As most healthcare organizations have implemented fundamental patient engagement strategies such as patient portals and secure email, the healthcare industry is now entering a new stage, Patient Engagement 2.0, yet it appears there is still much work to be done in order to increase patients’ meaningful participation in their own care.
The findings of the NEJM Catalyst Patient Engagement Survey indicates that close to 70 percent of healthcare leaders report their organizations use patient engagement initiatives, yet many potential patient engagement programs have not been fully scaled and integrated into practice.
NEJM Catalyst, which is part of the NEJM Group that produces the New England Journal of Medicine, conducted an online survey in July polling 369 U.S. healthcare executives, clinician leaders and clinicians at healthcare delivery organizations in order to gauge participation in and effectiveness of patient engagement strategies. The majority of respondents were clinicians (53 percent), with executives (22 percent) and clinician leaders (25 percent) nearly evenly split. Most respondents described their organizations as hospitals (40 percent) or health systems (15 percent). These hospitals were predominantly midsized (33 percent had 200–499 beds) or larger (47 percent had 500 or more beds).
An analysis about the survey was written by Kevin Volpp, M.D., Ph.D., director of the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania.
Nearly half of the respondents report that their patient engagement initiatives are having a major impact (14 percent) to moderate impact (34 percent) on quality outcomes.
“That’s pretty remarkable considering we are still in the earlier stages of patient engagement and that many potential approaches have yet to be fully scaled and integrated into practice,” Volpp wrote. “Interestingly, clinical leaders (60 percent) feel more strongly than executives (47 percent) and clinicians (43 percent) that their efforts to engage patients are working.”
However, fewer than 10 percent of survey respondents say their current patient engagement initiatives have a major impact on cost, and fewer than 20 percent noted a moderate impact. “With the shift to value-based payment models, there may be more of an imperative to design and test new ideas to engage patients between visits that will improve both cost and quality,” Volpp wrote.
In addition, about a quarter of respondents said they don’t know if their organization’s patient engagement initiatives are having an impact on cost or quality.
More than a third of respondents (38 percent) say patient portals are the most effective patient engagement tool, followed by secure email, however only 14 percent of respondents choose that tool as an effective technology to increase patients’ meaningful participation in their care.
In fact, 88 percent of healthcare leaders surveyed said their organizations currently use or have plans to implement a patient portal and 77 percent are using or plan to use secure email as part of their patient engagement initiatives. Taking a look at other approaches, such as patient-generated data, social networks and wireless/wearable devices, and it seems most efforts are still in pilot or planning stages.
While 68 percent of respondents are currently using or have plans to implement patient-generated data, such as within the electronic health record, only half of those organizations (34 percent) are currently using it at scale, leaving 13 percent in pilot stages and 21 percent planning to implement in the next 24 months. About a third of respondents said they are not using patient-generated data and have no plans to implement it in the next 24 months. Patient-generated data refers to health-related data that patients transmit or share with providers, such as the results of blood glucose monitoring, blood pressure readings, or exercise programs.
Of the respondents, 38 percent have an online/mobile scheduling patient engagement initiative operating at scale and 33 percent in pilot or planning stages. Furthermore, social networks are only 31 percent at scale today, with 26 percent in pilot or planning stages.
Only 16 percent of respondents have patient engagement programs that utilize wireless and wearable devices, which includes heart rate monitors or activity trackers, operating at scale. About a third of respondents (31 percent) say they are in pilot or planning phases for such efforts.
Furthermore, Volpp noted that provider organizations "must make significant strides in assimilating the large amounts of data generated by these devices into clinicians’ daily workflow."
Benefit design also is a tool for patient engagement, and 17 percent of respondents are using this tool at scale at their organizations. However, 61 percent of healthcare leaders surveyed said they are not using benefit design and have no plans to implement it in the next 24 months.
“Providers plan to restructure patient benefits to align with intended behaviors, such as decreasing required co-pays for smoking cessation classes or insulin education visits for diabetics. Co-pays traditionally are meant to deter overutilization, but providers must align their patients’ best interests — for example, getting diabetes under control — with the design of benefits,” Volpp wrote.
These anticipated initiatives could help boost the cost impact of patient engagement, Volpp said, as noted above, few respondents reported that their current patient engagement initiatives had a major or moderate impact on cost.
Healthcare leaders do seem to understand the importance of engaging patients between healthcare visits, as 90 percent say care coordinators are either essential, very important or important in improving patient engagement. “Care coordinators seem to be the litmus test for organizations to prove they are serious about patient engagement,” Volpp wrote.
Within healthcare organizations, chief medical officers often are the ones leading patient engagement efforts. Overall, 38 percent of respondents identified CMOs as leading the charge with patient engagement efforts. Other top positions leading patient engagement are staff physicians (35 percent of organizations), staff nurses (23 percent), the chief nursing officer (19 percent), the chief marketing officer (15 percent) and the chief experience officer (15 percent). Twenty-three percent of respondents choose “other.”
According to the survey results, executives and clinical leaders say the CMO is best equipped to head up the patient engagement challenge, while clinicians say staff physicians should take the helm.
“No matter who takes on the responsibility of getting to the next level of patient engagement, they must be innovative enough to strengthen the foundational elements and to build the next wave of initiatives that will improve outcomes and experience for our patients,” Volpp wrote.