A crowdsourced view into engaging patients

Key trends and what works for patient engagement
By Todd Rothenhaus, MD
08:17 AM
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According to a recent study put out by the retail care giant CVS, somewhere between 37-57 percent of patients are interested in using web-based tools to fill prescriptions, track their own health, and access health information, but few (4-8 percent) actually do it.

Herein lies one of the greatest disconnects in healthcare today – and one that is actively being studied at athenahealth. Today, patient engagement is most often delivered via mobile tools or "patient portals," making enrollment a critical first step on the journey to engagement, activation, and better health.

At athenahealth, we've studied adoption in exquisite detail, naming portal adoption as one of ten "sentinel metrics" we measure and manage on behalf of our more than 37,000 providers and 50M patients. Through this work, we've identified a number of key trends, as well as five learnings on what works when it comes to patient engagement.

A real demand for engagement

We are clearly seeing increased patient demand to interact with healthcare providers the same we interact with other businesses: online and asynchronously. At the same time, the move from fee-for-service to fee-for-value is highlighting a need to interact more – at least with sicker patients – between face-to-face visits.

Patient engagement looks a lot like any other form of internet commerce. At the low end of the acuity spectrum, patients access information about services (from solo practitioner to a health system), select, schedule or reschedule appointments, pay bills online, read and interact with their own data, and communicate with providers. In this regard, patient engagement is a strategy to improve barriers to access, and improve loyalty as a healthcare consumer.

At the high-end of patient acuity, patient engagement is an essential gateway to patient activation – patients' understanding of their role in the care process, and the knowledge, skills, and confidence to assume at least some responsibility to improve their own health. While studies on patient activation are sparse, it seems fairly clear that "activating" leads to improved outcomes and reduces cost.

But in healthcare, not so much

In any new economy company – like Airbnb or Uber – strategies to grow and improve adoption are culled from data across thousands and thousands of clients and millions if not billions of interactions. Data science, growth hacking and e-marketing have become the de-facto standard of success.

Unfortunately, well over 90% of the healthcare information technology marketplace is still controlled by legacy software vendors. In fact, every one of the nation's academic medical centers – the very institutions we look to deliver medical insights – is running a bespoke, stand-alone, version of a client server system.

Gaining this insight outside the walls of their systems is impossible, limiting them to their own data, or resorting to pooling data between "centers". Medical science just can't crack the code of patient engagement; but for those who've embraced the cloud – in and out of healthcare – the data is just a few clicks away.

Uncovering solutions for today and tomorrow
So, who are the very best providers at getting patients engaged? What do they do? What works? What doesn't work?

Based on host of A/B tests done with providers, care team staff members, and patients across the U.S., as well as from a data analysis conducted across millions of patient portal visits from more than 2,000 healthcare providers who use athenahealth's cloud network and services, here's what's trending in the world of patient engagement and portal adoption:

Age is not a barrier to digital engagement. Providers with low portal-adoption rates often think that their patient mix is to blame. Data shows that's rarely the case. Patients in their 60s register for portal accounts at almost the same rate as younger adults. And imagine this, patients between 70 and 79 are only about 25% less likely to use portals than patients in their 50s and 60s. Moreover, older patients sign into their portal accounts significantly more often than younger patients to check their health records, refill prescriptions, and contact providers.

Portals work well for specialties. There is significant adoption in certain specialty practices like orthopedics, which generally see patients only a few times before returning them to primary care. These practices saw tremendous reductions in staff work from engaging patients electronically, as well as better adherence to perioperative protocols. All they really needed to do was adopt the portal as a policy and make patients use it.

Defaults or "choice architectures" are particularly effective at driving enrollment. Practices that use an "opt-out" approach to the patient portal by automatically registering patients see a much higher adoption rate than practices that ask patients to register for the portal on their own. This aligns with the findings in other parts of healthcare such as organ donation, where "presumed consent" leads to much higher donation rates.

Poor people are unnecessarily at risk of being digitally disconnected. Medicaid and uninsured patients are only about half as likely as commercially insured patients to use a patient portal, a disparity that has the potential to widen the gap in health outcomes between wealthy and disadvantaged patients. However, some athenahealth practices with a heavy Medicaid case mix were able to achieve high adoption rates.

Practices of all sizes can be successful. Practices across the athenahealth network have similar adoption rates, regardless of the number of providers they employ. There seem to be no efficiencies of scale when it comes to this measurement. What's cool about this to me is that small medical groups can have the same digital "footprint" as the largest health systems.

These findings are valuable because they can be used to focus and prioritize patient engagement initiatives whether you're on a cloud network or not. Such small but meaningful learnings like the fact that age doesn't matter when it comes to communicating digitally, or the realization that there's proven benefit in making portal adoption an "opt-out" function, can have vast impact if the behavior is emulated across the industry.

Healthcare is rich in data focused on cost and outcomes, but very rarely implements the learnings from that data along the way or at broad scale. The opportunity to leverage, learn from, and change behavior based on crowdsourced data is vast. It will help providers engage patients over the complete cycle of care, better understand patients' full health stories, react better to health needs, and more confidently participate in innovative reimbursement approaches without fear of sacrificing their own financial health.

This data insight comes from athenahealth, a company that operates a national cloud network and delivers a set of services to more than 67,000 providers across the U.S.. Data insights from the athenahealth network are used to inform providers about best practices as a means to drive improved financial and clinical operations and outcomes. Data from the network is also used for public-health projects such as tracking the impact of the Affordable Care Act in practices, monitoring the spread of influenza, surfacing novel insights about pediatric mental health, and synthesizing the first national map of antibiotic resistance. For more information please visit: http://www.athenahealth.com/network-data-insights