Why we need to rethink patient engagement
The cost and health benefits of the direct patient engagement model
The healthcare system is difficult to navigate, and for individuals with underlying psychosocial issues like mental health diagnoses, substance use disorder, homelessness, or other social determinants of health, it becomes even trickier.
Many of these individuals face challenges traditionally stigmatized by the healthcare system—leading them to feel distrustful of providers or unsure of where they can turn for help. They may resist engaging in the basic and/or preventative care needed for their underlying conditions, which then slowly exacerbates their status until a crisis event occurs, leading to ED utilization, and subsequent admissions.
Breaking this cycle requires fundamentally changing the way we approach patient engagement—utilizing engagement specialists that can rebuild trust, change patterns, and ultimately improve outcomes.
Current barriers to patient engagement: establishing trust
“Mary” had a history of alcohol abuse, often showing up to the emergency department suicidal and intoxicated as she strove to subvert her depression with alcohol.
Mary was enrolled in the CBCS high utilizer program, and staff began trying to contact her. However, the phone number on file was invalid, as was the address. Through the regional Health Information Exchange tool, CBCS was able to contact her during her next ED visit.
By meeting her in person, CBCS staff was able to describe the program and begin to establish trust. While it took ten visits before she trusted them enough to initiate talking with staff about being “ready” to work on recovery, over the following months they worked together on detoxification, recovery, housing, and job placement issues. After several months, she became an advocate within the outreach program!
Mary has reiterated how persistence in contacting her during each ED visit is what eventually led her to agree to “give [CBCS] a chance”. It was through direct patient engagement that Mary overcame her distrust after years of dead-ends and frustrating encounters that focused primarily on very partial treatments based on provider perceptions. She felt that if CBCS were continuing to reach out to her time and again during moments of crisis, it was a resource she could depend on to support her in addressing her issues.
As Mary’s story demonstrates, successful patient engagement for our most challenging complex patients requires being available to help, to listen, 24/7, and address issues with effective treatments. We need to become the “round-the-clock specialists” trained to work directly with complex care patients in addressing social determinants.
Social determinants as a specialty
Referring patients to specialists is a common practice within the medical field. While a primary care physician wouldn’t think twice about referring a patient with a complex heart condition to a cardiologist, physicians often feel the need to address social determinants themselves without adequate training to do so.
The CBCS direct patient engagement program provides specialists in community engagement that can work alongside patients to address social determinants and improve health. Each team member is trained to work with marginalized populations—helping these individuals overcome stigmas they face in connection to homelessness, substance use, incarceration, or other traditionally overlooked issues.
Because most crises fall outside traditional working hours, but require immediate intervention for resolution, CBCS’s direct patient engagement team members are available 24/7 to connect, support, and engage individuals—whenever they need it. By meeting with patients when they are most vulnerable—often during crisis moments and in the ED—our care teams can more effectively establish that trust and credibility so that, next time a crisis hits, the patient knows who they can call.
Finally, outsourcing engagement for patients with complex conditions frees up physicians to spend their time on what they do best—solving complex medical problems for better care—and leaves solving for societal needs to those who have the bandwidth and community connections to most effectively address them.
The clinical and financial benefits of the direct patient engagement model
As patients are provided with an advocate to help them navigate our nation’s healthcare system—while building rapport and trust—costs are reduced, and patient outcomes improve.
National data suggests that roughly two percent of patients account for 25 percent of healthcare dollars spent, and five percent of patients account for almost fifty percent of our nation’s healthcare spending. While some of this cost can be attributed to treating costly conditions—like chronic kidney disease and diabetes—much of it comes down to unnecessary acute care costs resulting from unmanaged chronic conditions and social determinants of health.
For example: the average patient with complex care needs costs the healthcare system between $60,000 and $100,000 annually in medical costs (admissions, ED utilization, prescriptions) if they have between five or six visits a year. When factoring in social determinants common to individuals with psychosocial issues—including frequent need for law enforcement, time spent in the prison system, or utilization of ambulatory services—that number increases.
Implementing direct patient engagement programs can reduce costs by 20 percent a year—or four to five times the initial implementation investment—by reducing that unnecessary acute care and connecting patients to the community resources that help address the other social determinants impacting health and utilization. CBCS patients enrolled in the direct patient engagement program experience, on average, a 50-60 percent reduction of ED visits, and reduce opioid prescriptions by 20 percent.
When we tailor our programs to be patient-friendly, they become provider-friendly, too. Physicians partnering with CBCS for direct patient engagement programs have reported lower burnout and higher job satisfaction—with one physician stating the program motivated him to postpone retirement another ten years as he was able to get back to doing what he did best: caring for the medical needs of each individual. It’s a win-win.