Hospital Impact: Care transformation demands consumer engagement

Editor's note: A previous version of this post misidentified the program that provides a “prescription” for healthy foods for diabetic patients. The correct name is the Prescription Produce Program.

In January 2014, Maryland’s hospitals agreed to partner with the Center for Medicare & Medicaid Innovation on a five-year experiment to test whether a shift in hospital focus from acute emergency care, surgeries and inpatient stays toward preventive, community-based care could not only control cost growth but also help people get and stay healthy, before they need a hospital visit.

This was a 180-degree turn from the traditional hospital business model and from the way things are done just about everywhere else in the country. No longer would hospitals be paid based on how many patients they treated or services they provided, but rather on making sure that people receive the right care, at the right time, in the right setting.

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Last month that experiment reached its midpoint with Maryland’s hospitals building a solid foundation for care delivery transformation:

  • Readmissions rates are decreasing faster than the national rate
  • Hospital-acquired conditions are down by more than one third
  • Avoidable hospital visits are down more than 17 percent

Much of this has been accomplished through innovative, non-traditional hospital activities like the Maryland Faith Health Network, a pilot program that connects hospitals with churches, synagogues, temples and other faith organizations to improve their congregants’ well-being and ability to navigate the system. Other examples:

  • A free program that connects people who have complex health issues with a health navigator--a registered nurse or licensed social worker who provides one-on-one guidance and care coordination.
  • “Care A Van,” a large RV that transports a social worker and medical staff, who provide free health screenings, help with Medicaid applications, immunizations and more for uninsured children and their families with no regular source of medical care.
  • The Prescription Produce Program, which provides a “prescription” for healthy foods for underinsured and uninsured diabetic patients. Vendors at local farmers markets accept these “prescriptions” and provide healthy food at a reduced cost.

For the most part, these programs and others like them were conceived and implemented by hospital staff and leaders. While the initiatives have generated strong results, consumers have been largely unaware of these seismic changes, or what they mean for navigating the rapidly changing world of healthcare.

Enter a new statewide public engagement campaign, launched in late June, to connect healthcare consumers to this transformation through their local hospitals. The campaign, “A Breath of Fresh Care,” features several health engagement tools for Marylanders who would like to know more about how healthcare is changing and about how they can partner with healthcare providers to take a more active role in staying healthy before they need care, being empowered during care and remaining healthy after care. The primary vehicle to deliver this information is a web-based statewide clearinghouse of hospital information that includes direct links to:

  • Every hospital’s patient bill of rights
  • Information on how to navigate the healthcare system, from interacting with a physician to understanding medical bills
  • Wellness and chronic disease management initiatives for consumers’ local community hospital
  • Contact information where consumers can register a complaint or concern

Why is this important, especially since hospital-driven initiatives have already led to noteworthy progress in Maryland?

Because the overhaul of the care delivery system, and the positive results that come with it, will not be sustainable without the help of patients and communities. Care delivery transformation cannot be solely about offering different programs to patients; communities must take advantage of them as well, and they will need to be proactive in making lifestyle changes that can help them avoid unnecessary hospital visits. Both of those require that individuals be not only informed, but empowered as the focal point of their own healthcare.

There’s ample evidence of the benefits of consumer engagement.

A 2013 policy brief in Health Affairs notes that a growing body of evidence demonstrates that patients who are more actively involved in their healthcare experience better health outcomes and incur lower costs. And just this month, Duke University Hospital Community Health Chief Michelle Lyn spoke at the 2016 Health Forum and American Hospital Association Leadership Summit on how advancing population health means incorporating a framework that targets vulnerable populations and gets clinicians deeper into their communities.

Lyn sums up the need for consumer engagement well: “We’re really transitioning to a time when we’re talking about improving the health of populations, and that means reaching into communities and across sectors to improve health at the community level.”

Carmela Coyle is president and CEO of the Maryland Hospital Association.