Patient-Centrism: What Does It Mean in Value-Based Care?

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By Mandy Armitage, MD, Clinical Content Medical Writer

 

In recent years, there’s been a shift in healthcare toward patient centrism, or patient-centered care, as we see organizations attempt to improve patient care. To understand how patient-centered care (PCC) plays into healthcare reform, it’s important to understand what it is. It has been defined by the Institute of Medicine (IOM) as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” Patient-centrism calls for more involvement on behalf of patients in their healthcare decision-making, rather than decisions being made for them. PCC was one of the 6 objectives described by the IOM as necessary for improving healthcare. That was in 2001,[1] but the idea seems to be finally gaining traction.

 

What do doctors think?

Some physicians are hesitant to embrace patient centrism, which is understandable if you consider how it may change the status quo. Medicine has historically been very paternalistic in nature, with decisions made solely by the physician in his/her patients’ best interest. Patient centrism would require shifting away from that mindset, and as we know, nothing in medicine shifts quickly or without debate. A common theme is that we shouldn’t be creating a culture that prioritizes patients’ wants over the expertise and experience of their physicians. If clinical decisions are made largely based upon patients’ preferences without proper consideration of clinicians’ judgment, clinical evidence, and best practice, outcomes could ultimately suffer. Hardly anyone would disagree with that, but perhaps it doesn’t have to be one or the other. Improving the lines of communication between the two parties can result in better understanding of each other’s objectives, which is a critical foundation for this relationship. Additionally, we know that poor communication can lead to poor compliance and unnecessary tests and referrals (and cost), so it behooves everyone involved to optimize communication.

 

Does it require technology?

Yes and no. Patient engagement platforms are great for optimizing communication between providers and patients. However, PCC also requires sufficient coordination of care among multiple players. Coordination of care and constant communication between provider and patient is often time-consuming and requires resources that most systems/offices simply don’t have. Technology may not be necessary, but it certainly makes things easier and more efficient. Many physicians welcome the opportunity to keep better tabs on their patients between visits, and technology is a great way to bridge this gap. But just having a mobile app or patient portal is not enough. If the technology does not provide an excellent or even satisfactory experience for patients, they are unlikely to remain engaged. Finally, it’s important to bear in mind that better outcomes have been demonstrated with PCC-centered health technology.[2]

 

Do patients like it?

As discussed, we know that the dynamic of the doctor-patient relationship affects outcomes and patient satisfaction. Patients appreciate sufficient communication to make them feel “kept in the loop,” so to speak; it makes them feel heard and respected. Patients need to feel respected, and they need to know that their role in the decision-making process is important. Not only is it intuitive that PCC can lead to improved patient satisfaction, but the literature supports this as well.[3]

 

What does it mean for healthcare on a larger scale?

With the emphasis now on value-based care, patient outcomes are becoming increasingly more important. It’s been said that patients are the most underutilized resource in healthcare, and it seems the healthcare world is finally starting to take advantage of that resource. With the April 1 launch of Comprehensive Care for Joint Replacement Model (CJR), there’s even more reason to stay connected with patients, especially after hospitalization, as CJR incentivizes patient outcomes and coordination of care. Increasing emphasis on patient centrism will likely be accompanied by better utilization of health technology (such as patient engagement platforms) to optimize it. Time will tell how it all plays out, but it’s certainly an exciting time to be involved in the process.

 

[1] Crossing the quality chasm: a new health for the 21st century. Institute of Medicine. March 2001.

[2] Enabling patient-centered care through health information technology: evidence report/technology assessment executie summary No. 206 (AHRQ Publication No. 12-E005-1). www.effectivehealthcare.ahrq.gov/reports/final.cfm. June 2012.

[3] Rathert C, Myrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Medical Care Research and Review. 2012; 70(4): 351–379.

 

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