Stepping Outside the Box - Part III

Geoffrey E. Moore, MD FACSM

Part III: Leveraging Technology and Winning C-suite Support

In Parts I and II, we explored strategies to optimize your health and well-being service line, from billing tactics to harnessing the potential of non-physician team members. Now, in Part III, we'll delve into the role of technology and the key to gaining support from your C-suite.

Health Informatics: Patient-Generated Data, Wearables, Telemedicine, and Analytics

The Affordable Care Act ushered in health informatics as a tool to lower health care costs and enhance quality. While electronic medical records (EMRs) are the cornerstone of health informatics, many physicians and staff feel like they’ve been turned into data-entry clerks. While health administrators believe that analyzing all that data will improve quality and reduce costs, in truth the jury is still out on that. [Bond; Johnson; Meyers] Nonetheless, EMRs are here to stay. 

EMRs aren’t optimal tools for health and well-being services. They are primarily designed for managing health system-generated data that is focused on disease-care, not patient-generated data focused on health and well-being. A health and well-being service line heavily uses patient-generated data in the form of questionnaires, wearables and internet-connected devices (e.g., bathroom scales). Let's explore the types of patient-generated data and how to integrate that data management into your services.

The first crucial piece of patient-generated data is the Health Risk Assessment (HRA), mandatory for annual wellness visits (AWVs). While paper-based HRAs are an option, it's important to track this data over time, particularly for lifestyle risk factors. A digital record is better suited than paper questionnaires to tracking data over time, because a paper questionnaire can’t be analyzed unless someone types the responses into a database. Additionally, you'll need to evaluate and address social determinants of health (SDOH), another area that requires tracking. Wearables and internet-connected bathroom scales will play a central role in real-time monitoring of patient progress with weight management and physical activity, which are billable services under remote physiological monitoring. Telemedicine services are also valuable for brief patient follow-ups and clarifying issues with missing data or data that is changing too quickly or is out-of-range. All of these essential services look to be Medicare billable in 2024.

Data alone will not be sufficient to keep patients motivated in their behavior change journey. You'll need to stay connected to help them stay committed to adopting new habits and truly understand their motivation. Patients must have easy access to their data and the option to share their data with community-based organizations (CBOs). EMRs fall short in these functions because of privacy and security concerns, so you'll need a different tool for managing patient-generated data. You’ll need an electronic coaching record (ECR), such as the one we have offer from Sustainable Health Systems. 

Creating a Financial Pro Forma

Lastly, let's discuss securing the financial support needed to advance your health and well-being service line. The good news is that if you're not constructing a physical facility, you won't require a substantial initial investment. Everything we've discussed in this series is covered by insurance, ensuring smooth payment processing. You can just start doing it as soon as you have the expertise, and can expect to be paid in the same time-frame that you’re being paid now. 

When I aimed to expand beyond my solo practice and establish a lifestyle medicine clinic, we needed to build out a facility. I was asked by the hospital CFO to create a comprehensive financial pro forma to gain traction in the C-suite. This financial model demonstrated how my program would be self-sustainable and not lose money. Since then, every organization to which I've consulted on healthy living services has requested a pro forma, even if just informally. If you need financial support to launch your initiative, you must create a spreadsheet with a realistic clinical model that outlines how you'll generate income.

Summary

In summary, here's the secret sauce for creating a profitable health and well-being service line:

1. Collaborate with payers to gain their support;
2. Develop a program using research-proven methods for behavior change;
3. Hire or repurpose staff with expertise in lifestyle and health coaching;
4. Use AWVs conducted by lifestyle staff to guide patients to your program;
5. Harness the power of group visits to boost efficacy and practice productivity;
6. Use billable informatics technology to enhance the patient experience; and
7. Create a detailed financial pro forma to secure C-suite backing.

If this sounds appealing and you're eager to move forward but need guidance or an electronic coaching record, don't hesitate to reach out to us at Sustainable Health Systems—we're here to help you get started.

References

AM Bond, WL Schpero, LP Casalino, et al. Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes. JAMA. 2022;328(21):2136-2146. doi:10.1001/jama.2022.20619 

M Johnson, DM Berwick. Medicare 2.0—A Vision for the Future of America’s Health Insurance Plan. JAMA 2022;328(21):2107-2108.  doi:10.1001/jama.2022.22092 

DJ Meyers, AM Ryan, AN Trivedi. How Much of an “Advantage” Is Medicare Advantage? JAMA 2022;328(21):2112-2113.