The New Healthcare Consumer Engagement Landscape for Whole-person Health Management

As health plans and providers transform operations to support value-based care, it’s important to keep in mind that successfully engaging consumers in their health is also critical to managing costs and outcomes. Inspiring patients to act independently outside of care settings is notoriously difficult. Typical communication tools like portals and apps have produced mixed results but are showing some promise. (Harvard Business Review) So, what is a healthcare organization supposed to do when so much of their success is tied to consumer engagement?

Value-based Care Makes Healthcare Consumer Engagement a Necessity

The shift to quality and savings required for accountable care, Medicare Advantage, and commercial value-based models has fundamentally changed how health plans and providers work together to deliver and measure care. However, the patient’s role in their own health —and therefore quality and cost — cannot be overstated. Not only are they taking on an increasing share of the bill, but their engagement, or lack thereof, significantly influences outcomes.

Sandra Hewett, Chief Nursing Officer for ZeOmega, says in many cases, healthcare is something of a mystery that patients don’t understand until they really need it.

“At that point, it’s scary,” Hewett said. “I think in today’s world, we really need to outreach to our health plan members, and our providers need to outreach to their clients to build engagement and get personal buy-in when they’re not in sick mode. We really need to get people thinking about their healthcare in terms of wellness rather than managing critical illness.”

More than 60 percent of American adults are living with at least one chronic disease (CDC), which causes seven in 10 deaths each year in the United States. (CDC) As clinicians try to work more closely with healthcare consumers who are living with chronic illness, it’s easy to overlook that actual patient-provider time represents a very small percentage of the overall time spent managing conditions or treatments. Healthcare consumers and their personal care givers are largely responsible for adhering to care plans and making the necessary lifestyle changes to accommodate chronic conditions. Engaged patients educated about their conditions and involved in treatment will more likely succeed in keeping their chronic conditions in check than those who are not.

With better managed outcomes, of course, comes meaningful cost reduction. Patient engagement has proven essential to meeting the cost savings required of value-based models. A study for the National Health Service (NHS) found significant cost-of-care differences between those patients who were minimally activated (engaged) and those more highly activated. Patients with low engagement cost eight percent more in the first year and 21 percent more in the first half of the next year than more engaged patients. (Health Affairs)

Consumers Expect More from Their Healthcare

Another factor amplifying the importance of healthcare consumer engagement is a shift in consumer expectations. As they take on a larger share of medical payments, consumers — especially millennials and Generation X consumers — are asserting more preference for convenience and a seamless patient experience. These groups show promise in wanting to be engaged about healthcare —the top five healthcare websites log more than 190 million unique visitors monthly (eBizMBA) — and will actively seek a provider with engagement methods tailored to their needs. (Salesforce)

Without understanding patients’ engagement preferences up front, providers risk losing patients to practices more focused on the patient experience in and out of the office.

“Educationally, the population today is much more aware,” Hewett said. “I think we have a healthier population, if you discount people over 30 who are already in the beginning phases of a chronic condition. But, just like anything in life, you really need to have your own personal investment, and you really need to feel like you’re being heard.”

The Roadblocks to Effective Engagement

Clearly, healthcare consumer engagement can have a huge impact on care costs and outcomes. While many healthcare stakeholders are creating and testing new solutions, the barriers to effective engagement remain steep for providers, health plans, and patients.

For many providers and health plans, the struggle to engage patients results from:

• A lack of meaningful, consolidated patient data. EMRs alone are not equipped to present whole-person health and often don’t include the full picture of services for a patient, the social determinants affecting their health, engagement tools like assessments, nor analytics capabilities.
• The primary care shortage across the U.S. means provider time is at a premium and time spent face-to-face is, understandably, prioritized over time spent on patient engagement activities.
• Reimbursement that isn’t built for patient engagement. Not only is a provider’s time more valuable to the patient face to face, it’s also more valuable to the provider, as few are reimbursed for patient engagement outside the exam room.

There are any number of reasons patients may not be engaged in their care, but here are a few we can tackle as an industry:

• Lack of education and a clear action plan pertaining to wellness and managing chronic conditions.
• Having the appropriate tools, triggers, and incentives in place. While incentive plans aren’t the be-all solution, they can be effective if paired with education and action.
• Missing the value in patient portals. Patients’ access to online records is a step in the right direction, but without personalization and educational content, most patients lose interest or never access them in the first place. (JMIR)
• Communication, technology, and language barriers. Consumerization of healthcare means patients increasingly expect a retail experience — communicate with me how, when, and where I want. (Salesforce)

One approach seems to be showing some promise toward nudging patients and driving toward an appropriate journey through the health care system, SMS Texting.  According to Patient Trak, “9 out of 10 consumers prefer to communicate with businesses through text messages. And more than 50% of consumers would prefer text messaging over phone calls for customer support. Use of texting as a reminder or as a device to prepare a patient for a call from their care manager could result in higher engagement.  While use of SMS texting is not recommended for discussing health conditions or for including personal health information, it can serve as a mechanism to send the patient to a secure app or portal that allows this type of communication to take place.  Use of URLs within the text can easily accomplish this.  Think of being able to get even 10% higher engagement using a self-service approach that patients can use on their own terms.  That could help to change the game when it comes to all levels or risk within your patient population.

“This country is better than most places in the world in terms of healthcare, but there will always be barriers,” Hewett said. “We have some really good clinics now where providers take time to get to know their patients, but there are still providers who don’t treat patients holistically. There are still so many barriers, but educating patients and providers helps overcome some of them.

“Health plans today have a lot of information they can collaborate on with providers to make sure they are supporting the messages the doctors are giving patients,” she added. “I think that’s a big help. We are collaborating with groups like Healthwise, where we get to deliver a longitudinal message onto patients that both the providers and the health plans can support collaboratively. I think that’s where technology can really help drive a single solution for both payers and providers.”

If your healthcare consumer engagement program could be more engaging, it may be time to chat.

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