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How to Improve Medicare Patient Health and Encourage Healthy Habits

Posted, by Deborah Merkin
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The rate of people with chronic health conditions is growing and, unfortunately, people often have more than one condition. Half of adult Americans have at least one chronic condition, and more than two thirds of Medicare patients have two or more, according to a 2019 Premier analysis of emergency rooms across the country.

People with chronic and behavioral health conditions contribute to higher healthcare costs and account for more than 90 percent of the nation’s $3.3 trillion healthcare expenditure. The top six chronic conditions that factor into elevated healthcare costs are:

  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
  • Heart Failure
  • Hypertension
  • Behavioral Health Conditions, such as mental illness and substance abuse

Something as simple as scheduling a regular physical can help reduce the frequency of emergency department (ED) visits and related costs. Research suggests that up to 27 percent of ED visits in the U.S. could be managed in physician offices and clinics. With the average cost for an ED visit estimated at $1,917 by the Health Care Cost Institute, if all visits outside of the top performing quartile were preventable, healthcare spending could be reduced by $8.3 billion annually. 

Costs aren't only for medical reasons either. A big cost in this population is social isolation, and the most at-risk patients are senior individuals. We are social animals and we live longer when we have strong social ties; however, as we age, particularly in the US, the elderly can easily become isolated from others because their kids live across the country and old friends pass. People who may be lonely may subconsciously use the ED to fulfill their socialization needs.

For these reasons, healthcare organizations in every state work diligently to address the quality and cost of care to improve the health outcomes of their Medicare patients and help manage their chronic conditions. A key to their success could be in educating and incentivizing people with Medicare to improve their own health habits, such as regular, preventative check-ups with their primary care physician (PCP).

Based on our own knowledge of wellness incentives, we’ve rounded up three important factors to consider when attempting to engage patients and encourage healthier habits.

1. Promote Patient Health Ownership

People with chronic conditions need more preventive and proactive care to thwart disease progression and the escalation of care, including reliable access to their primary care provider (PCP) for urgent issues rather than relying on ED visits. However, putting the onus of patient care regularity on the healthcare organizations and providers may not be the most effective way for patients to receive the ongoing care they need.

According to a 2016 study by the American Association of Family Physicians, one of the five most important motivators for improving patient health is to promote a patient's ownership of their condition. Essentially, when the patient feels like they are an integral part of their care plan, they are more likely to take an active role in it.

Providers and administrators can coach patients to take charge of their own health. Program admins shouldn't be the only ones reminding patients to take medication or follow medical orders; patients need to feel confident in their ability to understand and own the process so that they can successfully stick to a healthy regimen.

2. Communicate Positively and Set Attainable Goals

Patients who are non-compliant with medical instruction have their reasons for not adhering to orders. Whether it's due to a lack of resources, difficult feelings, or social influences, health-related tasks and regimens that may otherwise seem simple to healthcare administrators can become barriers to managing patients' chronic conditions. It's crucial that you know and understand effective communication strategies that get to the heart of the matter.

The AAFP suggests a “motivational interviewing” style of communication to promote patient autonomy and guide the conversation in a positive direction. Additionally, communication should be focused on positive outcomes, like setting attainable goals, and making plans to achieve them. It will be easier for them when they are working towards something, rather than feeling guilty about the past.

3. Use Incentives to Encourage Healthy Behaviors

Driving motivation by offering a “carrot” incentive for hitting a milestone, achieving a goal, or for maintaining chronic disease care over a set period of time can be effective across a large, diverse group of patients. Personalization of incentives is key to ensuring effectiveness across diverse patient demographics, but some studies suggest that choosing incentives that more closely resemble the desired health outcome may be more effective.

For example, for a person with diabetes (one of the top six chronic conditions in the US), incentivizing routine check-ups with their PCP with a gift card that promotes wellness is more effective than cash incentives because you're encouraging them to make healthy decisions by controlling and personalizing the reward. Non-cash rewards are better at creating memorable experiences than cash rewards are, according to the Incentive Research Foundation.

A person's health is a sensitive matter. Finding ways to motivate patients to adopt healthier behaviors and improve their health can be difficult, but starting with small, attainable goals, setting a plan, and using personalized incentives like gift cards to motivate patients can help providers achieve program goals. Furthermore, it will allow them to scale their program over time as more patients become receptive to developing healthy habits and sticking to their healthcare regimen.


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Topics: Health Incentives, Medicaid and Medicare, Patient Health

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