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How Context Improves Outcomes, Revenue


Words exchanged are not the only, nor the most important, element of an exchange between physician and patient. Contextual factors surrounding the patient can play a major role in how patients approach the visit.

Words are exchanged in almost every communication transaction between patient and physician. But those words are not the only, nor the most important, elements in that exchange. Contextual factors, or circumstances, surrounding the patient — ranging from issues related to their jobs to the emotional challenge of caring for an aging parent — can play a major role in how patients approach their visit to the physician, and their follow-up afterward.

According to a recent study conducted by the University of Illinois at Chicago and the U.S. Department of Veterans Affairs, patients’ health outcomes improve “when physicians individualize care and take their patients’ life circumstances into account.”

Raj Toleti, president and chief technology officer of Coordinated Care Solutions at PatientPoint explains that more and more information is being given to the provider during the patient-physician encounters. The key is for providers to put things in context so the patient can act on that information.

Revealing recordings

A UIC news release indicates that 774 real patients were recruited for the study, and asked to secretly record their visits with 139 resident physicians at two Chicago VA facilities. The physicians had agreed to participate in the study, but were not aware which patients were recording their visits.

The study found that, in cases where contextual red flags were identified and contextual care plans were addressed, health care outcomes improved in 71% of the cases compared with 46% were contextual issues were not addressed.

Toleti says that context is extremely important during physician-patient encounters, and for physicians, the challenge is two-fold. When patients provide information to physicians, that information must first be captured either in an electronic medical record, on an iPad or on paper, and then stratified and distilled so the physician can make sense of it. Within that process, context is often lost in translation. However, tools are being developed, he says, to make it easier for patients to disseminate that information so that their physician can speak with them in context.

“When patients have to provide self-reported information to the physician or another care management person in the physician’s office, that information also has to be in context,” Toleti explains. “What part of care management and the physician-patient engagement can you automate in context — pre-care, post-care and point-of-care? That is our focus.”

Tools demonstrate results

PatientPoint and other companies are building more of these tools of engagement. One such tool, says Toleti, is an electronic depression-screening device patients use when checking in. A patient may have scheduled his or her appointment because of lower back pain, but that context, he explains, is a valuable point from which to screen for depression.

“We’ve actually seen through studies 19.8% more patients have been diagnosed with depression in certain settings that, when treated, are able to take medication, and within a month they were off all pain medication,” Toleti says. “So, there are specific situations where we are able to automate some of these things in context.”

Adoption of these tools of engagement is simplified, says Toleti, because the technology is adapted to suit the workflow of the practice, as well as the patient’s lifestyle. Once patients complete a survey, it’s sent to the physician as a lab result that’s present when they open their chart.

“Most of what we do is in the front of the office, so it’s very non-invasive to the physician.”

Tangible practice benefits

Toleti says increased focus on contextual factors during the physician-patient encounter can provide two very tangible benefits to the medical practice. The first is clinical, in that the practice will be able to manage its patient population much more effectively. More preventative screenings — such as depression or colorectal cancer screenings — will increase the practice’s care coordination capability and produce better quality outcomes.

The second factor is an increase in practice revenue that Toleti says can be significant for a primary care practice.

“Every time the depression screening tool is administered, the physician makes another $55 more for that visit,” he says. “A couple of screenings can mean several hundred dollars more per day, which amounts to a lot of dollars per month. While they are making money in this fee-for-service world, they are also moving towards fee for value, because they’re actually providing these types of additional services that attribute to value. So, we feel that’s a pretty compelling story.”

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