Wednesday, April 17, 2013

Engaged Patients Cost Less

Engaged Patients Cost Less

Marianne Aiello, for HealthLeaders Media , April 17, 2013

It's safe to say that practically everyone reading this article would be an engaged patient. It would be hard not to, being in the industry that we are. While this is beneficial to us personally, I wonder if it skews our views of how many patients are truly engaged and what the value of that engagement actually is.
This question is something I've been thinking about a lot lately as I prepare for the second surgery to repair the damage I did to my left thumb in a gruesome vegetable-chopping incident. (If you're sick of me harping on about this since November, just think of how tired I am of dealing with it.)
During my pre-op phone screen for my coming out-patient surgery, the RN rattled off a list of preparations and rules I had to follow before arriving for my procedure; track down and wash with a particular antiseptic soap three days prior, don't eat anything after midnight the day before, take this medication the morning of but not that, acetaminophen is okay for pain but no ibuprofen or aspirin, etc. 
I dutifully wrote all of this down and, of course, am following it to the T. But what about the people who don't? I can think of several happy-go-lucky (that's putting it kindly) friends and relatives who would easily brush off most of these instructions, who wouldn't bother trekking to three different pharmacies before they found the correct antiseptic.
There are also the varying levels of health literacy to consider. I had to ask the RN on the phone to clarify a few things for me, including the scientific name of the antiseptic, which she had spat out as if it were a common item for the everyday person. Had I not felt empowered to ask, I would not have understood or followed that particular instruction.
Spacey, disinterested, and low-health literate patients are out there, in abundance. Some patients do the best they can and still fall short. Others simply 'go with the flow,' essentially relinquishing responsibility for their care to others.
Improving communication with these types of patients is something healthcare marketers should focus on. And it's more than just good medicine—it can improve costs.
A study in the February issue of Health Affairs looked at the role that patients play in determining health-related outcomes. Researchers found that patients who were more knowledgeable, skilled, and confident about managing their day-to-day health had healthcare costs that were 8% lower in the base year and 21% lower in the next year compared to patients who lacked this type of confidence and skill.
These savings held true even after adjusting for patient differences, such as demographic factors and the severity of illnesses.
Furthermore, engaged patients with the same chronic illness had lower healthcare costs than their less-engaged counterparts; less-engaged asthma patients had 21% higher costs than the most engaged patients. With high blood pressure, the cost differential was 14%.
"There is ample evidence that the behaviors people engage in and the health care choices they make have a very clear effect on both health and costs, positively and negatively," the study authors wrote.
"The most innovative healthcare delivery systems recognize this and see their patients as assets who can help them achieve the goals of better health at lower costs. From this point of view, 'investing' in patients and helping them to be more effective partners in care makes good sense."
Dave deBronkart, a.k.a. e-Patient Dave, also talks about the value of engaged patients in his most recent Forbes column, says "Let patients help." In the article, he describes how being an engaged and informed patient when diagnosed with stage-IV kidney cancer improved his outcome and possibly even saved his life.
The question for marketers, then, is how can we most effectively invest in patients in a way that fosters higher levels of engagement? The Health Affairs study authors offer two suggestions:
  1. Build into every step of the care process a meaningful role for patients and their families.
  2. Tailor and customize care in a way that helps patients acquire the knowledge and skills they need to effectively manage their health.
I've seen some organizations tackle these steps by creating easy-to-understand brochures and literature for patients to take with them after their hospitalization. Some take the next step of a follow-up call to make sure patients understand the instructions and are following them. And many hospitals, like the one where I'm receiving my care, check in with patients before their procedure.
While these are all likely effective, it seems to me that hospitals need to move away from fostering incident-based engagement and toward patient-based engagement. Patients should be engaged in their health and healthcare at all times, not just when they are having surgery or contract an illness.
It's up to marketers, working with physicians, administrators, and patients, to figure out what that balance is.

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