Patient and Family Engagement: Nice to Have—or Strategic Necessity?

October 13, 2017

For some time now, Medicare has been financially rewarding hospitals for good patient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

Next year, about 2 percent of Pennsylvania hospitals’ Medicare fee-for-service payments will be affected by how well they do on the Centers for Medicare & Medicaid Services’ value-based purchasing calculations. HCAHPS scores account for about a fourth of value-based purchasing scoring, so hospitals are working hard to improve their HCAHPS performance.

Meanwhile, the literature and emerging practices point to patient and family engagement as an even more powerful driver of better health outcomes and reduced heath care utilization and spending.

A study in the Journal of the American Board of Family Medicine shows that, during the course of a year, patients who received more patient-centered care had significantly:

• Decreased number of visits for specialty care
• Less frequent hospitalizations
• Fewer laboratory and diagnostic tests
• Reduced total medical charges

Engagement practices vary. How does your hospital stack up?

Results from a 2015 survey of U.S. acute care hospitals show variations in how hospitals are implementing patient and family engagement. Among the 1,457 hospitals that completed the survey:

• Most (68%) encouraged patients and families to participate in shift-change reports
• Most (67%) had formal policies for disclosing and apologizing for errors
• Fewer (only 38%) had patient and family advisory councils

Geisinger’s “compassionate care” money-back guarantee and app

Geisinger was providing safe, high-quality health care. But, HCAPHS scores and other evidence indicated that patients sometimes experienced that care as less than consistently and remarkably kind and compassionate.

To address this disconnect, Geisinger began offering a “ProvenExperience” warranty. Care is guaranteed to be outstanding—up to patients’ standards—or Geisinger will refund patients’ co-pays, coinsurance, self-pays, or other out-of-pocket expenses.

Geisinger’s ProvenExperience app makes it easy for patients to make good on that promise by:

• Voicing dissatisfaction with their care, and identifying the source(s) of their discontent
• Indicating how they would like to communicate their complaints to the health system
• Requesting refunds from the health system

Geisinger has given refunds to unhappy patients. But, most refunds are partial—sometimes just $20 copays—and the vast majority of patient feedback is positive. Most negative responses also acknowledge positive aspects of the care received.

Geisinger’s CEO looks at the guarantee, and the refunds, as the “best secret shopper program ever.”

Involving parents in their children’s care

At every children’s hospital across the nation, at just about any time of day or night, you are likely to see at least as many parents as patients.

Children’s Hospital of Philadelphia provides “family-centered care” and offers Your Voice Matters as a convenient way for parents to give instant feedback about the care their children are receiving.

How HAP fosters patient and family engagement

HAP has pioneered groundbreaking work with its Patient and Family Engagement Advisory Council and new, related work as part of the Healthcare Innovation Improvement Network (HIIN). Many hospitals across the state have started their own councils, with advice and assistance from national entities such as the American Medical Association.

Empowered patients, powerful results

When patients are meaningfully engaged—and that means giving them some real power!—the caregiving dynamic changes. Instead of being passive recipients of care, patients become an activated part of the process.

As a result, more effective communication and learning can take place. Patients and families are more likely to understand and follow through on the best ways to take care of themselves and their loved ones. And that’s a promising strategy for achieving better health, less health care utilization, and lower overall spending on health care.