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Podcast length – 1:19

Patient Engagement Part 2 Podcast Guest: Dr. Neal Kaufman, CMO, DPS Health

Topics Covered in Podcast:

Interpreting “patient engagement” and why it’s an important piece of the new healthcare paradigm as a key driver of health system performance. Why is patient engagement using personal health IT tools beneficial for providers, patients, and the system overall?

How do other physicians feel about using technology (e.g. smartphones, apps, wearables) to engage with patients?

How significant a role will mobile devices be in the push for increased patient engagement across the healthcare industry? Does a patient engagement mobile strategy approach differ based on socioeconomics?

Topics Covered in Podcast (continued):

Insight on how the healthcare industry can inspire patients and providers to consistently engage with technology as part of an overall push for more widespread patient engagement

What is the financial impact of increased patient engagement? In addition to improving health, how does patient engagement financially benefit both patient and provider?

Will wearables play an important role in increasing patient engagement? Will wearable and other patient generated data help improve healthcare and keep doctors engaged with their patients?

If you were to create software or an app that sums up patient engagement in a nutshell, what would it look like, what functions would it perform, and how would patients and doctors interact with it?

Topics Covered in Podcast (continued):

How can the healthcare industry can better “activate” patients to be more responsible and accountable for their own care?

With such a large influx of patient engagement tools now flooding the market, how can the healthcare industry avoid patient/provider confusion and overload and direct patients to the most applicable and effective platforms?

Why is it important that patient engagement in healthcare continually evolve?

• Behavior is a key factor in vast majority of individual health conditions – it’s both a community and individual initiative • Individual behavior is a balance between external environment and

what’s available based on their surroundings (ex. availability of fresh fruits and vegetables) and the personal goals of the patient

• What does it take to incite individual behavior change? • People need to have a basic set of knowledge – what are risks?

Challenges? What behaviors need to change? • Need simple tools to help overcome barriers to changing

behavior • Need to identify behaviors to change and then make then make

the efforts measureable, incremental, and achievable • Monitor performance • Need feedback on progress in a systematic way • Build and maintain a support community

• Once this structure is in place – the challenge is “activating “ – getting a patient ready to go down a path and make behavior change happen

Interpreting “Patient Engagement”

Behavior Change:

Interpreting “Patient Engagement”

• Key to improving outcomes (especially for chronically ill patients) is to get patients to understand what needs to be done to improve health and then motivate them to do it

• Engagement can come from clinician or patient’s own individual support network (family, friends, etc.)

• Patient engagement has a community ripple effect – patients more engaged are a clear influence on others that don’t

Patient Engagement Systemic Influence

• The jury is still out! • Distinction between tools and interventions (Comprehensive Programs):

• Tools: Tens of thousands of tools have been created for activated patients to help quantify their results, have to understand how information will help you change behaviors

• Intervention: Not a series of tools – answers question, “Who is my target population? What are their characteristics? “– helps to self-tailor solutions

Physician Reactions to Patient Engagement

• Important to note that technology should not be center of conversation • Question is – how to physicians feel about empowered, activated

patients who are participating in their disease management and are actively engaged?

• Clear that patient/physician relationship has drastically changed • Patients priorities must be taken into account more than ever when

offering suggestions on what to do (Ex. – how long does a patient plan to live and what will that lifestyle be like?)

• Engaging patients in all decisions for setting priorities is critical – more physicians are aware of this

• Practical realty for modern clinician’s is in most settings they aren’t given the capacity to do this because of time

• Clinicians aren’t as interested in day to day data reporting as they are in summaries, and patterns – clinicians need wisdom, they don’t want a barrage of data

• Clinicians see patient engagement as a key tool to help get and keep patients healthy

• Patient engagement is about changing clinician mindsets

Physician Reactions to Patient Engagement

• Patient engagement components: Data, Information, Knowledge, and Wisdom • Data: The simple mathematics – facts that come in with no

interpretations (e.g. – what’s my blood pressure? Weight? Glucose levels?)

• Information – what do the facts mean? (e.g. - Is there a trend one way or another? )

• Knowledge – the basic understanding of what the information is trying to tell you

• Wisdom – what to do with the knowledge • Currently we have a lot of data, some information coming to patients

and providers but we have less knowledge and wisdom

Did you know?

About 3/4 of patients surveyed consider online reviews from other patients, the ability to book

online appointments & paying bills electronically important in choosing a physician.

*Source: Health Data Management, http://bit.ly/1wKolrL

Patient Engagement and Mobile Devices

• Mobile devices will be transformative for effective patient engagement • Mobile devices will help clinicians better serve larger populations – the

merger of the personal health approach (single patient, single clinician) but doing it with large numbers, still being able to individualize and personalize care

• Mobile provides an answer to the question – “In what way can technology be used to help individuals better manage their conditions?”

• Mobile tech proves to be a “game changer” for patient engagement • Reflected in the increase of people using mobile tech for individual

health and the interventions being created focusing on hard to reach, vulnerable, underserved patient populations

• Mobile will also have an impact via employee wellness programs to help individuals get healthy, and stay healthy over longer periods of time

• Mobile could possibly have the highest future return with the “emergent risk population” – (i.e. – the 25% to 35% in the middle whose behaviors cause them to increase the number of chronic conditions) to help them change behaviors and improve outcomes

Patient Engagement and Mobile Devices (continued)

• Patient engagement mobile strategies approach differ based on socioeconomics • Ex. – emergent risk population: factoring in the economic costs of

changing behaviors must be considered • The best mobile strategy based on an intervention will identify

archetypical patients (wealth, education, income, geography all factor in) and then create the capacity for mobile approaches to be self-tailored to an individual based on these characteristics and how they respond to the approach that’s being used

• Technology has a capacity to modify the user experience based on past performance

• Mobile strategies definitely need customization based on one or many characteristics (i.e. – age, gender, ethnicity, existing chronic conditions, risk factors, etc.) – this is ideally one of the catalysts for successful interventions

• A pillar of successful patient engagement is the ability to tailor and customize engagement solutions to different populations - Mobile will play key role in ability to customize solutions for different demographics

Patient Engagement and Mobile Devices (continued)

• Promise of technology and the use of big data over the next 5 – 10 years will provide the ability to take a large population and educate, activate, and engage to help them get involved to manage their own conditions • Will help determine through trial and testing which approaches are

the most likely to succeed so when the next population materializes, population segmentation based on past history will facilitate more effective ways to realize what approaches are the most effective

Did you know?

According to a recent survey, more than 40 million Americans with smartphones use them to

track their wellness or fitness through an app.

*Source: HealthIT Outcomes, http://bit.ly/1zHAj5m

What are Keys to Patient Engagement Consistency?

• It all starts with a better understanding of patient populations and taking a more population vs. individual approach

• Learn as much as possible about individuals in population to understand and track individual experiences based on their characteristics • Allows you to visualize what approach is going to be the most

effective for that individual and then modify the approach based on past experiences

• Drop expectations that the intervention begins when patient enrolls – pre-history of how patient got there, how they heard about it, were they ready to use it, have they reached the stage of understanding why they have to do it are all key elements

• Question becomes - How do you create an ecosystem of information support, preparing patients and moving them along the patient activation or “readiness to change” scale?

• The methods used to get patients to a higher engagement level is largely dependent on how they perceive support levels – relying only on cajoling, incentives, etc. will not work for sustainable engagement

What are Keys to Patient Engagement Consistency? (continued)

• Ex. – incentives work well initially, but once goal is reached it becomes difficult to sustain engagement and enact true behavior change

• Patience is key for engagement consistency – don’t expect immediate results, the process takes time and must be a strategy that matches the needs of your patient population

• Patient behavior change shouldn’t be expected overnight - getting someone to change their way of thinking can be an arduous and lengthy process

• Key is to send the message that a patient doesn’t need to radically change their life to make a difference – it’s all about incremental steps and your patient engagement strategy should support that

Financial Impact of Patient Engagement

• If you are talking purely cost, you have to define it as people who are costing the system a lot of money – have to be sure you are targeting the right individuals • Automatically, a majority of wellness programs will have a bigger

challenge showing a healthcare related return on investment (ROI) • You then have to be targeting behaviors that impact individual

health status and their expenditures (e.g. – Early stage Type 2 diabetes patients - no provider will save a penny by getting that patient actively involved in their diabetes care, the cost savings comes from preventing the onset of another chronic condition resulting in neglect of existing conditions)

• Question becomes – what are the avoidable conditions that cost money that are preventable by patient activation? (e.g. – improving lifestyle, losing weight, eating healthier, being more active, medication adherence, following Dr’s advice, etc. – lowers the rate of adding new chronic conditions – this is where the savings originates)

• Part of the cost savings is selecting the right patients to target and picking the right outcome where behavior can make a difference

Wearables Impact on Patient Engagement

• In next 3 – 5 years, wearables will have little to no population health impact • With the exception of in-home monitoring or wearables for very sick

patients, the majority of wearable users will be younger, more fitness oriented individuals and it will take time for the emergent risk population to adopt them • Why? – data and information will quickly get stale, the

expectation of immediate results will turn patients away from using wearables and most importantly, if the data isn’t coupled with knowledge and wisdom, it’s just “noise”

• 3 to 5 years from now, there will be more integrated interventions in which tools become important elements but they aren’t the highlight

• Technology is an enabler, and when it becomes the “star of the show” it isn’t doing much to advance patient engagement – it’s the knowledge and wisdom that comes from it that has the biggest impact and can truly make a difference

• The challenge becomes – how do you pay for it?

Wearables Impact on Patient Engagement (continued)

• Patients can pay themselves – risk is shifted to patients as deductibles get higher and people spend more of their own money on health

• Payors (i.e. – employers, health plans, at-risk healthcare providers) could assume costs but only if they see value – this scenario is likely but comes with great challenges

• Do we have any current examples of wearable data that has been turned into wisdom for either patient or provider? • Ex. – glucose monitors: Technology now allows patients to check

blood sugar levels with a sensor vs. a pin prick, and has shown to be more effective to help patients monitor and control – sensor integration allows for faster feedback, quicker adjustments if needed

• Ex. – fitness wearables that track steps – research indicates people will move more with these devices than without

• Wearables more effective when embedded within context of a therapeutic relationship & provide information, knowledge, & wisdom

The ‘Ultimate’ App – What Would it Look Like?

• Fact: Pace of technological advancements is rapid and dynamic • Future scenario:

• A patient decides to make a behavior change • Able to get assessment “in the moment” of a range of different

characteristics (e.g. – vital signs, how they are feeling at the moment, etc.) – referred to as ecological momentary assessment (e.g. – in the moment, in your own ecology, an assessment is made of your status)

• Analyzing not only the symptoms of the condition, but the precursors of what make that condition worse

• Imagine the assessment analyzes this data and makes a prediction of when you can expect adverse conditions to arise

• Result would be knowledge that provides patient with ecological momentary intervention (assessment in the moment, intervention in the moment – “micro-interventions”)

• Over time, patients begin to intuitively know what their status is without even looking at a wearable – patients begin to feel it on their own

The ‘Ultimate’ App – What Would it Look Like?

• Patients can predict adverse conditions, apply interventions, and then receive real-time feedback and assessments on effects

• Smart phones are and will continue to play key role in the new healthcare paradigm: • Patients can carry information with them 24/7 • Allows data, knowledge, and wisdom personalization and

monitoring that is unique to each individual • Future interventions will be built upon:

• Social learning • Cognitive theories • Individual behavior change approaches

Did you know?

HealthTap is a Web site which has

released dozens of lists ranking the top apps recommended by physicians. Visit their site at: www.healthtap.com

*Source: mHealth News, http://bit.ly/1wKs5cE

How Do You Better ‘Activate’ Patients?

• The first step is to better understand patient needs, goals, desires, wants, support levels, etc. and customize your approach to match those unique attributes

• Also comes from the ability to understand as patients age, how do they want to live their life? (i.e. – the ability to have the capacity to do the things that are important to an individual)

• Healthcare has moved too far away from “performance span” and become too focused on life span (i.e. – patients won’t be engaged if you aren’t spending enough time and effort increasing performance span)

• The more healthcare can engage patients in such a way that shows empathy to their concerns the easier it will be to help them reach their personal goals

• Recognizing the centrality of patient’s priorities is the key • Patient activation is much more than shared decision making

Help On Choosing Most Effective and Applicable Patient Engagement Platforms

• First question should be: Are you using platforms to improve patient outcomes? Loyalty? Brand awareness? • History has shown that at times, a majority of engagement

platforms pushed by health systems, employers, or providers aren’t necessarily positioned to change health outcomes – tends to be more altruistic in nature

• Key is to look at theory and research of engagement tools to see if proper amount of experience has been attained with a large enough group of people to predict whether it may work for a patient population

• Smart approach is to test engagement tools with a sample patient population first to gauge success – does it change behavior and change outcomes? Lower the rate of getting a new chronic condition? • Provides more realistic expectations on whether engagement tools

will improve outcomes and lower costs • Requires careful analysis of what outcomes are expected • *At DPS Health, their behavior change technology solutions address increasing costs

associated with unhealthy patient behaviors. They offer early and cost-effective intervention for emergent risk individuals that can quickly progress to the high cost group.

The Importance of Patient Engagement Evolution

• #1 – The constant battle for hearts and minds of patients, and many ways people can think of ways to improve their health: • Direct-to-consumer approach: very rapid changes, less validated

research, often meets aesthetic and immediate needs of an individual, portends a future where only chronic patients need in-hospitalization care and the rest of the population self manages their own conditions

• Patient engagement must continue to show value and evolve into a model that meets patient needs as consumers while meeting their needs as patients

• Individual health ecosystems must be incentivized to meet patient heath needs, show value over volume, focus on outcomes

• Patient engagement evolution will continue to push health accountability and help health ecosystems maximize patient knowledge

Thank you to Neal for his time and knowledge for this podcast!

Please visit Neal and DPS Health through the following communication channels:

www.dpshealth.com; nkaufman@DPSHealth.com DPS Health

@dpshealth or @NealKaufman

Read the DPS Health White Paper!: http://dpshealth.com/component/content/article/5/315-issue-brief-download

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