New payment models reward healthcare systems and providers for improving the health of populations. Providers are understandably concerned about the extent to which they can succeed in such models because so much of patient health is beyond their personal control.
Seventy-five percent of our health dollar is spent on chronic conditions that have everything to do with the choices made by patients, notably diabetes and degenerative joint disease as they relate to obesity. Therefore, engaging patients in the management of their own health is vital to achieving population health improvement.
At a recent national health conference I attended, the speaker asked the audience, “What is the least utilized resource in the American healthcare system?” After a few seconds of silence, as thousands scratched their heads for the answer, the speaker called out, “The Patient!”
Accountable systems and providers will increasingly need to learn how to empower and “activate” patients, rather than encouraging their dependence on the system to provide cures. Similarly, providers and care managers will need to reach out proactively to patients, rather than passively waiting for patients to seek care.
Here are nine key approaches to patient “activation”:1. Charge Patients with the Primary Responsibility for their Own Care
Some patients have never been encouraged to think of their disease as their personal responsibility. Remind them there are some things they can do for themselves that no one else can do for them. For instance, no amount of insulin or other diabetic medication will overcome the effects of excessive eating.2. Encourage Patients to Monitor their Own Conditions
Provide glucometers and blood pressure devices and ask patients to log their daily readings and progress. Let them know that you expect them to bring their logs (or devices that store results) to visits so you can monitor their progress. Teach them how to adjust their diets or medication to respond to their daily readings.3. Encourage Use of a Patient Portal If You Have One (And Agitate Your System to Invest in Portal Technology if it Has Not Already Done So)
Make the procedure for signing up for the portal easy and understandable for the patient. Show them how to use the portal to check their own lab results or request appointments. Let them know that you want them to regularly use the portal so it can become a reliable channel of communication between you and them.4. Plug your Patients Into Community and National Support Groups for their Condition
The local park district may hold free exercise classes, for instance. Many communities have free smoking cessation clinics. National organizations representing almost every major disease have websites that provide educational support materials and may introduce patients to local support groups for their condition.5. Consider Group Visits
Group visits have several advantages that accrue to the providers (it saves time and enhances revenue) but one of the best outcomes of group visits is that they greatly increase patient engagement. Patients with chronic conditions gain significant emotional support and encouragement from interacting with other people “like them” who share their condition. Social support is one of the most powerful motivators of behavior. Group visits produce surprising improvements in the health of their members.6. Pull Patients into the Electronic Health Records ("EHR") Screen in the Exam Room
EHRs threaten direct eye contact of health professionals with their patients. Savvy providers have learned to turn this liability into an asset by bringing the patient “into” the EHR as they work, showing them computer-generated charts, for instance, that trend their blood pressure or blood sugar, or to have the patient verify their medications and doses. The EHR becomes an engagement tool, and patient trust is enhanced when they realize the provider is not hiding information from them.7. Use In-Office Instructional Videos
Some practices run motivational or educational videos in their waiting rooms or have a learning room with a library of instructional videos on a variety of health-related subjects. A well-organized file of printed educational materials is a low-tech way to achieve the same ends. The more information patients can absorb about their conditions, the more engaged they will be with their self-care.8. Create an Interactive Website
Numerous providers have created their own webpage or blog and write about topics related to the health of their patients. These providers found that this strategy increased the engagement of their patients and generated new business.9. Convey an Openness to Questions and Support Initiative
Consider the factors that might harm patient engagement and work to reduce them. Be there to support and respond to patients when they attempt engagement. This requires a positive response when the patient asks about their condition and how to improve it. Old-fashioned paternalism, which thwarts patient questioning, kills patient engagement. Patients respond to praise for even modest health improvements they achieve.