To transform a healthcare system to an effective, efficient and affordable system, it’s not enough to enlist the efforts of the physicians and hospital, says Jay Driggers, director of consumer engagement at Horizon BCBS-NJ. Consumer participation is an equal part of the equation, with self-accountability topping the list of seven key objectives for consumer engagement.
The first is, ‘Become knowledgeable on care models and/or benefits.’ Today, all health plans probably recognize that they have a problem with their membership understanding their benefits and how to use them. It’s a big pain point for a lot of health plans. We’re also now introducing new care models, such as a patient-centered medical home (PCMH), and we need patients to understand these models, the role they need to play, and the role they should expect their PCMH to play in their care. This is a very important objective for us: to get patients, members and consumers to understand and become knowledgeable about their benefits and their PCMH.
Second, we want them to select and develop a relationship with a preferred PCP — that is, them saying, ‘I want to work with a PCMH, I want to select a medical home to drive my care.’
The third objective is somewhat self-explanatory: we want people to adopt healthy behaviors. That means making a healthier choice when it’s possible or available. And similarly, the fourth is using preventive care regularly — getting the preventive screenings and check-ups based on recommended guidelines. We definitely want to encourage that behavior as part of our models.
Fifth, we want people to be accountable for their treatment selections, to play an active role in their health — to not sit back and say, ‘Okay, doctor, you tell me what I’m supposed to do and then I’ll go.’ We want to make sure that the patient is playing an active role in that decision so that it’s a two-way street, not just a passive scenario.
The sixth one is to create and adhere to treatment plans; this targets more specifically those with multiple chronic conditions, which we know are the high cost drivers in the system today. We want them to work with the PCMH or with an accountable care organization (ACO), whatever model you may be a part of, and work to pull a plan together for all the different conditions that you may have, making sure that you can comprehensively manage your health in all the ways that are needed.
Lastly, if all of these first six happen and we all play the roles we’re supposed to play, we should see higher levels of satisfaction with the healthcare experience among individuals, among consumers. If you’re getting higher quality care and having a better patient experience, if costs are being contained or controlled or eventually reduced, which is the ultimate goal, you should ultimately be more satisfied with the experience you’re having.
Guide to the Patient-Centered Medical Home: Metrics, Models and Engagement provides an overview of PCMH adoption and results and examines nuances of the model that have emerged in recent years — including the embedding of case managers on medical home teams.