With a perspective that spans direct patient care and health system leadership, Gary Kaplan, MD, Chairman and CEO of Virginia Mason Health System, says that if health care providers are truly committed to patient health, then they must deepen their commitment to prevention, patient engagement, and care redesign.
Kaplan lays out several essentials for clinicians and health care leaders.
Understand the Patient at a Deep Level
“Understanding the patient’s capacity is critically important,” Kaplan says, referring to factors such as a patient’s living situation, challenges, literacy, financial status, health care coverage, support structure, behavioral and social functioning, and any chronic diseases. “A deep understanding [of capacity] is important to our ability to really engage the patient as a mutual partner in their health and health care journey.”
Develop Care Road Maps
Clinicians need to develop robust plans of care — customized road maps that go beyond a single episode of care or office visit, even multi-year plans, he says. These plans make clear what the provider needs to do, what the patient needs to do, and what they need to do together to help the patient stay healthy.
“Unless we are explicit with our patients, I think we’re sub-optimizing and perhaps not giving them the information and the tools they need to manage health and well-being in between their episodic health visits.”
Make Patient Information Accessible
“I think having prevention and screening available and actionable at every touch point is critically important,” Kaplan says. By starting with a deep understanding of its care processes, and using the Virginia Mason production system tools, the health system partnered with its electronic health record vendor to create a health maintenance module. “When I go in to see a patient, that health maintenance module is the first screen on the computer for every patient, every time; and it’s customized to that patient’s specific prevention and screening needs and indications.”
That same module is available to call center operators. “So, using our tools, on top of good processes, and making the screening visible and actionable at every touch point for the patient, really helps a lot,” he says.
Use the Power of the Portal
The patient portal can be a powerful tool to improve engagement. If, for example, a patient has a weight-loss goal, clinicians can check in with the patient at appropriate intervals on progress. “Making their targets and their progress visible gives us a chance through the portal communication to give them encouragement and positive feedback,” Kaplan says. “Kudos on their successes. Because the patients need those just like all of our team members do; they need to feel valued and to feel that they are making progress.”
Virginia Mason also uses OpenNotes. “We have all of our notes fully visible to our patients through the portal, so that is further engaging,” he says. “Having the patient understand their screening needs on their own website is very engaging for our patients.”
Educate and Empower Patients
Meaningful education is very much part of shared decision-making, Kaplan says. “Shared decision-making is really about engaging the patient in understanding their choices and that they do, indeed, have choices. That the doctor is not in charge and that the patient’s in charge . . . if we engage patients that way, we can make better decisions together.”
Find Creative Partnerships
“One of the things we’re doing is partnering with the YMCA of Greater Seattle so that I, as a primary care doctor, can actually order directly a consult with the YMCA’s weight-loss program right out of my electronic health record,” Kaplan says, noting that this option may be more convenient for the patient.
Structure the Right Team
It is important to consider the care team itself. “How do we best leverage the primary care teams so that we’ve got the right people doing the right work? One of the things that our Virginia Mason production system has taught us is how important skilled task alignment is to optimal flow and to optimizing the patient experience,” he says. For example, medical assistants can schedule preventive testing using the health maintenance module, and they can also routinely screen for depression, anxiety, and other factors.
Nurses are probably the best trained and positioned caregivers to engage in coaching and conversations that empower patients to reach their goals, Kaplan says. Pharmacists can counsel on appropriate medication dosing. “It’s about having the right people do the right work and fully leveraging all the team members.”
Another important player in health care is the payers. It’s essential that a provider organization’s innovative efforts be reimbursed.
“That’s a challenge in today’s payer/payment environment; it’s a piece of the puzzle,” Kaplan says. “We think we’ve got to do the right thing for our patients and ultimately this will help us. If we were paid capitation, for example, it would make it that much easier, but our market’s not going there any time soon, so we have to do the best we can with what we have.”