Patient engagement: No longer optional, Part 1
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Focus on: Digital Transformation in Health |
Part 1: It takes engaged clinicians to engage patients
Experts tell us the day for health systems when fee for value payments overtake fee for service is upon us. When that day comes when fee for service is in the rear-view mirror, health systems will no longer be able to succeed by improving care experiences, outcomes, or even safety–at any cost. They’ll have to deliver all of it at the same, or lower cost… and there’ll be no looking back.
But if there’s one painful lesson that the last decade has taught us, it’s that health systems and insurers can’t deliver all of it at the same or lower cost without the active participation and partnership of patients. Recent studies have shown that patients’ Patient Activation Measures predict their healthcare cost to the system during the next year. To put it bluntly, accountable care can’t succeed without accountable, engaged consumers. That’s because we know that patients who actively participate in their own health and care typically drive better outcomes, require less care, and cost less. The good news is that consumers tell us in nearly every survey that they want to engage in their health and care.
So, if patient engagement makes perfect economic sense and patients want to do it, then why is it still the exception rather than the rule for consumers to actively participate in their health and care? Especially those with complex, chronic conditions that have the most to gain?
Harder than anyone thought
The problem is, getting patients to engage in their health and care is really hard and really complicated, mostly because every patient is unique and because “patient engagement” requires patients to perform an unnatural act–assume more responsibility for their health and care. They have to decisively change their behavior– stopping old ways and starting new ones. And, speaking from experience, that’s really hard. Starting is easy, but sticking with any new behavior that’s good for you is anything but easy.
On top of all that, what makes behavior change even more challenging is the reality that the health behaviors of each of us are really defined by a complex calculus of choice architecture, health literacy, social determinants of health, our social network, technical literacy, and the do-it-yourself tools at our disposal. Which explains why changing behavior usually requires a trusted, helping hand that understands those forces and is there for us–either physically or virtually–to offer guidance in our moments of need.
Wait. What is patient engagement again?
Of course, by now there are 100s of apps out there for patient engagement. Like almost every problem in healthcare, the HIT industry indubitably comes to the rescue bearing more technology to throw at each new problem. The fact that there are so many solutions suggests that technology is a major part of the solution, but alone doesn’t solve the problem.
But before moving to technology solutions, I’ve always found it best to first make sure everyone agrees on what the problem is that technology needs to help solve. So, let’s start by reaching agreement on exactly what “patient engagement” is.
Unfortunately, the term “patient engagement” is vague enough to mean just about anything to anyone. To some it’s a mobile app, a wearable, or a virtual reality experience. To others it’s a human coach, a navigator, or a care manager that calls patients after discharge to keep them from doing a U-turn back in. And there are others that equate patient engagement with patient education, satisfaction, and patient experience. And, of course, there are the early academic definitions, which I’ll leave for another day.
But patient engagement is really about turning the intent of the consumer into results that lead to better health or a better and faster recovery. The problem with all of these engagement definitions is that the term “engagement” implies action by the patient but none stress the criticality of actions initiated by the patient. They seem to fixate on what the health system does and end there. Plus, being engaged also infers that individuals are somehow empowered and equipped to take action.
In the spirit of modernizing the definition of patient engagement to one that’s more relevant within the rising fee-for-value practice model, here’s one that describes the actors, process, and end goals:
Patient engagement: The unbounded ways that organizations and clinicians collaborate with and empower individuals to take actions to maximize their health and realize the greatest value from care
This definition emphasizes the five critical components of patient engagement:
- Unbounded. Collaborative interactions among patients, clinicians, and health systems are no longer confined to those within the physical four walls of health facilities. Technology innovations like virtual health, remote monitoring, intelligence agents, and machine learning are blurring of the digital and physical worlds.
- Collaborate. Collaboration, which means working together, effectively as one team. Patients are partners in their care and the core members of the care team. They need to engage in dialogue, reach mutual understanding, and then agree on actions needed to maximize their health and maximally benefit from their care, based on their needs and preferences.
- Empower. Engaged patients must be empowered to be more self-reliant and depend less on the health system. Patients must be empowered to do for themselves the things previously done for them that they’re perfectly capable of doing on their own in less time, and at a time and place most convenient for them.
- Meet their health goals. It’s up to the patient and their provider, together, to agree on health goals and take the best course of action to achieve those goals. Each party needs to be clear on who’s responsible for what and what each hope to get out of their work together.
- Greatest value from care. Value under fee-for-value involves improving care experiences, outcomes, and safety at the same or lower cost. Patients are equal partners with clinicians in co-creating high value-health and care.
This leaves inquiring minds of the industry with the question, “What are the most cost effective and proven ways that organizations and clinicians today are collaborating with and empowering patients to maximize their health and realize the greatest value from care?” What’s the right mix of strategy and technology that yields the greatest impact?
In search of a bright spot
So I set out on a search to find a bright spot where patient engagement is the rule rather than the exception and, within that bright spot, surface the formula for success and the optimal role of technology. I knew that San Diego-based Sharp Rees-Stealy Medical Group (SRSMG) was the bright spot I was looking for when I realized that every one of their physicians and care members across 22 sites of care were fully engaged in patient engagement. Why? Because Elan Hekier MD, their Chief Medical Information and Innovation Officer told me that patients won’t engage unless clinicians and care teams are engaged in engaging them.
To get the inside story I sat down with Elan Hekier MD to find out what they were doing differently to make patient engagement commonplace across their 22 sites of care. Next week in Part 2, Unbounded ways to collaborate with and empower patients, I’ll post the transcript of my interview with him.
