We get so caught up in our day to day work that we often forget what it is all about. We focus on the technology and clinical side of Population Health, but there is another aspect that is harder to control; Patient Compliance. One of the agenda items at a Physician Group Board meeting I attended included the dismissal of patients. These were primarily patients that had been abusive to staff or had failed to meet financial obligations, etc. On some occasions we had patients that failed to follow through on the provider orders and was placing their health at risk.

These situations are difficult. On one hand the provider cannot stand idle as they watch a patient ignore medical advice and jeopardize their health. On the other hand, you don’t want to leave the patient without medical options. These are often elderly patients that may not have a family member helping them navigate all the treatment decisions or translating the medications and therapies to layman terms. They are also patients that have a surgical procedure and fail to attend or complete physical therapy, severely affecting their range of motion or quality of life. Then there are also patients that are non-compliant with drug therapy or maybe they never scheduled the specialist referral.

Population Health will be tracking various provider metrics and could reflect if a patient is consistently showing non-compliance with prescribed therapies. This has the benefit of identifying those patients with certain special needs. These can include language barriers; help with navigating the healthcare system, or patients with transportation problems. There are also patients that can’t afford the deductibles, or co-pays associated with therapeutic treatment or medications. Some patients are either too proud or too uncomfortable talking to the providers about these issues.

In the physician group that I worked with, they had very solid policies and procedures with specific escalation points to deal with non-compliant patients. Often it only took a friendly letter to say that you are concerned about their health and maybe offer someone on staff to schedule their referral or go over the treatment options that were presented. Of course all the letters and policies had to have a legal review. You also had to have the information technology systems that tracked, flagged and even produced alerts to providers when someone missed appointments.

Population health cannot just include what we are doing on the clinical side, we must understand what unique issues our patients are having and help them make the right treatment decisions. Often these include an advocate or patient coordinator. However, sometimes it may also include a letter stating that they cannot continue to ignore medical advice. It is always an uncomfortable conversation for the staff and patients. However, it is at the core of the goals that we set for improving clinical outcomes.