The definition of an engaged patient population is not universal. Different communities across the country are bound to assign different meanings to that term.

For Malcolm Butler, M.D., and the other practitioners at Columbia Valley Community Health (CVCH), a 24-provider health center with three clinical sites centered in Wenatchee, Wash., patient engagement doesn’t mean having patients look up their lab results online, or request a referral through the click of a button. For them, it simply means getting patients to care about their health as much as the people who take care of them.

As Butler, CVCH’s medical director, explains, much of this has to do with CVCH’s locale and the community it serves. Divided by the Columbia River and kissing the eastern foothills of the Cascade Mountains, Wenatchee is located in the heart of orchard country. The town sign welcomes people to the “Apple Capital of the World.”

While Wenatchee itself has a higher overall cost of living than the national average, Butler says most of the people who are patients at CVCH work in the fruit agriculture industry, speak only Spanish, and 90 percent of them live below the poverty line. To top it off, a good chunk of these patients, he says, have “complex medical problems.” With this reality, he and his colleagues at CVCH are dealing with basic challenges that many providers in more affluent communities don’t commonly have to face.

“When I hear others talk about patient engagement, it’s often about patients interacting with their medical record and having informed conversations. I’ve got to tell you our population is two-to-three levels below that population [socioeconomically],” Dr. Butler says. “We have patients who find it difficult, when you explain to them they have diabetes and they need to take a medication, it’s hard for them to grasp the concept that they’re going to have to take that same medication every day for the rest of their life.”

Butler, who has an impressive grasp on his patients’ attitude towards life, says these are the kinds of people who flow with a “river of experience.” He quips, “If the river delivers them some thyroid replacement therapy, they’ll take it. But as soon as it runs out, they’re on to the next thing.”

Leveraging the Smartphone

When figuring out how to best reach this patient population, Butler recognized that traditional printed material was a dead end. Instead, he noticed that while his patients didn’t have a lot of resources (for instance, no health insurance or car), most seemed to have a smartphone. That triggered an idea.

“I’m thinking— here’s a diabetic patient who gets about a total of five minutes with their doctor, three to four times per year. There’s no way I can communicate everything that needs to be said on the management of diabetes in the course of 15-20 minutes a year,” Butler says. “But what if every morning, while they’re waiting for the bus, they get on their phone, go to [an app], and see a post from Dr. Butler on how their diabetes works?”

In an attempt to get something like this off the ground, Butler has joined up with WellFX, a Petaluma, Calif.-based developer of a healthcare-based social platform that aims to create a virtual community and empower patients through education. For various CVCH patient populations, such as obstetrics or diabetics, this smartphone app will try and provide them with interactive resources such as educational videos, a digitization of WellFX’s support groups where they can communicate with others that share the same disease, and text message reminders and support.

Malcolm Butler, M.D.

The goal of the platform at CVCH, which is in the early stages of rolling it out to its patients, is to “build healthier habits,” Butler says. While many of his peers in the industry look at specific goals like lowering ER utilization rates, at CVCH, he says that’s not realistic. Instead, the health center will look at softer goals such as getting patients to be active users of the platform and finding out that they got something out of it.

Focusing on High Utilizers  

Working to engage this population, with this platform, even at a basic level, is extremely challenging and doesn’t come with many financial incentives. Furthermore, Butler admits there are no best practices manuals available to work off of, because so few have undertaken something like this.

Still, Butler and his colleague CVCH will move forward with this initiative, knowing that it could reap benefits that will not only help his population, but others like it across the country. And as he notes, it’s this kind of population that needs the most help.

“We’re running into this problem where the people who most need our help aren’t even willing to engage at a level where we can help them,” remarks Butler. He adds that while it’s great there are people excited about being able to interact with their medical home on the internet, using the patient portal, these people are often slender, healthy, athletic, and literate. 

“Frankly, they are not the 3 percent of the population causing 50 percent of the [healthcare] costs. The challenge is engaging that 3 percent. What we’ve learned is you need to do it at a personal level. You need to befriend them first, and they need to feel the information is coming out of a true sense of caring and concern, and then that might motivate them to engage.”