Project HealthDesign Workshop and Emerging ODL Themes

Libby Dowdall, Communications Coordinator, Project HealthDesign National Program Office

We routinely hold workshops that allow the five Project HealthDesign teams, the national program office and other project advisers to meet in person. At a recent workshop at the Vanderbilt Center for Better Health, we focused on the evaluation phase of the project.

 

During the workshop, we identified several themes that resonate across the five teams:

Patients and clinicians have different perspectives on which ODLs are important.
The observations of daily living (ODLs) that are crucial to a particular patient’s daily life and health may not seem as important to his or her clinician. Or, a patient may grow tired of collecting data about an ODL that the clinician finds important. In “Whose ODLs Are They Anyway?” on Pioneering Ideas, Steve Downs, chief technology and information officer at Robert Wood Johnson Foundation, further examines this difference in perspective, and also details the Crohnology.MD team’s innovative approach to negotiating common ground between the two perspectives.

Patients may want flexibility in how they use ODLs.
Because the projects are breaking new ground as they look to see whether and how ODLs enter the clinical decision-making process, several teams left a measure of flexibility for patient preference. They recognized that even though patient and clinician focus groups helped to choose and prioritize the ODLs tracked in each study, each individual patient might value another ODL that is not part of the study’s standard ODL set. The iN Touch team, for example, allows participants to choose an extra function in The Carrot platform that they’re interested in tracking. Additionally, each participant in the BreathEasy study will be able to use a journal feature to write narratives pertaining to the ODLs that matter to him or her.

Clinical workflow varies by team, but several use “intermediaries” to review ODL data.
The five project teams were chosen, in part, for the various types of clinical partners with which they work. Thus, it is no surprise that each project team has taken a different approach to incorporating ODLs into the clinical workflow. We were intrigued, however, to see that several teams are using an “intermediary,” such as a health coach or nurse, to routinely analyze the ODL data and act upon the findings.

 

Our teams are beginning to recruit (and even enroll) patients for the evaluation phase of their projects. We’re excited to think that data is already being collected from sensors in several elders’ apartments as they use the phone, and dozens of overweight teens are meeting regularly with their health coaches and collecting ODLs. Rest assured that the teams will soon be sharing new developments as their studies progress!

Patient Engagement: A Key Ingredient in Accountable Care Organizations

Bob Belfort, Manatt, Phelps & Phillips, LLP

On March 31, the Centers for Medicare and Medicaid Services released a proposed rule governing the approval and operation of Accountable Care Organizations (ACOs) under the new Medicare Shared Savings Program.

The program creates financial incentives for providers to work together to treat patients across multiple care settings, including physician offices, hospitals, and in the home. Under the proposed rule, an ACO would consist of a group of providers that have agreed to collaborate to coordinate care for patients enrolled in Medicare Parts A and B. ACOs are intended to be patient-centered organizations that deliver integrated, efficient and cost-effective care. ACOs that successfully provide lower-cost care and that achieve quality targets will be eligible to retain a portion of the savings shared with the Medicare program.

ACOs would have to define processes to promote evidence-based medicine, patient engagement, and care coordination. They would also have to report on quality and cost measures.

In some cases, the proposed rule is prescriptive about the health IT tools providers should use to achieve these objectives. One example is the requirement that at least 50 percent of an ACO’s primary care physicians must be meaningful users of electronic health records at the beginning of the second year of the ACO’s existence.

In other cases, the proposed rule does not establish specific criteria. In the area of patient engagement, for example, the proposed rule allows ACOs the flexibility to choose tools that are most appropriate for their practitioners and patients. Activities that promote patient engagement may include, but are not limited to, use of decision-support tools and shared decision-making methods that help patients assess the merits of various treatment options in the context of their specific values. Patient engagement may also include methods for fostering basic knowledge about maintaining good health, avoiding preventable medical conditions and managing existing conditions.

It is worth noting that the proposed rule encourages ACOs to use remote monitoring and telehealth to coordinate care; however, the rule does not specify exactly when or how such tools should be employed.

We think that knowing a patient’s observations of daily living (ODLs) could help ACOs meet quality improvement goals under the Medicare Shared Savings Program. We also believe that the program, with its focus on patient engagement and care coordination, could go a long way toward convincing health care providers to incorporate patient-defined, patient-generated health information into the clinical care setting.

Do you agree? What are your predictions about what health care providers will do to satisfy the proposed rule’s patient engagement and care coordination requirements?  What about your big picture reactions to the ACO concept? Will ACOs help improve health care quality and efficiency or are they just another passing fad?

To learn more about the proposed rule, read the summary prepared by Manatt, Phelps and Phillips, LLC.