Payers and providers have been intent on engaging patients and members. And for good reason: It can foster loyalty, build trust and encourage proactive healthy behavior, which all lead to reduced healthcare costs and lower consumption of healthcare services.
"If we're going to make connected health a widespread reality in the lives of consumers and patients, we have to double down on engagement," says Joseph Kvedar, M.D., vice president of connected health at Boston-based Partners HealthCare.
While an NEJM Catalyst survey reveals that 69% of providers are using patient engagement strategies, the figure should be much higher, says Kevin Volpp, M.D., Ph.D., director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Perelman School of Medicine.
But even as health information technology programs and platforms advance the cause, there are still some low-tech and high-touch ways to engage patients. The best methods, of course, are a blend of the two.
Some payers and providers rely on tried-and-true approaches, enlisting everyday technologies such as communication tools and paper-based education methods. Others are tapping a slew of emerging technologies, from apps to patient portals.
We've gathered a variety of approaches from our coverage over the past year, along with advice from healthcare pros on how to make it all work.
For the past nine years, Brigham and Women’s Hospital in Boston has been striving to better understand what it’s like to be an inpatient and how to improve the patient experience. Maureen Fagan, associate chief nurse for OB-GYN and the executive director for its Center for Patients and Families, recommends building an advisory council featuring patients and caregivers who can serve as “meaningful contributors to policy and process changes.”
Shared-decision making isn't easy to teach or encourage, says Sherri Loeb, RN, a research coordinator for the Advocate Lutheran General Memory Center in Park Ridge, Illinois. Encouraging families to be involved in care decisions demands additional time, manpower, skill and perseverance.
Patient engagement starts with the initial visit, which provides a prime opportunity for physicians to establish a plan for strong communication and build rapport. Brenda Avadian, executive director of The Caregiver’s Voice, says engagement requires both doctor and patient involvement.
Low-tech talking can go a long way to better healthcare and millions in savings, she says. Both patients and doctors should also do a bit of prep before the visit, she recommends, so that both parties are in sync to discuss issues and treatment. “While doctors are under pressure to keep a tight schedule, patients arrive poorly prepared,” she notes.
Vikas Saini, M.D., a cardiologist and president of the Lown Institute, believes engagement can be advanced with simple communication.
“Listening promotes healing and causes no harm. In fact, it’s the bedrock of a genuine trusting relationship—something everyone wants from their doctors and nurses,” he says.
The Cleveland Clinic enlisted a paper-based educational strategy to promote better relationships with their patients with a book on communication insight, which is now required training for physicians.
Louisiana-based Ochsner Health System aims to stop patient procrastination and foster greater patient engagement in healthcare, using an automated phone approach that makes it easier than ever for patients to schedule appointments for colon cancer screenings. The approach allows Ochsner to send notifications to patients’ cell phones and patients can response with a touch of a button.
Web-based tools are at the heart of the Maryland-based hospitals that launched “A Breath of Fresh Care” campaign midyear focused on engaging with patients. It offers up free online tools to help patients stay better informed.
Online patient portals
Many payers are launching online portals specifically aimed at boosting patient involvement, and it’s a tool both caretakers and patients can benefit from.
In fact, a recent NEJM Catalyst survey found that 33% of respondents believe web portals to be the most effective tool for patient engagement.
One example is the portal strategy at the Colorado Permanente Medical Group. The organization helps train physicians on how to use the portal screen in patient discussions and use it to expand patient knowledge of online resources, such as fitness videos.
“Physicians can incorporate technology not as an intruder but as a facilitator,” William Wright, the group's former executive medical director, says. Portals can offer everything from easy appointment scheduling to test results and prescription data. Wright said a big benefit has been increased patient satisfaction.
Patient portals must provide personalized, direct communication features to propel patient engagement. Yet there is much improvement to come as most interactivity is tied purely to text messaging. There is value in providing quizzes, risk assessments and video content within the portal—all features now mostly accessible as external resources.
When it comes to leading the portal charge, one-third of hospitals are relying on chief medical officers, staff physicians and staff nurses to serve as point person for patient engagement. Avera McKennan Hospital and University Health Center splits the job between the chief medical and chief nursing officers and uses a multidisciplinary team focused on patient engagement efforts.
Such diversity in the process is key, according to Allison Suttle, M.D., senior vice president and chief medical officer at Sanford Health.
“I don’t know that there is one person who is fully in charge of patient engagement—it has to be everyone’s priority,” she says.
Successful portal engagement is tied to providers understanding patient needs and a collaborative environment, says Eric Fleegler, M.D., a physician in the emergency medicine division at Boston Children’s Hospital.
MedStar Health is developing a customer engagement platform to give users a bevy of digital capabilities, from scheduling appointments to a collaborative environment for determining best care scenarios. The system will let users access services and communicate with care providers no matter where they may be.
It's "less about doing a cool, sexy application than about providing a service to our patients no matter where they are," says Mike Ruiz, MedStar VP and chief digital officer. "What we're doing is providing a [platform] that aligns with what our patients are looking for."
Patient use of and increasing reliance on mobile devices is spurring payers and providers to develop apps for patient engagement.
A recent survey reveals that nearly 90% of patients want to partner with caregivers to improve their health, and 84% view self-monitoring apps and devices as tools that can help boost health management efforts.
Yet providers are "woefully inadequate" in offering mobile apps, with hospitals engaging less than 2% of patients with such tools.
There will be a seismic shift in the next four years, predicts ACT | The App Association, as the connected health market is projected to hit $117 billion by 2020; 86% of clinicians believe mobile apps will be central to patient health. Consumers are hungry for mHealth features, with more than one-third of adult smartphone owners claiming they are healthier thanks to health apps and features, according to a recent report from Apigee.
An increasing number of providers and payers are jumping aboard.
NewYork-Presbyterian Hospital and its Regional Hospital Network are collaborating on a new mobile app to boost communication and access to care providers and the hospital center. NewYork-Presbyterian recently announced an app challenge and "appathon" to get inspiration from clinicians, developers, the public and members at NYP's university partners.
New Jersey-based Hackensack University Medical Center’s app allows patients to access health records, make appointments and search for physicians with the click of a button.
"We knew it had to be functional, usable and reliable," says Shafiq Rab, M.D., CIO at Hackensack UMC. "But there are two additional things we wanted that don't get consideration often enough in healthcare IT: We wanted using the app to be meaningful and pleasurable."
Many insurers are building apps to connect members with benefit plans, find providers and track health goals. Humana’s San Antonio division is developing an app that connects newly diagnosed diabetes patients with a bevy of community resources.