From chronic disease management to risk stratification, these patient engagement terms are key to value-based care models.

By Sara Heath

– Healthcare professionals are increasingly adopting value-based care models, and turning to strong patient engagement tactics to drive success. However, the language used in patient engagement and value-based care discussions is sometimes nebulous, difficult to understand, or overlapping with other industry keywords.

In alphabetical order, defines the latest patient engagement buzzwords pertaining to the current rise of value-based care initiatives.


Patients with a life-long, chronic condition typically receive treatment and self-management plans from their providers. These patients may maintain a strict medication regimen, wellness activities, and health behavior change plans to help keep a chronic condition from developing into a more serious condition.

However, it is not enough for providers to prescribe these activities to chronic illness patients. Clinicians must also use patient engagement strategies to motivate patients to complete the patients’ ends of the care plans.

Patient engagement strategies for successful chronic disease management can range from medication reminder apps to motivational engagement to uncovering the barriers patients face in engaging with their care plans.


READ MORE: How Patient Engagement Supports Chronic Disease Management

Not to be confused with patient satisfaction, patient experience is the sum of all patient interactions during a care encounter.

“Patient experience encompasses the range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities,” according to the Agency for Healthcare Research and Quality (AHRQ).

Healthcare professionals measure patient experience by understanding the different parts of the care experience that are valuable to patients, AHRQ added. These elements may include timely access to treatment, simple access to individual health data, and clear communication between the patient and provider.

Patient experience is an objective measure of facility quality. This is different from patient satisfaction, which measures how well a hospital met a patient’s expectations – a subjective measure.

Patient experience is often a more useful measure for value-based, quality care. Instead of determining how much a patient liked or enjoyed the care encounter, patient experience examines whether a provider did things that constitute a quality visit, such as offer access to physician notes.


READ MORE: Exploring Patient Reported Outcomes Measures in Healthcare

Patient-reported outcomes measures (PROMs) are a burgeoning clinical quality measure in which providers collect patient reviews of how they are recovering from a procedure.

PROMs are “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else,” according to the National Quality Forum (NQF).

Rather than focusing on technical clinical quality, PROMs usually look at quality of life following a surgery or other health intervention. Traditional clinical quality measures (CQMs) usually look at mortality rates or preventable 30-day readmissions. While these are important measures, they are not always within provider control.

However, determining how a knee replacement surgery helped a patient walk better will help a surgeon understand the quality of the procedure.

Taken together, CQMs and PROMs will offer insights to providers about both the technical quality of their work and how that technical quality improved a patient’s lifestyle. Understanding the effect of a certain procedure in improving quality of life will help determine the value of that procedure.


READ MORE: Using Risk Stratification in Patient Engagement Strategies

Risk stratification is defined as the practice of separating various patient populations by their clinical or cost-related risk. Patients with a high-cost chronic condition – or those who are likely of developing such a condition in the future – may be considered high-risk patients.

Healthcare organizations use risk stratification to determine their care efforts, including patient engagement efforts. Clinicians may choose to target their engagement and prevention efforts on patients who are likely to develop a serious or costly health condition.

Healthcare professionals may also use the social determinants of health as a means for risk stratification. Patients who are otherwise perfectly healthy but live in an environment where they may develop a chronic condition – an urban area with air pollution, for example – may receive more targeted preventive care than patients who live in rural areas.


The social determinants of health are increasingly becoming a key component of patient-centered care, specifically as more healthcare organizations adopt value-based care models.

The social determinants of health are “‘the structural determinants and conditions in which people are born, grow, live, work and age,’” according to a report from the Kaiser Family Foundation. “They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care.”

As healthcare organizations continue to embrace value-based care, they are turning to the social determinants of health to meet all of patients’ healthcare needs. Research suggests that 80 percent of patient health is influenced by the social determinants of health.

Healthcare professionals trying to drive a value-based care experience – as opposed to a fee-for-service model – leverage social determinant data to help care for patient social needs and ultimately drive better outcomes at a lower cost.

Understanding these key concepts will help healthcare professionals navigate the value-based care world. Each of these keywords will assist clinicians in targeting their patient engagement efforts to the appropriate patients or help them determine the value of the care provided. Eventually, this will result in a high-value care encounter at a lower cost.

Editor’s note:This article is adapted from the July 26, 2017 newsletter

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