Digital technologies are touted as an effective means of engaging patients and incenting better behaviors and adherence.
Yet recent research indicates that if the healthcare industry simply automates existing processes such as they are, those digital initiatives are likely to fail. When it comes to patient engagement, digital solutions must be designed to help patients heal according to their own situation and measures, thus helping the industry achieve success by its metrics as well.
The Healing Study, conducted by Cognizant Technology Solutions and ReD Associates over five months, involved a team of researchers spending time in the homes of patients managing chronic conditions, followed by a 5,000-plus respondent quantitative survey. The study made clear that patients find the U.S. healthcare system cold, unengaging and disempowering. For all the healthcare industry’s talk of patient-centricity, patients generally find that the system and related engagement efforts are built to the industry’s quantitative measures of good health outcomes. The current system is also heavily invested in one-size-fits-all patient journeys. Further, it’s focused on reducing patient deviation from treatment regiments rather than acknowledging each patient’s unique circumstances.
While many patients are already taking steps to warm their care so they may heal according to those measures, healthcare organizations must follow the patients’ lead to design optimal engagement tools and processes.
Eight ways patients warm their care
Researchers for the study shadowed patients as they interacted with family members and caregivers. The study found patients have developed ways to warm up their care that do not track with industry approaches to engagement and health management. In fact, the findings indicate some industry thinking about how patients want to be engaged should be dismissed as myth. The findings revealed:
1. Patients measure their healing by how well they function and their quality of life. The survey found people are three times more likely to make a successful behavior change when they rely on how their bodies feel to tell them they are getting better. By contrast, the healthcare system measures healing by clinical numbers – and numbers signaled healing to just 14 percent of the survey respondents.
2. Patients rely on their peers’ experiences in managing conditions versus following expert health prescriptions. Peers supply individualized, experience-based insights and recommendations, whereas only 36 percent of patients bother to read information given out by their healthcare providers (HCP). When HCPs did offer realistic instructions and explanations to patients with multiple morbidities in the survey, they were three and a half times more likely to adhere to treatment.
3. Patients often take a few steps forward, then fall back a pace or two as they heal. Meanwhile, the industry is invested in mapping linear patient journeys. Treatment plans and engagement tactics instead must offer personalized nudges that reflect these fits and starts.
4. Patients and caregivers will go to great lengths to minimize the impact of their health conditions; however, the conventional wisdom is that successful engagement should minimize the patient’s efforts. Yet the study indicated digital solutions intended to take guesswork out of treatment devalue patients’ health management skills and solutions, leaving patients feeling disempowered.
5. Patients want to tell the stories behind their medical conditions to feel more connected to their physicians. While most electronic medical and health records capture full medical histories, they miss the human story. The study showed that individuals with multiple morbidities are three times more likely to follow treatment plans when they felt as though their HCP heard their stories and took them seriously.
6. Patients need to go through a process of trial and error to find out how their meds and treatments work best for them, whereas the industry shoots for by-the-book adherence. Our survey showed 47 percent of people who take prescription drugs have explored different ways of taking them, e.g., different times of day, different amounts, etc. Rather than fight this trend, engagement initiatives should guide patients through it.
7. Patients who follow treatment plans to the letter may nonetheless feel as though they are not healing, because the industry focuses on treating conditions, not people.
8. Patients heal during an evolving process that often involves many relationships, from relatives to professional caregivers, yet the industry focuses on patients as the sole agents of adherence.
Design digital for autonomy, personalization and empathy
Digital technologies can be designed to support patient efforts to warm their care. Backed by artificial intelligence, machine learning and analytics, digital can power ‘precision engagement’ initiatives that are customizable, adaptive, empathetic and scalable. Before investing in a digital engagement tool or system, healthcare organizations should evaluate it against the following patient-driven criteria:
• Does it establish and track the patient’s meaningful goals? These are goals that matter to patients and tell them they are healing versus medical numbers or industry standard. At the same time, it is possible design experiences that help the patient progress toward personal goals while mapping these to accepted clinical metrics.
• Does it empower patients and their support community? Healing doesn’t take place in a vacuum; caregivers, physicians and family members can be brought into the patient’s journey according to the patient’s desires.
• Does it provide contextualized follow-up care? “Contextualized” here means providing recommendations and suggestions based on the patient’s lifestyle, support resources, personal goals, etc. This information must help a patient problem solve and figure out how to fit their treatment into their daily lives.
• Does it guide patients through an active process of trial and error? Engagement tools must recognize and support patients in their inevitable experimentation, guiding them toward discovering adherence that works for them vs. issuing orders.
The research indicated healthcare organizations can warm the cold system by focusing on these areas:
• Pricing transparency. Patients need self-service tools that go beyond accurate, up-to-date lists of in-network providers to help them navigate medical billing and benefits in clear, understandable language. Only 5 percent of the respondents said the system is set up to help them with billing or co-pay issues.
• Personalized follow-up care. The study indicated that within the last two years, 69 percent of patients had not heard from their providers outside of a scheduled visit. Clearly there’s room for improvement. Data analytics can help identify patients most in need of follow-up support – and create personalized advice that fits into a patient’s daily life.
• Scale individualized care. High-tech tools combined with a human touch make it possible for healthcare organizations to affordably deploy individualized chronic care and wellness management solutions on a large scale. These programs still must adhere to the patient-defined principles for success.
• Contextualize consumer choice. Healthcare too often provides the illusion of choice rather than a range of meaningful options from which the patient may choose. Analytics and algorithms can offer choices based on analysis of a patient’s actual behavior.
• Increase the impact of virtual care and remote monitoring. Remote monitoring can be designed to be interactive, providing actionable, immediate feedback to patients; supplying HCPs with real-time data and alerts; and building reciprocal relationships between patients and providers.
Healthcare organizations who tackle these areas to warm their care can help minimize the effects of a cold system. The study indicates patients who receive warm care are more likely to change behaviors to improve their health in ways meaningful to them. Such self-management leads to outcomes measurable by healthcare organizations as well as patients. Warming care should sustain a virtuous cycle of healthier patients who need less expensive care as effective digital engagement tools enable them to manage their care, their way.
*The Healing Study was conducted by Cognizant Technology Solutions and ReD Associates over five months in 2017. Researchers used ethnographic methods to immerse themselves in people’s everyday lives, visiting people in their homes, shadowing them at the doctor’s office, taking part in their daily routines. The research team did fieldwork with 30-plus “respondent ecologies” -- gaining insight into the lives not just of individuals but also of those the family members, friends and colleagues around them. Patient recruitment was for the most prevalent and costly conditions. The qualitative research’s insights were validated using a quantitative survey (N=5,068). A subset of the respondents (approximately 1800) answered a more in-depth version of the survey.