The word partnership has
long been used to describe the relationship between physician and patient. In many cases, it’s a stretch. The best-laid treatment plans rely on both partners performing as agreed and, in the real world, it just doesn’t go as planned. It’s been estimated in diabetes care, for example, that less than 60 percent of patients take 80 percent or more of their prescribed medications.
In glaucoma, even patients who remember to take their drops may be splashing more of them down their cheeks than reach their target. Given the multitude of issues that can derail medical management of glaucoma, it’s not surprising that much of the research and literature on compliance has focused on drug delivery mechanisms, patient education, reduced dosing, and other factors outside of the clinic. This month, our Glaucoma Management department (p. 66) looks at a less widely discussed area of compliance—keeping follow-up visits. It’s an interesting take on an issue that can greatly affect outcomes even in patients who follow their drug regimen.
One the key tenets of the new Affordable Care Act is taking physician/patient partnership into some uncharted territory. In an effort to increase patient engagement in their own care, meaningful use incentives are being offered to hospitals as well as certain eligible providers who can demonstrate that 5 percent of their patients are using their patient portal or EHR system to send secure electronic messages and enter data on their medical care. Certainly, they’re not targeting the chronically ill such as glaucoma or diabetes patients. And if you had to today find 5 percent of your patient base that is eagerly involved in their care to this degree (to be clear—you don’t) most doctors could.
But the concept of an incentive to drive this kind of patient engagement is established. There is, likewise, consideration of providing not just providers but patients with financial and other incentives in order to motivate healthy behaviors and improve their performance as medical “partners.”
In the Deloitte 2013 Survey of U.S. Physicians, participants were asked for their perceptions about the types of incentives that might work best with consumers. “A majority of physicians (71 percent) believe that if consumer incentives were widely introduced, financial ones (e.g., direct payments, reduced insurance premiums or reduced co-pays) might work best with consumers in an attempt to motivate them to engage in healthy behaviors,” the authors report. An equal number agree that “consumer incentives could be very helpful to achieve better treatment compliance.”
The search for an engaged partner goes on.