The Patient Engagement Wave
Engaging patients is at the foundation of nearly every current trend in healthcare and one of the most important components of health care reform. Health Affairs defines patient engagement as a “concept that combines patient activation (patient’s knowledge, skills, ability, and willingness to manage his or her own health or care) with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly.” 
EHRs and Patient Engagement
The EHR Incentive/Meaningful Use program lists patient engagement as one of its core tenets by developing measures to ensure patient accessibility to their health records. And with the introduction of smartphone healthcare apps and mobile fitness and health monitoring devices, the wave of patient engagement or consumerism in health care is growing. Access to these devices and the internet to find out more about managing their health has led to patients’ increasing desire to communicate and receive personal health data from their providers wherever and whenever they choose.
A 2013 Health Affairs article stated a “growing body of evidence demonstrates that patients who are more actively involved in their health care experience better health outcomes and incur lower costs.” The Robert Wood Johnson Foundation has reported that patients not engaged in their own care can cost 21 percent more than “highly engaged patients.” In truth, it all centers on each point of the healthcare triangle: reducing costs, improving outcomes, and better engaging patients. The reality is that the first two are inherently tied to the third.
ACOs, PCMH, etc and Patient Engagement
In addition to the EHR program, new payment and delivery models, such as risk-based contracts, Patient-Centered Medical Homes and Accountable Care Organizations are springing up across the country – all programs designed to lower health costs and provide patient accessible quality healthcare. By taking on risk with bundled payments, providers must be able to affect patients’ behavior after they leave the office, or they will exceed the reimbursement rate for their care.
Medical practice has been gradually increasing its focus during the past decade from a more authoritative/paternal model to a more collaborative/consumer model. Hospitals, doctors and public-health officials are calling upon patients as consumers to become more active in their own care decisions by keeping track of their medical data, seeking preventive care and staying on top of chronic conditions.
Consumers now have a greater personal financial state in their healthcare as well. The public health insurance marketplace, created by the Affordable Care Act, as well as the private insurance marketplace, enable consumers to annually choose from multiple health plan options and provider networks. But understanding these health plan options is complex and demands much more consumer evaluation of costs, what they are getting for the cost of their coverage and if their preferred providers are in the plan’s network.
In order to accommodate this patient interest and engagement in their healthcare, medical practices must implement strategies to engage patients and include them and their families in decisions about their health.
Technology will be part of these strategies. One stategy is to make sure people have easy access to their medical records online. Reading and understanding one’s own health record enables patients to have more informed conversations with their physicians. With all the new fitness and health apps, consumers can now plug in data from their own medical record, such as generating a fitness regimen that takes into account a knee injury, weight and blood pressure.
Web-based patient portals have been installed in many health care institutions allowing patients to book appointments, obtain referrals, request prescriptions, pay their medical bills, obtain lab results, radiology reports, physicians’ notes and see their own medical records. Many systems allow patients to check their data to make sure it’s accurate.
It has been suggested that organizations should strongly consider open systems that can integrate with their current financial and clinical system, but also capture data from unaffiliated entities and patients. “Providers that are first to integrate the various information sources – from pharmacists, ambulatory centers, clinics, and so forth – will find themselves central to a consumer’s health and will be rewarded with increased loyalty and more effective interactions with patients.”
All technology must be simple to use and understand. The portals should have a dedicated mobile application that allows users to access their PHI and perform common tasks such as appointment scheduling or requesting a prescription renewal.
Yet, according to a survey from consulting firm Technology Advice, 40 percent of people who had seen a primary care physician within the last year did not know whether that doctor offered a portal. Only 9 percent said their physicians followed up with them after the visit via a portal, and 48 percent stated there was no follow-up. Certainly providers must provide patient education concerning the availability and usage of patient portals and other devices offered by the provider or institution.
Health Literacy and Patient Engagement
However, significant barriers exist for many patients to access and understand their patient health information. The National Assessment of Adult Literacy (NAAL), which measures the health literacy of adults living in the United States, reported that only 12% of the population is considered proficient in healthcare literacy. A patient’s degree of engagement may be affected by such factors as cultural differences, sex, age, and education.
So, it is not only important for healthcare entities to provide access to their patients’ health information but providers may need to understand that specific competencies, such as language skills or an awareness and understanding of religious beliefs may be required on the part of physicians to effectively engage patients with diverse cultural backgrounds and socioeconomic status. Physicians should be ready to take on the role of educator. Shared-decision making offers an option for better educating patients about their conditions. Participation in the EHR meaningful use program assists physicians because its requirements include engaging patients and families in decision making and providing them with their health records and clinical summaries they can view and share with other physicians. The requirements also specify that a percentage of patients must actually use the information, which gives physicians a reason to encourage them to do so.
Besides taking the time to review findings and outcomes of tests, physicians must understand where the patient is coming from and what they want to do. The patient needs to be engaged with personalized information and advice but challenges remain in figuring out two way communications will work through portals and other electronic means.
Healthcare organizations that install technology and provide strategies and workflows designed to assist patients in understanding their health care and condition will be competitive and will survive in this new health care age. The time is now to jump on the patient engagement bandwagon if you have not already done so.
Here are some resources that can be used by physicians and/or recommended to their patients.
The Blue Button
The Blue Button first appeared in 2010 on a patient portal where veterans could log-in and download their health records. Since then, many other organizations including physicians, hospitals, health insurance plans, retail pharmacies, labs, etc. have implemented Blue Button to make it easier for people to access their vital health information online.
Blue Button allows patients to see, download and keep their personal health data by clicking the “Blue Button” on a secure Internet site. Patients can then choose to share their data with their physicians or family members or make it available if emergency treatment is needed. Blue Button downloads are delivered in text files that can be downloaded, read, stored and printed on any computer without special software. Patients can also authorize use of a Blue Button transfer of their medical data from a treating physician to another medical provider.
In the Spring of 2013, The Centers for Medicare and Medicaid Services launched the Blue Button Connector which allows patients to download their health information to their computer or their mobile device.
Medicare beneficiaries can also view and download their Medicare claims through the Medicare Blue Button which now covers three years of a patient’s health history, including claims information on services covered under Medicare Parts A and B, and a list of medications that were purchased under Part D. This service is also available to Veteran’s services and the Indian Health Service.
National Coordinator for Health IT Karen DeSalvo announced at the 2014 Consumer Health IT Summit this September that there will soon be a new Blue Button campaign, that’s “gonna really explode.”. A new Blue Button toolkit was also unveiled at the event.
Payers including UnitedHealthcare, Aetna Inc. and Humana Inc. offer a Blue Button link that lets members download personal health records into a single file, and retail pharmacy chains are in various stages of using Blue Button to let customers download prescription histories.
Robert A Wood Johnson Foundation – Patient Engagement Resource Guide
This guide provides a list of patient-friendly materials to help people chose high-quality care, manage their health care conditions, and make informed decisions regarding hospital and emergency care. The guide also provides clinicians with resources to engage patients in their own care and involve them in other aspects of health care delivery.
The article in the Wall Street Journal listed the following two products that providers can recommend to their patients to assist them in monitoring their health.
Partners Health Care – Wellocracy (website to help people review the health trackers and mobile apps on the consumer market.)
Healthwise, Inc. – offers solutions to physicians to share health education solutions, technology, and services with their patients. One of the popular products is “information prescriptions” in the form of a video, brochure or interactive decision tool to help patients deal with a health problem.
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 Health Policy Brief, “Patient Engagement,” Health Affairs, February 14, 2014
 Versel, Neil, “Models of Patient Engagement,” HealthcareIT News, August 22, 2014
 Watson, Zach, “What Every Provider Needs to Know about Patient Engagement,”Technology Advice, May 13, 2014.
 Landro, Laura, “The Health-Care Industry Is Pushing Patients to Help Themselves,” Wall Street Journal Online, June 8, 2014.
 Davenport, Vern, “Is Healthcare Really Ready for Consumerization?” Government IT Health, August 7, 2014. (This is a quote in the article from McKinsey & Company from a 2010 article in the American Journal of Managed Care.)
 Dvorak, Katie, “DeSalvo Touts Iinteroperability, Blue Button at Consumer Health IT Summit.” Fierce Health IT, September 15, 2014.
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