We recently wrote about patient engagement and the leading role that technology, and mobile technology specifically, is playing in helping this approach to telehealth come to fruition.  Patient engagement has been increasingly singled out as providing perhaps the best chance for improving patient care quality while controlling costs.

While it’s easy to take the “bully pulpit” approach:  dictating healthy habits through subscriber communications,  sharing guidelines through employee newsletters,  establishing mandatory behavioral modification classes, these approaches rarely work for the long term.   They may not be enough to change patient outcomes, and resulting HCAHPs scores. 

It’s really about engaging the patient, using ubiquitous wireless mobile technology and well-designed tools and techniques to inform, engage, measure, communicate, incent, and support patients in participating in their own health care management.

Engaging patients makes real economic sense, and has the potential to deliver more positive outcomes for more patients.

  • Engaged patients are far more likely to follow discharge instructions provided by their physician.  Smartphones and tablets can enable early, continuous access to patient electronic health records (EHR) and condition-specific care data, especially among patients with cognitive challenges.
  • Engaged patients are able to research their own chronic conditions, often using wireless mobile devices to join social media networks designed and operated specifically to offer support, medical information, and instructional content.
  • Patients who take an active interest in managing chronic conditions can take advantage of social network features like emotional support circles, peer alerts, calendaring, etc. to build a locus of support for battling chronic conditions and addictive behaviors.
  • Wellness-oriented social communities can be instrumental in establishing an understanding of health, and building and supporting healthy habits, can be a significant part of a long-term solution to ensuring highly productive employees, and lowered incidences of acute healthcare needs.

Why It Matters

Health Affairs editor-in-chief Susan Dentzer set the tone by noting patient engagement has been called “the blockbuster drug of the century” for its potential to improve the quality of care and lower costs.

Patient engagement is also more important than ever for two, very expensive reasons. The first is the ever-more-pronounced shift in the burden of disease among the U.S. population from acute to chronic conditions.

  • 148 million Americans, or roughly half the population, suffer from asthma, depression, diabetes or some other chronic disease.
  • Perhaps more important is that they now account for three of every four dollars spent on health care. Chronic diseases have become the leading cause of death and disability.

CDC figures cited in “Triple Solution for a Healthier America” put it starkly:  “Chronic diseases are crushing health care.” Quite simply, chronic disease cannot be successfully fought without enlisting the patient in the battle. When many providers hear, “Patient engagement,” they think, “Lifestyle changes and medication compliance.”   But, it’s much more than that.

Meaningful Use Standard 2, a component of the Affordable Care Act, is forcing medicine to enable access to via technology-focused strategies. When Stage 2 of the federal electronic health records (EHR) incentive program known as Meaningful Use begins in October (for hospitals) and in January 2014 (for physicians), compliance for the first time will not be completely in the hands of providers.

  • Stage 2 rules require participants to give at least half of their patients the ability to view and download their own medical records through online portals or personal health records, up from 10 percent in Stage 1.
  • But more significantly, 5 percent of patients actually have to log in to those portals or healthcare providers will lose out on Medicare and Medicaid bonus payments.

The 5 percent figure may not sound like much, particularly because an earlier proposal called for the threshold to be 10 percent, but it has a lot of providers scrambling.

The new requirement, for the first time, makes hospitals, health systems and medical practices responsible for engaging patients in their own care or risk losing extra revenue.  Hospitals are even now being penalized not engaging patients, and in the resulting readmissions that an inability to manage a chronic condition can lead to.


Social Engagement Models in Participatory HealthCare

In the last several years, the concept of social engagement has gained considerable ground as a component of participatory medicine.   Gaining the trust and ongoing involvement of patients in their own healthcare is at the core of the telehealth or mHealth movement.

While conventional social networks like FaceBook, LinkedIn, and others are open to all, healthcare social networks typically are controlled access, with some form of vetting, a physician’s prescription, or membership in an insurer’s network required for access.  For purposes of this blog post, we’ve identified four common types of social engagement models.


Chronic Condition Management Communities

There are literally thousands of condition-specific social communities available today.  Given the dramatic increases in the incidence of juvenile and adult-onset diabetes, diabetes-related social engagement networks are most numerous.   One of the largest collections of condition-specific communities is in www.patientslikeme.com.  Patients, typically anonymous, are able to list diagnosis, symptoms, and treatments.  A mood setting is useful for communicating mental condition, which in turn alerts the patient’s network to offer support.  The ability to communicate using wirelessly enables patients to have access to their network at any time, with support readily available.

www.patientslikeme.com is able to collect and compile much of the data offered by patients, such as diagnosis data, perceived efficacy of treatments, symptoms, and progress of the disease.  The data, in anonymized form, is collected and analyzed to assess impact of treatments and network support .  See the article in Nature Biotechnology about studies underway.


Behavioral Modification Communities

There are several social communities that are dedicated to modifying negative behaviors, many of which revolve substance abuse, emotional conditions, such as depression, and other antisocial activities. These often are prescribed by a primary care physician to provide patients with a level of mutual peer support and coping mechanisms that isn’t normally possible on a daily basis.

Wireless connectivity is especially critical when patients find themselves in an environment where “trigger” for the negative behaviors exist, and there is a temptation to engage in destructive behaviors.  The www.onehealth.com community employs a peer alert mechanism that employs emoticons to underscore how patients are feeling; patients can appeal to their support network for avoidance support or to engage a coping strategy with their support network.


Wellness and Lifestyle Networks

A significant hit at the 2013 CES, many insurers and providers are encouraging their clients or employees to join as way of addressing lifestyle-oriented issues like high blood pressure or overweight that may be symptomatic of poor diet, tobacco use, or lack of exercise.

Employing the “carrot” of a connective, supportive social network with the “stick” of personally-stated health, dietary, or fitness goals, these wellness and lifestyle networks are oriented toward the adoption of a healthy lifestyle, reducing poor health choices that often lead to illness and hospitalization.  The real payoff is in lower employee health care premiums and increased productivity.

Wellness communities, like www.keas.com or www.cafewell.com, are garnering support among insurers and employers, creating a pleasant, participative atmosphere to acquire healthy habits, while encouraging and supporting these behaviors with goal-setting games and “achievement badges” that reward positive behavior.    The up-front investment is small in comparison to the possible cost of medical treatment or hospitalization down the road.


It’s Proving to be a Good Investment

  • Average health care costs — including inpatient, outpatient, primary, and specialty care, along with lab and medication expenses — were 8 percent higher in the least activated patients (who scored a 25/100 or under) as compared to those who were most actively engaged (75/100 or above).
    Attribution: kdonovan_gaddy
  • A new study lends credence to return-on-investment (ROI) claims. In the February issue of Health Affairs, a meta-analysis suggests that medical costs fall by $3.27 and absenteeism costs fall by $2.73 for every dollar spent on employee wellness programs.
  • Patients who were most skilled at managing their day-to-day health and most knowledgeable about their health care had significantly lower health care costs than more passive patients.

There are a very wide assortment of wellness communities out there, many of them fully integrated with social components, tracking and reporting tools, gamification strategies, and more.

The growing investment in making patients healthy, monitoring their healthy behaviors, and maintaining long-term health management will a significant contributor to keeping the Affordable Care Act on track to fulfill its promise of creating more effective and more affordable healthcare for the US taxpayer.

Original Author: Jeremy Eckhous