Health Road – Patient Engagement Series Part 2: Opportunities (Providers)
Blog by Vishnu Saxena – VP & Business Head – Diaspark Healthcare
I have lived in a Provider environment since I gained consciousness (my early childhood days) until I left home to join an Engineering school. The reason being the grandson and son of great Physicians. My late grandfather after being retired from a government hospital, started practicing medicine at home clinic while my father was in a medical school and later on he joined as well. He still practices medicine there. I grew up watching variety of patients on a daily basis (all the time: between 9 – 1 and 3 – 6 regular clinic time; patients coming in late evening, mid night, early morning, you name the hour). I have seen and learnt at 1st degree, how profound Physician – Patient relations are and what Patient Engagement really means for a Physician even when there was no such term “invented” or not even anyone had thought of it and none of these technologies existed. As I spent a long period of time with great Physicians at home besides being into Healthcare IT business over the last 5 years (which in fact happened accidentally and now I’m very deep into it) and when I think about PE in Provider settings – I realize Patient Engagement was always there in the hearts of both – Physicians and Patients. Though it was not practiced as a philosophy and there was no technology to make it happen yet it was not a new thing. Physicians always knew the importance of Engagement and having patients motivated to be in charge of their own care and wellness whether it was 34 years back, now or in future. With or without technology. Thanks to Healthcare reform which not only mandated but also categorically triggered Providers to embrace and foster the Patient engagement philosophy and culture as one of the key means to improve quality of care and reduce overall healthcare delivery cost.
So, I am very much close and into Patient Engagement and always excited to write about it. Let me take you to my version of Patient Engagement in those days ( Really..? Was it there anyway!) and then fast forward to present days of Patient Engagement in Provider settings. Going back to memory lane – I feel that Patients were highly engaged with their Physician then (when the technology didn’t existed) and were responsible towards their medication adherence. There was absolutely no technology and far less number of Physicians, Pharmacies were available. There was absolutely no concept of Payer (I guess if you asked this term then, the response would have been, “What did you say..? Did you mean a bank..!”)
These limited resources made patients responsible and motivated to engage with the Physicians towards their medication course. Making a mistake was not an option and it costed huge if happened (Just a caution – I am not saying that having multiple resources make patients not-responsible). Physicians cared deeply about their patients and they were their ONLY source for all the engagements (awareness, advice, what to do/eat etc. during illness and post recovery).
My father also evolved with time and now uses some cool mHealth apps and encourages his patients to follow as well. But Patient portal for him is still a distant dream. I am working on it…!
Fast forward, for Providers, opportunities to engage Patients in these days (because of innovation in digital health technologies) are simply enormous and there are multiple points and involvement scenarios where Provider can engage “consumers” and be their wellness partner. I see Patient Engagement for Providers across five stages- 1- Inform me, 2- Engage me, 3- Empower me, 4- Partner with me, 5- Support my e-community . This is an incremental – structured approach to educate patients and simultaneously empower them with tools that facilitate stronger collaboration with care providers.
Patient Engagement is not a silo activity for Providers. It is all about collaboration and management of Healthcare information regardless of the clinical care setting. Patient portal, Care portal, hundreds of mHealth apps (white label) are great tools that can timely share information between providers and patients for concerns like symptoms, conditions, preferences, clinical advice, self-management, medication adherence, compliance related alerts and choice in treatment options. Generally, patients are very poor in post visit recollection and often forgets taking pills on time. A simple pill reminder application that engages patients and drives their adherence towards medication would be very helpful. mHealth apps such as care4today from J&J is one great example. Providers can be extremely instrumental in informing and educating a specific Patient Population about disease prevention, post discharge instructions which can significantly help reduce readmission rates.
Patients do have a wish to participate in the management of their own health but the challenge is what are the steps a provider and healthcare delivery machine as a whole should take to facilitate and encourage patient engagement.I have seen it, experienced it and strongly believe that Engage the patient even before he reaches to a Physician’s office/waiting room; Provide them a Patient Portal or a mobile health application, where they can schedule an online appointment, see their Lab results, get disease/surgery specific education, prepare and complete the necessary documentation that can save a lot of time and make their visit a better Patient experience. Then, start with the lobby/ patient lounge/ waiting room since this is often the first point of interaction for Patients with the health system. This is first point of engagement where personalized health education can be provided with the intention of preparing patients for a much more meaningful encounter, access to frequently asked questions, patient success stories, attractive health related offers and incentives ( kind of reward programs) besides provide exposure to Patient portal and other digital health stuff (apps, devices etc. for those who don’t know or have not accessed it yet – 1st timers)I see Telehealth also plays a great role in engaging Patients. Though Telehealth is newer disrupter care delivery model but it engages patients where they are and when they need it. What better engagement could be..?
A leading Telehealth software provider did a survey (it had an impressive presence in ATA15) in which 70% of the respondents said that they would prefer an online video visit to obtain a prescription than visiting a physician. With 20 days as an average wait time to see a physician here besides so much of logistics issue, sometimes people don’t go to see a Physician altogether and rush to ER when the problem becomes severe. In my opinion, Telehealth is one of the best driver to achieve Patient Engagement objective while bringing down the cost significantly. I will again write on this topic sometime soon.
Providers are leveraging wearable health devices and mobile applications to empower patients in personalized medicine, wellness levels besides providing timely information to actively manage their conditions. Mobile applications focused on personal wellness and medical engagement are empowering patients like never before. Mix of Providers (and payers) are estimated to have developed and used over 35,000 mobile health apps in order to improve patient engagement. mHealth apps and wearable medical devices potentially empower patients to monitor their own health from home and take proactive steps to manage their disease. For example: vital sign monitoring, measuring calorie intake, monitoring fitness levels and sleep patterns. Typical implants such as glucose sensors and drug delivery systems implanted in the patient would facilitate improved medication compliance and checks on metabolic activity. Further, medical devices implanted into diseased organs could report biological data to physicians to facilitate real-time disease treatment.Partner with me: Social discussion groups and apps (e.g.- patientslikeme) are giving a lot of hope and relevant information in the hands of patients and partnering with them into their wellness journey. Providers can enable patients specific social groups that can be tailored to any patient’s situation that will readily fill information and self-management gaps that are currently provided only via an official clinical encounter. Providers are partnering with Patients with chonic conditions inside their homes as homes are becoming “smarter”. A patient’s home with remote monitoring solutions makes it possible for patients to remain connected to the physician/care manager and manage their wellness and recovery through constant vigilance mechanisms. Post discharge, Providers are sending patient’s home with an array of digital health devices including a smart phone, wireless sensors, blue tooth enabled medical devices, webcams that are integrated into a single system facilitating proactive and responsive patient health monitoring while reducing hospitalization costs. A caregiver can monitor high risk patient’s vitals, dietary, medication adherence, telemedicine needs and personalized wellness resulting significant reduction in re-hospitalization.
Support my e-Community:
Providers are now gearing-up to engage patient populations through their Population health management programs. A simple community outreach programs such as – keeping patients involved in local blood drives , epidemic warnings, education material for individual disease/treatment would be a very healthy contribution to support local communities. With the “baby-boomer” generation reaching retirement, the financial burden of medical care for such large population is straining the budgets of many providers. To help reduce such burdens, the providers can proactively support local communities to enable patients stay informed and allow them to take their healthcare decisions. With last available data healthcare expenditures in the US is totaled to $1.35 trillion. Super utilizers – the top 1 percent of the population accounted for nearly 23 percent of total healthcare expenditures with an average cost of $97,956 per year per patient while top 5 percent of the population accounted for 50 percent of total expenditures with an average annual expenditure of $43,058 per patient. The five most costly medical conditions contributing to above are- heart disease, trauma-related disorders, cancer, mental disorders and chronic obstructive pulmonary disease. With effective Patient Engagement by Providers, these numbers have great potential to be brought down.Providers have tremendous opportunity and “moral obligation” to leverage Patient engagement solutions across these 5 stages: Inform – Engage -Empower – Partner – Support my community and the good news is that it is happening and Providers are now starting PE initiatives. I wish if these cool digital health technologies and mobile apps were available then, that would have made life of two physicians at my home and their patients far easier..!Payers next.