If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.
-- Leonard Kish
True patient engagement should have metrics of demonstrable success – at scale – over time. Generally speaking, this is still lacking. The current model adopted seems to be one of outsourcing (for lack of a better term) i.e. shift a lot of the healthcare burden (either administrative, cost or actual service delivery) directly to patients. But data and metrics are being gathered and continue to prove that patient engagement can have significant value if done in a coordinated fashion. With the advent of devices to track activity, heart rate and much more, the rise of AI to predict health issues from that flood of data, automation to “hover” over patients and so on, we are on the cusp of putting patients where they belong - at the center of their own health (with some assistance).
There have been earlier reports on the value created by coordinated care programs such as the VA’s Care Coordination/Home Telehealth program which showed amazing results:
- 19.74% reduction in hospital admissions
- 25.31% reduction in bed days of care
- 86% patient satisfaction
- $1,600 average cost per patient per year, compared to $13,121 for primary care and $77,745 for nursing home care
- 20% to 57% reduction in the need to be treated for the chronic diseases studied, including diabetes, COPD, heart failure, PTSD, and depression
And this study was run from 2003 to 2007! More than a decade ago but we’re still waiting to see results like this more generally.
The root cause seems to be two-fold:
Alignment of incentives
Lack of resources / automation
Alignment of incentives
This has always been a problem in healthcare. Why should I do something when someone else is likely to get the benefits? It is no surprise that the biggest such successes we see come from systems that are aligned such as the VA or Kaiser. However, this is changing. With the rollout of the much maligned Accountable Care Organization (ACO) model (and several other programs) by CMS, health plans and health systems are increasingly beginning to align around quality and cost. Innovative models are going to be the norm where more of the burden will begin to fall on health systems and providers with attendant profits. But that journey will require some changes
Resources and automation
It is possible to provide amazing care to any individual but it can come at a significant cost. Concierge care for all - sure, but at what cost and who will pay that price? This is where advances in technology and “automated hovering” will play an increasingly important role. We, at Way To Health, have seen providers reduce automated hovering costs from over a $1000 per patient to less than $50 while still getting the same results and not increasing provider workloads.
Innovations will continue but it is critical that we all not only share our knowledge but also provide evidence that specific engagement models work. The VA results for example are great, but can you expect to see the same results if you read the paper and tried to apply it to your health system? Will you see the same results in Alabama, Pennsylvania and Northern California? It is that level of research, data and evidence that is needed. Way To Health is at the forefront of this movement.
No one can predict the future but we believe that evidence based patient engagement is sure to play a huge role in improving quality of care while still controlling costs.
