Patient Engagement and Wellness: A Critical Piece of the Puzzle as Health Care Moves to Value-Based Models

When the Institute of Medicine (IOM) released its landmark 2001 “Crossing the Quality Chasm” report, it called for providers to support continuous healing relationships” with their patients. Although we have seen some progress through the proliferation of patient-centered medical homes (PCMHs), most clinicians have not fundamentally altered their basic approach to engaging with their patients. In most cases and in most places, PCMHs have tinkered around the edges to meet specific new requirements, but most primary care physicians generally remain on the proverbial treadmill, trying to treat a high volume of patients in the typical fee-for-service payment model.
The PCMH is a good start as an organizing framework for a care delivery model, but achieving true care transformation remains elusive in the context of traditional approaches to payment that simply add on small bonus payments around the margins. Conversely, primary care practices that have entered into alternative payment models (APMs) that hold the practices accountable for a global budget have been more transformative. In some cases, these APMs have generated a fundamental reorientation from episodic, sick-care encounters with the delivery system to a continuous cycle of care.
Fundamentally changing the payment model is a necessary but insufficient step. Alignment of incentives is a prerequisite, but providers still need a lot of additional support to reorient, reorganize, and reshape the care paradigm. Primary care providers, especially those operating in small practices, need substantial technology and infrastructure support. However, before an organization invests in that core support, it’s imperative that they know what patients want. To paraphrase Yogi Berra, “If you don’t know where you’re going, you might not get there.”

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