Apr 7th 2015

Health Road – Patient Engagement Series: Part 1 – Challenges

Blog by Vishnu Saxena, VP & Business Head – Diaspark Healthcare

Patient Engagement is one of the top key agendas of the healthcare IT town and it is a deep and strategic topic. I was trying to stitch my thoughts in one blog but then I realized that, I can’t do it even in 3 subsequent blogs. Therefore, I am writing it in 4 part series. In the part one, I am talking about the challenges associated with Patient Engagement adoption.

The way Patient Engagement is trending these days, everyone is talking about it (which is a great thing to happen actually) makes me feel that the communities ( I mean – Feds, Providers, Payers, VCs’ , Healthcare Tech entrepreneurs enthusiast, startups accelerator community etc.) have now woken up and trying to pick up pace in this area. Particularly, Providers and Payers in my opinion, can’t plan anything without Patient Engagement philosophy being at the core of their long or short term strategy. So you just imagine, how critical it is.

How this suddenly happened ? Well, it actually did not happen overnight and was brewing-up for a while. Reforms in healthcare ( shift from volume to value based culture ) placed a great deal on Patient Engagement and triggered an urgent need for health organizations ( now payers as well) to embrace the philosophy as a viable solution to lower costs and enhance care quality. Patient engagement is one of the three key attributes of a successful value based health system, along with a coordinated care continuum and physician alignment to performance goals.

We all know why Patient Engagement is good thing. First, it drives Patients towards to be in charge of their own health and from economy point of view, it has potential to save billions of dollars. The Institute of Medicine ( some time last year or so) came up with statistics that $750 billion of Healthcare spend is wasted every year. Out of which a substantial amount of money is lost due to the gap in Patient Engagement which could be as trivial as patients failing to do what has been prescribed by their physician. This cost of this non-compliance is around $290 billion for the US alone. $ 290 is certainly more than the overall spend for some critical illnesses across the globe or perhaps GDP of a small country..! So you get the context.

The concept of Patient Engagement has not significantly evolved beyond an ideology. However, at most fundamental level, opinions about Patient Engagement are divergent across the Provider, Payer, and Patient community. When I speak to various PE stakeholders, I get different versions and expectations based on their philosophy.

Lack of a common definition/ unified view of Patient Engagement:
Lack of a clear definition of what patient engagement means, across the stakeholders, is the biggest challenge faced by the healthcare industry today. It reminds me of the recent Pop Health Colloquium in Philly where Dr. David Nash asked key speakers to define their version of Population Health Management as it also lacks a unified view. So, if PE is in the same boat it does not surprise me.

This lack of understanding has created a gap in expectations and outcomes when engaging the patient in care management. As a consequence, the Healthcare market is flooded with physician and patient focused web and mobile solutions aiming to seal the lacuna. However, their adoption has been hindered due to the absence of industry benchmarks and standard definitions of key components of the Patient Engagement process.

Transactional interaction across the healthcare ecosystem:
Traditionally, providers had little control over patient’s compliance ( or better- they were not bothered but not all) once the patient is discharged due to lack of continuous communication between the two parties. Until recently, payers would offer patients a fixed menu of healthcare services based on their coverage plans. Now with changing delivery models and health reforms have forced providers and payers to adopt new mechanisms for interacting with patients and it brings patient engagement an uphill task. Further, the need to adopt technology, comply with regulatory requirements, and difficult economic conditions has forced health systems-providers in particular to prioritize Patient Engagement initiatives behind other activities such as EMR -EHR implementation. Though it is changing fast.

Lack of access to care and educational resources:
I believe that poor access to healthcare influences patient’s compliance and active participation in the care management. Inability to afford healthcare, lack of insurance coverage, or poor infrastructure forces the patient to skip treatments and medications until the condition is too severe. Patients often do not participate in self-care due to factors such as old age, complexity of care, lack of involvement in the treatment-decision making process, or the simple unwillingness to comply with the physician’s instructions. In such cases, it becomes really difficult for a provider to ensure the quality of treatment and adherence to prevention strategies. Factors such as lack of education, language and cultural barriers also contribute to non-adherence from the patients. They affect the patient’s ability to understand the physician’s instructions, and/or the available health information thus forcing them to miss out on following the treatment as required.We need to come-up with tools that psychologically drive patients behavior towards the adherence and we need to keep these factors in mind.

Poor technology adoption across the provider and patient communities:

Technological challenges faced by both care providers and patients have added to the burden of effectively managing the provider-patient relationship. With the mandatory requirements of technology adoption, the average time spent on interacting with patients is less than the time spent on electronic data entry. Though a recent study done by Nuance ( venture beat published an article 2 weeks back on it) suggests that Patients are getting comfortable with the use of mobile tech as long as exam room makes the experience richer and used collaboratively to educate or explain. Physicians are also not that happy either with the quality of apps available for their profession that indicates the need for further evolution in technology.Despite the growing internet usage among patients, a large population of older-aged patients are still unable to utilize electronic access to their personal health information. In such cases, it becomes imperative for physicians to ensure effective communication to ensure patient compliance. Factors such as the changes in regulatory requirements and moving to a pay-for-performance from a fee-for-service model, have influenced providers to focus on enhancing patient engagement.Where there are challenges lies the opportunity. The challenges that have impacted the adoption of patient engagement and increasing instances of digital health adoption across the care continuum offers tremendous opportunities for players across the patient centric ecosystem including providers, payers, and life sciences organizations ( I have not seen Pharmaceuticals being invited at the Patient Engagement discussion table and they are one of the key) to interact with patients in innovative ways and provide tangible health benefits and improve revenue outcomes across the stakeholder environment.In part 2, will share the opportunities Patient Engagement presents.
Stay tuned..
( Thoughts are my own)

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