Engaged patients are healthier patients — and generally have lower healthcare costs.
Those points are at the heart of a movement toward a healthcare model in which patients play a more active role in maintaining and managing their health. Meanwhile, healthcare providers are tapping new technologies and adopting new thinking to help facilitate more frequent and meaningful two-way interaction between caregiver and patient.
Compiled by Scott Westcott, Contributing Writer
Changing consumer expectations and requirements driven by the Affordable Care Act are making deeper patient engagement a priority at healthcare organizations. Yet making real progress requires effort from both caregivers and patients.
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Engaged patients are healthier patients — and generally have lower healthcare costs.
Those points are at the heart of a movement toward a healthcare model in which patients play a more active role in maintaining and managing their health. Meanwhile, healthcare providers are tapping new technologies and adopting new thinking to help facilitate more frequent and meaningful two-way interaction between caregiver and patient.
“The World Health Organization estimates that removing the risk factors for chronic disease would prevent at least 80 percent of heart disease, stroke, and type-2 diabetes and 40 percent of cancer cases,” says Ken Ong, the chief medical informatics officer at New York-Presbyterian/ Queens. “This means engaging people before they become ill. As Benjamin Franklin said, ‘An ounce of prevention is worth a pound of cure.’”
Still, focusing on prevention and getting both caregivers and patients engaged with one another to achieve better outcomes remains a daunting challenge. Dr. Ong recently shared his insights on the barriers to greater engagement and how they can be overcome in ways that benefit both provider and patient.
Q: What are some existing barriers to successful patient engagement?
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A: While greater patient engagement holds proven potential to improve outcomes and lower costs, there are both systemic and personal barriers that continue to slow the pace of change. From a systemic standpoint, the traditional health system is, in many ways, simply not set up to facilitate patient engagement in a meaningful way. From the way some healthcare facilities are physically designed to the patient-interaction training many providers receive, the system often discourages deeper engagement. Meanwhile, from the patient side, there is often a hesitancy to be proactive because of limited health literacy, lack of awareness around insurance benefits, or any number of other factors. There are myriad ways to approach this challenge, but I think Steven Weinberger of the American College of Physicians summed it up succinctly with this: “To get better engagement, a push needs to come from both the clinician and the patient side — each interacting with the other.”
Q: Is the old school culture that persists in healthcare today hindering improved patient engagement, and, if so, what can be done about it?
A: There is no doubt that in many clinical environments old school culture still persists. You have a situation in which the providers are viewed — and sometimes view themselves — as the paternalistic experts and the patients are submissive and overtly or subtly discouraged from playing an active role in engaging with the caregivers and asking questions. Part of this is simply habit — this is a long-standing model that is difficult to break. It is also due to the fact that the health system is so fragmented and complex that it makes it difficult to make changes simply from a logistics standpoint. Add to that the fact that there is often a lack of trust between stakeholders, and the high stress in many healthcare environments, and it is relatively easy to see why people on both sides get stuck in an outdated model. The damage is considerable in that this old model is really a lose-lose for both provider and patient. Providers are not able to reach their full potential, and patients feel disenfranchised and do not get the level of care they could in a more engaged relationship. And it is more costly for everyone involved. There is no easy fix, but it begins with the idea of both caregiver and patient making the effort and, from an institutional standpoint, getting buy-in at every level of the organization so individual caregivers don’t have to go it alone, and there is more support for strong patient engagement.
Q: How are patients’ personal barriers hindering effective engagement?
A: As I mentioned, it really is a two-way street when it comes to improving patient engagement. There is a range of reasons why patients are not proactive when it comes to their own care. In some instances, it is simply a lack of awareness that there is a new and different way to engage with healthcare providers outside of the traditional model. Beyond that, low health literacy and the complexity of insurance benefits make some patients hesitant to discuss anything for fear they will not look informed. Sometimes it is the health condition itself that is a barrier — depression, chronic or severe pain, or a range of disabilities may make it difficult for a patient to engage with their providers on a meaningful level. The same goes for personal issues that might be occurring outside the medical realm, be it financial problems or challenging family dynamics. Finally, there are potential cultural or language barriers that exist for some patients. Healthcare organizations have an obligation to meet each patient where they are on the spectrum of engagement and find simple and effective ways to introduce and encourage more interaction and engagement.
Q: You often write about personal activation. What is it, and what barriers stand in the way of achieving it?
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A: Personal activation, in the simplest terms, refers to a patient’s knowledge, communications skills, ability, and willingness to manage their own health and healthcare experience. Six key aspects have been identified that make up personal activism. Those include communications, convenient self-service, personal health information, financial awareness, education and support, and general capabilities referring to such things as managing insurance and coverage and analyzing health data. The barriers to personal activation, in many ways, mirror the larger barriers to overall patient engagement. If you run down through the list, you start to see the need for healthcare providers to better facilitate communication and improve access and ease of getting information to patients. Meanwhile, there is significant patient responsibility to get to a point of personal activation. Again, this speaks to the need to move toward a new collaborative model of healthcare in which patient and provider are on equal ground, working together toward improved outcomes.
Q: What role are smartphones playing in patient engagement?
A: Smartphones in many ways can be viewed as the lynchpin of patient engagement and personal activation. Specifically, smartphones are emerging as the ideal tool to break down many of the barriers to engagement we have already discussed. For starters, smartphones are a technology that has proliferated across demographics and a wide range of populations. Nielsen research found in 2014 that 71 percent of Americans have a cell phone. That translates to 171.5 million Americans who can be engaged via their phones, and the penetration is even deeper in certain demographic groups with 77 percent of Latinos and 73 percent of African Americans smartphone users. One huge benefit of smartphones is that they have made simple engagement relatively easy. For instance, there are many new apps that allow caregivers to remain engaged with patients via texts and reminders as well as electronically sharing health information easily. And, of course, there is the explosion of apps that can monitor and track activity and other health markers. These apps not only provide insight and data into health habits, but can also serve as a motivator to encourage activity or more healthy habits.
Q: When leveraged successfully, what benefits does engaging patients bring to healthcare facilities and patient care?
A: It’s difficult to overstate the potential — and benefits — of engaging patients. For starters, I think the key point is that deeper patient engagement — while challenging to get there — really does represent a win-win for both provider and patient. From a caregiver perspective, it really does allow us to be at our best, optimizing our ability to treat our patients in the most effective way possible and doing so in ways that ultimately are time- and cost-efficient. The focus shifts toward prevention and healthy maintenance of conditions as opposed to constantly dealing with chronic situations. From a patient perspective, engagement is a true game changer, allowing once passive patients to play an active role in managing and improving their health and building meaningful relationships with caregivers. The research is clear — a study of more than 30,000 patients in a healthcare system in Minnesota found patients with low activation scores had costs that ran 8 to 21 percent higher than patients with the highest activation levels. Beyond the numbers, this is simple common sense. Ben Franklin knew centuries ago that a more proactive and engaged patient stood a better chance than one who simply relied on treatment. As more caregivers and patients transform that understanding into action, we will continue to see improved outcomes and a more functional and efficient healthcare system.
Engaged patients are healthier patients — and generally have lower healthcare costs.
A: While greater patient engagement holds proven potential to improve outcomes and lower costs, there are both systemic and personal barriers that continue to slow the pace of change. From a systemic standpoint, the traditional health system is, in many ways, simply not set up to facilitate patient engagement in a meaningful way. From the way some healthcare facilities are physically designed to the patient-interaction training many providers receive, the system often discourages deeper engagement. Meanwhile, from the patient side, there is often a hesitancy to be proactive because of limited health literacy, lack of awareness around insurance benefits, or any number of other factors. There are myriad ways to approach this challenge, but I think Steven Weinberger of the American College of Physicians summed it up succinctly with this: “To get better engagement, a push needs to come from both the clinician and the patient side — each interacting with the other.”
A: Personal activation, in the simplest terms, refers to a patient’s knowledge, communications skills, ability, and willingness to manage their own health and healthcare experience. Six key aspects have been identified that make up personal activism. Those include communications, convenient self-service, personal health information, financial awareness, education and support, and general capabilities referring to such things as managing insurance and coverage and analyzing health data. The barriers to personal activation, in many ways, mirror the larger barriers to overall patient engagement. If you run down through the list, you start to see the need for healthcare providers to better facilitate communication and improve access and ease of getting information to patients. Meanwhile, there is significant patient responsibility to get to a point of personal activation. Again, this speaks to the need to move toward a new collaborative model of healthcare in which patient and provider are on equal ground, working together toward improved outcomes.
