The Case for Prescribing a Patient Engagement App

It is widely believed that a redesigned healthcare delivery model will put patients at the center. It stands to reason that healthcare spending is largely driven by poorly engaged patients. Without a patient-centered healthcare system, how can we credibly project improved outcomes at lower costs? Patients must be engaged in managing their own care and healthcare organizations must help them get there.

Foundational Engagement Tools

If patient engagement is based on daily self-care, then self-tracking and health and wellness education tools provide the foundation for engagement. Shared decision making between the provider and patient relies on this foundation.

Judith Hibbard of the University of Oregon developed a "patient activation measure" that surveys patients on the degree to which they see themselves as a manager of their health and care. Hibbard and her co-authors then studied the relationship between 30,000 patients' activation scores and their healthcare costs at Fairview Health Services, a large healthcare delivery system in Minnesota. The results were interesting:

"... they found that those with the lowest activation scores, that is, people with the least skills and confidence to actively engage in their own health care, incurred costs that averaged 8 to 21 percent higher than patients with the highest activation levels, even after adjusting for health status and other factors."

Payment reform means that these outcome improvements can improve a health system's bottom line.

Investing to Unlock the Value

A Rand Corp. study evaluated a 3-year demonstration project on shared decision making conducted at 8 primary care sites in different parts of the US. The researchers discovered 3 barriers to implementing shared decision making:

1. Overworked physicians

2. Insufficient provider training

3. Clinical information systems that failed to track patients throughout the decision-making process

It is no secret that electronic health records (EHRs) provide poor patient-facing support tools. Even the best tools provide little more than an electronic version of a personal health record with a few administrative tasks thrown in, such as appointment requests and prescription refill capabilities. The Rand study goes on to suggest that developing patient engagement capabilities will require health systems to make net new investments (i.e. post EHR). According to the authors:

"In the demonstration practices, the researchers found that electronic medical records lacked ways to store patient-reported values and preferences and to make sure that patients get personalized care.”

Measuring Patient Engagement via Mobile App

I confront these issues on a daily basis as vice president of product development at Axial Exchange. Many of the hospitals we work with are in the process of evolving their engagement strategies, which is reflected in what they measure. We see measurement evolving from virtually no measurement (today) to connecting engagement-to-outcomes (future).

● Reach = the percentage of all patients that have downloaded your engagement app. For hospitals, we normalize reach based on discharges. For clinics, we normalize reach based on total patients served. We’re working with health systems that are quickly moving past 25% reach.

● Retention = monthly active users as a percentage of all-time downloads. We are working with health systems that are seeing more than 1 out of 3 patients become active users of their app.

● Self-care = the percentage of all app usage that is related to tracking medications, vitals, symptoms, or other areas of health management. The highest-performing health systems are seeing over 90% of their app usage come from self-care activities. Fun fact: self-trackers use the app 13 times more than do non self-trackers.

● Engagement-to-Outcomes = tying the above metrics to outcomes such as 30-day readmissions rates, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and leakage rates. This is the future of engagement. Axial’s most advanced customers are currently working to pull this category of measurement together.

Strategic Urgency and the Post-EHR Era

Patient engagement is strategic ground that the best health systems will claim in order to thrive in a profit-from-quality world. Most EHR systems are fundamentally ill-suited as patient-facing engagement solutions. EHR systems were built to capture encounter information at hospitals and clinics. Part of the service that EHR systems have provided is codifying workflows and matching clinical activities with fee-for-service billing codes. Much time and resources have been put into standardizing workflows and keeping data locked carefully away inside of hospitals and clinics. In the uncoordinated world of pay-for-volume medicine, this has been an acceptable approach.

Mobile devices are quickly making an impact on how patients manage their health. For a health system, not having a mobile engagement offering in 2014 may be similar to not having a corporate website in 2004. Whether healthcare systems and practices are motivated by higher margin patients, professional reputation, payment incentives - or all three - they have everything to gain from enabling superior patient engagement and everything to lose if they do not.

Bottom Line

Most of us care about our health, and with the proper support, most patients will engage. Health systems will have to look beyond its EHRs and invest in new systems in order to succeed. This means moving beyond the old photocopied disease management handouts and tired web-based patient portals and offering patients health management tools that they will actually use. The next step is prescribing such patient-facing tools and using them to proactively and effectively collaborate with patients.

Matt Mattox is Vice President of Product Development and Co-founder of Axial Exchange. Prior to Axial, he led the global ISV group for Red Hat Enterprise Linux driving partnerships with SAP, IBM, HP and other global software partners. Mattox led the creation of Red Hat's open source ecosystem initiative, Red Hat Exchange, from concept to revenue. As Director of Product Management at Red Hat, he was named co-inventor on 13 patent applications related to software.