What do the best care teams in healthcare have in common? They don’t just take care of the sick — they help them get better. They engage and empower their patients to play a central role in their care and become healthy. The RWJ Foundation suggests that compared to highly engaged patients, patients without the skills and confidence to manage their own health end up incurring up to a 21 percent higher cost of care. It’s time we brought patients on to the center stage for the healthcare transformation.
While consumer engagement always plays an important role when delivering any kind of service, patient engagement is an important cog in the wheel of value-based healthcare; this much has always been clear. Whether or not we are capable of meeting these needs — or if meeting them is easy — is up for debate.
Patient engagement: The ‘quarterback’ of healthcare’s transition to value
As Dr. Geeta Nayyar, chief healthcare and innovation officer at Femwell Group, expressed in an interview this HIMSS19, “Patient engagement is the quarterback to get us from fee-for-service to fee-for-value,” and one cannot agree more.
Leading health systems recognize that patient engagement is a high priority. At face value, the term may seem pretty straightforward, but there is a lot more nuance to defining a truly engaged patient. It may start with giving them the tools they need to understand what makes them sick, enabling access to a portal where they can look at their information, and motivating them to take care of themselves with help from friends and family.
The well-being of a patient — broadly, the entire population — is an important measure of the quality of care and its effectiveness in a particular network. And that’s what providers need to realize. The healthier and happier their patients are, the better their network would be.
What does “patient engagement” mean in the current age of health IT? Given the recent proposed rules by CMS that tell the sector that all data generated by a patient in the care spectrum is their information, has much changed since the term took roost in healthcare several years ago? What is its catalyst in the current healthcare economy?
The patient engagement concept seems pretty easy to grasp: Getting a patient to pay close attention to their personal health and to stay active in the maintenance of it. Patients who are more involved in their personal care are healthier overall compared to patients who are not. While easy to define, patient engagement in dictionary terms, in real-world practicality, appears to be another thing altogether.
When thinking about patient engagement, many conjure up ideas of technology that interfaces with a patient who then uses said technology to accomplish some lofty goal set forth by the provider, the technology maker and even regulators. The technology might be some form of telehealth, for example. The technology might be vitals analytics or even smart devices, like watches and other wearables that track a patient’s movements and progress toward some pre-determined goal.
When the patient engagement movement caught fire, patient portals were the vehicles that were supposed to capture our (read: patients, consumers) attention. While the capabilities of such sites are vastly more developed than they were in their infancy at the start of the current decade, patients didn’t find much joy in using the portals for bill pay and scheduling. Also, there was no advocacy like the current CMS patient information ruling that allowed patients to easily take ownership of their health data through them.
CMS, lest we forget, once mandated patient engagement through the beleaguered and sometimes-hated meaningful use program (stage II, specifically). “To meet Stage II, providers must give patients clinical summaries after each visit. They must use electronic secure messaging to communicate with patients on relevant health information with a minimum of 5 percent of their patients during the review period. They must also provide patients with the ability to view online, download and transmit information about a hospital admission and give them access to any health information about that patient the providers receives, within four days of receiving it.”
Patient engagement today is not much different than what it has always been, it seems. Per HIMSS (in or about 2017) patient engagement is: “Providers and patients working together to improve health. A patient’s greater engagement in healthcare contributes to improved health outcomes, and information technologies can support engagement. Patients want to be engaged in their healthcare decision-making process, and those who are engaged as decision-makers in their care tend to be healthier and have better outcomes.” Or, pretty much the same definition as listed at the start of this piece.
Taxpayers and health systems have spent billions of dollars digitizing data, and clinicians have spent millions of labor hours entering it over the past decade. There’s too big of an opportunity to let that go to waste, said Mudit Garg, founder and CEO, Qventus. “More free-flowing data that creates greater interoperability between health IT systems has the promise to cut significant inefficiencies that benefit providers, payers, and, ultimately, patients,” Garg said. “Now, modern technologies, such as AI/ML and telemedicine, that harness the collective power of disparate data sources can surface new insights and solve highly complex problems.”
Sure, data is one of the key components of patient engagement, but the patient is the heart of the matter. The data they generate, and own, comes about through their own personal experience in and outside the point of care. “When that translates to a more delightful user experience, or a more efficient hospital visit, patients are more likely to engage in their care, which benefits all,” Garg said.
While healthcare leaders attempt to define the terms and how to best lasso or corral it in tangible terms (so as to produce desired outcomes) healthcare’s struggle of understanding the current definition of the term might be missing a broader point. Patient engagement conversations usually degenerate into technology and system applications and how these can be placed into patient/consumer hands. Alternatively, consumers tend to seek, discover and use technology that they feel betters, enhances or improves their lives.
Non-healthcare technologies developed for consumers seem to take a consumer-based approach driven by what might best attract a consumer’s attentions rather than the approach of pushing some piece of technology to consumers that might get used if pushed hard enough.
Patient engagement needs to find its Waze
A technology engagement story:
In 2006, FreeMap Israel was founded and developed with the crowd sourcing assistance of community users, a free digital database of the map of Israel in Hebrew, and to ensure its free content, update and distribution. In 2008, Waze was launched commercially. In December 2011, Waze employed 80 people, composed of 70 at Ra’anana, Israel, and 10 in Palo Alto, California.
In 2011, the app was updated to display real-time, community-curated points of interest, including local events, such as street fairs and protests. As of January 2012, the app had been downloaded 12 million times worldwide. In July 2012, Waze announced that it had reached 20 million users, half of them recruited in the previous six months. There were nearly 50 million Waze users as of June 2013.
In June 2012, Waze launched an update to provide real-time fuel prices. As with all Waze real-time updates, prices are submitted by users. In June 2013, Waze introduced a global localization project that enables future road closures and real-time traffic updates during major events in a given country, for example Tour de France.
Waze collects map data, travel times and traffic information from users and transmits it to the Waze server, at no cost to Waze. Waze users (“Wazers”) can report accidents, traffic jams, speed and police traps, and, from the online map editor, can update roads, landmarks, house numbers, etc. Based on the information collected, Waze is then in a position to provide routing and real-time traffic updates. Waze can also identify the cheapest fuel station near a user or along their route, provided Waze has enabled fuel prices for that country.
Waze offers turn-by-turn voice navigation, real-time traffic and other location-specific alerts. Waze encourages users to report traffic or road hazards by offering points. Add-ons expand the functions and personalize this interaction with the app. Add-ons can integrate Foursquare and Facebook friends to Waze or notify the user when driving through a high-crime area. In 2017, an option was added for motorcycle users, as well as specialized routes for people eligible to drive in carpool lanes.
The megalithic healthcare conference, HIMSS19, has come and has gone from the vast former swampland of central Florida. While I’m a relative newcomer to the show’s trajectory – I’ve been to four of the annual tradeshows since 2011 – this year’s version was, for me, the most rewarding and complete of them all. This could be for one of several reasons. Perhaps because I no longer represent a vendor so sitting in the exhibit hall in a 30×30 booth with a fake smile wondering when the day’s tedium would end and the night’s socials would begin may impact my rosy outlook.
Or, maybe I was simply content to engage in the totality of the experience, attend some quality sessions, meet with many high-class people and discuss so-called news of the day/week/year. Doing so felt, well, almost like coming home. Or, perhaps my experience at the conference this year was so good because of running into former colleagues and acquaintances that drove me to such a place of contentment while there. No matter the reason, I enjoyed every minute of my time at the event.
Something else felt right. An energy – a vibe – something good, even great, seems/ed about to happen. Something important taking place in Orlando, and I was blessed to be a part of it. Kicking off the week, CMS created news – like it does every year at about this time – with its announcement that it will no longer allow health systems and providers to block patients from their data. This was a shot across the bow of interoperability and the industry’s lack of effort despite its constant gibberish and lip service to the topic.
Another fascinating thing that finally occurred to me: no matter the current buzzword, every vendor has a solution that’s perfect for said buzzword. Be it “patient engagement,” “interoperability,” “artificial intelligence,” “blockchain”; whatever the main talking point, every organization on the exhibit floor has an answer.
But, no one seems to have any real answers.
For example, after nearly a decade, we still don’t have an industry standard for interoperability. Patient engagement was once about getting people to use patient portals for, well, whatever. Then it was apps and device-driven technologies. We’re now somewhere in between all of these things.
AI? Well, hell. It’s either about mankind engineering the damnedest algorithms to automate the hell out of everything in the care setting (an over exaggeration) or that AI/machine learning will lead to the rise of machines, which will help care for and cure people – before ultimately turning on us and killing or enslaving us all (again, I’m overly exaggerating).
During her trip to HIMSS19, Center for Medicare & Medicaid Service administrator Seema Verma spoke with registered members of the media to preview her keynote speech and answer questions about her department’s newly released proposed interoperability rule. The rule dictates that data generated by patients while in the scare setting is theirs to own, transfer and share with caregivers. It also would require healthcare providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types.
In a statement released prior to her meeting with the media, Verma said that ensuring patients have easy access to their information, and allowing that information to follow them on their healthcare journey “can reduce burden, and eliminate redundant procedures and testing, thus giving clinicians the time to focus on improving care coordination and, ultimately, health outcomes.”
During her meeting with the media at HIMSS, Verma started by discussing CMS’ “why” — why CMS is moving toward enhanced patient empowerment – as well as her and the administration’s focus on the improving the sustainability of the healthcare community.
Patient empowerment remains front and center for the agency, she said. For example, from the patient perspective, everyone has their own experience of going to the healthcare system and not being an empowered patient, she said, and not having access to data decreases patient engagement. CMS is working to change that, now.
When people understand their health and participate in their health, this has the ability to improve care outcomes, she added, and through complete access to their healthcare records, patient care can be more complete. Ultimately, she said, with every detail of a person’s health information in one place — and accessible to the patient — will kick start the digital health data revolution.
Primary care physicians are at the frontlines of our nation’s health. The average family doctor cares for 2,300 patients with visits varying from acute conditions to chronic diseases. Treating patients with the highest quality of care is a fundamental goal of every physician. However, with a very high volume of patients, limited in-office time and space, and restricted patient availability, doctors actively seek innovative alternatives to meet patient needs. More and more physicians see telemedicine as the solution and are now offering consultations through virtual devices, such as smartphones, tablets and laptops, to their patients.
Our primary care practice, the Kaufmann Clinic that has been around in Atlanta since 1954 and has multiple locations and multiple providers, recognized the need to incorporate telemedicine into our traditional, brick-and-mortar practice. Here are the ways telemedicine has benefited our practice:
Telemedicine optimizes our practice’s capabilities. A physician can only examine a limited number of patients in office due to administrative time, severity of cases, and number of exam rooms. By using telemedicine our practitioners can now increase the number of patients they see in a given day. Seeing less acute patients virtually enables us to be more efficient and effective overall. Not only remote visits, but also in-clinic visits are optimized.
By Robert Barras, vice president of health solutions, CTG Inc.
There’s nothing like a good bandwagon to get everyone excited. Whether it’s the success of your favorite sports team, or a hot new restaurant in town, or a movie that’s breaking box office records, once something gets hot it seems everyone wants a piece of it.
For healthcare IT, one of the loudest and most visible bandwagons in the last few years has been the cloud. The idea of being able to hand off the expense and resource-intensive hassle of purchasing, implementing, and maintaining hardware and software is very attractive to healthcare organizations continuously being challenged to “do more with less.” Yet that expediency is often offset by continuing concerns about security, especially as it relates to protected health information (PHI), speed of access, and other issues.
The reality is the cloud is the right choice for some organizations, or even some specific applications, but it’s not a panacea for HIT. Following are some things to consider as you make the choice of whether to move to the cloud at all, and what makes sense to move to it.
One of the top reasons in favor of moving data and/or applications to the cloud is the ability to scale them on an ad hoc basis – especially as healthcare data continues to grow exponentially. A report from EMC and research firm IDC projects the volume of healthcare data will grow from 153 exabytes in 2013 to 2,314 exabytes by 2020.
Of course, the growth won’t come in a steady stream. At some points, healthcare organizations will need to be able to manage a high volume of data. At others, they may need to boost their computing power temporarily to drive a specific objective.
Rather than trying to manage data or computing needs internally and ending up with over- or under-capacity, the cloud provides a convenient way to scale up or down quickly. It’s also more cost-efficient, as healthcare organizations only pay for what they consume, significantly reducing costs. Finally, expanding capacity through the cloud ensures processing-heavy analytics applications aren’t slowing down the performance of critical clinical applications.
All of that data won’t be coming from a single source, either. As more of healthcare shifts to being value-based, providers of all types and sizes need to populate their population health management (PHM) and other analytics applications with data drawn from a variety of sources inside and outside of the organization.
Most organizations, especially those hyper-concerned with security, will not want all of that outside data flowing into their core systems or internal data centers. The cloud presents an ideal alternative.
It can create a clean separation between the main storage of PHI and all other data by treating PHI as a source that feeds applications housed in the cloud. With the help of a partner, all the incoming data can be cleaned and normalized so it can be used within analytics or other applications, providing better, more complete answers to PHM, patient engagement, trends, and other questions than can be obtained with internal data alone.
As the use of data in this manner grows, it will simplify the exchange between providers – especially as standards such as FHIR proliferate throughout the industry. The result is interoperability almost becomes a byproduct of the use of data in the cloud, avoiding the need for expensive, time-consuming special projects just to send electronic health records from one provider to another.
By Poornima Venkatesan, senior consultant, Virtusa.
In today’s value-based care environment, patient engagement is a vital key to success in clinical outcomes. This is especially true for chronic diseases such as arthritis, where continuous care is necessary because of the disease’s physical, emotional and economic impact on patients. Although the advent of specialty drugs in the past decade has made disease control possible, clinicians still face challenges in patient care because patients’ preferences about therapy aren’t often considered.
Understanding patient goals and expectations
While a clinician’s goal is to achieve remission, a patient’s goal could be clinical or nonclinical and varies depending on their individual characteristics and demographics.
Patients from low-income countries such as Morocco expect access to primary care (never mind rheumatologists), support services and education about the disease. The high expenses related to rheumatoid arthritis (RA) in such countries result in poor treatment compliance, school absenteeism in children and deterioration in quality of life. Comparatively, even with excellent health insurance systems in the United States, one in six adults with RA reduce their medication use because of high out-of-pocket costs. Most patients expect cost-effective care. In wealthier countries like the United Kingdom, patients expect increased social connectedness and family support.
Elderly patients expect reduced pain, fatigue and side effects, whereas young adults expect independence and normalcy from their treatments. Women, who are most affected by RA, might expect a lesser impact on family life and childrearing.
If such multidimensional expectations are not met, patients tend to discontinue their treatment. As new biologics and non-biological complex drugs (NBCDs) are developed, patient adherence is essential in determining both therapeutic and potential adverse effects. Studies reveal that frustration towards the method of drug administration (like self-injection) also impacts adherence. In the U.S alone, the total cost of non-adherence is estimated between $100 billion and $289 billion annually.
Therefore, it is important for the patient and the physician to trust each other and have open discussions about treatment strategies and expectations to ensure better alignment and cooperation.
Measuring patient engagement
The first step towards patient engagement is awareness of their current engagement levels. The patient activation measure (PAM) tool is helpful here. PAM measures the attitude and knowledge of patients about the disease and treatments. Studies have proven that highly activated patients have better outcomes via increased medication adherence, resulting in lower healthcare costs through fewer ED visits, hospital admissions and re-admissions. By continuously monitoring activation levels, providers can measure sustained changes in patient behavior and personalize their care programs.
We can also measure engagement levels by taking advantage of data. Data derived from direct [electronic health records (EHR), claims] and indirect sources (wearables) provide a holistic view of an individual patient. Simple analytics applied to population data can predict patient behavior. For example, analytics can help providers know which patients are likely to miss their appointments, which patients will fill their prescriptions on time, and so on. Detailed patient-based data could also lead to better and more accurate diagnoses and treatments.
By Abhinav Shashank, co-founder and president, Innovaccer.
Consider a situation where healthcare is not just an industry term — a situation where EHRs are not an integral part of physicians schedule but just a support to providing care. All considered, imagine a situation where patient-centric care actually involves the patient, and patient engagement is not just a buzzword but a reality. Unfortunately, all these imaginations were supposed to be a reality, but still, healthcare managers and organizations are struggling with the problems such as the lack of patients’ adherence to medication, varying trends in the population health, and a lot more. Patient population, nowadays, expect the same on-demand delivery convenience from the healthcare organizations as they get from the other companies, like Netflix.
Why is Patient Engagement the Core of Providing Patient-centric Care?
To understand the value of the patient in the entire care continuum, let us take an example. Consider a patient, Marcus, who works at an IT firm and is affiliated to a Commercial ACO in his county. Marcus is a 65-year-old male suffering from comorbidities like Type 1 Diabetes, and diabetic retinopathy. He is at constant risk of sporadic elevated blood pressure.
In the year 2016, Marcus visited the ED approximately five times. Considering the situation, his primary care physician referred him to a specialist and prepared a schedule comprising at least two monthly visits.
The year 2017 started with a lot of workload for him at his firm, and he was unable to keep up with the prescribed schedule. Because of improper communication between his PCP and him, his physician was not able to keep track of Marcus’s health. As a result, the ED utilization rate for Marcus increased from five times to nine times. Because of enhanced stress and improper quality of care, the sporadic episodes of elevated blood pressure turned into a constant problem of hypertension. Also, the overall cost of care for Marcus increased drastically.
Challenges in Achieving True Patient Engagement
Patient engagement, in itself, is not as simple as ABC. It is not just bringing patients in the cycle of care continuum but enhancing the patient’s skills, ability, knowledge, and most importantly, willingness to participate in the task of managing his own care. The concept of providing care with “engaged patients” sounds great theoretically, but it is not that smooth sailing. According to a survey, nearly 87 percent of the patient population believes that communication with their doctor apart from their scheduled appointments is really important.
The major flaw is the lack of awareness among the patients regarding their care procedures. Many patients are ignorant of the clinical processes which a physician follows, and they might miss out on major health details. With no actual knowledge of the disease symptoms, patients might not report to their physicians which might lead to reduced patient engagement, not to mention the increased risk of developing a chronic disease.
Care teams play a vital role in engaging the patients through regular follow-ups. Irregular and fragmented workflows of care managers and lack of personalization might lead to the generation of ineffective care plans for the patients. Reduction in patient engagement could also be the result of under utilization of technologies to analyze the massive amount of patient data that care managers have at their disposal. Through building more personalized care plans, patients can be engaged at a more grass-roots level.
Driving Effective Engagements through Value-based Care
Predictive population health analytics is the answer to nearly every problem linked with patient engagement. Advanced predictive analytics tools will help in dealing with the problems of disparate data systems and can pinpoint the exact area on which healthcare organizations can focus. Leveraging the insights obtained by data analytics, care teams can prepare the statistical models to prioritize each patient and can take necessary measures to engage patients in the process of decision-making. Understanding the patients’ habits by the care teams increases the chances of preparing personalized care plans for them and enhancing the level of patient satisfaction.
According to the Office of Coordination of National Health Information, 50 percent of healthcare dollars are wasted on inefficient processes. Transformative innovation must not only change the current way things are done, it must be disruptive by having a meaningful impact on time, quality, cost and operational effectiveness – it must dramatically simplify and accelerate the process it enables.
There are very exciting ways in which digital technology is creating transformation across the entire healthcare system in areas such as connected health, artificial intelligence (AI), blockchain, mobile data gathering, analytics, digital therapeutics and remote patient monitoring. All of these technological developments will improve healthcare efficiency, but more importantly they will drive the delivery of individualized care and dramatically improve patient outcomes as follows:
Access to Care
Connected health, or telehealth, is enabling the delivery of care to rural areas, where access is often nonexistent or very limited. It is also being used to address growing medical staff and physician shortages by providing access to timely care through collaborative tools such as eConsults. Telehealth delivers faster, less expensive and more convenient healthcare and in doing so significantly improves patient outcomes.
Conventional patient engagement systems display information at the hospital bedside, which is only one of many relevant ways to connect with patients. Companies are now integrating artificial intelligence or ‘virtual’ health coaches into interactive educational platforms, resulting in higher utilization and engagement, and delivering more robust, actionable content.
Remote Patient Monitoring (RPM)
A vast array of innovative wearables and sensors such as the biosensor bra patch, implantable glucose sensor, electronic tattoos and the cardiac mapping vest are revolutionizing remote monitoring capabilities. These remote monitoring systems have the potential to help achieve triple aim goals by leveraging the latest advancements to collect and analyze patient data beyond the bedside. Patients and providers can use smart phones, tablets and apps to remotely assess, diagnose and monitor their patients. Electronic monitoring can be an effective solution to identifying issues as they happen while also enabling more effective tracking of patients post-discharge, improving compliance and adherence, and reducing the number of re-admissions.
New applications of telehealth that enhance existing provider-to-provider communications are revealing a new way for healthcare organizations to ensure patient care remains in-network. As hospital M&A activity accelerates and organizations strive to glean the most value from their investments in technology and human resources, telehealth is recognized for its role in keeping communications and care in-network.
Telehealth is increasingly being leveraged to offer providers immediate in-network specialist expertise and to reduce ad hoc out-of-network referrals. These kinds of applications make the in-network choice convenient for providers and patients while driving increased patient engagement and more integrated care across the broader care team.
Providers are seeing that telehealth applications can be complementary – instead of disruptive – to their workflows and provide them with a new approach to practicing medicine via technology.
Immediate Communications with Colleagues
Video-based technology can help providers optimize their current workflows by facilitating faster and more flexible consults with on-demand access to in-network specialists. A provider’s network of experts can be built into the technology, which enables a provider to immediately reach the designated, first available specialist for answers. Instead of wasting valuable seconds and minutes looking for the names and contact information for specialists, providers can use telehealth to expedite provider-to-provider interactions which accomplish the critical objectives of doing what is both right and timely for the patient’s situation.
For example, a provider may be examining a patient and realize that the patient’s condition requires specialist expertise. With telehealth, the provider can immediately reach out to an in-network specialist. The specialist accepts the virtual consult request, from anywhere and on any device. During the virtual consult, the specialist can evaluate the patient and communicate the appropriate next steps. All stakeholders – the provider, the specialist, and the patient – benefit from the immediacy, efficiency, and effectiveness of a virtual consult conducted in real time.
The broader healthcare organization (whether a medical practice, a hospital, or a health system) will benefit from an increase in in-network referrals. By leveraging the organization’s network to drive better patient outcomes faster, providers can deliver lasting value for the healthcare organization and enhance its overall reputation.
Increased Patient Engagement
Technology can also help providers optimize their current follow-up processes and easily check in with patients after a hospital stay or outpatient procedure. Providers can use telehealth to offer patients appropriate follow-up care at their own home via video. This allows providers (or providers’ in-network resources) to reach out to patients based on those patients’ preferred contact methods (e.g., email or text) and languages (e.g., Spanish, German, etc.) to remind them of their upcoming video visits. The result is increased patient engagement in their ongoing treatment plan. Travel time, related transportation expenses and appointment no-shows are minimized due to this efficient method of follow-up care.
For example, a provider can facilitate a virtual visit with a patient to ensure understanding and adherence. During a virtual visit, the provider (or related in-network care team members) can evaluate the patient’s progress, answer questions in real time, provide patient education, and re-emphasize the treatment plan – all while the patient stays comfortably at home and the provider remains conveniently in the office. All stakeholders – the provider, the care management team members, and the patient – benefit from timely conversations which can drive better adherence and overall outcomes.