Engaging Consumers in Health — The Basis of a Sustainable Future
Improving the delivery of appropriate health, cost and quality dataThere are thousands of sources of health information that patients access today. However, inconsistencies with the quality of that information can be harmful to the physician-patient relationship and to the patients themselves. Leaders we spoke with are all searching for the best ways to deliver the right health information to patients inside and outside their traditional facilities — whether through email communications with physicians, online videos, clinical social workers or online health sites. All leaders reinforced that delivering the right information is critical to supporting the right level of care.
James Farley, COO of Advocate Medical Group, based in Oak Brook, Ill., the largest health system in the state, agrees, stating "The majority of one's health and wellness care is really making personal decisions. We want to be partners in that decision-making, giving the patient information and guidance they need when and how they want it."
Lori Mitchell, CFO of University of Washington Medical Center in Seattle adds, "We are finding new ways to get patients information, like watching a video featuring one of our physicians, rather than a television commercial or website that may lead them to self-diagnose."
Information delivery is also changing inside the facility as treatment options and cost conversations become a more critical component of the physician-patient conversation. At Kaiser Permanente in Oakland, Calif., physicians are proactively bringing the cost conversation into the exam room. "We are putting cost information in the hands of the physician," says Chuck Larsen, Kaiser's vice president of products. "So, as your doctor, I can tell you the clinical effectiveness of various treatment options, and I can also tell you the financial impacts of those options. It's a new direction for us."
Additional online tools provide patients with options and cost information across multiple providers. Brian Ancell, executive vice president of healthcare services and strategic development at Premera Blue Cross in Seattle, noted that Premera's members have access to a growing list of common procedures and their comparative costs across multiple facilities. "Patients want to know about options, costs and quality when making decisions," he notes.
"We must help consumers swim against the tide of 'more is better' messages implicit in modern medicine," says Mary McWilliams, executive director of Puget Sound Health Alliance, an employer-led healthcare consortium in Seattle. "I'm encouraged to see more information now on cost and long-term efficacy of more conservative treatments. The consumer needs to understand that there is a double-edged sword with every intervention. They all carry risks."
New ways of delivering information to patients is a critical component of engaging consumers in healthcare. However, it is not the only way these leaders are extending care models beyond their traditional clinical offerings.
Increasing focus on wellness and preventionEmployers are increasingly engaging consumers through wellness and prevention, which necessitate development of new programs. Many wellness and prevention programs are fairly new, but success of early adopters show that employer engagement and the right technology investments are critical to success.
Both Advocate and Kaiser Permanente have invested in clinics that provide clinical services onsite. For instance, Advocate has launched onsite clinics at large employers through its Advocate at Work initiative. The system also provides fitness facility access throughout the Chicago metro area. "We have a number of contracts with large, and some mid-sized, employers to provide these employer-based services — all the way from health and wellness assessments to onsite care. In cases where the organization may not be geographically centralized, we still provide services such as wellness, screening, consulting or an ergonomics fitness test for workers. Employers see measurable results, primarily in decreased days lost from work due to injury and illness," says Mr. Farley.
Kaiser Permanente's customized wellness programs are also growing quickly, Mr. Larsen notes. "In three years, we've gone from providing [wellness programs] for a handful of employers to well over 1,000 employers participating in our programs. It has exceeded our expectations."
While productivity gains are measurable, introducing effective programs and achieving a return on investment takes time. Mr. Ancell agrees and points to Premera's success with its own wellness plan. Five years ago, the company invested in a biometric- based wellness program that provides financial incentives to reward healthy behavior. Early on, individual participants were rewarded with incentives — like a modest bonus to take a health risk assessment. Then, a cooperative aspect was introduced through corporate targets for weight loss. Teams worked together for additional incentives, and some of the incentives were incorporated into premium differentials.
"You take people on the journey and you do the education," Mr. Ancell says. "People first were interested. Then they were excited about it. Now it is just part of who we are as an organization. As an employer we provide a built-in community that is critical to engaging consumers through camaraderie, motivation, awareness and support. We've seen a dramatic improvement in our healthcare costs trend over time."
Mobile clinics, onsite facilities, wellness programs and the like showcase a shift in how providers and health plans think about care. "We're recognizing that a focus on wellness and other related programs are an important part of what we're supposed to be delivering. Our focus needs to be on improving health," emphasizes Ms. Mitchell.
Reshaping delivery with technologyAll of the executives we spoke with were engaged with, energized and excited by the promise of new patient-focused technology. Whether it be an iPhone to self-conduct an EKG, a diagnostic stocking cap to perform an at-home sleep study, mobile reminder tools that cut hospital re-admissions or the power of an EMR to recognize trends and patient risks, the promise of these tools — and the scale to which they benefit the patient — is just beginning to materialize.
One example, Mr. Farley noted, is the latest sleep-study technology used to test for problems such as sleep apnea. "Historically, these studies have been done in a hospital-based sleep lab. The patient comes in and spends the night hooked up to an ECG machine. But now the technology allows a patient to use a headband with sensors built into it. The patient takes it home, sleeps in their own bed with the cap on and downloads the data to us in the morning."
Electronic medical records are rapidly maturing and expanding in scope. As these systems gather a patient's data over the years, they begin to recognize trends and risks. At Kaiser Permanente, Mr. Larsen says, "There is story after story of cancers, heart conditions and COPD conditions being caught early simply because a patient went in for something unrelated, the system prompted that department to refer them for a certain diagnostic test, and the patients acted on that. "
Mr. Farley puts the cost of new technology into the larger context. "We are navigating, as a society and as healthcare organizations, how to pay for such advances … At the end of the day, we want to meet the patient where they are and deliver the care when they need it and how they need it. It's up to us to figure out economically how that works."
Focusing on consumer benefitsEnsuring that consumers adopt new information and treatment tools requires a concerted, cohesive consumer focus as well as rapid improvement in results. Expensive technology tools and new care models are doomed to fail if they do not adequately address consumer needs.
"You've got to translate everything into benefit to the consumer," Mr. Larsen says. "If it's a cost savings for us and a clinical efficiency for the physician, but it doesn't provide any tangible benefit to the consumer, there's no adoption. What's the tangible benefit to the consumer? That's what we are struggling with — trying to tie all those pieces together so that it's viable and valuable."
This consumer-focused effort has paid off for Kaiser Permanente. Mr. Larsen notes that the multi-year effort to drive consumer engagement with HealthConnect (Kaiser's EMR) is showing impressive results. For the first 10 months of 2012, metrics included delivery of 30 million online test results and 10 million online prescription refills. Others observed distinct trends in adoption. Ms. Mitchell noted that UW Medicine recently experienced a big increase in patient EMR usage when one of its hospitals sent out a publication encouraging patients to sign up for 24/7 access to their electronic medical record. "The population is changing. They want these tools," she says.
The leaders we spoke with realize they can look outside the industry for expertise and inspiration. "We ask consumer-focused companies in other industries to help us," says Mr. Ancell. "Folks from Microsoft and Amazon have come here to help us understand how to think about products and services from a consumer's point of view. Health plans can't say, 'Take things the way I want to give them to you.' That's not the world we live in."
What does the future look like?As in all other industries, this kind of disruptive change means that the future landscape will look dramatically different than it does today. Organizations that capture the opportunity this kind of change presents will follow key tenents. They will drive consumer focus into their organizations, define a clear multi-year vision and execute effectively to deliver the changes required. The leaders we spoke with articulated inspiring visions for the future.
Ms. McWilliams and Mr. Ancell both see a world where consumers are highly engaged and motivated to make healthcare decisions. "We have to learn what consumer-driven means to healthcare. We’re going to have to do things better," says Ms. McWilliams.
Mr. Farley and Mr. Larsen see a world where technology continues to revolutionize the patient experience. "As a patient walks out of a facility, the claim will be adjudicated, the funds will be pulled, the test results will be e-mailed … almost every part of that transaction will be real time," says Mr. Larsen.
"Technology is helping reshape the paradigm of how care is delivered. The interface of care is moving to wherever the patient is," adds Mr. Farley.
All agreed that the future is coming quickly, and the changes required to be successful are far-reaching, long term and more consumer-focused than ever before. According to Ms. Mitchell, "This is not about doctors. It's not about hospitals. It's not about insurance companies. Patients — this is all about them."
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