In the pursuit of quality care, many organizations are experimenting with ways to incentivize physicians and other health care policies to improve their performance. These programs rely on evidence-based standards that are broadly accepted, clinically relevant, and continually updated by practising physicians (Rank and Averbeck, 2005; Gutman, 2004).
One of these initiatives is HealthPartners’ ORP program, which awards bonuses to primary care group practices that meet quality improvement targets set by the company. This is important because it rewards outcomes rather than processes and also helps encourage groups to experiment with clinical care strategies.
Patient-Centered Medical Homes
Patient-Centered Medical Homes are a type of primary care delivery system that emphasizes coordinated and comprehensive health services for patients. The model aims to improve the health care policies of populations and the quality of care while reducing costs. It incorporates a broad range of activities to achieve these goals, including team-based care and information technology.
In a patient-centred medical home, physicians are accountable for the entire life of their patients and work with the whole healthcare team. This includes the physician, nurse practitioner, social worker, dietitian, therapist, and pharmacist. A medical home also aims to improve patient communication, education, access to care, and coordination of care across the continuum of care.
While many states have launched medical home initiatives, the evidence of how effective they are is mixed. This is partly because of the variations in how medical homes are implemented.
To determine whether a patient-centred medical home model is effective, it needs to be evaluated in terms of its impact on healthcare use and cost. However, assessing these outcomes requires standardized criteria and rigorous quantitative analysis.
A recent study found that in Louisiana, PCMH adoption was associated with a small decrease in acute care visits but no significant difference in the cost of acute care or overall healthcare costs. The authors found that the effectiveness of a medical home is affected by the level of physician leadership, the use of disease registries, and the availability of patient portals.
Another important factor in determining the effectiveness of a medical home is the patient’s experience with the program. The authors found that a medical home model is most successful when it is used by practices that have built a relationship-centered practice environment, shared leadership, and time for group planning.
A number of healthcare providers are taking advantage of the opportunity to improve their practices through the implementation of the new Medicare Access and CHIP Reauthorization Act (MACRA). Some of these initiatives involve the use of a patient-centred medical home model. These practices have been recognized as PCMHs by the National Committee for Quality Assurance (NCQA) and may be eligible for incentives based on their performance under MACRA.
Patient-Centred Primary Care
The Institute of Medicine defines patient-centred care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” In addition, it involves a partnership between the healthcare provider and the patient that is based on the patient’s health goals and desired outcomes.
Patients are at the centre of the care continuum in patient-centred care, and they are treated not only from a clinical perspective but also from an emotional, mental, spiritual, social, and financial perspective. The care they receive is collaborative, coordinated, and accessible at the right time and place. The patient and family are active partners in their care, making decisions and acting as advocates for their own health.
In addition, the healthcare team is accountable for delivering care that aligns with the patient’s preferences, and preferences are central to how quality and safety measures are evaluated and improved. This means that primary care physicians, nurse practitioners (NPs), and physician assistants (PAs) must understand the patient’s preferences and how these affect the way they deliver care.
To implement this approach, health care policies professionals must make sure they are comfortable addressing patients’ concerns and anticipating their feelings of anxiety or fear. This includes taking responsibility to comfort and reassure them at every step of the process and providing any logistical or emotional support that may be necessary.
As a result, primary care physicians and NPs are better able to respond to a specific patient’s preferences than when they provide traditional care, which can lead to improved patient satisfaction, more effective care, lower costs, and increased access to services.
Nevertheless, to realize this goal, primary care practices need to make some significant changes in how they approach their patients’ preferences and how their practice is structured. This will require more research, outreach, and intervention to learn more about how patients view the care they receive from their providers and what changes in practice would be most effective in achieving patient-centred primary care.
There are a few simple, inexpensive innovations that could be incorporated into the practice of primary care physicians without much expense and with significant benefits to the quality of care. These include utilizing electronic medical records, sending an e-mail to patients, and obtaining patient survey feedback about their experiences with care.
Patient-Centred Specialty Care
Patient-centred care, also called person-centred care, recognizes patients’ experiences, stories, and knowledge. It provides a treatment that respects and honours patients’ values and preferences, transforming primary care into “what patients want it to be.” This model of care improves quality, patient experience, and staff satisfaction while reducing health care policies costs.
A key component of patient-centred care is a trusting, personal relationship between the doctor and the patient. This relationship is enhanced through a number of factors, including empathy and two-way communication, eye-to-eye contact, and the ability to see beyond immediate symptoms or pain. A patient-centred approach can be implemented in a wide range of healthcare settings, from family care and specialty providers to acute and emergency care as well as long-term care.
The patient and their doctor form a contract about the quality of care they desire, with performance measured against those goals. The contract is reviewed and updated regularly to ensure that patient and physician goals are aligned.
Unlike the traditional model of care in which doctors prescribe specific medications and procedures to their patients, patient-centred models often require patients to work with their doctor to make lifestyle changes that help them stay healthy. These modifications can involve counselling, social services, or other supports such as transportation and daily living assistance.
While there is a growing body of evidence about patient-centred care, it still requires further refinement and implementation. Ultimately, health systems and clinics should focus on implementing practices that are most effective in providing quality care.
In the case of specialty care, a strong focus on quality can be achieved by improving incentives for specialty physicians and teams to deliver high-quality care at a low cost. These payments should be based on the estimated cost of the services that a specialist team or provider delivers, such as the time spent in delivering these services and the costs associated with drugs and medical devices used.
To support the delivery of high-quality specialty care, health care policies has developed an Innovation Center with a broad strategy to test models and innovations that support access to specialty care across the entire patient journey. This includes testing models that support access to quality, integrated specialist care at the point of referral as well as episode payment models that promote active management of high-volume and costly conditions.
Patient-Centred Emergency Care
Providing patient-centred care is an effective way to improve the quality of care for patients. It also allows providers to treat patients from a holistic perspective that considers their physical, emotional, spiritual, and social needs. It can help improve patient satisfaction, which can, in turn, lead to better health outcomes.
The Institute of Medicine defines patient-centred care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This approach requires a true partnership between individuals and their healthcare providers.
Patient-centred care practices should be implemented across the entire healthcare continuum, not just at the emergency department. It should include the following components:
Shared decision-making (sharing information with patients, their families, and their caretakers); customized care; and information sharing. This practice can help improve patient outcomes and enhance the quality of care for emergency department patients.
In the ED, patient-centred care should also focus on communication between a clinician and the patient. This can be achieved by letting patients know that you have their best interests at heart and that you are available to answer any questions they may have about their treatment or health condition.
Despite these goals, however, some ED patients have been reported to feel isolated, helpless, and insecure due to the unpredictable nature of their medical conditions. Those patients are more likely to become aggressive and violent when they lack access to information about their hospital ED journey.
To help address these challenges, healthcare policies has developed a list of evidence-based practices that can be used to improve the quality of care in your facility. These practices are intended to be incorporated into the way you deliver care and are designed to improve patient satisfaction, health outcomes, and your bottom line.
These practices include performance feedback, leadership support, external and internal facilitation, provider and patient education, tailoring to the local context, using a quality manager, and regular data collection to drive and evaluate change. The goal of these strategies is to develop a culture that emphasizes continuous improvement and encourages the use of the latest evidence-based medicine.
