Patient engagement: Results from a focus group

In the past, I have found patient engagement to be a delicate topic to broach with healthcare executives because it starts with a recognition of the futility of our healthcare system — a recognition that traditional healthcare services alone are insufficient to dramatically and sustainably improve patient outcomes. That resistance to patient engagement as a tool is becoming less and less widespread.

In early May, at the Becker's Hospital Review Annual Meeting, I convened a focus group of around 30 executives from hospitals and health systems nationwide to help me dig into the strategy role patient engagement plays to help their organizations reduce costs and improve outcomes. (I've written about this series of focus groups previously for Harvard Business Review).

The discussion around patient engagement was lively and passionate. Here are some of the interesting insights that surfaced during the event.

More than ever, patient engagement is a strategic issue
When I asked this focus group whether patient engagement has been elevated to the strategic level at their organizations, not one of the participants said no. The group listed a variety of reasons for this internal promotion of patient engagement, including new competition from consumer-savvy retail companies and the rise of "doctor shopping," innovations from disruptive new technology including secure messaging and telehealth tools, changing consumer expectations around digital technology and, most commonly, the view that engagement will ease the transition to risk-based reimbursements.  

Executives are struggling with how deeply to invest in patient engagement efforts
Despite the belief that engagement should become part of any healthcare organization's strategy, executives are unsure how many resources to throw at outreach and engagement efforts. In fact, despite the elevation of this concept, none of the organizations present had appointed a leader solely responsible for driving patient engagement for their institution. Much of that confusion stems from the ambiguity surrounding the current reimbursement landscape. Patient engagement is most valuable in a fully value-based world, when sustained health (rather than periodic illnesses) is rewarded. But that world is still on the horizon. Making patient engagement pay today can be challenging — although new chronic care management schemes are increasingly paying for remote services. Nonetheless, as one executive put it, "There's no CPT code for patient engagement."

Patient engagement is hampered by the poor state of care coordination
Patients often see a variety of different providers for different conditions, bouncing around in what one executive described as a "smattering of cottage industries." When each provider has their own approach to patient engagement — their own portal, reading materials, etc. — and there is no coordination or overarching narrative, the experience for the patient can be intensely confusing and frustrating. "Patients need a GPS or quarterback, or whatever you want to call it," one executive said. "Patient engagement can't be separated from our industry's larger care coordination problem." There was a palpable level of frustration with this point in the room — feeling trapped is indeed an uncomfortable place.

Patient engagement technology risks worsening health disparities
If affluent, highly educated patients use patient portals at higher rates than the indigent, will that exacerbate health inequality? There's evidence, for example, that Medicaid patients use patient portals at a lower rate than the commercial population. Then there's the whole issue of tailoring digital engagement tools to different populations. "Some of our patients require language translation services, but our portal can't do that," one executive complained. Another shared how some of her systems' lower-income patients buy pre-paid cell phone plans, "so [they] won't hang around on hold waiting for lab results." I pointed out that the cell phone bill remains the most-often-paid bill in the United States — proof that digital technology has penetrated through society. So the potential exists to engage all Americans digitally — the question is how best to target outreach efforts. That leads me to the next insight.

Successful patient engagement requires customer segmentation
There's no "one-size fits all" approach to patient engagement for all populations. Healthcare is local and personal and different segments of the population desire — and will respond to — different means of engagement. Executives at the focus group recognized that they need to catch up with B2C companies in their ability to segment their customers and tailor their products and services accordingly. "We require differential means to approach our patient panel," one executive said. "But the science about how to do that isn't there yet."

Changing patient behavior is always hard — but sometimes fun
Any patient engagement discussion that isn't dripped in hyperbole must acknowledge that driving sustainable behavioral change — particularly when it comes to wellness — is incredibly challenging. But the focus group also spoke about the delight in discovering behavioral tactics and "nudge" methods that actually work. One executive recounted a peer-reviewed study about how people who put pedometers on their dogs are actually more likely to hit activity targets than if they wear the pedometer themselves. Another referred to good old-fashioned engagement in the community as the key — without the fancy technology. Apparently, when we feel responsible for a loved companion's health and the community supports us, we're more likely to make good decisions than when we care for ourselves. "We'll continue to make totally unexpected discoveries that have real impact for our patients," one executive said — an exciting prospect.

Doctors require support to make patient engagement work
Physicians are motivated by helping patients. So they should be a natural audience for patient engagement. After all, most people in the room agreed with the now oft-quoted assertion that "if patient engagement were a drug, it would be a blockbuster and malpractice not to use it." However, as one executive put it, "We need to build in time and bandwidth into physician schedules so they can actually dedicate themselves to it." I pointed out evidence from athenahealth's research department shows digital patient engagement tools — such as secure online messaging, online lab delivery and prescription filling — can actually save practices time and money.

Finding time for physicians is part of a larger imperative of freeing doctors from the burden of repetitive, administrative work to focus on where they can add the most value to the healthcare industry. In our experience, all physicians need is a bit of time to focus on the blockbuster drug of patient engagement — it doesn't take much for them to get hooked.

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