April 2018 Edition Vol.12, Issue 4

Digital Patient Engagement in a New Era of MACRA and Value-Based Care

By Gena Cook, CEO, Navigating Cancer, Inc

Over the past decade, we have seen the beginnings of digital tools to engage patients in their care. For providers, it started with the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act and the unprecedented investment in information technology (IT). In addition to incenting providers to adopt an electronic health record (EHR) and use it in a meaningful way1, hence “Meaningful Use”, HITECH also intended, among other goals, to engage patients and their families in their care to improve care coordination. To do this appropriately, HITECH required healthcare professionals to allow patients electronic access to their health information via patient portals.

The positive outcome of Meaningful Use and HITECH is that providers now offer their patients some level of digital access to their data via a portal. However in a recent NEJM Catalyst Insights Council survey, 42% of providers who responded said they do not think a patient portal is an effective tool to engage patients, revealing there is still more work to be done.2


Patient Involvement Essential to Success Under MACRA and Value-Based Care Initiatives

Although providers were rewarded for their efforts to adopt and use technology in the care delivery process, the bar was low for patient engagement. In this era of value-based care, cancer care providers will be paid based on their ability to provide quality care at a lower cost.  Although it may seem like “patient engagement” has been a buzzword for a while, MACRA places patient-centered care front and center; and in this new world of payment reform, patient behavior may impact a provider’s performance and ability to reduce costs of care.

Delivering patient-centered, coordinated care is integral to maintaining proper reimbursement and a necessity for long-term viability due to its competitive nature of comparing physician performance scores with other clinicians scores. Clinics must find a way to incorporate patient engagement into their value-based care strategy or risk falling behind their peers.

Data have shown that patients who are activated in their care consume less healthcare costs3, so it will become increasingly important for providers to develop strategies for engaging their patients.

Typically, the average time physicians spend with patients is about 15 minutes per visit4, which leaves patients on their own for most of the time during their treatment. Understanding how patients are doing outside the provider’s care and providing patients with tools, education, and self-care instructions will be key to ensuring patients do the right things to manage their care and minimize side effects to avoid unnecessary hospitalization costs.


Patient Relationship Management Technology in Value-Based Care

Engaging patients digitally is the growing expectation

Patients are paying more5 out of pocket for healthcare than ever before and as a result, they have higher expectations. For some cancer patients, out of pocket costs can be so overwhelming they may even forgo treatment.6

In the growing trend of healthcare consumerism, patients expect a level of service and attention they receive in other facets of their lives and are more willing to engage to ensure they get it. Despite the misconception that seniors are not tech savvy, Pew Research reports that 42% of Americans over the age of 65 own a smartphone and 67% of that same group use the internet.7

In a survey of more than 5,200 patients conducted by Navigating Cancer, patients reported they want to participate more in their care:

  • 93% want to access their health information
  • 92% want to read information about their diagnosis and medications
  • 71% are very likely to somewhat likely to use a mobile application to report back to their healthcare team how they are feeling on a regular basis
  • 72% prefer to be contacted by their healthcare team via electronic methods, with the majority preferring a text message

Survey respondents also indicated that having electronic resources improves their satisfaction with their care, which is a component of payment reform in value-based models.

To what level do you agree or disagree with the following statement: Having access to my data and personalized resources via the portal improved my satisfaction with my care.


How likely would you be to use a mobile app to report how you are feeling on a regular basis? Responses would be sent directly to your nurse, so they could monitor how you are feeling and call you if needed.


How would you prefer to receive appointment reminders and other information?


Digital patient engagement improves outcomes

Educating patients with cancer digitally and sending information when they start their medication and throughout their treatment journey has been shown to improve outcomes. In a 2017 ASCO abstract, a multi-center study showed significant improvement in IV treatment adherence in one-year survival rates for patients with lung cancer receiving and viewing a digital series of education about their treatment compared with patients who did not view treatment information: 66% vs 53%, respectively (p=0.01).8


Digital technology supports lowering costs

In the Advisory Board Cancer Care Transformation Playbook, the importance of a new model of cancer care triage is recognized.9 The Playbook highlights the need for dedicated triage nurses who can manage cancer patients’ issues immediately. It also notes the importance of patient management software including embedded, validated symptom management pathways that prompt nurses with decision support to reduce variability in care delivery. This technology enables nurses to provide consistent care for cancer patients in real time.

In addition, remote monitoring and tailored patient education are powerful tools. Allowing patients a direct connection to their cancer care team to report on symptoms and providing access to educational information such as self-care instructions enables patients to stay ahead of side effects and keep track of important information.

This new and emerging care delivery process has been shown to reduce hospitalizations for innovative practices who have adopted this technology and care methodology for their patients with cancer.10


PRM software reduces administrative burden, improves efficiency

Implementing digital patient engagement tools may be daunting to oncology providers; however, in the new landscape of value-based payment models, there’s really no choice. Care teams are doing more for patients, tracking more data, and must become multi-disciplinary in their approach. Oncology is ripe for technology support as these emerging complexities create a need for new workflows—manual and paper-based processes just won’t be enough anymore.

Patient relationship management software enables patients to participate in their care and allows providers to send required assessments such as pain, distress, and depression electronically days or minutes before the appointment. This way providers can spend their limited time on other aspects of patient care.



Additionally, through remote monitoring, patients can report oral adherence and side effects to triage nurses and pharmacy staff immediately, which improves efficiency. Automated patient education and self-care instructions and education can be personalized based on diagnosis, medications, side effects, which reduces administrative burden for staff and at the same time engages patients in their care.

Technology not only creates a two-way electronic communication with the patient, it also improves care coordination between mid-levels, triage nurses, navigators, social workers, case managers, any others associated with the patient’s care. This allows all the care teams to see how each team member is interacting with the patient, reduces duplication of services and, most importantly, improves the quality and efficiency of care as patient issues are resolved in a timely manner. Technology can also be used to automate mundane administrative tasks and assign tasks to the right care team member so each person can operate at their most efficient manner.


PRM software enables enhanced telemedicine services to increase reimbursement

CMS is also signaling that it values enhanced services for patients who have multiple chronic conditions by relaxing the requirements to bill for Chronic Care Management (CCM). The agency finalized a separate payment code, CPT 99091, in 2018 that allows providers to bill for remote monitoring. Not only are telehealth and remote monitoring services gaining acceptance with payers, they could become effective strategies to help improve quality and reduce cost of care.

A recently published study led by Dr. Ethan Basch at Memorial Sloan Kettering Cancer Center in New York offers strong confirmation that remote monitoring can have a significant impact on patient experience and outcomes. The study randomly assigned patients to “self-report 12 common symptoms via tablet computers.” Physicians were kept informed about these reports and nurses were emailed when patients reported severe symptoms, so they could intervene right away, and it resulted in increased overall survival.11


The Future of Digital Patient Engagement is Managing Populations to Deliver Personalized Care

So where do we go from here? Although value-based care is in its infancy, there will be financial adjustment for MIPS participants in 2019 and thereafter. Participants in other programs, like OCM, will also start realizing the financial impact in the next few years when they gain a deeper understanding of their costs with treating patients versus their peers.

In the future, every aspect of healthcare will have a digital element including care management and population health. Patients will expect options, personalized to them and will want transparency and access to information. Providers will also need to know when a patient is in need and have an easy way to track and manage those needs.

Patient relationship management (PRM) technology solutions connect the patient and their care team(s) with information in a dynamic, actionable way. PRMs can even facilitate the collection of patient reported outcomes (PROs) and stratify these data and other clinical data according to risk.

While MACRA shifts payment incentives from volume to value, the patient experience to care is directly linked to physician performance. Patient buy-in to treatment decisions, understanding their treatment plan, self-managing symptoms at home, and avoidance of unnecessary hospitalizations are all components of the patient experience. Digital strategies not only expand the care team’s capacity, but also can automate tracking and reporting to simplify compliance while also enabling high quality, comprehensive care. The time is right to focus on patient-centered care and employing digital strategies and supportive technology will be essential.


About the Contributor

Gena Cook is Co-Founder and CEO of Navigating Cancer. Navigating Cancer was founded in 2008 as the result of two healthcare and technology veterans coming together to fill a critical gap in oncology care: a better patient experience. Driven by a shared passion to leverage technology in the healthcare space, the co-founders set out to create the first patient-centered platform for oncology. Today, our Navigating Cancer platform supports over one million patients and thousands of cancer care providers nationwide to lower costs, improve patient satisfaction and drive better outcomes. For more information: visit http://www.navigatingcancer.com.



  1. Health Information Technology: HHS Should Assess the Effectiveness of Its Efforts to Enhance Patient Access to and Use of Electronic Health Information, GAO-17-305: Published: Mar 15, 2017.
  2. Patient Engagement Survey: Technology Tools Gain Support — But Cost Is a Hurdle, NEJM Catalyst Insights Report, July 10, 2017. https://catalyst.nejm.org/patient-engagement-technology-tools-gain-support/. Accessed March 15, 2018.
  3. Greene J, Hibbard JH, Sacks R, et al. When patient activation levels change, health outcomes and costs change. Health Affairs, 2015;34 (3): Variety Issue.
  4. Brodwin, E., Radovanovic D. Here’s how many minutes the average doctor actually spends with each patient. Business Insider. Apr. 6, 2016. http://www.businessinsider.com/how-long-is-average-doctors-visit-2016-4. Accessed March 15, 2018.
  5. Yusuf Zafar, S., et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. The Oncologist, 2013 and
    Weintraub, A., even insured patients are overwhelmed by the cost of cancer care. Forbes, 2017
  6. Valentine S, Masters G. Healthcare Forecast 2017: Top Trends Driving Board Strategic Priorities, The Governance Institute, Jan 2017. https://www.governanceinstitute.com/page/EBriefings_V14No1#hide1. Accessed March 15, 2018.
  7. Anderson M, Perrin A. Tech adoption climbs among older adults. Pew Research Center, May 17, 2017. http://www.pewinternet.org/2017/05/17/tech-adoption-climbs-among-older-adults/. Accessed March 15, 2018.
  8. Howard SC, Yeatman TJ, Watson ML, Lam C. Increasing the duration and efficacy of intravenous chemotherapy using a patient-centered digital education program, J Clin Oncol. 2017; 35:15_suppl e18025.
  9. The Cancer Care Transformation Playbook, Advisory Board, 2017. https://www.navigatingcancer.com/provider/wp-content/uploads/2018/03/Oncology-Roundtable_Cancer-Care-Transformation-Playbook.pdf. Accessed March 15, 2018.
  10. Navigating Cancer’s Triage Software with Symptom Management Pathways Facilitates $3.4 Million in Annual Savings, Aug 17, 2017. https://www.navigatingcancer.com/provider/triage-software-with-symptom-management-pathways-facilitates-3-3-million-in-annual-savings/. Accessed March 15, 2018.
  11. Basch, EM, Deal AM, Dueck AC, et al. Overall survival results of a randomized trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. J Clin Oncol. 2017; 35:18_suppl; LBA2.

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