ROI for Patient Engagement

The recent publication by the CDC on the prevalence of COPD (chronic obstructive pulmonary disease) is fascinating. Not just because it maps out the burden of this largely preventable disease within our country, but because it highlights to opportunities for population health management and patient engagement.

On average the prevalence of COPD in adults across the United States is 6.6%. In other worlds, one in every fifteen individuals had this disease. Now this is not quite as big an issue as diabetes within our society, but it is not far off, and the impact it has on healthcare delivery and costs is huge.

Not surprisingly the prevalence of COPD increases with age. This is because of the natural history of lung function decline. Once an individual is operating at about a third of their predicted lung capacity they become frequent users of healthcare resources, especially expensive emergency treatment

Take a population of five thousand individuals, the minimum number of patients an accountable care organization can be responsible for. Using the national average figures it is likely that 330 will have COPD to some degree of severity. In addition, according to the research 17.7% (or in this case 58) of these individuals will require hospitalization or review in the ER a year. Data from the American Lung Association suggests that the cost of such an admission is in the region of $20,000 per visit.

Undoubtedly some of these emergency admissions are totally warranted on clinical grounds, but as a pulmonologist I know that some are completely avoidable. There are two facets to this “avoidability”; the first is the fact that many (the exact numbers are rather hazy) patients do not take their prescribed medications as intended by their physicians. This non-adherence is often borne out of ignorance, rather than a conscious decision by individuals to be difficult or recalcitrant! Better education and the co-creation between doctor and patient of a self-management plans can have a dramatic effect here. The second issue is that we physicians often catch deteriorating patients late. Their exacerbation is in full swing and there is very little option but to transfer them to an emergency care establishment.

The solution to this last issue is a little more difficult. Many of my colleagues would day that there is nothing we can do. If a patient shows up with a severe exacerbation of their airways disease (or any other chronic condition for that matter), “how were we to know?”. This is true, however, it shouldn’t be the case. We now have the technology to keep in touch with our patients on a regular basis. I’m not even talking about sophisticated telemonitoring equipment here either. Secure email, text messaging, online symptom tracking should all be elements of a 21^st century physicians kit bag.

Just look at the savings that could be achieved by being more proactive. If just one exacerbation of COPD requiring hospitalization were prevented a year through this more proactive patient engagement approach that would be something, but I suspect that even in a 5,000 patient practice this number would be ten or twelve. And that’s just COPD…what about diabetes and congestive cardiac failure?