Unnecessary medical costs amount to nearly a trillion dollars annually—often due to inefficiency and error. Eric Beck, DO, MPH, has built a health care delivery model intended to reduce costs and improve outcomes.
Dr. Beck believes patients’ active participation in their own treatment will drive savings and better outcomes. His company, Dallas-based Evolution Health, coordinates care for more than two million medically complex and high-risk patients in 15 states, many of whom are elderly.
Meeting patients where they are
The patient population Evolution Health serves primarily comprises patients with multiple chronic conditions (MCCs), a group on track to grow nationally to around 157 million—nearly 40 percent of the U.S. population—by 2020.
Their health care costs on average are well above the rest of the country, however, within this group, there is a subset known as super-utilizers—patients with 10 or more annual visits to the emergency room and a high frequency of hospital admissions. One longitudinal analysis of publicly insured or uninsured patients found 3 percent of super-utilizers account for 30 percent of all adult care costs.
“Clearly, this is an expensive population to care for, just due to the nature of their illnesses. However, it doesn’t have to be so,” says Dr. Beck. “Much of this [cost] is driven by patient attitudes and beliefs around who is responsible for his or her own health.”
The ability and willingness to assume responsibility and advocate for one’s own care, called patient activation, is a measurable quality that is highly correlated to most metrics for health. Raising activation among MCCs is key to bending the cost curve.
The higher a person’s patient activation score, the more likely they are to adhere to their medication regimen, keep doctor’s appointments and even reduce potentially dangerous mistakes. People with lower patient activation scores are more likely to need and use hospital services.
“The great thing about improving patient activation is that it addresses two of the prevailing factors that drive avoidable health care spending, lowering unnecessary care and preventing errors,” explained Dr. Beck.
Evolution Health created a robust process to increase patient activation. The team begins with an initial assessment of how well patients understand their conditions and the care that is needed. Then, it provides supports to increase patients’ ability to self-manage and advocate for the care, be it medication or monitoring that is needed. In two months, patients typically achieve a 5–6 percent or greater increase in their patient activation scores.
“Our patient care model mirrors the philosophy of osteopathic medicine by taking a whole-person approach,” says Dr. Beck. “That’s why we say our care is person-centered instead of patient-centered. If you want to help someone, you have to go beyond their symptoms and understand them in the context of their culture, community and environment.”
That cultural competency is the cornerstone of staff training, in which clinical professionals are taught to coach patients in a manner that appreciates and addresses an individual’s social determinants of health.
“We provide education to help patients optimize their health and meet their individual goals through self-management. But we start by meeting them where they are,” Dr. Beck says. “That means literally at a time, place and manner of their choosing, with an empathic and nonjudgmental approach.”