Patient Relationship Management: Novel Software for a New Era of Patient Navigation in Oncology

Gena Cook

October 2016, Vol 7, No 9 - Patient Navigation


As cancer care providers well know, the landscape of healthcare delivery is changing in complex and dramatic ways. Two related trends are driving this change: the shift among payers to value-based reimbursement, and rapidly evolving patient expectations. As a result, providers are squeezed in the middle. Simply put, they are expected to provide better care at a lower cost—give patients around-the-clock access to their care team, involve them more in treatment decisions, and improve their outcomes and their experiences, all while lowering operational and treatment costs. There is only one way to meet this challenge: by embracing new technology. To meet the demands of patients and payers while keeping overhead costs low, cancer clinics must have a secure, intuitive way to communicate with patients between appointments, and have a standardized workflow to keep staff members organized and coordinated. In short, everyone, including the patient, must be on the same page at the same time. This represents a major shift for most clinics and requires systemic change that is dependent on technology but is well beyond the capabilities of an electronic medical record (EMR) or patient portal. This is where a new category of software becomes integral for success. Patient Relationship Management (PRM) is an all-in-one, patient-centered operating system that layers over an EMR to provide an engaging interface for patients and their care teams. The primary purpose of PRM is to stimulate an ongoing flow of information between patients, their providers, and their support network. Information collected, such as medication side effects and patient-reported outcomes, serve to populate a centralized, comprehensive view of each patient for every member of the care team, enabling the type of superior care coordination that is typically out of reach with a stand-alone EMR. Cancer programs that adopt an oncology-specific PRM solution will not just survive in today’s uncharted territory but also thrive, all while setting a new standard for patient-centered care.

Moving into the Information Age

It is ironic that a field as advanced as oncology, which saves so many lives with advanced medical technologies, is stuck in the Dark Ages when it comes to communicating and collaborating with patients. Today’s patients, even folks in their 80s, use technology in every facet of their lives, except in their interaction with healthcare providers. They book plane tickets online, manage finances with an application, publish holiday photos on social media, and make video calls with family abroad. Yet, at their cancer clinic visits, they have to hand-fill a symptoms assessment form that likely asks questions they have already answered and may never get looked at. To ask a question about a drug’s side effects, patients have to pick up their phone and hope someone will answer at the other end, or will at least call back. No wonder patients and their caregivers are frustrated.

Getting on the Same Page

Even when providers do use technology, the benefits for patients are limited. Because of siloed health information technology systems and EMRs that essentially function as electronic filing cabinets, care coordination is lacking. For example, a radiation oncologist and a surgeon may give the patient conflicting information, or a physician may forget to mention a medication switch to the patient, who finds out about the switch from a nurse. In addition, outside of clinic visits, patients are disconnected from their treatment plan and care team. According to a report published by Healthcare IT News, critical information stays locked up, requiring duplicate entries and ultimately hindering patient care.1 But patients are noticing and pushing back. Forced to absorb more of their own healthcare costs, patients are understandably demanding more in return. They want a larger role in their treatment decisions, more immediate access to their test results, and faster responses to their questions. Over the past 2 years, 57% of patients in the United States reported playing a more active role in their healthcare.2 There is no doubt this trend will continue, and, inevitably, patients will drift to the cancer centers that demonstrate exceptional clinical success and an exceptional patient experience.

Technology Needed to Scale Your Operations and Save Costs

Recognizing these trends, a handful of providers and payers have teamed up to pilot new models of care that focus on proactive outreach. Staff members contact patients more often, asking them about side effects, symptoms of depression, compliance with medications, and so on. Across the board, these programs have lowered costs while improving clinical outcomes and patient experiences. The following programs illustrate the impact that is possible with measures such as nonclinical navigators, extended hours, and care management:
  • A pilot program by Aetna, The US Oncology Network, and Texas Oncology improved care for 184 patients with lung, breast, or colon cancer, reducing costs by 12%, emergency department visits by 40%, and hospitalizations by 16.5%3
  • A UnitedHealthcare pilot program improved care for 810 patients with lung, breast, or colon cancer, reducing costs by 34%4
  • The COME HOME pilot program, an innovative medical home model, is projected to have $33.5 million in total Medicare savings
  • A University of Alabama at Birmingham pilot program reduced admissions to intensive care units by 14%, emergency department visits by 12%, hospitalizations by 18%, and overall costs by $18 million.6
Although these results are impressive, there is a catch—all of these pilot programs involved hiring more staff. Furthermore, the methods were tested on small populations. Many providers simply cannot afford to adopt these measures on a large scale without the help of technology. That is where the PRM technology comes in.

Patient Relationship Management: A Win–Win for Patients and Providers

Technology cannot replace the insight of an oncology nurse, the empathy of a social worker, or the physician−patient bond. But what software can do is automate routine tasks and spur patient involvement, freeing up staff to do what is most important—care for patients. By saving resources and time, a PRM platform makes it possible to:
  • Provide patients with 24/7 access to their health information, test results, personalized education, and prescribed medications and treatments
  • Enable all care team members to operate from a single-patient view and appropriately coordinate care
  • Embed care workflows to help to proactively manage all patients or specific patient populations
  • Give patients a remote way to inform their care team about treatment symptoms or side effects
  • Prompt patients to complete periodic assessments about how they are feeling, physically and emotionally
  • Remind patients to take their chemotherapy oral medications or attend upcoming appointments
  • Allow patients to connect with family, friends, or other patients for support, if they so choose.
In short, PRM allows clinics to take a proactive, dynamic approach to patient-centered care. According to patient surveys conducted by Navigating Cancer, when cancer programs implement the Navigating Cancer oncology-specific PRM platform, patients understood more about their diagnoses, felt more connected to their care teams, and complied more fully with their treatment plans. Staff members know immediately, not 3 days later, when a patient is reacting poorly to a new medication or needs help; hospitalizations decrease, reducing costs and emotional distress; and patient satisfaction surges. PRM creates a snowball effect in the very best way. Cancer care providers are at a crossroads. They can either continue down the same familiar path and risk alienating patients and payers alike, or adapt to the new consumer-driven healthcare environment by making the patient relationship their highest priority.

References

  1. Davis J. ONC cites security, incentive woes among 5 biggest interoperability roadblocks. December 17, 2015. www.healthcareitnews.com/news/onc-cites-security-incentive-woes-among-5-biggest-interoperability-road blocks. Accessed September 19, 2016.
  2. Westgate A. Eight patient engagement trends to watch. June 23, 2016. http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/eight-patient-engagement-trends-watch?page=0,1. Accessed September 19, 2016.
  3. Hoverman JR, Klein I, Harrison D, et al. Impact of a cancer management program. J Clin Oncol. 2012;30(34 suppl):Abstract 227.
  4. Newcomer LN, Gould B, Page RD, et al. Changing physician incentives for affordable, quality cancer care: results of an episode payment model. J Oncol Pract. 2014;10:322-326.
  5. The COME HOME model. www.comehomeprogram.com/index.php/come-home-practices/. Accessed September 21, 2016.
  6. Rocque GB, Pisu M, Jackson BE, et al. Trends in resource utilization and costs during implementation of a lay navigation program. J Clin Oncol. 2015;33(15 suppl):Abstract 6502.