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The evolution in digital patient engagement-perhaps revolution is more apt-is moving at warp speed. Coupled with the dramatic growth for elective procedures such as total joint replacement surgery, which is expected to increase by more than 170 percent by 2030, the pressure to leverage patients as active customers of the care and cost proposition has accelerated.

Last July, the head of the largest payer in U.S. healthcare, CMS Administrator Seema Verma, suggested that the agency’s digital data effort (MyHealthEData) is “driving a new era of digital health, one that will unleash data to trigger innovation and advance research.”

Now, in 2019, the question is: What works and how do we prove it?

Studies have substantiated the efficacy of both email and text messaging in improving patient engagement and outcomes:

• One systematic review found that 8 out of 9 studies “support text messaging as an effective tool for behavior change” in areas such as weight loss, smoking cessation, and diabetes management.

• Another study, by the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange, revealed a “small but meaningful” (approximately 4 percent) increase in flu vaccinations after sending customized weekly text messages to parents.

• A Kaiser Permanante study published in the American Journal of Managed Care linked patient-provider communication via email to better patient outcomes. 

Yet few studies have shown statistical significance and clinical impact. Instead, they focused on how email and text moved the needle. But today, it’s not solely about message type-be it text, email, mobile app, or web portal. It’s about smart, fresh, factual, multimedia content delivered in real-time at the right time. If it’s not relevant, easy-and yes-delightful, the patient is GONE! There are few second chances.

In 2018, we conducted a quasi-experimental study with a four-hospital system in the Midwest. We examined the use of a two-way digital engagement program and its impact on outcomes for total joint replacement patients-a critical population because these surgeries represent a tsunami of healthcare costs for Americans. Email and text messages were delivered to patients before, during, and after their hospital stay. We looked at engagement with the educational messages and outcomes regarding day of surgery cancellation, length of stay (LOS), discharge destination, emergency department (ED) use, and 30-day readmission. 

What we found:

• Significant cost-savings and efficiencies gained

     - 25 percent of a day reduction in LOS for hip patients; 13 percent for knee patients

     - 50 percent reduction in ED visits by hip patients who were highly engaged (opening ≥50 percent of the messages)

•  Early identification of at-risk patients

     - High engagement correlated with lower risk, enabling hospitals to target more support to low engagers

•  Equally high engagement across insurance types 

     - 71 percent of patients were highly engaged

     - Results were unrelated to insurance type-i.e., public (Medicare/Medicaid) vs. private.

Replicating these kind of results requires diligence in examining the how, as well as the what of patient engagement initiatives.

• Focus on the VEHICLE (the platform or technology) that best connects with those you’re targeting to create a sustained connection throughout the care episode.

• Make it EFFORTLESS. Patients will not engage unless there are no barriers to set-up and use (no required sign-up, downloading, or passwords). Additionally, anytime required of the care team to make it work is too much. So …

• AUTOMATE ENROLLMENT. Make the connection opt-out and part of your standard of care.

• Use REAL-TIME DATA to evaluate efficacy.

• Make content PERSONAL and AUTHENTIC. For example, if a patient just had a baby and hasn’t been able to sleep or shower for days, receiving images of well-manicured women with make-up on holding a perfect, sleeping baby will not cut it. Authentic means “I see myself in your connections.”

These are the things that make a difference in patient engagement and create opportunities to statistically substantiate that digital connections, sustained over time, do in fact improve outcomes, increase capacity for hospitals, and save time and money.

Betsy Weaver, Ed.D., is the co-founder, CEO and president of TPR Media LLC (d.b.a, UbiCare), an innovative, patient engagement company providing Internet-based healthcare content through a unique, proprietary platform. Weaver holds a master’s in education and a doctorate in social policy and trend analysis from Harvard University.