We often think of healthcare as the direct communication between provider and patient in an appointment or clinical setting. However, most of what influences health outcomes sits outside of the doctor’s office: This includes individual health behaviors as well as social determinants of health such as social support systems, access to health education and timely care, physical environment, and financial resources.
As we think about building patient engagement, especially related to preventive care and long-term management of chronic conditions, it’s important to think beyond just the quality of clinical care being delivered. Generally speaking, “engaged” patients are those who feel empowered and actively involved in managing their own health. The specifics of what this looks like may differ by population or condition area, but patient engagement is driven by a few key themes:
– Patient activation: Do patients feel motivated to make choices that will positively impact their long-term health?
– Patient education: Do patients have the information they need to understand how their choices and behaviors impact health outcomes?
– Care navigation: Do patients understand how to navigate the complex healthcare system in order to find and access the care they need?
– Patient support: Do patients have social support systems to help them adopt and maintain positive health behaviors?
In an increasingly technology-driven world, engagement can be improved through strategic and human-centered design of experiences and platforms that help patients manage their health. The following sections outline user experience best practices that can be leveraged to improve patient engagement and influence care quality as a whole.
Patient Activation
Much of the literature around patient motivation and behavior change is built upon theories of behavioral psychology. In her book Engaged: Designing for Behavior Change, Dr. Amy Bucher highlights the different types of motivation that can influence human behavior. These range from controlled (extrinsically imposed “you should…”) to autonomous (intrinsically driven by personal motivations). Understanding patient motivation is key to human-centered experience design.
By Shriya Palekar, AVP Health Plan Solutions, TytoCare.
The COVID-19 outbreak led many to realize the transformative value the virtual world can bring to their industries. The healthcare industry – where virtual care and telehealth integration are becoming more and more accepted – is no exception.
In fact, telehealth utilization rates have stabilized, ranging from 13% to 17% of total care visits across all specialties in 2021, compared to pre-pandemic levels – an upward trend that has continued in 2022.
These spikes, however, do not guarantee that virtual care will become universally accepted, especially when it comes to primary and routine care that go beyond on-demand needs. Many health plan members are used to in-person appointments for these types of care, and 53% of people still prefer an in-person visit for a non-emergency health issue, assuming out-of-pocket costs are not a factor.
Given this reluctance, the question remains: how can health plans boost adoption rates of virtual primary and urgent care for the benefit of both members and the overall healthcare system?
When looking beyond urgent and acute medical services, there are still barriers to virtual care adoption that need to be addressed. The path to increased virtual care adoption for routine care lies in differentiating unique segments of members and understanding their needs individually. Health plans and healthcare systems need to engage their members by understanding who they are and by breaking them down into clear population segments to reveal their unique needs, and understand how best to personally incentivize these groups to buy-in to the world of virtual and hybrid care.
By Vikram Savkar, vice president and general manager of the medical segment at Wolters Kluwer’s Health Learning, Research and Practice business
During the pandemic, nearly every healthcare provider in the country had to execute a rapid, unplanned switch to telemedicine for the majority of their consults and activities. According to one study from the RAND Corporation, there was a 20-fold increase in the rate of telemedicine utilization after March 2020. For the most part, this transition was executed well and successfully, but only due to heroic levels of creativity and dedication by clinicians in every field.
With few established practices to rely on, it fell to each hospital, each department, each clinician to more or less invent ways to conduct virtual consultations in dermatology, cardiology, oncology, and more. There was much trial and error, but a commitment to rapid learning meant that the community as a whole was able to achieve a reasonable level of healthcare delivery quality to patients via the web.
Now, however, it is clear that telemedicine will be a permanent and sizeable segment of healthcare delivery; some estimate that more than 20% of healthcare from 2021 onward will be virtual. As a result, every aspect of the healthcare ecosystem must move out of an “emergency” mindset when it comes to telehealth and focus on establishing scalable, sustainable processes that ensure that a steady shift to telehealth drives equity, access, and quality. Healthcare providers themselves are actively engaged in this effort, and medical schools also now need to evolve to reflect this new normal.
Medical schools have incorporated some telehealth training into their programs in recent years, but it has tended to be ancillary. Now, it will be critical for telemedicine training to be incorporated more structurally into core curricula. What is being called “webside manner,” for instance, is significantly different to “bedside manner” and needs to be taught explicitly ?— in both a classroom setting and during clerkship rotations, as well as residencies.
Clinicians need to be taught how to establish rapport with patients whom they don’t see face to face, how to assess possible domestic abuse threats when the patient may not be able to speak freely, and how to gather emergency contact information in case there is a critical event during the consult for which the clinician needs to call emergency services. They also must learn how to take advantage of the unique opportunity that telehealth presents to closely observe and document social determinants of health by, for instance, asking patients to show the contents of their refrigerator. And they must be taught how to navigate the “digital divide” and ensure that patients without access to broadband or smartphones aren’t consigned to a lower quality of telehealth care.
Telehealth, telemedicine, and virtual care are often used interchangeably to describe remote healthcare visits. But virtual care means something much more than just telehealth or telemedicine. In fact, virtual care is in a category all its own. It is the logical, necessary next step in providing access to healthcare for all.
Telemedicine is Evolving
Remote monitoring and telehealth are nothing new. For decades, doctors have been able to monitor patients remotely or provide medical consults over the phone. Anxious parents have called in to 24-7 nurse hotlines to get advice about childhood illnesses and accidents. More recently, with the advancement of smart phones and web cams, new business models were created to connect patients with doctors over the internet.
However, most people still preferred to visit their doctors in person, and most doctors and healthcare centers weren’t considering a major shift to video any time soon.
Then COVID hit. It accelerated peoples’ desire for virtual healthcare visits and helped them feel more comfortable using video conferencing technology. Zoom, FaceTime, Google Meet and Skype became the go-to solutions for clinics large and small that didn’t yet have telehealth in place.
Video conferencing did good things for healthcare:
• Prevented even higher rates of delayed care
• Enabled providers to triage patients from a distance
• Gave quarantined providers a way to treat patients remotely
• Kept more clinics open and providers working
• Improved access to care for more patients
And while these video conference technologies solved an immediate problem, they quickly showed their limitations. These bandage solutions solved one issue while encountering (and even creating) many more problems.
Rapid expansion of video conferencing for healthcare exposed its weaknesses from HIPAA compliance issues, non-secure connections, the inability to bring a third party onto the call, wasted time as patients and/or doctors wait for the other party to join, limited number of users, concurrent calls, and call minutes and even the limited length of calls. The pandemic accelerated everything, even the “bad habits” of telemedicine.
By Jim Somers, chief marketing officer, CipherHealth.
Jim Somers
Healthcare consumerism was already on the rise before the pandemic hit. The provider-patient power differential was already beginning to shift, with more high-deductible health plans being offered and employers shifting the burden of managing healthcare expenses to individual employees. Before COVID-19 entered our shared lexicon, patients were beginning to take a more active role as purchasers and managers of their own care.
This year’s explosion in telehealth, brought about by the COVID-19 pandemic, has dramatically upped the ante in terms of competition, enabling budget- and value-minded patients to shop for their care unfettered by geographical restraints. The turn to digital care isn’t one that will be undone after the pandemic, either. Eighty percent of patients say they’re likely to continue utilizing virtual visits with their doctors, even after the pandemic ends.
Providing an ever-more-discerning patient population with a new, vast array of providers has disrupted the longstanding monopoly hospitals held over their local patient populations. The fallout has come in the form of widespread network leakage and lost revenue. By October, in fact, revenue for hospitals in the U.S. was down 9.2% year-over-year. Able to select providers from the comfort of home and with an ever-increasing amount of personal health data at their fingertips, patients have far more freedom in 2021 to choose the provider that works for them.
That means that to compete, traditional providers have had to adapt quickly, training staff on remote care and making telehealth an option for every patient. According to McKinsey, health systems, independent practices, behavioral health providers, and others have reported 50-175x jumps in the number of telehealth visits since the pandemic began.
Having the technology to compete in the telehealth arena won’t be enough, however, for mainstream providers to compete, not to mention recover any lost revenue. Patients often don’t feel the same kind of brand connection or loyalty to hospitals that they might to other products or organizations. To keep patients in the network, we’ll see a new push in 2021 toward marketing, patient experience, and most importantly, loyalty.
By Troy Corley, executive vice president of service delivery, Proactive MD.
Troy Corley
In an ideal world, individuals would be able to access health care services in a quick and convenient manner — regardless of where they live. However, entirely too many residents in rural areas face a variety of barriers to access, limiting their ability to obtain the health care they need.
For many patients living in rural areas, having to drive for more than an hour just to see the nearest primary care practitioner is entirely too common. Because of this and other barriers, patients are generally not equipped to be proactive and preventive with their health due to the significant investment required to receive basic care.
Making matters worse, rural patients often face traditionally higher rates of poverty and are less likely to have health insurance than their urban counterparts. These economic challenges, in combination with higher rates of underlying chronic disease, make rural patients more likely than city dwellers to face poor health outcomes and suffer complications from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke.
Today, about 60 million Americans, or nearly 20% of the U.S. population, live in Census-defined rural areas. And with the U.S. Department of Health and Human Services reporting only 39.8 primary care physicians are available per 100,000 people in rural populations, the gap in care between rural and urban Americans is only growing wider. The provider shortage — coupled with increased transportation challenges, social inequities, and the additional access barriers brought about by COVID-19 — makes physical access to care extremely difficult for many rural communities.
The Rise of Telehealth
While the current pandemic has forced the U.S. health care system to face numerous challenges, it has catalyzed the rapid adoption of telehealth services to safely deliver care at a distance.
As patients embrace this digital transformation, health care providers are beginning to look outside of their traditional base to reach new patients in unexpected locales. Employing telehealth services reduces access barriers for patients in rural areas, allowing them to receive basic care regardless of how far they live from a physician’s office.
The digital age has changed our interactions and expectations in ways both big and small—from how we shop and travel, to how we communicate and connect with one another. As with all other industries, the pressures and the possibilities of these technological advancements has spurred digital innovation in healthcare.
However, with the additional stressors of COVID-19, the healthcare industry’s acceptance and adoption of these applications has skyrocketed, as has the opportunity to explore creative uses of these platforms while examining ways to improve both outcomes and experiences.
Virtual care, broadly defined as remote interactions between patients and healthcare providers, has been a part of the healthcare delivery ecosystem for years. It has been an option for some patients, particularly for low-acuity episodic care where convenience is the highest priority when resolving the clinical need, but it has not been widely pursued nor embraced by either providers or patients until now.
In a recent survey of 1,000 patients who utilized virtual care in 2020, 72% had their first-ever virtual visit during the pandemic. With the sudden onset of COVID-19, convenience was no longer the sole driver for pursuing virtual care, but rather a combination of safety, speed of access, and convenience.
Given that the majority of patients using virtual care are new to this care delivery method, health systems need to educate the patient community on both the availability of these types of appointments and on what to expect before, during, and after them. In the aforementioned survey, 52% of respondents received outreach from their established providers, with an additional 15% and 13% hearing from their health system and insurance companies, respectively.
By Scott Galbari, chief technology officer and CISO, Lyniate.
Scott Galbari
For as long as healthcare data has existed, so has the healthcare industry’s challenges with interoperability. The pursuit of healthcare data interoperability has been a longstanding industry challenge, and with the recently finalized interoperability rules from the ONC/CMS going into effect at the end of this month (though deadlines will be extended until mid-2021), interoperability yet again is at the center of many healthcare discussions.
The rules, which aim to provide patients with greater control over their health data and eliminate information blocking, has not been without its critics. Some argue this rule will put patients at risk by inadvertently exposing patient health data to security breaches. However, the spread of the coronavirus pandemic across the United States has underscored the dire need for seamless, bi-directional data exchange. The new rules’ focus on FHIR and APIs to enhance electronic health information sharing are proving to be exactly what we need in the current crisis.
The coronavirus has necessitated all kinds of changes — from rapidly escalating the use of telemedicine, to standing-up temporary testing sites and care centers, to meeting enhanced public health reporting requirements — all of which would have been much more easily addressed if the new rules’ requirements were already in place, and all of which have presented significant challenges amid the COVID-19 crisis.
Because of these unprecedented circumstances, healthcare stakeholders are being required to share health information and data at increasingly high volumes, emphasizing the importance of strengthening the internal infrastructures of these organizations to ensure they can properly send, receive, and analyze health information. However, because of the strain COVID-19 has put on healthcare organizations, the Department of Health and Human Services (HHS) has decided to push out the timeline for meeting the rules’ requirements. While the reasoning for this is understandable, in many ways it is unfortunate that these requirements were not already in place prior to the pandemic.
