March 26, 2019

What Patients Want, A Doctor Takes Note

The Partners Population Health Perspectives blog aims to share the opinions and ideas of our leadership team on health care topics related to population health management. In this post, Adam Licurse, MD, MHS , Medical Director of Patient Engagement & Telehealth at Partners Population Health, shares his thoughts on the patient perspective and how providers can be better attuned to the needs of their patients. 

We spend much of our time at Population Health designing and implementing programs to meet practice and provider needs, and related contractual performance requirements. Too little of our time is spent thinking strategically about what our patients really want from their care, and how those preferences can, in turn, help us meet our system’s goals. To help me better understand some my own patient’s perspectives, I recently asked a small sample (about ten) of my primary care patients two questions:

  1. As your primary care provider, how can I best keep you healthy and care for you without using costly healthcare resources (like ER visits or hospital admissions)?                                                                                  
  2. What role does technology play here – and are there tools you wish my practice (or Partners HealthCare) used which would help you improve your health? 

 

As usual, my patients taught me a lot.  Here were a few themes from their responses—

Dr. Licurse

Adam Licurse, MD, MHS

Help me navigate the health care system, and my health outside of healthcare. Not only was this the most common answer from my sample group, it reinforced the feedback I hear day-to-day with my patients as a primary care physician. Patients are faced with waves of decisions throughout their care, many with both quality and cost implications. Which specialists will approach my problems thoughtfully and in line with my values? Which treatment options match my goals? As one patient said, he wanted me to be the “umpire” to his care, checking to make sure the specialty options he faced lined up for him in a way that made sense.

These are hard skills for us as providers, and so often our approach to these questions is unstructured and anecdotal. How can we as a system use data and analytics to pair our patients with the right specialists at the right times?  How can we do a better job facilitating shared decision-making, to make sure our patients are getting the care that is most congruous with them as people? Finally, one of my patients said she appreciated when she felt like her care was for her as a “whole person” and “outside of traditional health care.”  So, how can we better guide people through these important health concerns without utilizing health care services? As providers, “health” outside our walls can be challenging and often an uncomfortable space, but one that people are increasingly looking to us to help navigate.

Be more accessible when I’m sick, and when I can’t see you make it clearer what to do.  As one patient said, “Primary care is the least accessible when you need it most – when you are ‘really sick.'”  Unfortunately, it’s often true. Most of us do not see our own patients in any consistent way when they’re admitted to the hospital, and urgent care needs often can’t be accommodated by our in-clinic schedules. The reality is that providers, in both primary and specialty care, struggle with urgent care access, which leads to fragmentation. There are many solutions to this issue: better coordination with urgent care centers, especially those in our own system, more schedule-access for urgent care, better tools to quickly triage and manage care remotely, and ultimately better team-based approaches to keep patients from feeling like no one really knows them and their health needs.  But as Atul Gawande observed when he came to our practice last year for his piece “The Heroism of Incremental Care,” we play a dizzying number of roles for our patients: chronic disease managers, urgent care providers, therapists, social workers, end of life planners, and many other “jobs” that arise in any given visit. So, unless we are careful about which of these roles our patients need most, we will be master of none and potentially leave important care needs unmet.

Use technology to take care of me without making me come into the clinic.  Multiple patients expressed their strong desire for patient portal messaging, email, phone, text messaging, and video as ways to make remote care more available. Many of us treat patients over these communication channels but run into a common set of barriers: challenging technology, limited time, and limited payment which can all lead to variable usage, financial pressures, and potential provider burnout. As a system, we are working hard to design better tools, scheduling approaches, and payment models to support this virtual work.

Reassuringly, a final theme was that primary care “worked” for these patients – which reflects both the programs we support through Population Health, and the hard work of the teams seeing patients every day. Primary care is critical, makes us live longer the more it’s supplied (as yet another study showed in February), and remains the bedrock of our clinical and contractual approaches to value-based care. These three components of primary care at Partners give providers a greater opportunity to keep our patient’s preferences at the forefront as we evolve the way we deliver care.


Adam Licurse, MD, MHS, Medical Director of Patient Engagement & Telehealth, Partners Population HealthAssociate Medical Director, Brigham and Women’s Physicians Organization; Medical Director, Brigham Health Virtual Care

In his Partners Population Health role, Dr. Licurse directs the strategy and implementation of the group’s patient engagement and telehealth programs, including efforts in shared decision making, in-office and virtual patient education, remote monitoring, patient texting, and virtual patient self-management. At Brigham Health, he leads a number of population health and care innovation efforts, including the Brigham’s patient reported outcome measure (PROMs) program and its virtual care programs including virtual visits, virtual consults, eConsults, eVisits and multiple others.

Dr. Licurse  has published multiple articles about telehealth, evidence-based clinical decision-making and financial ties to industry, teaches in BWH’s Clinical Process Improvement Program and the ambulatory curriculum of the BWH medical residency program, and has been an invited panelist and speaker at numerous national conferences on population health, telehealth, and patient engagement.  Adam practices internal  medicine at the Brigham.  He completed residency training in Internal Medicine at BWH, and earned his MD and MHS at Yale School of Medicine where he graduated cum laude.  He graduated from Yale College.

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