It seems like everyone is talking about patient and family engagement. But providing effective patient engagement that achieves better, more cost-effective outcomes can be a challenge.
Patient engagement – ongoing and constructive dialog between the patient, patient’s family and provider with the aim of improving the patient’s overall health – is a cornerstone of several of the Centers for Medicare and Medicaid Services’ (CMS) current initiatives, including Patient Centered Medical Homes (PCMH) and Stage 2 of Meaningful Use.
Why engagement matters
As the PCMH model becomes more widely used, it is increasingly important to include the patient’s voice. Patients who are engaged with their health care providers and can communicate easily regarding his or her care, can be expected to achieve better outcomes and have higher levels of satisfaction with their providers. A study conducted by the National Research Corporation shows a direct correlation between patient experience and an organization’s reputation. According to the study, “hospitals with low patient experience scores are four times more likely to have poor reputation scores.”
There is solid data behind the trend toward increasing patient engagement. A growing body of evidence demonstrates that more actively engaged patients incur lower costs. One study found patients with lower “patient activation scores” (a component of patient engagement) had 21 percent higher health care costs the following year, when compared with patients with higher patient activation scores. A fourth reason for improving patient engagement is the opportunity to access bonus Medicare payments. The CMS requires providers to meet several patient engagement benchmarks to improve the quality of care. Stage 2 of Meaningful Use (MU) Electronic Health Records (EHR) incentive program requires that, for providers to earn bonus Medicare payments, 5 percent of patients must log onto and upload data via a patient portal; more than 50 percent of all patients seen by clinicians must receive timely online access to health information, including diagnostic test results and medication lists; and that more than half of patients receive a clinical summary of his or her office visit within one business day.
How to engage effectively
Providers who want to increase patient engagement must first assess the practice’s current level of engagement as well as the range and type of patients’ engagement habits. Identify what engagement opportunities can be improved and develop a master work plan. Starting with a comprehensive plan for the practice will save time and resources in the long term.
While no provider could operate without the telephone, patient communication has expanded with email and other electronic formats. A patient portal – an online web-based connection that facilitates information sharing and two-way communication in a secure format – is the next step. About 40 percent of office- based physicians currently have a portal through their electronic health records
(EHR) system. If your practice doesn’t, develop a portal or activate it immediately through your EHR system. Cleveland Clinic says its portal is crucial in coaching patients and eliminating unnecessary office visits.
A patient portal allows patients to access his or her personal health information securely and reliably from a personal computer, cell phone or tablet. Overcoming patient resistance to using your patient portal, especially among older, less tech-savvy patients, will be crucial to its success. Research published in the Annals of Family Medicine reports that a practice must both actively promote and integrate portals into routine patient care. Small to medium practices are unlikely to engage in large-scale promotion, however, success has been reported with other, low-cost methods.
Eight small practices that used an “interactive preventive health record (IPHR) were studied for over two years. The IPHR provided patients with personally tailored recommendations and resources for chronic conditions and preventive services. Over 25 percent of patients created an IPHR account. The following methods were credited with the high utilization rate:
Use a team approach to notify and encourage patients about the benefits of the IPHR, not just the physician
Provide the ability to view lab results
Stress the importance of the IPHR for patients with chronic conditions
Customize treatment plans
Include the imprimatur of one’s personal clinician (Online personal health records offered by Internet companies or health plans did not provide this important element of gravitas.)
Cleveland clinic says that allowing patients to log on though the patient portal, view their provider’s schedule and make their own appointments was one of the Clinic’s earliest and most successful changes.
Ongoing patient education ensures both patient satisfaction and ongoing engagement. This component should include active involvement of family members and caregivers. Providing clear and concise written instructions after each visit is important to ensure the best outcome. Cleveland Clinic found that patients want to know two things: what’s going on with them and what’s going to happen next.
Cleveland Clinic is experimenting with a series of pilot projects that allows patients to enter data into their own health records via the portal. The data become part of the clinical workflow and let physicians track patient progress and potentially modify care between visits.
Look for other opportunities to engage patients outside of usual business hours. Modern technology makes this relatively simple and inexpensive for most providers. Social media options such as Facebook, Twitter, YouTube and Instagram are popular and successful ways to educate and message patients. Providers can use these channels to address general health issues and topics
without increasing overhead. The Center for Social Media at the Mayo Clinic reports zero cost for the Mayo Clinic’s social media (Facebook, YouTube and Twitter) and $75 annually for a customized blog. More than 1,300 physicians have joined twitterdoctor.net, a site that bills itself as a directory of the most influential doctors on Twitter. The number is indicative of a new generation of physicians using social media to comment on health and medical issues. Page content may include information on health screenings, patient reminders and instructions,
educational information about diagnosis and treatment options, weight management tips, updates on changes to clinic hours and relevant blog posts. You will be most effective on social media by using plain language and encouraging user interaction.
Mobile device “apps” are increasingly popular with younger, more highly educated urban/suburbanites. An “app” is software designed for mobile devices such as cellphones and tablets that extends the device’s capabilities. Apps are increasingly the standard pathway to connect to the Internet and reflect the broader trend toward mobile computing.
A November 2011, Pew Research Center study reported that 34 percent of adults with a cell phone or tablet computer had downloaded an app. However, having apps is not the same as using apps. Only about two-thirds reported actually using apps; about half of this group use an app on a weekly basis.
Apps that are currently available and being used successfully in clinics include:
Dietary apps: for food education, calorie tracking and weight management
Exercise apps: tracking walking, exercise and activity levels
Health management apps: provide more comprehensive information such as WebMD
Chronic disease management apps: for the management and treatment of a specific condition such as asthma or hypertension.
As technology advances and more data become available, it will be increasingly important to simplify data so patients can understand and easily apply it to his or her daily life. Most patients want to know what to do to help him or herself. Patients are more likely to make positive health changes when they take responsibility for their health and feel invested in health care treatment and services. The more a patient understands, the more likely he or she is to ask questions, learn, and obtain the care that meets his or her specific needs. Providers can encourage this by teaming up with their patients, encouraging and enabling them to take responsibility for their health and quality of life.
1. Davies E. Cleary D. Hearing the patient’s voice? Factors affecting the use of
patient survey data in quality improvement. Quality and Safety in Health Care
2005; 14: 428-432
2. Hibbard J. Greene J. Overton V. Patients With Lower Activation Associated
With Higher Costs. Health Aff Feb. 2013 vol. 32 no. 2 216-222
2. Hibbard J. Greene J. Overton V. Patients With Lower Activation Associated
3. Rowe J. 5 ways Cleveland Clinic improved its patient engagement strategies.
Healthcare IT News Oct. 1, 2013 blog post
4. Hirsch M. Study: Tailored team approach to portal promotion boosts patient
engagement. FierceEMR.com Sep. 15, 2014
5. Purcell K. Pew Research Center Half of adult cell phone owners have apps on
their phones. Pewinternet.org Nov.2, 2011
Dr. Milligan is an Associate Medicalvice president, corporate medical Ddirector
with the Arkansas Foundation for Medical Care.
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