The MCengage conference last week was one of the first national conferences dedicated to patient engagement.
Much to my delight, the conference focused on behavior change rather than technology and tools. There was a lot of attention given to “attention,” if not the need for an Attention War in health care. I learned a lot about what’s being called the “patient journey” that’s not unlike a hero’s journey, and often equally heroic; outcomes are rarely certain.
Some often-repeated words and phrases at the conference:
- feedback loops
- behavioral economics
- behavioral science
- activation energy
Focus on People, Not Tools
Unlike HIMSS13, where much of the talk was about technical solutions to engagement and engagement products, at MCEngage tools were a backdrop to finding real social solutions to winning the hearts, minds and actions of patients. And the word that kept circling back around was “culture.”
Culture was a large part of the story and was described in a variety of contexts:
- the hierarchical, paternalistic culture of medicine built on fee-for-service and a mentality of “just do more — more is more”
- A culture of information scarcity moving to a culture of access in terms of government data, research data and patient access to their own data
- The culture of sickness evolving into a culture of health
- Cultural disparities in care between various ethnic groups
- Cultural norms and beliefs of different patient populations, (e.g., who will care for whom and how)
While there seemed to be consensus on the importance of culture and the need for change, there was less consensus on how to change it. Still, there was some hope that it is possible to change it and the beginnings of a path forward..
Cultural Battles We Can Learn From
The meeting started off by going straight to messaging, attention and culture. Wil Yu gave a talk that involved a spot-on Mad Men reference that was aligned with what I’ve been writing about in the “Engagement Is a Strategy” series, that true patient engagement is about changing behavior.
Yu referenced an episode in Mad Men when the lead character, Don Draper (circa 1965) goes on a picnic with his family. At the end of the picnic they pick up their picnic blanket. Don throws his beer can onto the lawn and they proceed to dump all the trash, paper cups, plates, etc., out onto the lawn of the park, and leave it.
Yu and other speakers highlighted the importance of culture to drive behavior. Yu’s point was that this kind of behavior would be totally unacceptable today. That’s at least partially due to a campaign waged by the Ad Council and the federal government that changed cultural norms. You may recall (if you were around back then) the “Crying Indian” ad for littering with Iron Eyes Cody, or Woodsy Owl’s “Give a hoot, don’t pollute!”, both part of the Keep America Beautiful campaign.
And they worked! Littering is no longer socially acceptable in the United States. By getting people’s attention, and delivering the right messages, culture changed.
So right off the bat, the focus of the conference was on getting attention. Yu was using the analogy to say that we could change the focus of health care toward patient-centered care and healthy vs. unhealthy activities.
My question to Yu was this, “there was no ‘pro-littering’ lobby in the 60s and 70s, but there’s an entire economy built on unhealthy behavior, sedentary lifestyle, pre-packaged foods and pain killers. Is the same kind of change possible in this context?”
My question for Wil: Anti-littering worked great, but there was no pro-littering lobby. How do we fight the anti-health lobby? #MCengage
— Leonard Kish (@leonardkish) June 5, 2013
I seem to recall a proverb that says the definition of a hero is “someone who’s willing to fight even though they know they’ll lose,” and Wil Yu is not even going to consider the chances of success. It’s simply too important not to attempt change when the stakes are this high.
The Patient Perspective
I had a chance to sit down with some early heroes in the fight for more patient-centered care. I was fortunate to be able to ask them about culture in the context of Yu’s talk and what it will take to impact real change. You can see a recording here.
What came across is that it will likely be a long slog of battle, but there’s no more important cause to fight for. Sarah Kucharski’s (aka @afternoonnapper’s) response, “It’s OK to have conflict for what you want.” This was becoming a repeating theme with many people. It’ll be a sustained battle, but one that’s unavoidable.
From the Front Lines
There were several great events and talks at MCEngage. Highlights included Gregg Master‘s panel on “Patient Engagement in an ACO World” that included some great stories and promising reports from the front lines of a value-based health care system. Some sample quotes: “Communicators will be your key to success…storytelling is key,” Lanie W. Abbott, APR, Senior Communications & Outreach from EMHS Population Health Management. Lanie has deep interest in using narratives to improve the patient journey.
For the Pharma perspective, Paul Ewing, Senior Director, Global Digital Planning at Pfizer, talked about patient engagement and the patient journey. He discussed Pfizer supporting patients along their journey, in particular when they were confused about their next steps. Mostly these solutions seemed to be about making sure that people took their medications, which makes sense for a pharma company. My question for Pharma is whether they see patient engagement as more of a threat or an opportunity (it is, after all, a “blockbuster drug”).
While they appear happy to make sure folks refill their prescriptions on time if it’s related to outcomes, they are sensitive to the perceptions that they would be creating incentives for taking meds rather than healthy behaviors. A good way to do that would be to promote programs that lead to measurably better outcomes even if means less pharmaceutical intervention. That would be a good test of commitment to the “other blockbuster”.
There were several innovative startups, but the one that certainly got the most attention was Qpid.me. They do STD status sharing, which has some unique requirements: real-time patient data access, high security, mobility, and possible integration with unique social systems, among others. For such a nuanced, dare I say, “discreet” market area, they seem to have thought things through extremely well. They also have a tag line that is Draper-worthy, “Spread the love, and nothing else.”
Changing Culture to Less is More
I won’t be able to cover all the great presentations, but I encourage readers to look at the Engage YouTube channel for that. I do want to bring attention to the final presentation of the event titled, “Patient-Centered Care — The Right Thing To Do Right” by Victor Montori, MD, an endocrinologist at the Mayo Clinic.
Dr. Motori recently wrote a widely-read and regarded piece in the Wall Street Journal about Minimally Disruptive Medicine. I referenced his line “Less is More” in a recent post on social media for value-based health care orgs as part of the “Engagement Is a Strategy” series. He’s unabashed at calling the present system toxic, and this from a guy at the Mayo Clinic!
Dr. Montori gave one of the best, most energetic health care presentations I’ve seen in a long time. I highly encourage watching it.
Montori’s take is that we tend to collect conditions as we move through life (we’ll all have one or more conditions if we live long enough), and it takes a serious toll. Being human is difficult. Add on a few more chronic conditions and it quickly becomes overwhelming to even the best-equipped patients. Montori brilliantly went through how difficult it might be to get a patient’s attention in diabetes starting around 13 minutes into his talk.
“It’s a part time job,” taking 122 minutes a day on average for diabetes, according to Montori.
Montori also made the case that there needs to be better measures of “the burden of care.” Pay for performance needs to recognize the complexity that’s required to get results when working with complex cases.
Minimally Disruptive Healthcare, according to Montori, requires that we understand patient goals (what 1 year ago I called the “dark matter” of healthcare), the burden of treatment, coordination of care, and comorbidities need to be recognized in care guidelines. Suggesting engagement and coordination as part of the standard of care? Great to see another health leader talking this way.
Montori had few kind words for the health care system. He joked, “if one of you are healthy, it’s possibly because you have had problems accessing the health care system.”
Montori also went into culture. The culture that worries him the most is the culture of health care. “Healthcare is about itself, how do we get bigger, more market share, richer, how can we build that new wing”
He goes on… “we will have the best health care system in the world when it becomes the first health care system that shrinks.”
A Revolution Towards Patient Goals?
During Q and A, I asked Montori where do we go from here? How do we move to this future where patients really do have what’s needed? What could we do to get to that place where context, coordination and engagement are considered parts of patient care?
He gave a curious answer, and one that I wouldn’t have suspected. He said the problem goes to our political system.
I’m paraphrasing his response: “If we can’t fix our political system so that we can enact solutions that work towards us rather than for the companies that support all this unhealthy activity, we’re done. We need a revolution, and revolutions largely come from the ground up, but I’m doing all I can, and I’m here to help”
This had become a recurring theme, the need for people—for patients—to make the changes needed and to start a revolution in health care.
My takeaways from Montori’s talk are that:
1. absolutely, attention is important, but
2. for chronic diseases, engagement and management can be incredibly complex, so we need an adaptive system that can manage patient goals and understand their contexts.
The next morning after Engage concluded, I went to a workshop hosted by the Institute of Medicine focused on childhood obesity. It seemed like a fitting capstone to the week and Montori’s talk, as childhood obesity is where chronic disease often begins.
And here I ran into the “Crying Indian” campaign again. An executive from the Ad Council spoke about what campaigns they’ve been running to halt the spread of childhood obesity, and I’ll discuss what came out of that meeting in an upcoming post. I’ll just say for now that this was more evidence that we’ll need to fight an attention war to combat chronic disease before it starts.
Thanks to MedCity and Chris Seper as well as the Institute of Medicine for hosting such great events.