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September 12, 2014 Readers Write 8 Comments

The Engaged Patient – Are They Really?
By Helen Figge


Sorry to be the bearer of mediocre news, but despite the growing conversations around the value of engaging patients in their own healthcare, the term “patient engagement” is a really cute flavor of the month healthcare buzz phrase.

Many seem to be confused by what “patient engagement” means. It lacks a standardized approach to its interventional aspects or for a better sense rules of engagement.

The major thrust for patient engagement legitimacy comes in most part to the expansion of health insurers rewarding providers based on services that support the improvement of a patient’s health and wellbeing. Likewise, the anticipation that engaging the patient will reduce the utilization of healthcare resources plays into this concept. Finally, healthcare providers were vocal concerning the 10 percent patient engagement threshold originally mandated in Stage 2 of Meaningful Use and these “squeaky wheels” enabled a pushback to 5 percent.

The legitimacy behind engaging the patient appears evident because investing in the healthcare consumer who utilizes our healthcare resources (you and me) and turn creating healthier assets is the overarching goal of better health. This in turn fundamentally assumes we lower costs of healthcare. So, from this point of view, “investing” in consumers of healthcare and helping them to be more effective partners in our own care makes good sense practical sense, right? 

One would think and hope so. Based on several research sources, it is indeed possible to meet the requirements to support these patient initiatives through various technologies on the market today, like the patient portal, yet only a small percentage of providers are currently supporting these efforts.

The basic question is how do we engage patients to want to stay in control of their own health’s trajectory? What motivates and stimulates and excites someone to want to get and keep control of his or her own health destiny?

This is the one question gone awry, because the majority of consumers consistently participating in their health is quite low, with the majority of less than 5 percent consistently engaged if at all in their healthcare. Many practitioners are finding out that each and every one of us is motivated by something different when it comes to our own healthcare.

My dad was a great example of a non-compliant chronic disease sufferer who, when he felt better stopped taking his meds. Only when his blood glucose reading recordings were hooked up to his senior citizen daily calendar for dating (he was 87) did he remember to record his blood sugar readings for his care coordinator. One could say my dad’s health was directly stimulated by his desire to see which eligible senior citizen lady friend was going to the senior center that night for bingo.

In order for any patient engagement opportunity to be successful, each and every engagement might have to be customizable with each step in the care process to create a meaningful role for patients and their families and specifically tailored in such a way that helps patients acquire the knowledge and skills they need to effectively manage their health and do so in a consistent manner.

We also need to realize that some patients are not prepared to take on any type of role in their healthcare and might not be able to cope with their various illnesses regardless of the enticement. This is oftentimes a concern with those suffering from chronic diseases, where they will need to engage for the duration of their lives to keep and maintain their health.

I equate this type of patient engagement to eating your favorite food every day until after a while, boredom sets in. Your favorite food loses its luster. You just stop eating it and substitute another. When patients are unable to manage these types of often complex tasks, the result is less control over a person’s health and well being and ultimately higher health care and human costs.

If patient engagement has a chance to really hit the numbers we hope it will, it is important to tailor the care and instructions a patient has to support that care. In healthcare, we tend to provide the same amount of support regardless of the patient population or skill set at hand. We always try to standardize approaches, which 99 percent of the time is great, but patient engagement is that 1 percent where it just can’t be done. This is the reason for the low numbers in patient engagement we are seeing firsthand today. Each patient needs to be motivated in his or her own way to accomplish the empowerment needed for successful personal intervention.

Finally, another point to consider in all of this when trying to motivate a patient to “engage” in their own care is that it cannot be monetarily based. Patients are not motivated by financial incentives direct or otherwise for long-term behavior change. It is documented that highly engaged patients with the skills and knowledge respond better to the monetary gains of engaging in their healthcare, while some less than enthusiastic patients accept defeat much easier and accept their disease states and the sequelae of them regardless of intervention and assume it is what it is and thus accept any increased cost incurred by the disease state to be inevitable.

So when considering patient engagement, consider the patient first and foremost because patient engagement is based on the patient’s active and sustained participation in managing their health. It is a marathon race, not a sprint. Only through this mechanism will this lead to better health outcomes.

Proactive action to change and maintain our health into productive health behaviors is the mainstay of the effort. At its center is the concept of taking an active role in our own health and healthcare. We know objectively it can be measured using various tools like the Patient Activation Measure (PAM). This testing helps to identify a patient’s engagement level and used as a tool for improving activation for health and wellness, although I’m not sure how helpful it is right now given the lower-than-expected statistics of patient engagement overall.

The evidence suggests that increasing a patient’s engagement in their own health trajectory can have an impact on controlling costs and helping patients to become healthier – to live longer with fewer complications. The problem is that no one has come up with a standardized approach as to how to engage a patient for long-term success to any disease resolution. 

Maybe we need to interview each patient and see what drives him or her to wake up each morning. For my 87-year-old dad, it was trying to find a date for bingo night at the senior citizen center. Only after he answered his blood glucose reading did the senior citizen screen pop up. Maybe we need to do something like this for each and every patient. 

Helen Figge, PharmD, MBA is VP of clinical integrations of Alere Accountable Care Solutions

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Currently there are "8 comments" on this Article:

  1. Most people find their own health care either too scary or too boring to pay much attention to. This is why those who are attesting to MU Stage 2 are having to use a variety of games (“Click this button to return your questionnaire to our practice and register to win an iTunes gift card!) to get their messaging rate up to 5% of patients. People just are not as fascinated by health as we doctors are.

  2. I agree with the comments – unless we motivate patients to take care of themselves – healthcare engagements will go nowhere fast.

  3. I agree with the comments of this author. What are the outcomes from studies that measure patient motivation which ties directly into patient engagement.

  4. I’d encourage the author, commenters and readers to explore http://www.participatorymedicine.org The Society for Participatory Medicine’s (S4PM) website and related sites. The author is surely correct that each patient requires an approach to engagement unique to themselves. As a longtime clinician who learned that literally at my father’s knee (he was a physician) I find myself increasingly surprised by my Health IT colleagues who see the systemization of care delivery as an unalloyed good that would operate much more smoothly if only patients would adhere to the process. In the same email that brought notice of this HIStalk post, I received a post on the S4PM listserver that points to a wonderful post at http://assessment2020.abim.org/2014/09/dear-new-doctor/ that comes from a patient and strongly reinforces the same idea.

    The industrialization of medicine is inevitable and Health IT is critical and central to safe, efficacious and humane health care. Respecting and responding to individual humans as they wish is central to it as well.

    Thank you for this post Ms. Figge and to Mr. HIStalk for hosting it and this discussion. /Steve

  5. Great article!! All very valid points that i find on a daily basis. Like you said, patients may be engaged at the beginning but it, just like one’s favorite meal, will quickly lose it’s luster!

    I think it is the most important for those patients with chronic conditions to be engaged. It is important for organization’s to focus on that subset of patients first, as those are not only the ones that need it most, and the most expensive, but those who will benefit from the technology that allows them to be engaged in their health everyday.

  6. What percentage of people have a computer, smart phone, and internet access in the US?

    What percentage of people know how to read in the US?

    Interesting article, but I find the concept of patient engagement to be powered by a few vociferous noisemakers and ePatients and will end up being a dead end.

    Patient “engagement” is one of those contrived purposes to provide the illusion that EHRs have benefits.

    Still waiting to read of improved outcomes and reduced costs from the $$$billions spent in the US.

  7. Keith that is a truly enlightened comment. EHRs don’t have much of a real ROI. We would have been better off spending the money on nutritional education rather than flushing it down the meaningfully useless EHR incentive programs.

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