Medical Home Best Practices: How Patient Engagement Creates Tailored Solutions
By Emily Mullin
February 13, 2012
As the concept of the medical home gains increasing attention as a way to redesign primary care, it will be essential for providers to adopt new strategies to better engage patients in their healthcare.
Full participation of patients in their health is vital to achieving improved health outcomes, curbing hospital readmissions and driving down healthcare costs. People who aren’t able to seek care when they need it, don’t take medication as prescribed, can’t make it to doctors’ appointments and delay preventive care not only put their own health at risk, but they end up driving up total costs of healthcare spending.
In a 2009 report by the Center for Advancing Health in Washington, D.C., researchers said the transition from traditional primary care to a more patient-centric medical home model requires setting in place practices and services that will enable patients to participate in their healthcare.
“What is lacking from the model of the medical home is recognition that patients are not the object of care, but are rather that they are full-fledged participants in it – and unless that participation is active and informed, the impact of healthcare, whether services, drugs, surgery or devices, is severely muted,” the authors of the report wrote.
For Vivian Campagna, assistant vice president for case management at Lutheran Medical Center in Brooklyn, N.Y., it’s her job to help patients navigate the healthcare system and engage them in their health as much as possible.
Campagna says patients need information and education in order to make decisions for themselves, including making appointments and seeking out different types of treatment.
Patient engagement is crucial, Campagna says, because it directly affects patients’ compliance and adherence to medication or a care plan. Campagna says that if patients are not able to make different health choices or change their daily behavior by doing things like eating balanced meals and getting adequate exercise, then they won’t be able to manage their health properly.
But before you engage patients, Campagna says you first have to tailor your message to them. In a diverse city like Brooklyn, Campagna deals with this on a daily basis. Her patients are from different racial, ethnic, religious and socioeconomic backgrounds.
“You have to understand where patients are coming from before you can help engage them,” Campagna says. “You have to be fully aware of the cultural and psychosocial aspects that are going on around them.”
Campagna says there are multiple compounding factors that contribute to patient engagement, including whether patients understand the care plan to begin with, and once they are discharged from the hospital, there’s the matter of whether they can afford to purchase necessary medications and go to follow-up doctors’ appointments.
“If you’re asking a patient to go to the doctor and they don’t have health insurance, they’re not going to do that. So we have to decide how we’re going to reroute them and get them a treatment plan,” Campagna says.
What it comes down to is tailoring a case management intervention plan to the individual patient, Campagna says. A care plan needs to fit a patient’s education background, socioeconomic status or cultural background in order to be successful.
In the medical home concept, patient engagement is an important piece of the puzzle as medical home patients are often elderly or have chronic conditions that need constant monitoring. Campagna says in a medical home, there is a huge potential for greater patient engagement because the medical home model is more comprehensive than traditional primary care. A team of providers is involved a patient’s care, and the more culturally appropriate the care is, the more successful that team will be in managing and improving a patient’s care.
More engaged patients will yield better health outcomes, Campagna says. But it takes both the healthcare provider and patient working together to produce a more engaged patient.
“Particularly for patients with chronic illnesses in a medical home, by having them come back and work with staff, they can get a better outcome,” Campagna says. “Obviously, the fewer complications you have, the less you spend in healthcare dollars.”
.jpg)
SAVE THE DATE 
.gif)
Gina, our March issue will have a strong focus on education through the generations so stay turned. That should be out the first Monday of March.
Marilee, the focus of the Medical Home should be on 'total' healthcare. As more and more caes managers become invovled as part of the core team of the Medical Home, this should become more of a focus as there will be someone to raise the question, but you are so right, prevention is critical.
In addition to what has already been mentioned, part of the engagement process should also involve assessment of readiness to change, including assessment of the patient's confidence and knowledge levels relative to being able to engage in self-management skills.
And while implied in the article, it deserves to be pointed out that relationship building with the collaborative care team, of which the patient is the center member, is also key to engagement and maintaining adherence to the care plan. That needs to be a core competency of the care manager and members of the care team. It's not a skill that necessarily comes with the health professional degree or certification and therefore may need to be developed as part of the practice transformation process and training the care team.
Can you also perhaps clarify for readers the difference between patient engagement and patient activation as both appear in the literature?
I agree, patients are the key to makeing this and all other efforts work.