The Triple Aim

Patient Engagement: A Potential ‘Holy Grail’ for Achieving the Triple Aim

As patients evolve into discerning, retail-like customers and the shift toward value-based care continues, providers and payers face pressure to control costs, with patient engagement (PE) becoming more important than ever. Mobile, integrated PE solutions could be the “holy grail” for achieving the Triple Aim: improving the patient experience of care, improving the health of populations and reducing the per-capita cost of health care. But how do we get there?

The case for investing in PE

The PE sector is composed of both traditional patient education (e.g., print, video and web/digital) and more interactive patient communication solutions (e.g., symptom checkers, financial access tools, medication adherence tools, inpatient interactive care portals). While traditional PE solutions have informed provider-patient and payer-patient interactions for decades, more novel interactive solutions have been coming to market in recent years, fueled by a number of macro healthcare trends in the U.S. that are impacting payers and providers alike. 

  • Rising role of the consumer in healthcare — Patients are increasingly looking at health care through a more exacting, consumer-like lens, forcing providers to change their offerings to improve the patient experience and retain customers. Additionally, providers are placing more emphasis on the patient experience to drive volume through differentiated patient experiences as competition increases (e.g., from health systems and from retail concierge medicine and urgent care centers). PE solutions can enhance patient experience by demystifying conditions and treatments and by providing more consistent end-to-end care, ultimately improving perception of the experience and loyalty.

     

  • Greater emphasis on reducing total cost of care — Payers are under pressure from the ultimate funders of most health care services (e.g., employer groups, the government in both Medicare and Medicaid) to control costs and deliver value as they assume more financial risk for population health management. Effective PE solutions can help with user-friendly care management, disease management and wellness campaigns.

     

  • Continued shift toward value-based care — As both government and commercial payers shift reimbursement models to value-based care (e.g., global capitation, bundling, readmissions penalties, MACRA/MIPS), providers are placed at greater financial risk for patients outside of their specific care settings. PE solutions improve value-based outcomes and patients’ experiences by enhancing their understanding of conditions and treatment plans to boost full treatment success rates. They also help providers manage/prompt continued patient adherence and compliance. 

PE use cases and functionality that are driving growth

While the PE market is experiencing rapid growth (10-15% per annum), not all segments are growing quickly — some interactive, technical subsegments are growing faster, and some older, static segments more slowly. 

Based on the macro-trends discussed above, the following use cases are likely to continue to see outsized growth:

  • Patient financial responsibility/patient access tools in revenue cycle management — For both acute and ambulatory providers, rising patient financial responsibility as a result of the growing prevalence of high-deductible health plans is fueling significant investment in point-of-care, pre-service payment-planning solutions.

     

  • Interactive tools to help facilitate behavioral change and improve patient/member care — Payers and providers want to facilitate behavioral change through interactive tools, such as those that send patients medication reminders, help them track their weight, and help them calculate the costs and understand the risks of various treatment options.

     

  • Integrated solutions for effectively engaging patients/members — PE solutions engage patients/members throughout the patient journey and through a number of multi-modal devices (e.g., tablet, phone, personal computer) that take into account the consumer’s communication preferences to maximize the ability to change behavior.

     

  • Platform-based solutions with broad content — Payers and providers want robust and digestible content about pre-procedure preparation, procedure risk, post-event care, and managing and monitoring a health condition to provide patients/members with actionable information to improve their health. Given a desire for consolidating vendors and standardizing care across a healthcare organization, as well as for increasing preference for “whole person” care vs. isolated conditions or bodily systems, solutions that include content across therapeutic areas are likely to gain favor.

As the PE market continues to mature, we expect to see more mobile solutions that coordinate engagement across the care continuum, from acute to post-acute to community-based settings, allowing for health data aggregation and feedback.

The “holy grail” solution would leverage an integrated platform — one that allows patients and clinicians to engage and share information agnostic of the site of care or patient location and that enables healthcare providers to drive outcomes and patient experience while patients play a greater role in their own care.

L.E.K. Consulting, along with Triple Tree and the Marwood Group will be joining KLAS' ​2018 Digital Health Investment Symposium (DHIS) to discuss patient engagement and other up-and-coming health IT subjects.

Learn more about DHIS18 here.