 30 days of discharge | 13% | 28% |
| Experience a medical error | 19% | 36% |
| Suffer a health consequence from poor communication among providers | 13% | 49% |
| Source: AARP survey of patients over 50 with 2 or more chronic conditions | ||
The Bipartisan Policy Center reported that patient engagement is associated with:
- Reduced diagnostic testing and expenditures
- Fewer referrals
- Fewer elective surgeries
- Increased adherence to prescribed medical treatments
- Increased functional status and faster recovery
- Higher levels of satisfaction
- Higher levels of health literacy
- Higher levels of positive health-related behavior changes
Nicolato said HIT systems that do more yield better results. Kaiser Permanente, for example, found that patients who engage regularly with a personal health record are significantly more likely to remain members of a health plan.
A survey of Federally Qualified Health Centers revealed that centers with the highest levels of IT capacity experienced:
- More use of reminders for follow-up, preventive, and continuous care
- Better rates of cholesterol, breast and prostate cancer screening
- Greater receipt of discharge summaries
- More timely appointments
Case Studies Spotlight Patient Engagement Benefits
MedStar Health
This large regional health system in the Washington, D.C. region conducted a study to determine whether a diabetic patient portal would improve outcomes for low socioeconomic status and elderly Type 2 diabetes patients. Participants were provided with tools to promote collaboration, an OneTouch glucometer to track readings and trends, alerts and reminders, care plans, health journals and reports.
Preliminary Outcomes:
Average HbA1c reduced from 9.3% to 7.7%
- Average HbA1c reduced from 9.3% to 7.7%
- Average blood glucose reduced from 181 mg/dl to 153 mg/dl (Each 1% absolute reduction in means A1C levels was associated with a 21% reduction in the risk of any diabetes-related complication or death.)
- Increase in ehealth literacy levels
- 88% still using tool post-intervention
(Source: Get Real Health)
National Taiwan University Hospital Telehealth Center (NTUH)
Since 2009, NTUH has offered telehealth services including: instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis, mutual telephone communication and health promotion, and continuous analytical and decision-making support.
- Between November 2009 and April 2010, NTUH conducted a 141-patient study of patients with cardiovascular diseases who received NTUH telehealth services. The study collected data on the patients’ hospital visits and health expenditures for the six month period both before and after receiving telehealth care.
- The telehealth intervention significantly reduced admission rates per month per person for non-seniors and seniors alike.
- Telehealth intervention reduced inpatient cost per month in the non-senior group from $814.93 to $217.39, and reduced costs in the senior group from $954.78 to $485.06.
Resources
For additional resources on patient engagement, visit:
- Society for Participatory Medicine www.participatorymedicine.org
- Get Real Health www.getrealealth.com
- HIMSS http://www.himss.org/library/patient-engagement-toolkit?navItemNumber=13556
- Bipartisan Policy Center Health Innovation Initiative http://bipartisanpolicy.org/projects/health-innovation/about
Footnotes
1 Premier QUEST collaborative report, March 2013
2 The Healthcare Intelligence Network survey, 2012
3 The American Journal of Managed Care, March 2012
4 “Is There a Business Case for Engaging Patients?” Forbes, October 2012