Cathy Levine, Executive Director of the Universal Health Care Action Network of Ohio (UHCAN OHIO), tells us the two key factors we need to know when it comes to patient-focused and team-based care.
1. The definition of patient engagement can be thought of as a partnership.
“'Patient engagement’ or ‘patient-centered care’ is about a partnership,” says Levine.
“It’s about respecting each person as in individual, getting to know that individual. It is about meeting each patient where s/he’s at and helping the patient make progress. It’s not just better health—but a better patient experience and better health.”
“People are uncomfortable with the triple aim’s ‘better patient experience.’ What does that mean?”
“’Patient experience’ is more than better magazines in the waiting room, or someone smiling at you. You have to feel welcomed when you go to the doctor. It has to be a safe, trust-building, nurturing environment. For people from different racial, ethnic, and socio-economic backgrounds, they may need to encounter people who look like them for the patient to feel comfortable. The need for that kind of experience is part of why there is a movement to transform primary care.”
Given financial pressures and time limits primary care physicians have today, it is just that primary care physicians may be frustrated with some of their current constraints.
They need practice design and financial support in creating these relationships with patients and support so they can spend adequate time with each person. And that’s also where doctor involvement with consumer groups, as well as taking advantage of clinical team support IT services such as EngageHealth IQ, enters into the picture.
“Doctors need to reach out to consumer groups about working together to change the way doctors are reimbursed for patient visits and to get feedback on patient-centered practice design,” adds Levine.
“We have to reinvent primary care. We have to build up primary care. The investment has to follow the words. If we are serious, let’s put the money there.”
Primary care physicians may feel the squeeze of market conditions at present, but ultimately, doctors – especially in partnership with patients - can be agents of improving health care.
2. The change required for a patient-centered approach starts with practice culture.
“If reimbursement, incentives, measures and other rules need to change, primary care providers should sit down with consumer advocates, and let’s work together on this,” says Levine.
“Let’s identify our common ground. If the patient-centered medical home is going to work, the culture in the team of providers has to change. It has to be one where every member of the team is empowered to contribute to the work, and is respected for their expertise, and where the patient is now treated not as an outsider but as a partner,” she adds.
“We are talking about building relationships and building trust with patients,” says Levine.
If you have a true team-based approach, it’s not up to the doctor to do it all. “The [support team] is paid less, but they are highly trained in narrower areas, and are trained to do different parts of what needs to happen. It’s not all on the doctor. That’s part of the design of your practice.”
“The question is, are doctors trained to take every patient, where they are at, and are they able to respect that patient? Doctors need to enter into a relationship of mutual trust and respect and figure out how to move that patient to another level of partnership.”
“Keep in mind we’ve all been raised in health care system that very seldom encourages people to be partners in their health care. It’s very much a system of ‘doctor knows best,’ where you don’t question the doctor. You can’t expect patients to, overnight, learn how to be partners,” she adds.
"There has to be an invitation, and someone has to tell patients that the practice is changing for the better."
We also have to consider what it means to provide care to the aging population. Once again, to connect and to best influence and empower these patients, it starts with a new culture at the practice level. “The goal is for people to be healthier. Many providers don’t understand what it means to invite their patients into a partnership. That requires a big culture change.”
Primary care practices must figure out effective strategies for figuring out where each patient—where she is currently in her health journey—and figure out how to move that patient along to manage their own health.