Improving outcomes with a bundle of nudges

phone apps
Nudging patients toward better health can improve control of chronic conditions.

Preventing common, chronic diseases can be as simple as a timely reminder, but payers need to figure out how to reimburse practices.

Technology allows healthcare providers to deliver reminders that help chronic care patients manage their conditions more successfully. Whether that means text messages that remind patients to take their medications or a more comprehensive program customized for diabetes management, healthcare providers see value in behavioral services delivered to patients between office visits.

As the healthcare industry shifts its focus toward value-based care models, such relatively low-cost methods for improving outcomes will become increasingly attractive, writes Mike Payne, head of commercial and policy at Virta Health, in a post for AJMC.com. His company focuses on “nudges” delivered to patients via frequent contacts from health coaches. Despite research indicating the value of this approach in modifying patient behaviors, Payne reports the biggest barrier to broader adoption is its ill fit with traditional fee-for-service (FFS) payment approaches.

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The problem, he says, is any measurable value from a high-touch approach will be visible on the outcomes end of the equation, and will appear over time. Higher message volume is the point, so a system that charges insurers per nudge would need to charge a very small amount. Given the administrative overhead to submit multiple claims per day every week, such an approach is impractical, according to Payne.

His preferred approach pays a per-patient amount for hitting predetermined clinical outcomes, which he calls a “Bundle of Nudges” approach. Comparing the model to Medicare’s Comprehensive Care for Joint Replacement, Payne points out, “It does not require massive overhaul of claims systems or FFS coding rules.” The biggest issue will be getting buy-in from major carriers and agreeing on appropriate clinical outcomes. If successful, Payne sees a bright future for nudging patients toward better control of chronic conditions.

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