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Patient Engagement - Is it time to think differently?

Without a doubt the changes occurring within the U.S. healthcare system are unprecedented. Whatever your thoughts about the merits, or otherwise, of healthcare reform it is clear that the status quo is not an option if America is to maintain its position as the pre-eminent economic force in the world.

There are many similarities to the way the U.S. government is restructuring the healthcare system to the changes that are concurrently occurring across the Atlantic in the UK. Both systems are trying to move away from the episodic, transactional model of care to one that encourages and rewards total population cost management and outcome improvement.

In my previous Healthcare Finance News blog I alluded to the fact that outcomes from most major diseases were very similar between the U.S. and UK. Indeed, neither of our nations should be proud of what we have achieved to date; we both find ourselves languishing mid-table in global health outcomes league tables.

To this end, critically examining the way we fund, remunerate for and deliver healthcare services seems like a good way to tackle the discrepancy between total spend and outcomes.

The changes that are happening in the U.S. are by no means insignificant; in fact they are probably the biggest changes to the way the health system operates that we have ever seen. But tough times require tough measures and America simply cannot afford the 18 percent of GDP that is currently spent on healthcare, never mind the predicted rise to over 20 percent by the end of the decade.

All is not doom and gloom though. With change comes opportunity and I believe we have a huge opportunity to really start engaging our patients in discussions about their healthcare needs in a meaningful and proactive way. As a group we physicians have been singularly poor at taking a population view of the people we serve. We have no contact with the vast majority of our patients for 360, or more, days a year and are the only professional body that “discharges” our clients. The medical profession really does need a sea change in the way it approaches population health.

If we have learnt one thing from the past few decades it is that focusing solely upon the needs of the 15-20 percent of the population that incur 80 percent of the costs does not reduce cost burden; in fact it actually leads to increasing costs over time. I am not suggesting that we ignore these people; rather we spend some of our time, energy and resources on managing the health of the rest of the population in order to try and reduce the likelihood of them becoming high-cost utilizers of services in the future.

The last decade has seen this sort of approach increasingly adopted in the employer health management setting, with some good results in terms of cost containment, and even return on investment. With the likelihood that financial risk will continue to be shifted away from employers towards providers of care it is worth spending a few moments examining some of the ways employers have approached managing the health of their employee populations.

At the heart of most employer health initiatives is the annual health risk assessment, which provides valuable snap-shout data on the health status and lifestyle choices of individuals within that population. I have frequently wondered why we don’t adopt this sort of approach more often in the provider setting.

Amalgamating this kind of self-report data with information held in an electronic health record would provide a powerful resource to stratify the population and target appropriate interventions to appropriate individuals. At the very minimum we could identify those individuals whose insurance covers an annual wellness and preventive care visit; however, we could do so much more.

Targeting relevant information to individuals as well as making them aware of what local services and initiatives are available to them would help establish an ongoing dialog. And this is precisely the thing that has been missing from the delivery of healthcare for too long now.

As physicians we have one of the only remaining “special relationships” in society. In general, society no longer has a high level of respect for bankers, politicians or captains of industry, but members of society still trust doctors and value the doctor-patient relationship. We need to leverage this going forward and move away from the episodic nature of care delivery and embrace a new way of interacting.

Many of my physician peers throw their hands in the air at this point and say they hardly have time to see patients who are acutely unwell let alone be proactive with those who may need care in the future. But again, this is where we have to think differently.

Not all interactions have to be face-to-face; telephone calls, text and instant messaging, emails and provider specific portals can all have a role in creating a meaningful ongoing relationship and dialog with our patients. Healthcare is changing and we as providers of care need to be part of the solution as our healthcare systems cannot afford to continue as they have been.


Peter Mills, MD, is a practicing physician in London, UK. He is the founder of Glasslyn Health Solutions and works with corporations, health insurers and healthcare providers in the UK and USA to develop sustainable population health management initiatives.

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