Enthusiasm for patient engagement as a means to improve population health and lower costs should be tempered, according to a commentary in Health Affairs.
The authors, leaders of Express Scripts, a pharmacy benefit management organization, provide three reasons why patient engagement may not be the best method to improve quality and lower healthcare costs:
1. Evidence of the effectiveness of interventions to increase patient engagement on health outcomes is not definitive.
2. Ongoing and sustained patient engagement conflicts with cognitive limitations that are the hallmark of basic human nature.
3. In some settings, choice architecture and associated strategies provide a clear alternative for improving behavior and decisions without relying on ongoing engagement.
The authors suggest using choice architecture — environmental changes that encourage better behavior — as an alternative to patient engagement, at least for one-time decisions. Using prescription medication choices as an example, the authors examine three choice architecture interventions:
1. Defaults. Defaults assign people to a desired behavior and then present an opportunity to opt-out. The authors conducted pilot studies with two employers, in which patients were assigned by default to a program that required the use of preferred, first-line medications before they could access other options. The opt-out rate was 1.5 percent among all members of an employer, and was 6.9 percent for an employer's members who were originally taking non-preferred medications.
2. Active choice. "With active choice, people are stopped partway through a process and required to select among relevant options," according to the authors. They asked patients who received medications in a retail pharmacy to state explicitly whether they preferred to continue receiving medications in a pharmacy or switch to home delivery. In a study with 85 plan sponsors, 39.6 percent of patients chose home delivery.
3. Precommitment. In precommitment, patients choose ahead of time a behavior they may later find unattractive. For example, the authors allowed patients receiving medications by home delivery to consent ahead of time to switch to a lower-cost alternative medication if their physician approved the change. Of 340,683 patients, 52.8 percent precommitted to these switches.
The authors concluded that choice architecture may be used effectively for one-time choices, but a more in-depth study of how to most effectively combine patient engagement strategies with choice architecture interventions may be necessary to change ongoing behaviors.
5 Barriers, Facilitators of Shared Decision-Making
Health Literate Care Model Supports Patient Engagement
The authors, leaders of Express Scripts, a pharmacy benefit management organization, provide three reasons why patient engagement may not be the best method to improve quality and lower healthcare costs:
1. Evidence of the effectiveness of interventions to increase patient engagement on health outcomes is not definitive.
2. Ongoing and sustained patient engagement conflicts with cognitive limitations that are the hallmark of basic human nature.
3. In some settings, choice architecture and associated strategies provide a clear alternative for improving behavior and decisions without relying on ongoing engagement.
The authors suggest using choice architecture — environmental changes that encourage better behavior — as an alternative to patient engagement, at least for one-time decisions. Using prescription medication choices as an example, the authors examine three choice architecture interventions:
1. Defaults. Defaults assign people to a desired behavior and then present an opportunity to opt-out. The authors conducted pilot studies with two employers, in which patients were assigned by default to a program that required the use of preferred, first-line medications before they could access other options. The opt-out rate was 1.5 percent among all members of an employer, and was 6.9 percent for an employer's members who were originally taking non-preferred medications.
2. Active choice. "With active choice, people are stopped partway through a process and required to select among relevant options," according to the authors. They asked patients who received medications in a retail pharmacy to state explicitly whether they preferred to continue receiving medications in a pharmacy or switch to home delivery. In a study with 85 plan sponsors, 39.6 percent of patients chose home delivery.
3. Precommitment. In precommitment, patients choose ahead of time a behavior they may later find unattractive. For example, the authors allowed patients receiving medications by home delivery to consent ahead of time to switch to a lower-cost alternative medication if their physician approved the change. Of 340,683 patients, 52.8 percent precommitted to these switches.
The authors concluded that choice architecture may be used effectively for one-time choices, but a more in-depth study of how to most effectively combine patient engagement strategies with choice architecture interventions may be necessary to change ongoing behaviors.
More Articles on Patient Engagement:
Developing a Customer Experience Culture to Enhance Patient Engagement5 Barriers, Facilitators of Shared Decision-Making
Health Literate Care Model Supports Patient Engagement