Does Patient Engagement Really Matter in the Business of Healthcare?

By Sujay Kakarmath, MD MS, Research Fellow, Data Science & Analytics, Connected Health Innovation, Partners HealthCare And Kamal Jethwani, MD MPH, Senior Director, Connected Health Innovation, Partners HealthCare; Assistant Professor, Harvard Medical School

Sujay Kakarmath, MD MS, Research Fellow, Data Science & Analytics, Connected Health Innovation, Partners HealthCare

Patient engagement has become a theme that is being repeated ad nauseum in healthcare. By being primary stakeholders in their own health, aren’t patients already engaged in their health? Moreover, given that healthcare is a universal human need, does a healthcare business really need to worry about engaging its ‘customers’? The answer to these questions lies in the value-based health movement taking over the healthcare space. We refer to it as a ‘movement’ because it is a work in progress and is fundamentally changing the core product of the healthcare business, especially in the United States. For decades, the business of healthcare has largely been about providing backend support and infrastructure to health professionals, whose services were the ‘product’. Under the value-based model, ‘health’ is the product. What changes the business fundamentally is that the product, due to its very nature, will now be co-created by the healthcare provider and the client. The most successful (and profitable) healthcare organizations will be those that can create an ecosystem which pre-empts poor health in the first place, and secondly, maximize the ‘Health ROI’ for every intervention delivered. Patient engagement is a cornerstone of the future healthcare enterprise.

Given the mandate to keep the patient out of the hospital, the inevitable role of digital health technologies for patient engagement is self-evident. However, these technologies by themselves are ineffective at shifting the balance and truly engaging patients in a meaningful way. At Partners Connected Health, we invest a lot of thought and effort into understanding and incorporating the context of a patient’s life in the design of a digital health product. For instance, take the case of wearable health trackers. Popular perception about them changed from being seen as a promising tool to increase physical activity, to skepticism when it was seen that most people stop using them after the novelty wears off. As is often the case with polarized opinions, the truth lies somewhere in the middle. Even in earlier studies where we used a relatively simple approach to engagement, we have seen patients in the intervention group achieve 1.5 times as much physical activity as those in the control group. Further research over the past 5 years suggests that the psychological make-up, stage of behavior change, perceived barriers to physical activity, disease profile are some of the key factors that contribute to differential wearable tracker use. We have used these insights to build automated engagement tools that are highly personalized to the context of our patients. These tools have shown great promise in the development phase and are currently undergoing rigorous evaluation in a clinical trial.

Kamal Jethwani, MD MPH, Senior Director, Connected Health Innovation, Partners HealthCare; Assistant Professor, Harvard Medical School

On the other hand, technology innovations can help providers meaningfully too. In an era of evidence-based medicine, it is hard to maximize the ‘Health ROI’ of interventions by focusing on biomedical factors alone. Health literacy, socioeconomic status, presence of a caregiver and the design of the healthcare delivery environment are some of the factors that directly impact the effectiveness of an intervention. Moreover, a vast majority of our clinicians are trained in a fee-for-service world, and are not yet adept at accounting for these social determinants of health into their practice seamlessly. Technology solutions can solve this conundrum for them, as these can be trained to consider multiple data inputs and personalize interventions in a million different ways. In an internal analysis, we found several clues in a patient’s historical data that could predict their future healthcare costs to the system. We are increasingly leveraging machine learning to gain insights from electronic medical record data that help us in optimizing the use of resources for patients who are predicted to be worse-off in the future. If clinicians are able to leverage these programs successfully, their efforts and prescriptions can be augmented in ways that are impossible to replace with human effort. Technologies today can support people 24/7, unlike trained clinicians, and are set to become the mainstay in clinical care delivery of the future.

Aligning the delivery of interventions with a patient’s context remains largely an untapped opportunity to maximize the Health ROI. Interest from the technology world is certainly at an all time high. However, even good tech startups experience unpleasant surprises when making a sales pitch. The greatest companies in this space will be those that invest effort into understanding clinical workflows and stakeholder priorities when designing their products.