ACOs are asking patients ‘What matters?’

Dr. Eric B. Larson discusses a survey on patient engagement and activation at accountable care organizations around the nation, featuring Group Health

To improve the quality and contain the cost of care, health care providers will need to engage more actively with patients and their families. But what’s the current state of patient communication, activation, and engagement? What are the main challenges—and strategies to address them? To find out, Stephen M. Shortell, PhD, MPH, MBA, a professor of public health and organizational behavior at UC Berkeley and the former dean of the UC Berkeley School of Public Health, led a team that did a national survey of 173 accountable care organizations (ACOs) and phone interviews with 11. They also conducted two site visits: at UCLA Health and Group Health.

Why Group Health?

The team was likely attracted to Group Health because you would expect patient engagement to be “leading edge” at a member-governed integrated delivery organization, started by patients themselves. In fact, patient engagement is key to good medical care, particularly managing chronic diseases. And the widely used Chronic Care Model is a product of Group Health research. Patient engagement is “core” to the effectiveness of chronic disease care, according the model, which is widely credited to our MacColl Center for Health Care Innovation.

Dr. Shortell recently discussed the survey at a meeting of Group Health’s Patient-Centered Care Interest Group.  What emerges from the survey, he said, is that practitioners feel that time constraints make it challenging to achieve patient activation and engagement. That said, as the report stresses, leadership at Group Health has consistently supported patient activation and engagement and worked with practitioners to provide supportive systems that will engage patients.

The most evident of these systems is Group Health’s shared decision making efforts. Led by Dr. David Arterburn and in collaboration with specialty providers, Group Health has distributed more shared decision making aids than any other institution in the country. These aids have been shown to be effective in engaging and activating patients in such a way that they make better decisions in so-called “preference-sensitive care” areas like back surgery, hip- and knee-replacement surgery, and prostate specific antigen (PSA) testing. In these areas, clinical evidence doesn’t clearly support one treatment option over others. So the appropriate course of treatment should depend on shared decision making between the patient and the caregiver, with emphasis on the patient’s values and preferences.

In some cases, not only are decisions more congruent with outcomes that patients value. They have also led to reduction in expensive elective surgeries—and thus cost.

What matters to patients—not what’s the matter with them

Dr. Shortell’s team found that ACO leaders, including at Group Health, recognize that it’s crucial to learn, as he put it, “more about what matters to patients and their families as opposed to focusing only on ‘what is the matter with you?’” ACOs, encouraged by the Affordable Care Act, are health care groups that provide coordinated high-quality care to ensure that an assigned population of patients get the right care at the right time, avoiding unneeded services and preventing medical errors.

The team also found that greater use of patient activation and engagement activities at the point of care may be related to positive perceptions among ACO leaders of the impact of investments in these activities on ACO the quality, costs, and outcomes of care. Practices associated with greater patient activation and engagement—in place at Group Health—include high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training, use of interdisciplinary care teams, frequent monitoring and reporting on progress, as well as recognizing that it takes time to spread these activities throughout an organization.

Dr. Shortell and colleagues at UC Berkeley, the Center for Healthcare Organizational and Innovation Research in Berkeley, and the Geisel School of Medicine at Dartmouth and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, NH, recently published An Early Assessment of Accountable Care Organizations' Efforts to Engage Patients and Their Families in Medical Care Research and Review.

The Gordon and Betty Moore Foundation, The Commonwealth Fund, and the Agency for Health Research and Quality supported this research.

Going forward

Group Health will continue to aspire to be leading-edge in the general area of patient activation and engagement through its leaders and in partnership with patients and physicians and other providers. One key area where Group Health has made particular gains is in awards from the Patient-Centered Outcomes Research Institute (PCORI), all of which engage and benefit from patient partners who are involved in designing and conducting research.

Eric B. Larson, MD, MPH
Executive Director, Group Health Research Institute
Vice President for Research, Group Health