Are you engaged?


This is not a question of marital status but one that underscores a big challenge to improving our healthcare system today.  Are you engaged in your existing care plan or overall wellness plan?  The answer to this question has real consequences that are important to your primary care provider and to your individual health as well.

Patient engagement is a phrase that is embedded into the lexicon of the move from fee for service to pay for value.  The term integrated care references the domain that asks whether or not you as a patient are personally involved in pursuit of an improved clinical outcome through a given episode of care or overall wellness plan.  Practically speaking, are you knowledgeable about the care you are receiving and have a firm grasp of what your role in the plan involves.  For example, are you aware of the importance of taking a specific medication at the prescribed dose and time interval?  Do you know which activities help improve your condition versus worsen it?  Is there a conflict between what you know you should do and what you are challenged to act upon based on socioeconomic or mental challenges that take priority?

Patient engagement is a new solution domain that helps to insure the success of value based care models through the following connected elements:

1)      Patient Activation- At the outset of any new change in care plan, the measurement of how willing and able a patient is to be engaged in his or her care plan is a required step.  In this crucial first step, the patient is asked questions about their knowledge of their condition and how empowered they feel to make a change. The form of the instrument can vary with the two most frequent being a health risk assessment(HRA)  and patient activation measure (PAM)© from Insignia Health.  Having an indication of where on the spectrum between uninterested/unempowered to highly involved/activated provides an opportunity to tailor specific engagement plans for a given patient’s needs.

2)      Shared Decision Making (SDM) – Rather than a care provider telling you what is going to happen, SDM (originally coined by Cathy Charles in 1997) involves the forming of a partnership where each party has a say in the agreed upon care plan.   Increased buy-in or engagement has been shown to occur in several studies with SDM. A related set of capabilities, though different in application, are shared decision aids.  These involve means to compare and contrast different behaviors or specific treatments.  One example of this might be a timeline visualization to show a patient the negative effect of continuing to smoke on their life expectancy as compared to if they were to quit today.

3)      Bi-directional Communication – Meaningful Use has established hurdles for exchange of clinical data to patients through medium including patient portals, secure messaging, or even hard copy printouts of a visit summary with instructions for the patient to follow.  Patient self measurement applications are taking engagement a crucial step forward allowing patients to continually collect and share of a slew of personal data while outside of the clinical setting. Most popular forms of this include vitals monitoring such as blood pressure, blood glucose levels, or weight.  New techniques for measuring patient sentiment information such as mental status or even happiness are promulgating.   Hardware with interfaces to software on PC’s and smartphones are being released to assist in this self-quantification aspect of data gathering which actually extends the clinical setting to everywhere.

4)      System retention and patient satisfaction – Organizations that are accepting risk for the total cost of care for attributed patients now have a vested interest in measuring system retention information which tracks how much care an individual patient receives internal or external to their accountable care organization.  Tracking and trending both frequent patient satisfaction and system retention information in concert with one another helps to show where leakage is occurring and what areas to focus on for improvement (provider bedside manners, improved access, or improved care management interventions).

The solution domain of patient engagement is evolving quickly from a traditional view of secure messaging, online appointment booking and bill pay to one that plays a critical role in the success of value based care delivery. The four pieces above are a representative list of capabilities that patient engagement will embody and we can expect to hear much more about the topic across the healthcare IT industry as more and more provider organizations take on risk-based contracts.


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2 thoughts on “Are you engaged?

  1. Your analysis misses a couple things that are important to engaged patients. For example, what about clinician activation, the measurement of how willing the clinician is to learn about and pursue patient-defined goals, or to review information or research the patient has brought in. Another example would be the ability of the patient to access all the information in THEIR medical record. (Nothing about them without them.)

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