The Future of Patient Engagement: It’s Everyone All the Time

Bob Abrahamson, Chief Marketing Officer pCare

Multiple Touch Points

The July 10 edition of The Keckley Report addressed The Five Most Important Questions Hospitals must Answer in Planning for the Future. Question 2 asked if social determinants are a core strategy or distraction. Paul Keckley closed this section by proposing “Yesterday, SDOH was about risk factors; today, it’s about low-income populations who lack insurance; tomorrow, it’s everyone.” For some reason, that framework resonated strongly with me. I started to see how the “yesterday, today, tomorrow” framework applies to the patient engagement.

Patient Engagement Yesterday

Yesterday, patient engagement was measured by adherence. Did the patient change their diet, take their meds, do their rehab exercises. Little attention was paid to distinct patient desires, needs, and abilities. If the patient followed doctor’s order, they were engaged. 

But the concept evolved as patient centricity evolved. Theories such as the Transtheoretical Model of Behavior Change and the Patient Activation Measure offered a more refined look at understanding health self-management. One size does not fit all, and providers needed to understand a patient’s mindset and abilities to help them effectively get “engaged” with their self-care. And engagement is not a straight line.

Patient Engagement Today

Today, patient engagement is more expansive and rooted in collaboration. In terms of expansiveness, a KLAS sponsored summit outlined a framework that in part outlines engagement touchpoints across the care continuum. It’s generally understood today that patient engagement can start at provider search or symptom checking and spans through chronic care management and all points in between from booking appointments to managing prescriptions and payments.

Collaboration takes into consideration how the patient works with other stakeholders including care partners (friends and families) and providers (doctors, nurses, care navigators) to coordinate on better outcomes AND experience. And it considers how technology can be leveraged by the various players to facilitate engagement that matches personal preferences.

We see an explosion of engagement technology spanning digital front doors (chatbot my symptoms, book an appointment), telehealth, patient facing technologies at the point of care, mobile care journeys to facilitate engagement across the continuum, online bill payment and more. And while the stated goal is to provide a cohesive experience (digital and in-person), we are not there yet. There is still a plethora of point solutions in play. And coming out of the pandemic with the great resignation and economic headwinds, health systems’ first priority is financial stability and staffing. Layer on top of this the relatively nominal progress we’ve made transitioning to value-based care, and it’s understood that we’ve yet to reach an optimal patient engagement paradigm.

Patient Engagement Tomorrow

Tomorrow, I believe a value-based care (VBC) system is inevitable. In time, the favorable economics and care outcomes delivered in a VBC system will prevail. I also believe the cultural roadblocks that have stood in the way of wide adoption of a value-based model i.e. individualism and interestingly tribalism, will ultimately give way to a sense of community.  This could be spawned by people coming together in the face of growing climate driven catastrophes (fires, tornadoes, floods, etc). I’m not predicting environmental apocalypse but I do believe climate change will drive us to work together with a common sense of purpose in much the same way geopolitical conflicts did in the past. Maybe VBC will emerge for other reasons, but I do believe it will define the payment models which drive the system.

What does engagement look like in a Value-Based System? It impacts everyone all the time because VBC is rooted in a population health approach as opposed to caring for the sick – either episodically or chronically. If you look at the above reference framework from KLAS, it is rooted around moments of (sick) care as defined by pre-visit, during-visit, post-visit. It makes sense on where we stand today. But with VBC, while the capabilities outlined will still occur (booking appointments, patient-doctor communication, filling prescription, etc), the model will not be visit or sick-centric.

For the wellness paradigm to thrive, VBC needs to create continuous, harmonious, integrated engagement amongst all stakeholders across the care continuum. Engagement of health will be a team sport that is woven into the tapestry of people’s lives. It’s not about getting better but staying healthy. In the Declaration for Human Experience, The Beryl Institute notes “ . . we can create a more effective, responsive, and equitable healthcare system that results in better experiences and outcomes for patients of all backgrounds, a more supportive, energizing and collaborative environment for healthcare professionals and healthier communities that break down barriers to care.” In effect, engagement in health involves all stakeholders and becomes part of our daily lives. Patient or health engagement will be happening everywhere and all the time. This is the future state we need to work toward.

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