There is, without a doubt, a growing consensus among providers and many Health IT innovators that user engagement, physician engagement and patient engagement are becoming critically important as we shift payment models. There are growing hints that we’ll need new Health IT architectures to support them.
Part of all the engagement talk, I think, is that engagement is tightly linked to experience. Engagement and experience are in some ways synonymous: We engage with things that drive positive experiences.
In contrast, we are repelled by those products, services and people that give us negative experience (and there are plenty of those in Health IT).
As patient experience is one third of the triple aim, and a driving force behind Meaningful Use and payment reform, we’ll all need to be experts and developing engagement through positive experiences. Behavioral science will be a big part of a new, post-EHR era of Health IT.
Key takeaway from HealthDataPalooza: the realization that highly engaged patients may be the one measure that is most tightly aligned with the triple aim of better patient experience, better outcomes and lower costs. Higher engagement means less risk for all involved. If you can get engagement, you can drive the entire triple aim. This could be called the engagement cascade. Higher engagement of patients in their care will propagate into better experiences, better outcomes and lower costs. Engagement is the triple-aim linchpin.
I was deeply encouraged that these topics are now on the radar screen of providers, nowhere more apparent than on Atul Gawande’s brilliant panel at the HDI Forum: Accountable Care Organizations: Using Data to Deliver Patient Centered Care and Improve Population Health While Lowering Costs. I highly recommend watching the sessions if you are planning on selling solutions into ACOs.
Yet, while there is growing recognition of the importance of engagement and experience in delivering effective ACOs and the triple aim, there was far more darkness and befuddlement among providers. This is new territory and they had many questions. Some of the questions that came up: How can we engage with patients? Do we want to engage with patients? Do we want to give them their damn data? Can we? Will they go somewhere else if they have their data? Is it a strategic asset? Is this part of quality assurance internally, or is it something different?
I only wish that the provider panelists on ACOs had been at some of the HealthCa.mp sessions on engagement and Do-It-Yourself (DIY) health care on Monday at the Kaiser Center for Total Health.
I had the treat of talking with some of the people and companies who are getting serious about engagement, including Avado, PrivatePractice, Sapient and Massive Health. Out of a dark night sky of darkness in this area I was given hope by the stars of patient engagement that were shining through. There are a growing number of patient-centered Health IT providers that are really starting to “get” this idea. It even appears that there’s an emerging market. PrivatePractice has captured 25% of the certified midwives market, and they share all their data and decisions to get them engaged in the process. Patients can revisit their shared decisions.
The panelists would have found (and perhaps have been made a bit uncomfortable) among the conversations at HealthCa.mp the concept that drives engagement: patient goals.
Patient goals are the dark matter of health care. It’s the stuff that holds the whole health care universe together, yet is rarely observed and ever more rarely considered. The goals we each have as individuals drive many of our decisions in health care and, in fact, drive our daily health, yet how often is our provider aware of our goals? We need our goals tied to our choices. We need to shorten those feedback loops.
All health decisions happen in a context of goals and where we want to arrive. Health is a vehicle to help us achieve these goals, yet rarely are providers aware of these goals. How can we be coached if our coach doesn’t even know what sport we’re competing in?
Key takeaway: One of the best ways to get people engaged is to focus on their goals and how their decisions (health care and others) impact their goals. And focusing on their goals will likely also reduce costs.
I came away from the sessions and several conversations with those leading the charge, people like Brynne Potter, co-founder of Private Practice, believing a large part of engagement means getting on a path toward a goal (sometimes artificial as in games, other times life and health goals).
It says something that one of the most successful examples of patient engagement technology exists to support midwives.
I’m not sure traditional providers or even ACOs are up to the task. It doesn’t seem to be in the DNA of a problem-focused industry, but I’m hopeful new incentives will shift my thinking.
Medicine today is akin to car mechanics. There’s a problem, a case. It needs to be solved. All of medical training is based on this problem-based approach. Grand rounds, Tumor Board, Case presentations. Problem, problem, treatment.
But what we need are navigators, or tour guides. When we move into real cost reduction, we have to reach the folks who aren’t just responsible for keeping the vehicle running, but getting it to where it needs to go, a wedding, a job, caring for kids. We all have different things we need to get done, different goals. We need a Getting Things Done (GTD) for health care, a goal-driven approach to patient management.
Right now, patients don’t have a map, they might know what they want, but they don’t really know how to get there (no accident that Avado describes their product as a GPS for health care). Once in a while a patient can ask for directions at the crossroads of health, such as clinic visits, but they remain in many ways a bystander in their own journey. It just remains unclear whether traditional providers, care coordinators or some new role will become the experts at engagement and new skills like cognitive and behavioral science.
In future posts, I’ll explore some of the different, yet intertwined approaches to engagement and goal development in health IT, including gamification, user experience design, participatory architectures, GTD and shared decision making, and how they can affect the economics of health care.
All of these emerging forces together, all focused on goal-centered principles, will provide some powerful tools to keep patients on their path and achieve the triple aim of care experience, quality and price. It will make for an interesting journey, hopeful arriving at the triple aim.