The Prescription for Patient Engagement

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Patient engagement has been dubbed the blockbuster drug of the 21st century. Proponents point to studies suggesting it improves care, saves lives and cuts costs. Data are so persuasive that policymakers have addressed patient engagement in Meaningful Use measures and the Affordable Care Act via quality metrics in accountable care organizations (ACOs) and medical homes. Yet, the prescription for patient engagement entails far more than pill popping. Patient engagement reframes medicine and requires providers and patients step into new roles. Is your practice up to the challenge?

The time is ripe

The definition of patient engagement continues to evolve; the fundamental concept focuses on patients’ empowerment and direct involvement in their healthcare. There are myriad IT, management and infrastructure ways practices can launch the patient engagement process. While there is no one-size-fits-all solution, most providers can identify approaches that dovetail with their needs and goals. The first step may be making the case.

With countless challenges facing healthcare, why has patient engagement burst onto the agenda now? It ties together two primary needs—improving quality and decreasing cost. “The level of technical brilliance isn’t producing the kind of outcomes that we expect,” explains Jessie Gruman, president, Center for Advancing Health (CFAH). Many behaviors that contribute to health outcomes, such as smoking cessation, diet, exercise and medication adherence, take place outside of the physician’s office. Patients control them.

A provider’s technology, knowledge and experience are for naught, continues Gruman, unless the patient follows through.

The growing consensus that patient engagement drives success spurred policymakers into action. Consider:

  • Multiple stage 2 Meaningful Use measures address patient engagement, including provision of patient-specific education resources and use of a patient portal.
  • ACOs will be measured by patient engagement strategies such as physician communication, access to specialists, health promotion and education and shared decision-making.

However, patient engagement transcends health information, says Kate Berry, CEO of the National eHealth Collaborative (NeHC). “Success requires leveraging health IT tools to help patients better manage chronic conditions and monitor their health.”

She cautions providers against falling into the trap of a tech-centered approach to patient engagement. “A lot of providers are deploying the next whiz-bang technology—the personal health record, the patient portal, believing ‘if we offer it, the patients will come.’”

It’s not that easy. Technology sans strategy or culture change may set the stage for failure. Providers need to understand the whys and hows of patient engagement and how to encourage it to create a new culture between providers, families and the care team, says Berry.

Patient engagement strategies may go against the cultural grain of some providers or it may impact efficiency or earnings. A physician may believe he or she is not paid to explain test results to patients, notes Berry. “We all want to do what’s best for patients. But sometimes that’s not best for the department,” says Alexander J. Towbin, MD, director of radiology informatics at Cincinnati Children’s Hospital Medical Center (CCHMC).
What’s more, patients themselves can be a barrier.

Patients may be reluctant to question a provider, with age, culture and background affecting patient-physician communication. Patient-education materials are often written at a reading level beyond most U.S. adults, hindering knowledge and engagement.

The motivation to spur change among providers and patients may be on the uptick. Although current reimbursement models and financial incentives may deter patient engagement, both public and private plans are shifting to performance-based models that will encourage providers to boost their focus on outcomes. In addition, as patients pay a greater portion of the costs of care, their approach to responsibility for care will change.

Beyond the basics

Beware the Barriers

RAND Corporation has identified 3 barriers to shared decision-making
1. Overworked physicians
2. Insufficient provider training
3. Clinical information systems that fail to adequately track patients

Progress on the patient engagement front may be hindered by a lack of understanding. Patient engagement has rapidly ascended into healthcare hegemony, and it’s a sharp turn from the status