Patient care is very personal. The physicians and care teams of cancer practices constantly assess what they see and hear relating to the patients when they are in the office. Unfortunately, patients are outside the office more than they are in front of the care team.
Using Technology to Leverage Outcomes
Value-based care is an overused phrase to describe market care delivery, contracting relationships, programs, and even technology products. Yet the crux of true value in healthcare lies in the personalization of understanding the patient’s needs, and the outcomes of how those needs are met. How do we accurately measure outcomes and value in healthcare without obtaining, recording, and analyzing the social, mental, physical, and emotional impact and improvement for patients over time? And how can we possibly track what is happening with our patients during the hours, days, weeks, and months when they are not actually in our office being seen, which is actually when most symptoms and side effects of health and care develop?
Despite, or in some ways because of, our resource-intensive human staff, the answer is that we cannot. We need to work smarter. Technology, when built around the needs of the patient and their healthcare teams, can provide a cost-effective, enhanced solution by integrating artificial intelligence (AI)-enabled dashboards, telehealth, and remote patient monitoring to support clinicians and proactively manage patient symptoms and concerns.
Many patient engagement or “touch tools” are left-to-chance encounters by automated calls, messages left for patients to respond (if they do), and lengthy phone trees with selections that can cause confusion. Remote monitoring that simply waits for the patient to hit a specific number that triggers an alert to the provider does not actually provide useful information for a targeted response to the patient. Clinical resources and staff do not have the time to connect with every patient, every day, to monitor important changes adequately, or to be sent lists of patients that need follow-up calls without much other information.
Patient Engagement Platform Case Study
In this issue of Oncology Practice Management, a case study (Leveraging Technology to Care for Patients When and Where They Need It) shares the story of how a unique patient engagement platform enabled remote patient monitoring, which in turn triggered remote nurse triage assessment and escalation to a provider for symptom management and referral assistance. This was accomplished despite patient challenges such as advanced age, education, health literacy gaps, and patient hesitancy to discuss symptoms when at clinic visits.
Demand Is Growing, We Need to Be Ready
Employers are showing great interest in how their employees are monitored and managed because they ultimately hold the risk for the costs of symptoms, side effects, and improved outcomes. Emerging trends such as direct provider contracting between primary care providers and employers are starting to look at opportunities for specialty providers. This trend often looks at proactive patient management, getting ahead of issues and problems before they escalate, which is difficult to support in the traditional world of fee-for-service care, driven by numbers of “sick” encounters, rather than proactive avoidance of escalating symptoms. Payers and pharmacies often include patient management in their services to their own customers—very limited in scope, and often intrusive and confusing to patients. Medical practices are the most appropriate site for effective patient management.
Opportunities for Oncology
What does this mean for oncology? I see opportunities on multiple levels. The first, and easiest, is for an oncology practice to include technology and AI partners to raise patient awareness to include the time when the patient is not in the office, between visits and treatments. This will require partners that are not just technology-based, but that can mirror the complexity that is healthcare. In the case study, AI virtual coaches interact with patients to share information that may be useful during the interaction, even if their needs or problems are being escalated to a human provider. Patient dashboards can offer additional support and supplemental educational materials for patients and caregivers, tailored to their unique physical, social, and emotional needs.
On a higher level, I see an opportunity for oncology specialists to collaborate with primary care, employer clinics, and other patient support entities that are also engaged in advanced up-front patient engagement technology and AI platforms. Wellness and early management of leading indicator symptoms or stressors are a focal point for employer healthcare cost management but do not usually offer much opportunity for oncology specialist engagement. Many symptoms may be in common with multiple diseases. Collaboration and early patient intervention could lead to more appropriate cancer screenings, vaccines, and early or targeted treatment before disease advances beyond cost-effective care options. The best treatment for cancer is to prevent or catch it early. Such collaborations bring oncologists into the picture much earlier, making them part of cancer prevention rather than just coming in following an advanced diagnosis.
We have already seen billions of dollars invested in complex computer systems, like IBM Watson, that were inadequate to replace the human element of healthcare simply with processing for patterns and history. There are many factors affecting patients (mental, physical, social, medical, economic) that technology partners should be able to recognize and integrate—not just to produce a report, but to offer healthcare providers the input, decision support, and diverse information that providers can use to learn and make appropriate decisions.
What Can Practices Do?
It is time to embrace patient engagement platforms for connection with every patient between office visits and treatments. An effective platform will yield cost-effective care support and increase the practice’s value to employers and payers. Physicians are the best equipped to manage their patients’ care; and if practices do not step up with such 24/7 patient engagement innovations, health plans, specialty pharmacies, and even employers are likely to intervene with their own versions (which will exclude the treating physician).
AI algorithms are already prevalent in health systems and some practices and are a topic at every conference this year. Too often, I hear conversations focused on analyzing data, or medical records, or images. Those are useful applications but miss out on engaging the patient on a constant basis. Unfortunately, use of AI algorithms appears to be rapidly expanding in the payer segment, but those applications are even more distanced from the individual patient and their unique needs. Many payer uses of AI algorithms are being challenged, asking if denials or coverage decisions are being rushed and automated, without recognition of current medical practice or individual patient needs. AI and technology should support provider decision-making, not replace providers with “medical” decisions.
Practices that proactively manage their patients both in and out of the office and can leverage technology to support effective human care management will provide a better value equation for their own operations and staff, patients, employers, and other payers. These practices will also enjoy significant real-time data from the ongoing patient engagement that will lead to tangible proof of effective care management—irrefutable by other entities that do not have the patient-provider interface.
What to look for in potential technology partners:
- Dashboarding built with input from patients, data and educational libraries, and direct medical record access, as well as physician/practice guidance
- Care coordination, symptom management, telehealth, referral management, and facilitated goal-concordant care discussions between patients and providers
- 24 hours/7 days a week live and virtual patient engagement, educational support, and navigation tailored to practice guidance
- High patient engagement rates over multiple platforms meeting patient choice (SMS, phone calls, email, patient-facing platform)
- AI algorithms powered by behavioral health, cognitive science, oncology guidelines and pathways, practice guidance
Reach Out
There are a number of one-dimensional or siloed patient outreach platforms. There also are very few that offer patients and practices the next generation of patient support beyond the practice walls. The more we develop these as part of our own patient management, the less patients will be confused by intrusions from other entities. Have you found good platforms yet? Share comments with me at