Value-based care impacts patient satisfaction

So in 2012, I want to move on to talk a little bit about experience because we have something that you all know is the quadruple aim. Two of those pillars are outcomes and cost, and we're going to get to cost in a moment. But the other two are related to experience, the patient experience and the provider experience. Both are incredibly important.

A 2021 internal Humana survey that's very similar to the CAP survey that we're all really familiar with and a very important, as was mentioned, stars metric weighted now three times show that members rated value based physicians roughly 7% higher overall than non-value based physicians. And there are particular categories as you see here on the slide where value-based physicians overall really do get better.

You know, patients are not always super excited about going to see their doctor, but it can be sometimes frightening, uncertain. It takes time. There's sometimes transportation issues. And so I know that all of you and the physicians you work with are very, very attuned to the patient experience when they walk into your offices or enter the health care system in whatever way that they may.

I'd love to hear with you from you, starting with you, Dr. Suresh, how your organizations approach patient experience and maybe tell us something that is unique or different about your organization and what they do to try to make patients feel good about visiting your office?

Absolutely. Patient and provider satisfaction or context and things that we discuss with our physicians every single time, whenever we are able to meet with them. First off, on the support that we provide with how can a patient complaint or patient grievance be timely, be addressed timely in a timely manner? That goes a long way to our physician, but also providing a peer group session between physicians.

So I was just I'm just coming off a major physician meeting where we had different market physician leaders meet and shared some of their best opportunities. How they addressed patient satisfaction. And they all understand patient satisfaction. At the end of the day, it results in good outcomes, right? So that's equal. And then there's no doubt in their minds that CMS has put so much out of that, so much importance to patient satisfaction of about 40% of all their CMA star rating is going to be tied to patient's patient satisfaction.

So one major thing is the physicians know that patient it's about patients perceptions. And so how do they impact perception? So they share best practices. They go through they develop a strategies within their organization or within their practice and share those strategies with the other physician. So we create that medium for physicians to exchange ideas. And some examples would be as simple as How can I impact wait time office wait time is a constant problem.

And in day and age, when they are, they are required to see more patients. And how do I impact that? It starts from the whole office, right? It starts from the front office or whoever answers the phone. So all rooms, the patient and how they interact with the patient. So everything is tied to how the patients perceive things and physicians to share ideas between each other and say, Hey, these are the three things that really work in my and they can show the outcomes.

They started this about three or four years ago and they showed their improvement in their patient satisfaction scores. The second the second thing that we all provide is internal survey. So we actually sample patients and provide the survey scores of each of their physicians. And you would not believe it. Some of the physicians who have the best outcomes, they were surprised to see how their patients were rating them.

And so they immediately employ tactics or strategies to improve that perception so they can only improve when they know. So that's one of the things that we have been able to provide in order in order for the physicians to see how their patients perceive them. And some of the offices have other advanced technologies, like sending an email to their patients right after an office visit, seeing if they completed the survey, and taking that feedback very closely and working on those.

So they have done and this is not consistent across all physicians, but several physicians who are technologically advanced and savvy do that. They send an immediate survey to the patient after office visit and take that feedback. So in my opinion, our organization, the way we have a proposed physician patient satisfaction is engaging the physician leaders, peer groups, peer group, best practice sharing as well as the internal survey provider satisfaction.

And I think goes back to a different area of opportunity for us where we, we, we lean on the, the, our reducing office burden, right? So how can we reduce provider office burden, which is a constant theme. Previously we heard from these offices. You are telling me a bunch of forms, you're asking me to do this, that in the end you're not providing any support.

So our IPA and the relevant physician organizations have the embedded value based care nurses in the office that act as a liaison between the management company as well as the IPA practices. And they provide so much reduction in office burden. And the second strategy that is really is really taking a lot of momentum recently is process improvement. We are as an MSO providing process improvement opportunities in terms of education as well as coaching, as well as evaluating their offices and simple things that how do you improve this one process, the referral profit.

If we can change the way that a formal process from this one to this one, patients are satisfied. Providers are satisfied, it reduces their burden. So process improvement, we have put crews in our management company that goes into the patient's the physician's office, assess their practice, provide that opportunity and tools or solutions to improve that process.

So this has been really taking good momentum, I would say, in the last two years. It is a lot of investment in time. They understand that the offices have to provide that time to the process improvement claims. However, the outcomes are phenomenal bid and they have the process improvement crews have specific areas of improvement. They would say, What does your office really need now?

Do you want your annual wellness exams to be improved or they want your 8-K to be reduced or admissions 4000 or use your office focusing on readmission reduction or is your office focus on focused on patient satisfaction? So they have modules for each of these practices and they can they can choose the office say, I'm doing well in this, I need support in there.

So I think providing that support to the providers have made them extremely satisfied and that really impacts down to their patients. So those are some of the techniques that our IPAs and management companies have come up together to address both patient and provider satisfaction.

That's fantastic. Dr. Feldman. You know, I'd be very interested in hearing what you and your practice are doing, in particular related to provider satisfaction. Certainly happy to have you speak to patient experience as well, but the pandemic is just so exacerbating clinician burnout across the spectrum of clinicians. How is your practice sort of focusing on tending to the well-being of the providers?

I think that's a challenge for everybody. So we've spent time and energy working on it, and I think that the real magnifier from the pandemic was the staffing shortage. So organizationally, at the very top of our organization, we quickly recognized early that maintaining adequate staffing was critical to maintaining adequate physician and provider happiness. Right? So when your care teams are depleted, the work sort of drifts up to the top and the physician or the provider ends up doing work that should be done by somebody underneath him or her.

And so our organization spent capital. We put $6 million in raises toward line employees, clinical employees to maintain care, team staffing. And so that was highly successful. So once the teams are well staffed, our workflows are very successful in providing top of license work for each of the components of the care team. That is to say the medical assistance really are optimized to queue up orders for care gaps interface with patients for and between care.

The nurses do high level triage and the providers can spend their time and energy with in office visits and complex care coordination between visits. So I think from an organizational perspective, you got to put your money where your mouth is. It's not enough just to have slogans on the wall, an email campaign saying We value you. What the providers really care about is having amazing nurses and registration technicians so that their office doesn't grind to a halt.

The effects are magnified with staffing shortages because the work increases for the remaining staff who then leave. So I think smart organizations quickly, quickly understood early in the pandemic that it was going to cost more to provide the quality care from the patient level experience. I'll just give you a few brief statements on that one. I think that experience needs to be unpacked.

It's a big word, and I think we spend a lot of energy on our patient surveys. And I think that what we've learned is that there are a few key components that drive reported patient experience, and the first is access to care. If they call and can't get in, you've lost the battle immediately. The second is, as was already explained, wait time once they're in the care.

And I think the third component is communication, both communication, ease of access, of interfacing with the with the care team, whether it's through an electronic portal message or whether it's through a telephone call or and the communication piece also includes results notification. Right. Nobody wants to have their results linger in the wind for days and days and days.

So our organization has an enormous effort on in engaging patients with the portal, the patient portal. It's an epic platform called MyChart, and it's extremely useful. And despite being a geriatric practice, it's predominantly rural. We have more than 82% of our patients signed up, which means that they have instant access with their with their providers. From a management perspective, we monitor inbox time, how long messages are linger in inboxes before they're closed.

We spend energy sort of managing providers who have sort of long inbox lags and we have standards in the organization. So carrots and sticks, but fundamentally understanding that access is the main driver of patient experience.

I think I'm probably the best value-based patient because, you know, I don't want a checklist. I'm not a checklist. I've lived many, many years.

At Norton Health Care, we've done a great job in terms of making sure that we have all the pieces in place, having that extra set of eyes to make sure we're hitting these important markers of prevention. So that way we're taking the best possible care of the patient.

I've been seeing Dr. Taylor about six, six and a half years and a Norton patient for many years before that, before Dr. Taylor, I had to stay a family practitioner. And as I grew older, I developed more health issues. And someone recommended that I go see an internist.

Back in 2020, Ms. Wilson had a hospitalization, which was very prolonged. We were there for 21 days.

21 days.

At a Norton's hospital. And I had all these people around me and I thought, Wow, there's something must be really difficult going on here because I had five or six people at my bed all the time. So I came through that very well. I've had probably ten or 11 joint replacements. And, you know, I fell at work and broke my elbow and I fell in my garden and broke my wrist.

And so but come to find out, a Norton's physician found out that my parathyroid score leeching calcium out of my body.

One of the things that Ms. Wilson remembered is that Humana Medicare had sent her meals following her hospitalization because they recognized that she was tired. She had just come home from the hospital and she would need that extra support in terms of meals. Obviously, we were calling to check on her, make sure things were going okay. Had a visit right after the hospitalization to review everything that happened and make sure that she understood what was going on.

I like the talk and so I want her to know about, you know, I woke up with a headache on the left side and could it be a brain tumor, you know, whatever.

So it ended up being this very terrible hospitalization. But we had it. We made it through it and we made it through it together.

And as I grow older and I've had more serious health concerns, I feel very I feel very comfortable.

Well, I think it's definitely made my patient visits a whole lot more holistic, fully integrated for the human that is sitting in front of me. And not just the medical conditions and doing the best I can for the patient who's in.

Front of me. I'll be 72 in three weeks. I'm going to be around for a little bit longer.