Informed patients have lower readmission rates, better therapy adherence and reduced miscommunication errors among providers, outlining the critical need for providers to share patient data and engage with patients. Historically, such initiatives have often failed or have been underutilized. Nevertheless, the need and desire for patient engagement programs have increased in recent years, partially due to quality programs introduced with value-based care requirements, but also because of improvements and innovation in digital and mobile technology.
In determining the right way to engage patients, it is important to first examine previous initiatives and why they were unsuccessful. Under Meaningful Use, for example, five percent of patients were required to view and download their records. Many providers had a hard time meeting this requirement, and in order to comply, many resorted to patient rounds, traveling bed-to-bed, to request patients to download their records.
Many other initiatives have leveraged patient portals in efforts to increase engagement. When using such portals, patients are often faced with confusion surrounding the correct one to use – a hospital-specific portal, the primary physician’s portal, the surgeon’s portal or the payer’s portal? According to one client, portal usage statistics reveal patients are really only using them for financial information and not on a regular basis to manage care.
Other initiatives have attempted to gauge why patients are not leveraging information provided to them. The Centers for Medicare and Medicaid Services (CMS) conducted a survey regarding their “Blue Button” initiative, which gave patients the ability to view, print and download their personal health information and customize the view of their record. Survey results showed a critical need for patients to have access to their online records. However, three years after the initiative started, only three in ten patients knew they had access to their information online, and one in three patients had to address miscommunication among providers and a delay in information being shared because of the program.
There were some successes with Blue Button, however. Nearly three-fourths of patients used their online information to monitor their health and share information with their providers and care managers, which is a significant rate of acceptance. While the number of providers sharing information digitally has increased and will inevitably continue to grow, the use of such an opportunity is still in a nascent stage.
Geisinger Health System, a leading Pennsylvania-based health maintenance organization (HMO), also conducted an initiative to monitor Congestive Heart Failure (CHF) patients’ weight using Bluetooth scales. This initiative had positive results, with a reported 40 percent reduction in emergency departments and direct admits, and a higher patient satisfaction rate.1 This initiative involved heavy involvement from care management staff, making it viable only for the highest risk patients. How can this improve?
By reviewing previous initiatives, it’s clear that when there is actionable information, patients are much more willing to engage. Below are some best practices for communicating with patients:
- Educating patients. Providers need to educate their patients regarding potential problems, which can raise the “impactability” of information. For CHF patients, educating them around cardiac event indicators, such as a weight gain of five pounds, incented these patients to know and track their weight. Just getting patients to download their records does not have definable next steps, therefore patients do not see the benefit. Involving patients in the process of facilitating clinical care is key to their engagement. How using such a report, unnecessary lab tests, visits or behavior patterns can help keep patients healthier and drive meaningful action. Identifying ways to embed patient actions within existing clinical workflows will help patients understand the benefit of engaging.
- Clearly explaining next steps. More than one-third of U.S. adults – 77 million people – have difficulty with following directions on a prescription drug label or understanding when their children need shots.2 Providers should be able to help patients understand “How does this affect me?” Creating summarized versions of patient data with concise, easy-to-follow next steps enables and encourages action from the patient, and allows the provider to more easily explain the why a follow up appointment or next step is necessary.
- Leveraging mobile or digital devices. There is a clear disconnect between how portals, devices and applications communicate pertinent problems, and more importantly, how to handle next steps in an easy-to-follow format. For example, scheduling a follow-up appointment when there is a negative lab test or a gap in care should be easy for the patient to do. An electronic reminder is proven to be successful in creating the correct follow up action – scheduling a visit – over half the time, and it relieves the burden on staff to reach out to the patient to engage. Similarly, Geisinger Health System created engagement with scales. Building interactive communication based on data from apps and devices helps both patients and providers, making the system truly interoperable. Patient adoption and engagement will come when existing patient portal features align with patients’ and providers’ information needs and functionality requirements.
On the business side of it, bundled payments, value-based initiatives and shared savings are some of the key initiatives that require coordinated care. Most providers have started to understand the value and are taking steps to introduce these programs in their business strategy and roadmap. Patient engagement presents an opportunity to drive the coordination between providers by actively involving the patient as the glue that drives meaningful change.
1 http://www.amchealth.com/_files/published-outcomes/PopulationHealthManagement-GeisingerHFStudy-May2014.pdf
2 https://health.gov/communication/literacy/issuebrief/