It was fascinating to listen to the keynote address presented by Katherine Schneider, M.D., CEO of the Delaware Valley Accountable Care Organization (DVACO), a fortnight ago on May 21, during the Health IT Summit in Philadelphia, sponsored by Healthcare Informatics. As I reported here, Dr. Schneider, under the session title, “Patient Engagement Is Not an App,” “offered attendees a bracing view of the challenges facing patients and their families as they navigate the U.S. healthcare delivery system.”
As I wrote, “Dr. Schneider illustrated her theme through a complex, multi-partite personal story about her family’s experiences with well-coordinated and poorly coordinated care. Cleverly, Schneider contrasted the experience of family member ‘A’—a family member who had experienced very well-coordinated, patient-friendly care for an urgent condition—with that of family member ‘B,’ who had experienced extremely uncoordinated care delivery that was frustrating to ‘B’ and to the entire family. After going through the experiences of both family members, she revealed to the audience that ‘A’ was her family’s dog, and ‘B’ was her husband, who also happens to be a physician.”
First of all, kudos to Dr. Schneider as a speaker. She was able to captivate her audience through her approach to her narrative, keeping attendees in suspense until the “big reveal”—when she was able to share that family member A was her dog, and family member B was her husband. And guess who had the well-coordinated, patient-friendly care delivery experience? Yup, her dog.
But beyond that, Dr. Schneider made a bunch of great points about patient engagement, on a broader level. “The goal is to reduce the friction in healthcare. That’s where people get frustrated, and there’s a lot of waste,” Schneider said. “And this word ‘engagement’ is probably the most overused word in healthcare now.” Per engagement, she noted, “We hope that it’s about patients feeling like they are a part of this team, and probably the most important part, in terms of patients engaged in their own health. Sometimes, we use the term in terms of loyalty—we want patients to be loyal. But that’s peripheral to how we can engage patients better to be part of their own care team.”
What’s needed, Schneider said, is “a patient-centric view of health engagement. Where are all the levers to get me engaged in my own health? Maybe the insurer? There may be a wellness vendor. The employer. The public health community.”
The key here is that Dr. Schneider urged Health IT Summit attendees to work with her to begin rethinking the whole concept of patient engagement. The problem, as she pointed out, is that “[W]e want patients to be loyal. But that’s peripheral to how we can engage patients better to be part of their own care team.”
And therein lies the rub. Clinicians and administrators in healthcare largely continue to think of “patient engagement” in the same way that they think of “consumer loyalty,” and also in the way that they think of “patient compliance”—Mrs. Smith is filling her prescriptions, take her medications as directed, and following her doctor’s orders. But that’s a very superficial way to think of this, given A) the tiny percentage of time that patients/healthcare consumers actually spend with clinicians; and B) the explosion in chronic illness in the U.S. The reality is that, in order for Mrs. Smith to become “fully engaged,” she’s going to have to do more than “follow orders” and continue to see the same doctors and nurses.
In fact, Dr. Schneider told her audience, what really engages her around her health is engagement with her community—the neighborhood she lives in, in Philadelphia, among other things. And her community, of course, is where she lives, 24/7/365. And, as she also noted, apps alone won’t do it. There has to be a human connection—and, though she didn’t say it explicitly, a process connection.
And the many-millions-of-dollars question is this: in the shift in U.S. healthcare from a fee-for-service-based payment system to a value-based payment system, where does this concept of patient engagement fit in, really? Because on some level, it’s got to. One arena in which this will inevitably play out will be in the context of care management, within the framework of accountable care organizations (ACOs), and other value-based contracting arrangements—in which, frankly, it’s in the economic interest of providers to engage with their attributed patients in certain ways. What’s exciting is that the patient care organizations whose leaders are architecting new forms of care management, are developing multidisciplinary care teams that really are engaging more fully with their patients, beyond the much-noted nine minutes that the average physician actually spends with her or his patient during a patient visit. And that means nurse case managers, nurse practitioners, physician assistants, dieticians, social workers, pharmacists, and others, are all becoming more active and involved with patients; the burden doesn’t just fall on physicians—and everyone knows it can’t.
So in the emerging value-based healthcare, there is a new dynamic beginning to become more common, one in which entire care teams are engaging with patients. And that’s where that engagement is inevitably going to take place.
There’s a further wrinkle here, too, in that health plan leaders want to become more engaged with their plan members. That’s a different level of engagement—one that’s possible, but even more complex, given the mistrust that many plan members feel towards their health plans (often justifiably). But that level, too, is going to need to emerge going forward, for everyone to become successful.