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The Role of Personalized Healthcare

Jon-Michial Carter
Written by Jon-Michial Carter

Every patient who enters your practice is imprinted with a unique medical story. They may have lost their father to colorectal cancer, watched their grandmother battle diabetes for decades, or just learned that their sister has been diagnosed with breast cancer. One patient may be a nutrition-conscious, high-performance athlete, while another may be struggling to quit a pack-a-day smoking habit that’s spanned the past twenty years. 

With an array of backgrounds so distinct, a one-size-fits-all approach to healthcare is outdated, ineffective, and needlessly expensive. Instead, wellness plans should be personalized to fit each patient's individual lifestyle, risk factors, and medical history. 

The effects of transitioning to personalized healthcare are transformative. Personalized healthcare improves clinical outcomes, enhances quality of life, reduces healthcare costs and resource utilization, and fosters a deeper connection between patients and their healthcare providers. 

In this article, we will explore the significance of personalized healthcare, how personalization can elevate the treatment of chronic conditions through Chronic Care Management (CCM), and discuss how Annual Wellness Visits (AWVs) can help practices tailor personalized wellness plans for each unique patient. 

What is personalized healthcare?

Personalized healthcare is a proactive healthcare strategy that uses a patient’s distinctive genetic profile and health history to create an individualized wellness plan. This tailored wellness plan is intended to catch diseases early in their development, encourage optimal health outcomes, increase the quality of a patient’s care journey, and minimize the risk of complications and disease progression. 

Personalized healthcare emphasizes preventative care informed by familial and personal medical histories, lifestyle and risk factors, Social Determinants of Health (SDOHs), and biometric data obtained from tests and screenings. The goal of personalized healthcare is to equip patients and providers alike with a comprehensive evaluation of an individual’s health, risks, and gaps in care. The care plans created through personalized healthcare are designed to help each patient navigate their unique health journey, rather than apply a generic, one-size-fits-all approach using statistical averages. 

Why does the personalization of patient care matter?

Personalized healthcare is a patient-centered, preventative approach to care delivery. When illnesses are identified at an early stage, patients have a broader range of interventions available to them. Patients who begin treatment early are more likely to make robust recoveries and return to a high quality of life. Research also demonstrates that personalized healthcare reduces treatment costs and facilitates favorable long-term clinical outcomes

For example, prediabetic patients who engage in evidence-based lifestyle alterations reduce their risk of developing type 2 diabetes by as much as 50%. These prediabetic interventions are as simple as implementing physical activity, maintaining a healthy weight, and altering nutritional intake. Patients who reduce their diabetic risk avoid unplanned, invasive, and expensive follow-up care, and may even extend their lives. 

However, almost 80% of American patients with prediabetes are asymptomatic or otherwise unaware they are at risk for developing the chronic illness. 

A provider using a personalized healthcare approach would identify patients who are at particularly high risk for diabetes by taking into account any familial history of diabetes, observing the patient’s lifestyle risk factors like smoking, diet, and inactivity, and routinely performing preventative blood sugar testing. These intentional, targeted interventions help prevent a prediabetic patient from becoming a diabetic patient, saving the patient money, facilitating a future free of the risks carried by diabetes, and conserving the resources of the broader American healthcare landscape.

Learn more: 5 Strategies to Improve the Quality of Healthcare

What are the benefits of personalized healthcare?

The personalization of healthcare offers a wide range of benefits for both healthcare providers and their patients. These benefits include: 

Improved disease detection

Care plans built around a patient’s unique set of risk factors improve the early detection of disease. Using a patient’s family health history, providers can schedule recurring screenings for potentially hereditary chronic diseases like cancer, heart disease, diabetes, and osteoporosis. 

Lower healthcare costs for patients

When diseases are identified early, patients usually face less expensive and invasive treatment options. Hospitalizations are also reduced, as is overall healthcare resource utilization. The earlier a disease is detected, the less likely it is to need expensive and drastic interventions. Lifestyle adjustments and prescription medications can often be used to try and control the illness’s progression. The patient’s early awareness of their condition also reduces the risk that they end up hospitalized due to unforeseen complications from previously undetected illnesses. 

Better clinical outcomes and patient quality of life

The earlier a disease is identified, the better the patient fares in their wellness journey. Personalized healthcare facilitates early disease identification and intervention by closing gaps in care unique to the patient’s medical, familial, and social circumstances. When treatments can begin before the disease progresses, patients are also less likely to face dramatic and disruptive alterations to their quality of life. 

Reduced patient fatigue and resource drain

When care is personalized, the number of redundant and superfluous tests, screenings, and appointments is reduced. Personalized healthcare aims to eliminate trial-and-error medication prescriptions and specialist referrals, instead funneling resources toward evidence-based interventions. Personalized healthcare also includes intentional care coordination and communication. 

Increased patient activation and engagement

High patient engagement correlates with improved quality of care and better clinical outcomes. Engaged patients are more likely to adhere to medications and treatment plans, improve their health literacy, and actively seek out medical care. 

When patients understand that their healthcare providers are creating wellness plans customized to meet their specific risk factors, cultural and social influences, and socioeconomic circumstances, they are more motivated to actively participate. As they see the benefits of engaging with personalized healthcare, their confidence in their provider and care plans also increases. This facilitates stronger bonds between patient and provider and higher levels of patient engagement and satisfaction.

Learn more: A Provider’s Guide to Value-Based Care

How to develop personalized healthcare plans with Annual Wellness Visits 

When implementing personalized healthcare strategies, many providers struggle with limited insight into a patient’s familial medical history, lifestyle risk factors, and SDOHs. Patients with chronic illnesses are likely to spend most of their regularly scheduled appointments discussing symptom management, test and lab results, and disease progression. The focus of the discourse is often narrow in scope, and there may not be time or opportunity to explore other chronic conditions the patient is at risk of developing. 

Medicare’s Annual Wellness Visits (AWVs) were designed to solve this problem and promote more effective preventative and personalized patient care. Eligible Medicare beneficiaries can receive a yearly appointment dedicated to reviewing their health through a holistic lens. With the administration of AWVs, providers craft care plans that target each patient’s unique gaps in care. 

Annual Wellness Visits take into account a wide array of factors, including a patient’s current health conditions, behavioral health, familial medical history, cognitive ability, diet and nutrition, and socioeconomic influences. Patients begin AWVs by completing a Health Risk Assessment (HRA). An HRA is a self-guided questionnaire designed to identify risk factors that providers may otherwise miss during routine appointments. HRAs can also be further customized to target information pertinent to specialty practices and providers.

Upon completion of the HRA, the provider uses the information gathered from the questionnaire to create a personalized healthcare plan for the individual patient. HRAs provide crucial insight into a patient’s risks and unaddressed gaps in care. For example, a provider may discover that a patient has familial history of breast cancer, but has not been receiving annual mammograms. 

Once this risk is identified, the provider can incorporate regular mammograms into the patient’s care plan. During follow-up visits, the provider can continue to check in with the patient on the results of these cancer screenings. If breast cancer develops in this patient, early detection through proactive care will provide the patient with an optimal foundation for successful treatment and recovery. 

AWVs grant you critical insight into the health of your patients. They allow you to identify gaps in care, facilitate proactive healthcare engagement, encourage patient activation and self-management, and create personalized healthcare wellness plans.

Learn more: The Ultimate Annual Wellness Visit Checklist for Providers

The role of personalized healthcare in Chronic Care Management

Chronic Care Management (CCM) is a care management program designed to improve the quality of care for Medicare beneficiaries with multiple chronic conditions. Through a consistent cadence of communication with patients, CCM services extend care beyond the walls of a practice, integrating conversations about patient’s health and wellness plans into every month of the year. Like AWVs, CCM programs create opportunities for the integration of personalized healthcare into a patient’s wellness journey.

Chronic Care Management programs are designed to keep the continuity of care on track, creating the optimal clinical outcomes for every enrolled patient. Every patient enrolled in a CCM program will receive a monthly call from a care manager. These calls can be used to explore any issues a patient may be experiencing with care coordination, medication side effects, new or worsening symptoms, and their overall health. They are also prime opportunities for care managers to learn more about every patient’s unique circumstances, challenges, and lifestyles. 

Offer tailored lifestyle recommendations

CCM care managers are trained to help patients cope with self-management and lifestyle adjustments. They can offer recommendations and access to resources to help patients struggling to implement more nutritious diets and better exercise regimens, as well as offer monthly accountability and encouragement. This includes educational materials and connections to resources like food banks and local health and fitness programs for seniors. 

Since care managers have access to the patient’s medical history, risk factors, and familial background and touch base with each patient monthly, they can update the care plans and goals based on changes in the patient's health status, progress toward existing goals, and any new patient-reported concerns.

Address the patient’s unique Social Determinants of Health

CCM care managers can also personalize healthcare by assisting patients with SDOHs that are impeding their access to care. A patient may lose access to reliable transportation between a visit with their primary care provider and a follow-up screening. When a care manager learns of this through their monthly call, they can help the patient arrange transportation, ensuring that the patient can continue with their screening and facilitating the ongoing delivery of personalized healthcare. 

Provide the patient with a personal human connection

Furthermore, many patients enrolled in CCM are older and live more isolated social lives, so this recurring call can be an uplifting touchstone and offer valuable emotional support. Patients enrolled in CCM do not have to face the daunting task of chronic illness management alone. Care managers add a distinctive personal touch by offering patients a safe, non-judgmental space to talk frankly about their illnesses, struggles, and successes. The empathy and compassion extended to patients through care managers add a deeply personal touch to the patient’s overall healthcare experience.

Learn more: Chronic Care Management: A Guide to Benefits, Requirements, and Reimbursements for Providers.  

Create meaningful personalized healthcare through ChartSpan

ChartSpan’s industry-leading preventative care services empower providers and patients every day. Through our turn-key, fully-managed CCM solution and our innovative AWV software, we help practices deliver high-quality personalized healthcare without disrupting workflows. Our programs are also designed to help providers create additional streams of revenue, all while facilitating stronger clinical outcomes for patients. 

Annual Wellness Visit software

RapidAWV™, ChartSpan’s proprietary software, is a dynamic tool designed to integrate AWV administration into any practice. 

RapidAWV™ offers flexible, customizable HRAs. As a provider, you can fine-tune the questionnaire to target your patient population. This allows you to create personalized wellness plans that are relevant to both patients and your practice’s specialty or specific concerns. 

The software will then deliver preventative care plan recommendations based on the answers provided by the patient. This allows you to seamlessly assemble actionable care plans designed to close gaps in care and encourage positive lifestyle choices. 

The HRAs can be administered on a wide array of devices, including tablets, desktops, and mobile devices. Patients can complete them in the comfort of your practice’s waiting room while awaiting their routinely scheduled appointments.

The convenience extends to your office’s clinical staff as well. ChartSpan’s RapidAWV™ solution offers real-time eligibility checks against CMS’s (Centers for Medicare & Medicaid Services) HETS (HIPAA Eligibility Transaction System), eliminating the need for your staff to verify program eligibility individually. Operating a robust AWV program also has the added benefit of increasing practice revenue by improving your practice’s quality metrics and driving tertiary services. 

Transform your quality of personalized care with ChartSpan

Contact us to learn more about how ChartSpan’s Annual Wellness Visit software and Chronic Care Management services can transform the quality of care of your practice. Together, we can forge a partnership that delivers personalized healthcare to your patients and facilitates a frictionless integration for your practice and clinical staff.

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