Engaging patients: Health care’s new ‘holy grail’

It has been called “the blockbuster drug of the century,” the holy grail of health care and the next great frontier in the search for a more responsive and cost-effective healthcare system. But is it a truly achievable goal, and will it really transform the way health care is delivered in the United States?

We’re talking about the health system’s vast, but still halting, movement to engage and empower patients. The ability and willingness of patients to engage more fully in their own health care and disease prevention is the lynchpin of the health system’s gradual but inexorable embrace of patient-centered care, and advocates say it will transform the relationship between patients and their clinicians — and, along with it, the way health care is delivered in America.

“Patient engagement is at the forefront of today’s health reform debate to the extent that it has even been called the next blockbuster drug,” said Wendy Everett, president of NEHI, the nonprofit health policy and advocacy group formerly known as the New England Health Initiative. “And as the system begins to focus on improving value and controlling costs — and as providers are increasingly held accountable for patient outcomes — how patients are engaged, empowered and activated will all play a critical role.”

Kristin Carman, a VP at the American Institutes for Research, describes the engagement process as “patients, families, their representatives and health professionals working in active partnership at various levels across the healthcare system to improve health and health care.”

Writing for Medical Home News, Sara Guastello, a director with the influential health consultancy organization Planetree, defines patient-centered care as “care delivered in a way that incorporates the patient’s perspective, is organized around his or her experiences and values, and is responsive to needs that may change over time.”

“For the vast potential of patient-centered care as a crucial lynchpin for healthcare quality to be realized, we must invite patients in to be a part of the discussion … and to be a part of developing the solutions for achieving that aim,” Guastello said.

“Patients with the skills and confidence to be actively engaged in their health care,” Guastello said in a conference earlier this year, are less likely to require an emergency room visit or hospital stay; “more likely to adhere to treatment plans;” more likely to adopt healthy behaviors and achieve better health outcomes; and less costly to insurers and health plan payers. That makes patient-centered care and a full regard by health providers for the patient experience “nothing less than a quality and business imperative,” according to Planetree.

How much progress has the nation’s health provider community made in adopting the new, more patient-centric and patient-engaged model of care? Not nearly enough, say many providers.

Among them is physician Robert Mandel, CEO of Health Dialog, a provider of health management services. “I don’t think we’re very far along on rewiring [the healthcare system],” he noted. “Traditionally, the health system has taken [patients’ sense of] control away. It’s been a very lopsided relationship that’s created this sense of helplessness among patients.”

The healthcare industry, Mandel noted at an Oct. 3 conference on patient engagement hosted by NEHI in Boston, “needs to think of itself in a much broader way. It’s really about individual well-being and how we as clinicians contribute to people’s well-being in the most effective way possible.”

“This is a continuous dialogue for your entire life, about how you optimize your well-being based on a whole host of things — your environment, your genetics, your behaviors,” Mandel added. “It’s not just about self-management of a condition. It’s about how you manage your health throughout your life, and how we [as clinicians] support that.”

In one respect, the demand by patients to share more completely in their own healthcare decisions could be seen as just the latest stage on which the Baby Boom, Gen X and Gen Y generations are acting out their lifelong determination to exert their influence and individuality. But the rise of the engaged and more informed patient is also gaining traction among health providers at all levels. Among the reasons:

1. It works. According to studies, patients who are encouraged to participate fully in their own treatment plans by empathetic doctors, nurses and pharmacists show demonstrable improvements in outcomes;


2. Patients who become true partners in their own health — including adopting healthier behaviors and researching their own conditions and treatments — can help ease the practice loads on time-pressured, overbooked primary-care physicians; and


3. Patients effectively enlisted in their own care are more likely to adhere to their medication andtreatment regimens.

Fueling the drive to engage patients as partners is the urgent need to curb the nation’s runaway health costs. Citing federal statistics, Planetree’s Guastello reports that 24.7% of Medicare patients are readmitted to hospitals within 30 days of discharge, costing taxpayers an extra $17 billion annually. And with health reform gradually shifting hospital reimbursements to penalize those with excessive readmission rates and reward providers for measurable improvements in patient outcomes, the need for a paradigm change in health delivery has only increased.

Indeed, increasing transparency about the true cost of care will help drive patients to become more engaged in their treatment, experts say. “At the very least, it stops the conversation and focuses on how important is this test, and what are we going to do with the results?” Diane Gilworth, a geriatric nurse practitioner and director of clinical care at Dovetail Health, said.

“It’s going to engage a new kind of conversation when we begin to infuse costs,” she added. Health practitioners, she said, have “always been worried about having that conversation, because we don’t want to be in a situation where cost influences our choices. But the reality is we have to … begin to have that conversation.”

“We’re not going to solve health care’s problems unless we fundamentally restructure the way we see patients,” Gilworth said. “We need more time to have trusting, vulnerable, trust-based relationships so things don’t fall through the cracks, and that’s going to take an entire change in the way we pay for health care.”

According to the National eHealth Collaborative, the overarching goal is to develop “more efficient and effective models of care that treat patients as partners instead of just customers.” To that end, the collaborative devoted nearly a year to developing a Patient Engagement  Framework — based on input from more than 150 experts in health care, technology and human behavior — “to guide healthcare organizations in developing and strengthening their patient engagement strategies through the use of e-health tools and resources.”

“It provides a basic framework” for patients and providers, beginning with “informing, navigating the system, finding a provider, etc.,” said Kate Berry, CEO of the National e-Health Collaborative. The framework addresses the whole continuum of care between clinicians and empowered, informed patients, including such issues as