Ask almost any healthcare professional, and they’ll tell you that it’s sometimes tempting to blame the patient for what ails them. If only Mr. Smith would exercise more and cut down on those burgers. How many times have I told Mrs. Jones to quit smoking?
It’s easy to understand the frustration. Our unique genetic makeup predisposes us towards certain health conditions. But behaviors like tobacco and alcohol consumption, poor nutrition, and a sedentary lifestyle play a very important role in our epigenetics, or how our genome functions and expresses itself. The effects can be highly detrimental to our health. In fact, lifestyle factors are the leading cause of chronic disease.
Chronic conditions are on the rise around the world. The reasons for this rise are systemic. The ageing global population is one prominent example. But the habits and behavior of individuals, when viewed at scale, are systemic as well. When one person at risk for chronic kidney disease skips his annual urine test, he may have missed an opportunity to detect the potentially fatal disease in its early stages. But when 80% of the Americans at risk for the disease don’t do their annual test, the consequences for society are enormous.
Tempting as it may be to blame a patient who didn’t adhere to a test or treatment plan, that clearly isn’t the right approach. As the World Health Organization stated in its seminal report on the prevention of chronic diseases:
"Individual responsibility can have its full effect only where individuals have equitable access to a healthy life, and are supported to make healthy choices."
Outside of the healthcare space, consumer-centric services are the prevailing standard, offering personally tailored experiences conveniently available online. The coronavirus pandemic has only accelerated this trend.
To better serve and protect patients, healthcare should take a page out of the e-commerce playbook, and meet patients where they are. This is a tenet of patient-centered care: placing the individual’s specific health needs and outcomes at the heart of the clinical process. But healthcare must take an even wider view, and work itself into the life flow of patients. Rather than assume that patients will prioritize their health, healthcare must find its way into patients’ priorities.
When people’s time and preferences are respected, they are empowered to take a proactive and willing part in the maintenance and monitoring of their health, rather than having to be convinced to do so. Combining healthcare with the best that technology has to offer can activate patients to take a central role in managing their own health.
How Patient Activation Influences Outcomes and Healthcare Costs
Patient activation is a concept that describes the “knowledge, skills and confidence a person has in managing their own health care.” The concept has been translated into a quantitative measure proven to accurately predict patient outcomes. Patients with higher scores are more likely to engage in preventive behaviors and to follow care plans.
Additionally, higher patient activation strongly correlates with lower health care costs, because activated patients have lower rates of hospitalization and emergency room admittance (they are also more likely to have better blood pressure, blood sugar, BMI, and cholesterol levels).
Conversely, patients with lower scores are less likely to follow the ideal medical regime and are generally in a higher risk category than their activated counterparts. Accordingly, their health outcomes—and the associated costs—are likely to suffer.
Low activation among patients can result in costly and dangerous outcomes. People with diabetes or hypertension have a high risk of developing chronic kidney disease, or CKD. The disease is asymptomatic in its early stages, when its progression can still be slowed or reversed, before it reaches its later stages that can require kidney dialysis or transplant. A simple urine test that detects the protein albumin can diagnose CKD early, but the vast majority of people at risk don’t get tested.
The results of their low activation are severe. Treatment for CKD (including end-stage renal disease) costs Medicare over $120 billion dollars annually, nearly a quarter of total spending. It’s clear that patients’ behavior is not about to change on its own. A different strategy is needed, which tailors the test to people’s lifestyles.
Luckily, patient activation can be raised— by meeting patients where they are. Healthy.io’s CKD Early-Detection Service allows people to take the urine test for CKD at home, at the time most convenient for them. Using a simple kit which they receive in the mail and a user-friendly smartphone app, they can complete the test within minutes, and the results are shared with their doctor. If they don’t do the test, they receive a helpful nudge from a dedicated call center. And because the test is conveniently self-administered, it has the added benefit of empowering and motivating patients to take control of their health.
The service has been shown to successfully raise testing adherence. In a clinical evaluation conducted in partnership with Geisinger Health System, with funding provided from National Kidney Foundation, the service raised test adherence from 0% to 72% among people with hypertension who had never undergone urine testing for CKD and consented to participate in the evaluation. 89% of those surveyed preferred testing at home to testing at a clinic.
When a patient takes an at-home test, she’s taken a significant step towards activation. The more testing and care that utilize technology to meet patients where they are, the more activated patients will become. Such methods have the added benefit of keeping those most at risk from COVID-19 safe at home, and being more accessible for rural, home-bound, and other underserved populations.
As healthcare shifts to a value-based model, it becomes ever more important to find ways to involve patients in their own care, and make lifestyle changes that can help prevent the development of chronic conditions. When care is tailored and integrated into each patient’s life flow, patients become more involved in their care, more empowered, and likelier to change their behavior, with better outcomes for all.