Consumer engagement—what it means and how to do it well—is garnering a lot of attention and debate throughout the healthcare sector. There is broad consensus that better engaging consumers in their healthcare is essential to improving both patient outcomes and more optimally using healthcare resources.
Yet there is less agreement on what exactly this buzzword means and how it should play out in practice. The current leadership at the Centers for Medicare & Medicaid Services has made consumer empowerment a priority, with a focus on greater patient financial responsibility in their care decisions.
Many consumer advocates rightly take issue with this purely financial lens of consumer engagement and instead argue that patient-centered care should prioritize social determinants of health and involve consumers as partners in delivery system redesign.
In fall 2016, the Health Care Transformation Task Force—a consortium of patients, payers, providers and purchasers working to transform the U.S. healthcare delivery system to focus on value over volume—released a framework that seeks to define optimal consumer engagement and help systems move toward more person-centered care. The framework offered a set of six guiding principles accompanied by related key questions designed to facilitate dialogue within organizations that want to address consumer priorities through meaningful person-centered care policies and practices.
Seeking to expand upon this work, the task force conducted a series of interviews with health system leaders to identify the organizational structures and mechanisms providers have established to include consumers as partners in the governance and oversight of person-centered care delivery. The detailed findings from this project can be found here.
Ultimately, the task force found that healthcare providers are committed to consumer engagement but are still figuring out how best to involve consumers both locally and in their health system. In fact, 92% of participants reported an increase in the number of organizational structures that include consumer/patient representation—such as patient and family advisory councils—in recent years.
Yet while a majority of organizations (62%) reported including consumer engagement terminology in their vision, mission or value statements, more than a third (39%) reported they were unsure whether that terminology was included or said they thought it was only partially included in the stated mission.
Commonly reported barriers to including consumers in governance included difficulty with identifying and onboarding consumers (particularly nonretired consumers), lack of staff and resources, and an underlying organizational resistance to changing the “old way” of doing things. One interviewee candidly noted the difficulty of balancing organizational priorities—including consumer involvement in governance—with their top priority of delivering excellent patient care every day.
The underlying takeaway suggested that a sweeping culture change is needed to shift the way things have traditionally been done and that providers are eager for additional expertise and assistance to help them navigate how best to engage consumers.
Our research demonstrates that—even for organizations committed to patient-centered, value-based care—providers have had varying degrees of success with incorporating the consumer voice into traditional governance structures. The concept of “consumerism” as it relates to value-driven rather than volume-driven reimbursement models requires a new way of thinking about system-level patient engagement to support care model design.
Provider organizations are also busy trying out new and better ways of engaging patients in care delivery, such as proactive care management programs and consumer-facing health IT. However, consumer engagement in governance serves a different function than engagement at the patient care level, and should therefore be given distinction and resourced separately.
More work must be done to build upon this foundation by identifying and scaling promising strategies. This project revealed four important opportunities for further research and best practice development:
- Consumer recruitment
- Consumer training
- Operational structures to support consumer engagement
- Integration across “silos of patient engagement” within organizations, such as marketing, care management, wellness promotion and technology
The interviews also revealed that Federally Qualified Health Centers possess a wealth of knowledge on these topics, given their longstanding requirement to have 51% community member board composition. For example, Hudson River HealthCare, a network of community health centers in New York state, employs various structures to engage patients in the design of programs to enhance the patient experience. As a Planetree affiliate, HRH Care also involves patients in the quality improvement process as well as staff training.
Consumer advocacy organizations can serve as a resource for organizations that are just getting started with adopting more advanced models for consumer engagement, and several groups have already produced useful guides for providers to follow. Community Catalyst developed a toolkit to help organizations create buy-in and take steps to make consumer engagement a top priority. The National Partnership for Women & Families’ “Quality Tool Box” also provides practical resources for organizations looking to engage consumer representatives in governance, including consumer training and onboarding templates.
Additionally, multisector groups such as the Health Care Transformation Task Force stand as ready partners to collate best practices and develop practical tools for better involving consumers in governance. Although challenging, now is the time to put meaningful action to the words “consumer engagement” in healthcare.
Katie Green is the associate, mission support for the Health Care Transformation Task Force, where she is responsible for analyzing research and technical findings, and supporting tangible work products and strategies which help task force members implement effective person-centered, value-based care delivery models.
Clare Pierce-Wrobel is the director, payment reform models for the Health Care Transformation Task Force and holds an adjunct faculty appointment at the George Washington University Milken School of Public Health.