Aetna launched its first accountable care organization for Medicare Advantage patients in 2007, before the Affordable Care Act expanded ACOs and before U.S. healthcare had really conceptualized "patient engagement," the flip side of provider accountability.
Jan Oldenburg first heard the term patient engagement a few years ago when she was working as a practice leader at Kaiser Permanente, but she thinks the concept has been developing in practice for about a decade, with personal health records as one example.
Now Aetna's vice president of patient and provider engagement in accountable care solutions, Oldenburg is helping merge the goals of provider accountability and patient engagement.
Aetna currently has 24 accountable care agreements with providers for commercially-insured members and 75 agreements for Medicare Advantage provider collaborations. Just how successful those and several hundred other ACOs will be remains to be seen, but at the least, Oldenburg thinks they can "help fix some of the ills of the medical system."
In Part 1 of a two-part interview during the Government Health IT Conference in Washington D.C., Oldenburg talked about how Aetna is working with providers to redesign patient communications and care planning processes.
In Part 2 later this week, Oldenburg will share why population health may not be good branding for ACOs, why health systems are increasingly sponsoring farmers markets, and how the patient engagement movement fits with the notion of a "good death."
HPN: When was the first time you heard this term "patient engagement"?
Oldenburg: I was working on this a bit even in the mid-1990s, but we weren't talking about patient engagement. I think it was somewhere in my time at Kaiser. We started doing the personal health record, and calling it a personal health record, in about 2005-2006. I'm going to guess we really started talking about engagement in 2009-2010.
HPN: How does Aetna explain an ACO to members, or do providers largely do that?
Oldenburg: One of the things that we're doing working with provider organizations is to say, 'Maybe these communications should come from you,' because then you can do them in the voice of a provider organization or even in the voice of a doctor. So part of what we do is work with them to build an overall framework for communication: What are the kinds of communications you need to do with the patients and what are the kinds of communications you need to do with your staff? It's got some dimensions in both sides: what is an ACO, how are things different, what's population health and what does it mean that you're caring for the health of a population, and what does it mean to me as a patient, what can I expect if I'm coming to this health system and what's going to be different than the way I've gotten care in the past? And if I'm a provider, what are all the little touch points we can use?
And then we also look at the tools and capabilities providers have already got in place. They may have a robust set in place but really haven't gotten the adoption that they'd like. It's change management in a lot of respects internally.
HPN: So will you ask hospitals and health systems for data on their physicians' performance?
Oldenburg: There's some of that. Certainly we use data wherever we can. We want to know as much detail as they have about who's doing what, but not everyone's tracking that that well. You know, it's a stretch to get to some of the quality measure stats, and patient engagement hasn't really been up there on the top of the list of what people are tracking. Lots of that we do in workshops. We talk to people. We figure out their passions. We listen to the things their resistant about, and help talk them through that or think about programs that we can do that would minimize those fears, or pilot things that can show that their fears are not justified. Stats can help us enormously with figuring out where those variations are in quality and cost, looking at particular procedures or behaviors driving costs.
HPN: How are you encouraging patient engagement as a collaboration?
Oldenburg: We are really trying to look at their collaborative relationship, trying to build on strengths that they already have and then really collaborate around taking their clinical knowledge, our understanding of risk and what drives cost, and looking together how we can do the right things but eliminate unnecessary variations that aren't really adding to the quality of care.
On the patient side, part of what we've got to get them to is the state where they're actually tracking some of those things. One of the systems I'm working with has as a part of our work developed the position of a director of patient experience, so that they've got somebody who will be focused on these issues, as one of the first steps in figuring out their real patient engagement strategy. It had been in a set of different kinds of roles where everybody had a small piece but nobody was looking at it overall.