Kristie Arthur, with Mosaic Life Care in St. Joseph, the new brand for what had been Heartland Health, spoke to the value of the Cerner medical record program that her group has been using to target patients and track their progress. Mosaic has been taking some of the same quality metrics used for years at Heartland and employing them at the clinics. “We’re still in our infancy yet,” she acknowledged.

Patient Involvement

What has impeded the effectiveness of EMR technology across the board is the failure of patients to get with the program. Bruce Bagley objected to where the onus had been placed.

“I’m on a campaign to get the term ‘non-compliant patient’ removed from our vocabulary,” said Bagley. “We’ve used that far too long as an excuse for either our inability or unwillingness to engage patients to help them take part of their care.” He saw the need for providers to engage patients and motivate them.

“But we still find some patients choosing between health care and food and that’s where our financing piece has to be brought up,” said Kristie Arthur.

“One of the challenges we all share is from an engagement with the patient perspective,” said Bob Finuf. Despite all the advances in technology, almost none of it allows a patient to speak to a clinician remotely. “We all need to figure out those things and talk about how we engage patients.”

Tierney Grasser addressed the difficulty of getting her own staff to participate in a wellness program. She worried that they might fail to interact with patients because they don’t believe in it themselves. “That’s a challenge,” she said, “not only from a health-care perspective, but as an employer: How do I get my staff to engage in this as well?”

At Metro Spine & Rehabilitation, the most salient outcome measurement is pain reduction and quality of life. “I think people are non-compliant, either financially or otherwise,” said Joseph Galate. “They want to be done and get back to their lives.”

Rick Kahle asked how providers could incentivize patients to take more responsibility for health-care decisions. Bagley suggested a model in which patients are allowed to choose among treatment options presented in an unbiased way. In virtually every instance, “Patients choose less intervention, less pain, and lower cost. Employers can support that kind of work.”

Eric Justin admitted that it was difficult to pull physician bias out of the patient decision-making process—he called it “the hammer-nail thing”—but he thought it possible and useful to create a decision-making model directly focused on patients.

“Consumers are getting more savvy,” said Tierney Grasser. They are getting more involved in their care and more cost-conscious. They are more likely to challenge their doctors.

Much depends on plan design, said Jean Hansen. If patients have a “chip in the game,” they are more likely to get involved in the decision-making process.

“The vast majority of plans have co-pay for primary care and more for specialists,” said Danette Wilson. “It doesn’t do anything to encourage the consumer about whether or not to go. That’s another hurdle to getting consumers in the game.”

Patient-Centered Medical Home

Given the capabilities of the new technology, Kahle asked what kind of information the patients were receiving to make them better informed consumers.

Jean Hansen spoke to the promise of a patient-centered medical home model. At this stage, said Hansen, the communication was still largely one-to-one: “We’re not talking to the community about it, but we are talking to individual patients.”

“PCMH reads well in the magazine and looks good on paper, but it really takes leading practices,” said Brian Burns.