Provider Engagement in the New Digital Era

Calabrese

The way we practice medicine in the U.S. has evolved significantly over the last 20 years. What began as a largely entrepreneurial, small-group practice model where providers used paper charts and forged lifelong relationships with their patients, has transformed into large-scale health systems that favor IT infrastructure, data and analytics, and capacity. The result? A complex, still largely disjointed system where providers-and patients-are sometimes left behind as it relates to sufficient communication, coordination, and education/engagement.

Provider engagement, in particular, is more important than ever to ensure better outcomes and greater value throughout the healthcare system. Engagement requires heightened transparency and easing the administrative burden of physicians. 

I recently sat down with Bradford Curtis, MD, FAAP, vice president and senior medical director at OptumRx, to talk about his insights and observations, as well as where he sees the future of provider engagement headed.

Calabrese: What have the greatest struggles for providers traditionally been?

Curtis: The practice of medicine, whether in a primary care physician’s office or a tertiary care center, has always been about improving patient health. Rather recently, the delivery of healthcare has been reevaluated in terms of outcomes, and the focus now encompasses four key objectives:

• Improving population health,
• Improving the patient experience,
• Lowering healthcare costs, and
• Improving the work lives of healthcare providers.

Meeting each of these objectives is quite complex and has hindered the rate of digital transformation in healthcare in comparison to other industries.

Providers have experienced a tremendous increase in administrative burden as the number of pilot programs and initiatives attempting to solve for the “value” equation outpaced the technological infrastructure and operational systems to support the vast array of these efforts in an orderly, manageable manner.

Inefficient processes and systems with inadequate interoperability and static data capture hampered the full potential of data analytics, as integrated health systems attempted to meet new requirements from payers and regulatory and accreditation bodies, each of whom have a different agenda. One result was providers spending a significant amount of time entering data into an EHR system rather than directly engaging with patients in a more personal way that many would prefer, or that makes them feel valued. As a result, to meet the requirements imposed upon them, providers are now either seeing fewer patients per day, spending longer hours in the office to complete their administrative tasks or having to use scribes to enter data into the EHR systems, negatively impacting their professional satisfaction, quality of life, and practice overhead.

Calabrese: How have recent advances in digital technology enhanced providers’ abilities to engage with patients?

Curtis: Recent point-of-care innovations are allowing providers to engage with patients in new ways and better fulfill modern healthcare’s four primary objectives.

Technology is providing greater transparency than ever before. For example, providers can receive notifications about medication gaps-in-care and low medication adherence, allowing them to intervene before a patient suffers an adverse consequence. Electronic systems can support decision making around drug selection based on member formularies, allowing providers to consider effectiveness alongside total drug cost, patient out-of-pocket cost, and prior authorization requirements. These systems also support electronic prior authorizations, significantly streamlining the prior authorization process and saving time for both providers and patients. This higher level of engagement is leading to happier patients with lower out-of-pocket costs, reducing rework switching prescriptions, increasing adherence rates, and reducing complications from diseases associated with non-adherence-fulfilling all four objectives.

Patient portals that allow online scheduling, new patient registration, benefit information including prescription drug formulary details, educational materials, and prescription refill information have helped drive patient engagement as well. Telehealth service adoption has been slower than originally anticipated due to a lack of broad and clearly defined use cases, physician confidence, connectivity, scheduling challenges, and reimbursement issues, but these issues are increasingly being solved for in pursuit of telehealth’s promise of lowering delivery cost and increasing access for those in remote settings or with transportation challenges.

Calabrese: What have been some of the greatest successes as a result of improved digital provider engagement?

Curtis: From a pharmacy-centric point of view, electronic prescribing and electronic prior authorization have been the industry’s greatest successes as a result of digital provider engagement. 

Electronic prescribing increases both clinical quality and efficiency by enabling providers to easily view a drug’s formulary status, reducing prescription fill errors, supporting rapid fills at the pharmacy before patient arrival, supporting efficient tracking of medication history and medication reconciliation, and supporting an efficient refill process. 

Similarly, electronic prior authorization facilitates an efficient prior authorization review process, with the ability for some decisions to be rendered electronically in real time, without the need for manual review. 

Calabrese: What trends do you anticipate for the future of digital provider engagement?

Curtis: There is an ongoing focus on enhancing existing tools that allow providers to weigh the merits of different medications at the point of prescribing, as well as improvements in the electronic prior authorization space.
Additionally, we already see real-time integration of both medical and pharmacy data, leveraging machine learning to suggest possible diagnoses and the next best action for treatment-this will continue to play a bigger role in healthcare as the industry becomes more synchronized.

Also on the radar is the continued and further level of adoption of risk-based payment agreements, in which providers collaborate to manage the cost and quality of care for a patient population. This type of payment model is a natural fit for integrated health systems that can bring to bear greater data analytics capabilities to drive better clinical outcomes and lower cost of care. Those who can combine these capabilities, along with strong office workflow management, will not only enhance clinical outcomes and cost of care, but also succeed in improving the quality of both the physician and patient experience.

David Calabrese, RPh, MHP, is senior vice president and chief pharmacy officer of OptumRx. He also is an editorial advisor for Managed Healthcare Executive.