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How case managers can capitalize on the newest trend in health care
 

Health care is broken. Its evolution requires rethinking process improvements and integrating American ingenuity to improve the individual patient experience. It requires that entire communities receive health care at an affordable cost. And according to Dr. Sanne Magnan, Minnesota Commissioner of Health, it also requires the understanding that, “as health care costs go up, affordability goes down. As affordability goes down, access goes down. As access goes down, the number of insured goes down, as does quality. It’s a vicious spiral that affects the very health of our population.”

HOW DO WE GET A HANDLE ON THIS?

The answer has actually been in front of us all along. From Hippocrates to the house-call doctor to the transition of corporate entities, the trusted relationship was and always has been in the hands of the primary provider. The trend of rediscovering what worked in the past and carrying it into the future may actually be the “silver bullet” that we’ve all been chasing.
Peel back the layers a bit and it’s easy to discover that what works within the primary provider and patient relationship is trust and accountability. It’s this tandem approach that results in patients’ attention to positive behaviors and lifestyle-oriented action plans that will give rise to healthy, high-performance patients who are able to contribute their personal best at work and at home.

INNOVATION THROUGH A NEW PARADIGM

“The doctor/patient relationship is a long-term comprehensive connection that optimizes meaningful productive interactions, sustains positive behaviors, empowers with the right tools, and links to the care team resulting in better overall family health,” states Dr. Paul Grundy, IBM Director, Healthcare Transformation. The sum of these many moving parts has produced an outcomes-oriented approach that promotes personal health accountability and health achievement — resulting in positive health and life fulfillment.

The key acronym to learn in pursuit of this mindset is physician-led health and performance improvement, or HPI. This evidence-based, coordinated-care approach focuses on prevention-centered health achievement. HPI builds upon the Joint Principles of the Patient-Centered Medical Home approach established in 2007 by four primary care medical societies. HPI’s aim is to improve the quality and availability of both clinical and preventive services — including those that are community-based health access options.

HOW IT WORKS

“A new model of care is needed,” says Chad Boult, MD, MPH, MBA, a geriatrician professor at Johns Hopkins Bloomberg School of Public Health and author of Guided Care: A New Nurse-Physician Partnership in Chronic Care. Dr. Boult and colleagues developed one form of the patient-centered medical home called Guided Care that assigns a specialty trained primary care-based nurse to coordinate high-risk beneficiaries’ health care with the community services they need. Guided Care has shown promising results in a federally-funded, multi-state, randomized trial in the Baltimore-Washington, D.C. area: higher quality of care, lower net health care costs, improved physician satisfaction, and reduced stress for family caregivers.   

HPI specialists are the connection between the provider and their patients with health complexity — enabling patient-centered, accessible, comprehensive and coordinated care that is delivered with family and community in mind. Patients with health complexity are those who experience barriers to improvement due to the interaction of their poorly controlled medical and mental health conditions, their social situation, and the health system in which they receive services. For such patients, individualized care through HPI specialists supplements standard care.

Basing their recommendations solely on the needs of the patient, plans must include the resources to help the patient build skills to actuate behavior change. These resources must be wrapped in an emotionally supportive environment that has proven to facilitate change. More often, a patient needs to learn these new skills and have at least one person at home who will support their affirmation of personal health accountability. Synergy between the HPI specialist and patient occurring as meaningful productive interactions are built through support for evidence-based standards of practice and health improvement guidelines. Health advocacy care transition pathways, clinical protocols and information therapy are then transformed into positive, sustainable behaviors.

Cracking the code on behavior change requires a basic understanding of what inspires and motivates people to better understand their barriers to optimal health. That understanding must then be communicated in a manner that is fully comprehended by the patient and may include seemingly benign activities of everyday living. The Case Management Society of America’s new Integrated Case Management Training Curriculum clearly explains the specifics as it is designed for patients with health complexity.

FIVE EASY PIECES

The HPI approach combines physician expertise with an implementation specialist working in tandem with enabling technologies to assist patients in realizing their personal health best. These pieces include:

A community-based, affordable health access collaborative that provides members with comprehensive health coverage options;
Closure of care gaps and planned care coordination;
Productive interactions and preemptive interventions;
Value-based, personal care transitions and sustained engagement; and
A balanced-scorecard approach to HPI standards and measurement.
Dr. Darryl Landis, a senior HPI consultant with Watson Wyatt Worldwide, says HPI is about “measuring and improving patient outcomes, delivering high quality care, engaging patients through multiple relationship channels that extend beyond the office visit and motivate patient adherence, simplifying or re-designing work-flows to minimize disruptions, and implementing the grand HPI strategy in phased, bite-sized pieces.”

WHAT DOES THIS MEAN FOR CASE MANAGERS?

Case managers can quickly enter the field of HPI. They can leverage their essential skill sets and engage in meaningful productive interactions with patients to help guide them toward positive behaviors and health achievement.

Three unique dimensions of value — trust, results and expectations — drive HPI. Value realization demands unconditional trust between the buyer (patient) and seller (HPI specialist), plus the results (performance) of the seller’s value proposition and fulfillment of expectations as experienced, measured and evaluated by the buyer. Simply put, there’s a direct correlation between the trusted provider relationship and the positive effects of individual sustained engagement.

Creating personal accountability is a lifelong endeavor that integrates the mind and body to create optimal health. Deciding to thrive takes precision, passion and persistence, in the eyes of Mary VanderWall, RN, a former supervisor with Prevention Initiatives, Colorado Department of Education, who suggests that everyone should be focused. “For most people, living in a way that promotes health means change. Success depends on the way strategies work together and the lifestyle change process does not suddenly end — it is a lifelong dynamic and very exciting endeavor,” she says.

The power of fulfilling one’s potential is not surviving, but thriving. Essentially, a plan is just a plan until it is powered by the team. The hope is that the power of HPI is embraced by case managers.

SHAPE OF THINGS TO COME

The HPI approach as a human behavior change standard of practice is taking on new meaning for case managers to become HPI specialists and access opportunities as they unfold around the globe.

Vital to watch as the HPI movement takes off are the career opportunities about to unfold. Among these include enabling physician-led connectedness, facilitating caring relationships that are compassionate and culturally effective, and optimizing care transition capabilities and enabling technologies to improve patient lives.

“Recent studies suggest that HPI specialists, using CMSA’s integrated case management techniques, are the glue in many community practice settings that build upon the emotional bond between patients and physicians — and encourage collaborative practice and cohesive caring relationships for patients and family members,” says Dr. Roger Kathol, president of Cartesian Solutions Inc.

One final thought. The person with the best opportunity to influence personal accountability is you. Not just by action but by example. It’s up to case managers to collaborate and capitalize on physician-led connectedness opportunities that lead to positive behaviors and create healthy, productive and fulfilling lives.
 

Les C. Meyer is a seasoned health care strategist and CEO of HPI Advisors LLC, a Denver-based think tank. Mr. Meyer works with highly motivated organizations to help them achieve the highest levels of performance. For additional information visit www.healthandperformance.info. [ This e-mail address is being protected from spambots. You need JavaScript enabled to view it ]