Why current healthcare consumer engagement strategies aren’t hitting the mark

DECEMBER 16, 2019 / BY MATT ADAMSON, VP Product Planning and Innovation, ZeOmega

In part two of this three-part consumer engagement blog series, we take a look at today’s patient engagement tools, issues that are slowing their adoption, and how value-based arrangements are creating new opportunities to engage patients.

If you build it…they probably won’t come: the problem with portals
Historically, healthcare organizations have turned to patient portals as central locations to provide records access, direct messaging, scheduling, payment options, and more. Using a patient portal or similar technology seems like a logical way to encourage patients to learn more about their conditions and interact with care providers in a secure, HIPAA-compliant environment. Unfortunately, we all know it isn’t that easy. While rules, metrics, and evidence dictate the activities of the clinician community, there are no such rules in place that require patients to engage.

A recent study from The Office of the National Coordinator for Health Information Technology shows that of those patients offered access to their medical records in 2018 (only a little over half, but that’s a story for another blog), 58 percent actually took the time to view them, and most only once. (ONC) Just about half of those patients who accessed their records used direct messaging features in their portal, as well. A one-time records download does not constitute a successful patient engagement strategy, and not surprisingly those who accessed their records were more educated and of a higher socioeconomic status — patients who are likely already more engaged in their care. (BMC)

Portals are still invaluable for providing records access and streamlining administrative tasks like scheduling and payment, but if patients don’t visit them with any regularity or duration, their effectiveness as patient engagement tools is dubious. In the ONC study and others, patients have cited a number of reasons why they avoid logging on:

  • Security or privacy concerns with sharing or accessing information online
  • Preference to speak to their provider directly
  • Incomplete information like missing records or notes
  • Access to other, easier-to-use information sources, such as health and wellness apps and websites that provide a superior user experience

And it isn’t just patients who are underutilizing portals — any technology adoption must be accompanied by monumental shifts in attitudes among physicians along a move away from fee-for-service too, in order to be successful. Already strapped for time and rarely reimbursed for patient engagement outside the office, few physicians are trained for or desire the high-touch, after-hours interaction that a portal enables.

Care coordinators are promising, but they need the right tools for the job
Part of the solution to engage healthcare consumers between office visits is the recent evolution of the care coordinator or care manager, a member of the healthcare consumer’s care team in most value-based models, leveraged at health plans and other at risk-bearing entities for nearly all lines of business. Still relatively rare in the clinical setting of fee-for-service models, this role is typically filled by nurses in the health plan with care management experience, who can help put conditions and diagnoses into the appropriate clinical context while speaking with patients on their level.

Care coordination has influenced measurable improvements in both outcomes and patient experience, especially for those with chronic conditions. (NEJM) By helping patients navigate the healthcare system to stay on track with their treatments between physician visits, this pro-active model serves as a critical clinical bridge that connects patients to their care outside the exam room. At any given time, an effective care coordination model must alternate between high touch, frequent interactions to automated outreach based on the needs and preferences of the patient. While early literature on the benefits of care coordination is promising, are we missing opportunities to extend its engagement capabilities — and measure its effectiveness — using technology?

What’s missing in the EMR
Care coordinators or health coaches in the clinical setting often use EMRs as the primary platform to perform their duties, however systems like these have been typically designed to drive fee-for-service payment structures and can be limiting. EMRs often do not include the full picture of services for the patient, lack analytics capability, can’t provide content-driven assessments, and do not consider social determinants as means to drive proactive nursing care plans. Other critical tasks such as scheduling interactions like specialty visits or exams, making sure medications are picked up at the pharmacy, looking at conditions other than the current visit diagnosis, and developing and tracking a care plan are also not accounted for. An EMR alone makes the pro-active activities required to keep patients on track outside of the doctor visit at best undocumented, and at worst nearly impossible to coordinate.

It’s hard to make the call
Outreach by care coordinators — calling people on their home or cell phone to try and engage them in their health — is becoming more challenging each day. Consumers are opting out of land lines in favor of cell phones, which allow them to easily screen calls. With a strong preference for texting and social media as communications channels, care coordinators must leverage new technologies to enable outreach or see minimal patient engagement.

In a perfect world, care coordinators have direct communication with a patient and related care team, and a means to track and store their interactions as part of a reportable, clinical record. While portals are an avenue for patients to communicate with care coordinators, their lack of use gives them minimal value as an engagement tool. If a care coordinator can’t reach the patient by their preferred method, the coordinator’s ability to educate and intervene is limited.

It’s apparent that the patient portals and EMRs mandated by Meaningful Use will not move the needle toward smarter health choices on their own. In the third and final blog of this series, we’ll explore what to consider when implementing technology to facilitate patient engagement and highlight some emerging tools that can help build the connection between patient and care coordinator.

If your healthcare consumer engagement program could be more engaging, it may be time to chat. We hosted a webinar with our platform partner Comm100 discussing why and how healthcare organizations are embracing live chat and AI to take engagement to the next level.