The Business Case for
Patient Engagement

Dr. Peter Edelstein, FACS, FASCRS, Chief Medical Officer of Elsevier Clinical Solutions, proposes engaged patients result in better outcomes and lower costs of care for providers.

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Background

Patient and consumer engagement are structured around sustainable behavior change – of patients, family members, caregivers and healthcare consumers. As a discipline, process and strategic priority, engagement flows throughout the continuum of care – from hospitals, health systems and physician practices to labs, imaging centers, pharmacies, retirement centers and long-term care facilities.

Patient and consumer engagement embraces the “ecosystem” of lifestyle and care choices promoted via education, business, media and the community. Schools, churches, restaurants, retail stores, sports facilities and fitness centers can reinforce, accelerate or torpedo patient and consumer engagement, according to Sonika Mathur, Senior Vice President, Patient Engagement, Elsevier.

“It takes a village to inform, educate, engage and empower patients, families and consumers to take charge of their health and healthcare, as well as the health and healthcare of their families and the public,” she says. “Healthcare organizations have the knowledge and clout to mobilize the village, improving outcomes and controlling costs.”

When patients and consumers experience authentic education and empowerment, they become their own best providers.
- Dr. Peter Edelstein, Chief Medical Officer, Elsevier Clinical Solutions

Engagement also guides patients and consumers to knowledge and understanding of their own health, the process of healthcare and the ways of the healthcare system, noted Dr. Peter Edelstein, Chief Medical Officer, Elsevier Clinical Solutions.

“Engagement transforms patients and consumers into advocates and champions for their own health and the health of friends, family members and the entire public,” says Dr. Edelstein. “When patients and consumers experience authentic education and empowerment, they become their own best providers.

Healthcare organizations committed to the planning, design, implementation, monitoring and evaluation of patient and consumer engagement initiatives can build a business case through the following strategies:

Scope out patient and consumer engagement.

“Operating without a broadly accepted definition of patient and consumer engagement has serious consequences,” says Dr. Edelstein. “Lack of clarity allows the healthcare system to deny resources, projects and programs required to engage patients and consumers over the long term.”

He’s convinced that patient and consumer engagement will emerge as invaluable strategies for improving the value of healthcare – (quality divided by cost) – but only if the industry – hospitals, health systems, medical groups, and payers – reaches consensus.

To that end, Dr. Edelstein advises those tasked with pitching the business case for patient and consumer engagement to C-suite and board members to address the following issues:

  • Definitions: What are the most popular or accepted definitions for patient and consumer engagement? Which definition will we use for this discussion?
  • Rationale: Why should an organization implement orre-engineer patient and consumer engagement? What are the potential benefits, results and outcomes of doing so?
  • Myths: What are the most common myths and stereotypes of patient and consumer engagement? What are the corresponding realities?
  • Barriers: What are the barriers to patient and consumer engagement? How can they be managed or overcome?
  • People: Who will contribute to patient and consumer engagement? Who will participate in planning, vendor selection, implementation and evaluation?
  • Cost: How much must we invest in patient and consumer engagement over time? What’s the short and long-term ROI
  • Strategy: What principles or strategies will guide implementation, measurement and evaluation of patient and consumer engagement?
  • Results: What are the likely results and outcomes of patient and consumer engagement?
  • Lessons: What can we learn and assimilate from high performers in patient and consumer engagement?

Just as bookends support books on a library shelf, so patient and consumer engagement support population health management. – Sonika Mathur Senior Vice President, Patient Engagement, Elsevier

Secure C-Suite and board buy-in for patient and consumer engagement.

Secure short-term and extended financial, clinical and operational support for patient and consumer engagement, education and empowerment from C-suite executives, including CEOs, COOs, CFOs, CTOs, CIOs, CMIOs, CNOs and CNIOs.

Other vital chief officers and senior executives include those responsible for engagement, experience, innovation, transformation, population health, accountable care, marketing, clinical integration, data analytics, reputation management or performance management.

Organizations may want to expand the responsibilities of existing senior executives to include patient and consumer engagement or recruit and develop professionals to fill the roles of chief engagement officer or vice president, patient engagement. Others may decide to position patient and consumer engagement under existing divisions and departments, including marketing, accountable care or population health management.

Explore the principles that will support the organization’s patient and consumer engagement initiatives.

C-suite executives and board members may not need a full-blown implementation plan, but they want to review the principles, values and strategies that will support patient and consumer engagement initiatives. Consider elaborating on concepts like the following:

  • Continuum of care and living: Our program will integrate engagement, education and empowerment into the expanding continuum of care. We will provide information, education and advice across every continuum of care setting and beyond – in homes, automobiles, workplaces and other environments where individuals and families are willing to access, assimilate and act upon healthcare content. We will pursue engagement through the complex ecosystem that shapes the health and lifestyle choices of patients, families and consumers.
  • Healthcare journey: Our program will deliver engagement, education and empowerment no matter where the patient, family member or consumer stands in the healthcare journey: information gathering, knowledge sharing or decision making on prevention, symptoms and diagnostic testing, treatment, recovery and self-care.

Secure short-term and extended financial, clinical and operational support for patient and consumer engagement, education and empowerment from C-suite executives.

  • Personalized delivery: Our program will customize and personalize the healthcare information and knowledge sharing experience. We will make adjustments for co-morbidities, health literacy and numeracy, education, ethnicity, culture and other social determinants of health as defined by the Institute of Medicine.
  • Empowerment: Our program will help patients, family members, caregivers and consumers understand and take charge of their health and healthcare across the care continuum and throughout the lifecycle. We will guide patients and consumers from non-engagement to engagement, education and authentic empowerment.
  • Clinician alignment: Our program will mobilize clinicians – physicians, nurses and allied health professionals – to engage, educate and empower patients, families and consumers. We will blend macro engagement strategies involving social, print and online media with face-to-face interactions involving physicians, nurses, allied health professionals and others members of the village.
  • External expertise: Our program will rely on consultants and solution providers that provide the right information in the right format at the right time or “teachable moment” to the right patient. We will investigate securing patient engagement, education and empowerment solutions from a single vendor with expertise in patient data collection, risk stratification and content development and dissemination.

Explore and expand upon the evidence for patient and consumer engagement.

Positive engagement outcomes are already supported by research. Engaged patients have better outcomes, quality of life and reduced costs, according to four case studies in the February 2013 issue of Health Affairs.

Patients who are “activated” – meaning that they have the knowledge, skill and willingness to manage their health and healthcare – have much better health outcomes and lower costs than patients who are less activated, according to research from Judith Hibbard of the University of Oregon and her colleagues.

Activated patients are more likely to do the following:

  • Use medical resources and information
  • Eat a healthy diet, maintain a healthy weight, and exercise regularly
  • Possess normal blood pressure, cholesterol and HbA1c
  • Adhere to treatment regimens and recommendations
  • Better manage a chronic disease
  • Complete post-op physical therapy
  • Undergo preventive screenings

Patients with the lowest activation scores tend to lack the knowledge, skill and confidence required for engagement and self-management of health and healthcare. They are more likely to experience inpatient admissions, emergency department use and re-use and readmissions within 30 days of discharge.

They also incur costs significantly higher than those with the highest activation scores, leading Hibbard to suggest that healthcare organizations assess activation scores and engage patients to improve patient outcomes and lower costs. Among the specific findings of her research:

Patients with the lowest activation scores had predicted average healthcare costs that were eight percent higher than costs for patients with the highest activation scores. Among patients with high cholesterol, those with the lowest activation scores had 12 percent higher predicted costs compared with patients with the highest activation scores. For patients with asthma, those with the lowest activation had 21 percent higher costs. In the first half of 2011, patients with the lowest activation had 21 percent higher costs than patients with the highest activation.

Research completed in 2015 reveals that “when patient activation levels change, health outcomes and costs change too.” Higher patient activation levels are associated with “better clinical indicators, more healthy behaviors, and greater use of women’s preventive screening tests, as well as lower costs two years later.”

Among other evidence points on the link between patient engagement and lower costs, better outcomes and an improved patient experience are the following:

And don’t forget the ripple effect. “Engaged patients and consumers who become their own best healthcare advocates and champions will emerge as healthcare advocates and champions for family members and close friends,” says Dr. Edelstein.

While demonstrating the impact of engagement on patients, consumers and providers, be sure to discuss the role of engagement in fulfilling strategic imperatives, advises Mathur. Such strategies may include patient satisfaction and experience, accountable, value-based care and reimbursement, population health, clinical integration, and performance management. Among the engagement issues to address in a conversation about population health are the following:

  • What’s the optimal relationship between patient and consumer engagement and population health?
  • How do patient and consumer engagement contribute to effective population health management?
  • How does the absence or weakness of a patient and consumer strategy stymie population health management?
  • How could enhanced patient and consumer engagement initiatives improve the management of chronic diseases: CHF, COPD, asthma and diabetes?
  • How could we re-engineer existing engagement initiatives to improve population health outcomes?

Forward to the Future

Popular technologies like patient portals, mobile devices and electronic health records contribute to patient and consumer engagement, education and empowerment. Total engagement however, calls for enterprise-wide shifts in attitudes, beliefs, values and culture. Only then will patients and consumers appreciate the value of taking charge of their health and healthcare. Only then will they have the knowledge, skill and motivation to sustain behavior change and lead healthier lives.


About Peter Edelstein, MD, FACS, FASCRS

Peter Edelstein, MD, is the Chief Medical Officer at Elsevier. Edelstein is board certified by the American College of Surgeons and the American Society of Colon and Rectal Surgery. He has more than 35 years of experience practicing medicine and in healthcare administration.

Edelstein was in private practice for several years before serving on the surgical faculty at Stanford University, where he focused on gastrointestinal, oncologic and trauma surgery. He then spent more than a decade as an executive in the Silicon Valley medical device industry. Edelstein’s most recent role was as Chief Medical Officer for the healthcare business at LexisNexis Risk Solutions, a Reed Elsevier company. He is also the author of the recently published book, ‘Own Your Cancer: A Take-Charge Guide for the Recently Diagnosed & Those Who Love Them’.