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DHIS 2018—An Innovation Dilemma
Truly Activating Patients in Their Own Care
Author
Jennifer Hickenlooper
KLAS convened some of the most influential healthcare thinkers for its second annual investor conference, the KLAS Digital Health Investment Symposium, in Snowbird, Utah, August 14–15, 2018. Attendees included healthcare providers, healthcare payers, corporate development professionals, and representatives from private equity firms, venture-capital firms, digital health companies, health-system incubator companies, analyst firms, and investment banks. This white paper represents the collective insights from these healthcare executives exploring the difficult challenge of truly activating patients in their own care. Over the past two years, patient engagement has continued to be a high-energy market segment for innovation and investment according to KLAS’s Emerging HCIT Companies report as new companies continue to enter the market, attempting to solve complex provider needs. Due to this energy, KLAS asked these thought leaders to participate in a roundtable discussion to explore the biggest challenges and solutions relative to patient engagement to help push the industry to new innovation, investment, and solutions.
Introduction
KLAS convened some of the most influential healthcare thinkers for its second annual investor conference, the KLAS Digital Health Investment Symposium, in Snowbird, Utah, August 14–15, 2018. Attendees included healthcare providers, healthcare payers, corporate development professionals, and representatives from private equity firms, venture-capital firms, digital health companies, healthsystem incubator companies, analyst firms, and investment banks. This white paper represents the collective insights from these healthcare executives exploring the difficult challenge of truly activating patients in their own care. Over the past two years, patient engagement has continued to be a high-energy market segment for innovation and investment according to KLAS’s Emerging HCIT Companies report as new companies continue to enter the market, attempting to solve complex provider needs. Due to this energy, KLAS asked these thought leaders to participate in a roundtable discussion to explore the biggest challenges and solutions relative to patient engagement to help push the industry to new innovation, investment, and solutions.
Symposium Table Discussion Objectives
To convene healthcare providers, healthcare payers, strategists, and representatives from private equity firms, venture-capital firms, digital health companies, health system incubator companies, analyst firms, and investment banks.
To explore the biggest challenges related to patient engagement and uncover solutions that will lead to meaningful change.
To align capital with innovative companies and health systems to encourage solving some of healthcare’s most challenging problems.
The Mission
Patient engagement is not a new concept but has been growing in energy and demand for many reasons, including factors from the changes in the healthcare reimbursement models all the way to the health and wellness craze that many people are diving into. Along with this growing energy, KLAS’ research efforts have also increased over the past several years. In 2016, providers rated the impact of patient engagement solutions on patients’ health. Providers who had more complete patient engagement strategies saw higher impacts on patients when using certain patient engagement solutions. Even with the adoption of technology and its impact on patients’ health, there still remain problems to be solved and investments to be made. This leads to the primary goal of the symposium discussion: to identify the barriers and solutions to truly activating patients in their own care. Attending executives spent the first half of the discussion focused on barriers, followed by another discussion centered on finding ways to mitigate these barriers.
Patient Engagement Barriers
Many barriers emerged from the table discussions. Barriers were put into the following categories based on patient and provider goals: challenges motivating patients to live better (wellness); lack of collaboration among patients, providers, and payers; obstacles patients face navigating patient engagement tools; lack of trust among patients, providers, and payers; and difficulties leading to inadequate access to care. The details of each of these categories are represented in individual executive quotes below. One executive shared, “The biggest barrier for patients is that there are too many engagement points (apps, portals, etc.), a lack of transparency both financially and with quality of care, patient disinterest due to a variety of reasons, and providers facing a lack of time, data, and focus.”
Guiding Questions
1. What are the biggest barriers to activating patients in their own care?
2. What incentives are in place or not in place to motivate patients to be engaged in their own care?
3. What technology foundations are missing or lagging behind that would enable patient engagement?
Challenges to Motivating Patients to Live Better (Wellness)
“People will avoid spending money until they have to. They may not see the value of a little spending now that may avoid larger, more expensive procedures later.”
“A patient that has cancer is more likely to want to be engaged in their care than someone who is young and healthy.”
“People don’t want healthcare in the center of their life; we are forcing people to do something they really don’t want to do.”
“We see patient engagement from our own point of view. We need to compare how we want them to be engaged and how they want to be engaged.”
Lack of Collaboration and Trust among Patients, Providers, and Payers
“Misaligned priorities from patients, payers, and providers.”
Providers and payers are on different playing fields, especially with pre-authorizations.
Providers have trouble keeping track of each plan because “no two plans are the same.”
“Payers are indirectly paid per transaction, so if there are more transactions, they can then raise premiums and increase costs.”
Patients withhold information from providers to keep it from payers out of fear that their premiums will rise.
“Providers don’t know the information, so they can’t coach the patient. Providers default to what they have been trained on.”
Patients may be more interested in the quickest way to get healthy again and may not care about the long-term costs or whether the treatment is the right one for them if it is convenient.
Physicians are already overwhelmed and unable to build relationships because of lack of time with patients
Patients may have misinformation and lack understanding about the best care plan.
Lack of trust between patients and providers.
“There is a fundamental distrust of the medical industry; patients feel pushed around. Also, patients move from provider to provider, so there is a lack of relationship and trust.”
Obstacles Patients Face while Navigating Patient Engagement Tools
“Apps are really not all that convenient at this point; it still does not feel like the industry is focused on the patient and their needs or convenience.”
“The adoption rates for patient portals are so poor. Every EMR company says that they do patient engagement and population health through their portals. But when we look at the adoption rates, no one is using the portals. Vendors may have the best portal in the world, but that doesn’t matter if no one is using it. Obviously, vendors are doing something wrong from an engagement standpoint if no one is actually bothering to check the portal.”
“When a patient leaves the hospital or clinic, there is a loss of connection between the patient and those who can help the patient, leading to a lack of monitoring and intervention.”
“The fragmentation of healthcare as a patient moves from one system to another is difficult. If there are multiple portals, different digital apps, and so forth, it makes care so fragmented. Patients become overwhelmed with all the apps and tools that are being availed of. Patients move around and therefore have to use the tools that providers at different locations provide.”
“Even with high-deductible health plans, patients are not shopping for their care. It is too painful to go through three portals or call three providers. There is not an easy, transparent way to get that care for the right price.”
Difficulties Leading to Inadequate Access to Care
Patients may have trouble accessing applications to schedule appointments or have a hard time knowing who to go to based on web searches.
Some patients may have difficulty getting to appointments and want to connect in different ways that are sometimes not available, such as telehealth or home visits.
Patient Engagement Solutions
Many solutions emerged from the table discussions. Solutions were put into categories that correspond to top barriers. The details of each of these categories are represented in individual executive quotes below. Even with all the technology available, some groups shared the sentiment that “people are the first battlefront for engaging patients; technology is second. Technology can’t be the one source for closing patient engagement gaps. Technology is a tool, not a solution.”
Guiding Questions
1. What are the recommended solutions to activating patients in their own care?
2. How do we get beyond the basic patient portal features to engage patients?
3. What incentives can motivate patients to engage in their own care?
4. Is bringing care to the mobile phone a real solution? Is the Apple health record a real solution?
5. Do true patient-focused tools and applications exist?
6. What practices are in place or needed to help promote consumerism in healthcare?
Motivate and Empower Patient to Live Better (Wellness)
Incentives for patients such as sponsorship by employers, money for a wellness visit, lower insurance premiums, a gift card to a spa, or other money to spend.
Include a community aspect to incentives so people can motivate each other.
Gamification: “What if patients could get money back from their insurance provider if they hit a certain level in a gamified wearable system? For example, patients who take 1 million steps in a quarter could earn $10 toward their next premium. There needs to be an incentive program that maps patient behavior with financial incentives.”
Similar to care managers that currently exist.
“The facilitator could help drive engagement and inform patients of costs and provider quality and availability.”
“We have to be able to reach those who don’t care about their healthcare and move the cost needle to help them become healthier and increase engagement. There need to be people who help engage patients who haven’t been healthy historically. . . . There are financial advisors. Why don’t we have health advisors?”
Cultivate Collaboration and Develop Trust among Patients, Providers, and Payers
Align incentives between providers, payers, and patients.
More “economic transparency.” Don’t just refer to patients being able to have transparent prices but help “patients to avoid getting information from unreliable sources. There is a need to get the right sources of data in front of patients and make tools a trusted source for information.”
“Find a way to connect the patient, not the payer or provider, as the customer. Getting clarity to patients and consumers about their accountability may increase engagement.”
Share information between the patient and provider (with tracking). Providers could then see all the patient’s information but also see what the patient inputted.
“We could make it so that patients couldn’t edit their records, or there could be a certificate that verified the record wasn’t changed. Physicians won’t trust the data that comes through a portal like this if it could be manipulated.”
“For shared patient/provider records to be trustworthy for the patient and physician, they need to be vetted by both parties. For example, if a patient is diagnosed with heart disease but that turns out to not be true, the patient sometimes can’t get that removed from the record.”
Providers need to have more time to build better relationships with their patients.
“If patients are contacted directly by the primary care provider, their engagement is around 90%.”
“Physicians should be incentivized to offer tools that align to the patient’s journey. Value-based care reimbursements get providers engaged to do the right thing.”
“Payer incentives need to be aligned to set up these initiatives. If a payer policy is off, it needs to be changed.“
Physicians should work to find out what the patient’s goal is.
“If a goal is expressed from the patient (instead of from the provider or payer), that patient is much more engaged.”
“Get patients engaged in things they care about. Tell them what the options are and what things will cost. Give them the information to make informed choices.“
Enhance Navigation of Patient Engagement Tools
“Create a single app that is all encompassing rather than requiring patients to use lots of different apps.”
“Have a unified location to keep track of all the different portals, including price transparency, education, and quality information.”
Patients need vendors to “build a meaningful tool that goes beyond checking the box for meaningful use.”
Incentives for interoperability applications.
The biggest challenge with this solution is that “the incentives aren’t there for businesses to actually share patient data.”
As KLAS has historically seen in previous research, improving integration is seen as the solution that would be most clinically impactful for patient engagement.
It may be nice to have a “national patient identifier to leverage access to data.”
“Health apps should be integrated in the base infrastructure of the user’s life, like the Do Not Disturb While Driving function on Apple phones. It is important to create apps that truly make life more convenient for users.”
Improve Access to Care
“We need to know patients and meet them where they are, even physically.”
Solutions include virtual visits, offering a more convenient retail feel, and even doing home visits.
In the Emerging HCIT Companies 2018 report, telehealth was the most considered future technology to invest in for engaging patients more deeply in their care.
Patients need to be met “in their flow with no interruptions at inopportune times.”
Inova and Ascension “are creating large campuses where people can naturally become a part of the system through yoga classes, apartments to stay in, etc.”
Nontraditional Healthcare Players Driving Innovation
Recently Apple, Google, and Amazon have thrown their hats into the healthcare ring with financial investments. Symposium participants feel that these moves will shake up the healthcare market and motivate further innovation from other companies. One executive said, “In healthcare we don’t understand consumers, and we are just nibbling at the problem. There are a thousand dead and useless apps out there. Amazon and others coming into healthcare is going to cause a big shakeup. That is a good thing because it gives us opportunities to address one of biggest barriers: looking at life through the lens of the consumer.”
Conclusion
Patient engagement still has a long way to go and many problems to overcome, but the attendees at the Digital Health Investment Symposium expressed optimism about the future and innovation to come that will help activate patients to improve their own health. One executive shared this view of the future: “Imagine a single app on the phone with all my health information. . . . I could get reminders about doctor appointments and see my activity level. Then if all that information could be tied with healthcare insights, the app could know in real time what I should be doing in terms of my health.”
HIT capabilities that are strategic and foundational in nature can improve patient engagement. KLAS will be hosting our Keystone summit in October with a focus on tools and technology that can enable better patient engagement.
Sponsors
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Investors
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Providers and Payers
Atrium Health
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BCBSM
BlueCross BlueShield of Illinois, Montana, New Mexico, Oklahoma & Texas
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Dana-Farber Cancer Institute, Harvard School of Public Health
Duke University Health System
Fort Drum Regional Health Planning Organization (FDRHPO)
Franciscan Missionaries of Our Lady Health System
IU Health/IU Health Plans
Intermountain Healthcare
Jefferson Health
Moffitt Cancer Center
Nationwide Children’s Hospital
NorthShore University HealthSystem
Office of the National Coordinator for Health IT (ONC)
Penn Medicine
San Francisco Health Plan
Sentara Healthcare
Sharp HealthCare
Sutter Health
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Trinity Rehabilitation Services
UCSF Health
The University of Chicago Medicine
UPMC & UPMC Enterprises
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Walgreens
Vendor Companies
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NTT DATA Services
Nym
OpenTempo
Performance Clinical Systems
Protenus
QGenda
R1 RCM
Recondo Technology
Telmediq
TVR Communications
Verge Health
VisitPay
Vocera
Vyne
Vyne
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.