This post is a third in a series that discusses proactive health – how the U.S. healthcare system is transforming to a proactive health model, the definition of proactive health, the elements to commit, the challenges, and the benefits. Read the first post, “From Reactive to Proactive Health,” and second post, “Proactive Health: The Elements of a Provider’s Commitment.”
The Challenges to Achieving Proactive Health
Proactive Health is a challenging objective for all providers and physicians and in spite of their personal commitment and the available technology, there are obstacles when trying to move to a proactive health model.
The first step in embracing a proactive health model is for the provider and physicians to agree to take on risk – something only insurers have done in the past. However, before you commit to taking on risk, you need to be able to assess it – analyze the target population, identify access points and market penetration, understand how to spread the risk across the network, etc.
To assess the risk, you need technology – CRM and business intelligence / predictive analytic tools.
This means that the provider is making more than a personal commitment to proactive health – it is making a financial commitment as well.
The good news is that a CRM system has many purposes – it is a marketing tool with a proven ROI and is the cornerstone technology to drive proactive health.
Another important element in a proactive health model is that clinicians and marketing must align.
In a proactive health setting, marketing’s charter expands from patient retention and acquisition to the strategic management of population health. Obviously, marketing cannot achieve this objective in a vacuum.
Where marketing can identify the need for health services for an individual patient, the physicians deliver on the promise of improved health, one patient at a time.
In a value-based, proactive health environment, our last challenge is how to deal with non-compliant patients.
Regardless of the incentives, there will be a certain percentage of the population that will avoid treatment unless absolutely necessary. For example, according to a 2015 article published in the AAFP Leader Voices Blog, 50 percent of patients fail to take their medications as prescribed and with older patients, the proportion could be as high as 75 percent.
Non-compliance can create an adversarial relationship between a prescriber and a patient, which is the opposite type of relationship a physician wants to have with his patient. The challenges with non-compliant patients are an on-going topic of discussion among providers, physicians, and payers.
The Benefits of Proactive Health
The benefits of proactive health assumes that the provider has made the investment in a CRM system which it can leverage and use to analyze and identify risks, demographic and patient populations, services, and specialties that will meet the needs of their target market.
It also assumes that they have made an investment in a contact center solution to engage with patients and providers on a 1-to-1 basis and achieve a value-based healthcare model. The figure below denotes the benefits associated with the technology and action.
Can a move to proactive health improve the U.S.’s overall ranking among nations?
Unfortunately, we won’t know unless providers and physicians – hospital network systems and ACOs – make the investment.
The good news is that providers are starting to commit to increasing IT spending dollars. According to Mirror, Mirror on the Wall, 2014 Update, “the U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology.”
In summary, healthcare providers need to adapt to a changing landscape that promotes proactive health as the best way to address the quality, cost, access conundrum. Proactive health is a commitment between a provider and a patient, where both parties take an active role in managing the patient’s health to keep the patient healthy. In a proactive health model, the patient must be compliant and commit to self-care and the provider has a responsibility to proactively manage the lifecycle of patient care.