Patient engagement has more moving parts than many providers realize

Portals are just the beginning.
By John Andrews
01:37 PM
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While the healthcare industry by-and-large understands the importance of patient engagement in the service equation, setting up a system that empowers patients and gives them more control of the care process has been, for the most part, elusive.

Perhaps it is due to all of the moving parts of hospital workflow, relationships with post-acute providers that are still emerging and a complex customer dynamic that spreads across both provider and payer horizons.

Keeping the patient engaged amid a chaotic scheduling, clinical and financial environment is indeed a challenge. But technology companies are making inroads toward better patient engagement by targeting specific episodes and encounters in the vast healthcare continuum and it appears to leading to an improving climate of patient satisfaction and rapport with providers.

[Also: Demystifying patient engagement: strategies for a participatory health system]

Through a commitment to developing mobile device apps that tap into the machinations of healthcare provider organizations, companies like Panama City, Fla.-based Jellyfish Health are giving patients new tools for managing their episodes of care and any chronic conditions they may have.

"We focus on the patient experience from the outpatient side – ambulatory surgery centers, physician clinics, labs and other post-acute sites," said Jellyfish CEO Dave Dyell. "It starts with patient scheduling all the way through until check out. While clinician interaction is a major part of the experience, it is the non-clinical touch points that harm the experience.

"Most patients are happy with the care they receive, but they won't come back if they waited too long to check in or spent too much time in the waiting room. Our app ensures they have the opportunity for a positive encounter," he added.

Founded two years ago in the population health space, Jellyfish sharpened its focus on individuals managing their own health – a concept with promise if they could more easily navigate the labyrinth of obstacles in making appointments, cutting through insurance coverage snafus and optimizing their time spent at healthcare facilities, Dyell said.

The cloud-based Jellyfish app organizes how to navigate the provider landscape, anticipates workflow bottlenecks and keeps users up to date on their appointment status.

"It provides transparency in the healthcare experience," Dyell said.

Pediatric engagement
As if adult patient engagement wasn't tricky enough, pediatric engagement adds another layer of complexity with the family support network. Bethesda, Md.-based GetWellNetwork aims to include everyone involved in the pediatric patient's circle of care, said Shannon O'Neill, vice president of pediatrics.

"When you think of how healthcare is delivered, the focus is on clinical workflows and pathways," she said. "Our software is a way to engage families in the process. It is a cross-continuum platform that includes the patient and family-facing piece to the care puzzle."

It is the family dynamic that makes pediatric care special, O'Neill says. The blended families of today often consist of more than two parents located in different places, but who are actively involved in a child's care.

The key to effective pediatric engagement, O'Neill says, is empathy with patients and their families.

"Providers have historically had good data, but they haven't had the patient voice," she said. "Understanding the true voice of the patient is where you can affect the engagement process. Getting their perspective is an important piece of the puzzle."

Alleviating 'shock'
Chronic kidney disease is a serious disorder that is not well known within the usual spectrum of disease state management, at least when compared to the more common conditions of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease and asthma. Therefore, a diagnosis often catches patients by surprise and can come as a shock to the system, acknowledges nephrologist Carmen Peralta, MD, chair of San Francisco-based Cricket Health's Medical Advisory Board.

"What commonly happens is a patient gets sent to me because the primary care physician is concerned about abnormal kidney function, and even though they show no overt symptoms, they are seriously ill," Peralta said. "If they have advanced kidney disease, this is the first they've heard about it and it is very hard news to take. The worst part is when I go into their electronic health record and see that kidney function has been in decline for a decade and nothing was done about it."

If a patient reaches end-stage renal disease, there is no time for effective engagement, she said. Therefore, she advocates public awareness campaigns are crucial to educate society about the seriousness and commonality of chronic kidney disease.

[Also: Digital tools fueling patient engagement, survey finds]

Patients with less advances stages of the disease do have an opportunity for engagement and preventive measures, such as low sodium diets and regular monitoring of creatinine levels.

Peralta concedes she had never worked with a technology company on developing an app before and the challenge was determining what to do once it is detected.

"Their life is turned upside down – they need to learn," she said.

Cricket developed content in multiple forms – videos, online content for reading and user chat with patients who live with kidney disease.

"The people behind this technology are determined to help these patients know they are not alone," Peralta said. "It provides invaluable support about living with the disease."

The payer piece
Patient engagement also has a third component in the form of handling payment arrangements with the insurance companies. It is the wheelhouse of Centerville, Ohio-based PayorLogic.

Coming at the back end of the patient engagement process, reconciling co-payments and deductibles for services can be a multi-faceted source of confusion, especially for emergency room visits and inpatient stays, contends Tyler Williams, president of PayorLogic.

Misunderstandings about how much is owed "makes everyone look bad and makes the patient angry," he said.

Blame can be cast around to all parties, though Williams says patients need to be better versed at the information they need to give and providers must commit to a system that ascertains the correct profiles at intake, where 40% of errors are made.

"We used to work the back end to clean up messes – we would scrub to verify the patient demographic and ensure that all information was correct," he said. "But six months down the line it may not be right and suddenly the patient is getting bills from everywhere. So we built some real-time solutions for pre-registration at emergency or non-emergency and use third-party credit data to confirm. Any discrepancies are found, corrected and patient satisfaction goes up exponentially."

Getting up to speed
While technology is facilitating the growth of patient engagement, the healthcare industry still has a long way to go in empowering patients to take control of their health, chronicle their experience and synchronize with providers and payers, said Jean Drouin, MD, CEO and co-founder of San Francisco-based Clarify Health.

"Healthcare workflows remain broken and there is no such thing as a 21st century service experience," he said.

As "very much an optimist and pragmatic idealist," Drouin is promoting UPS and FedEx tracking systems for real-time patient engagement practices.

"What we see is a couple fundamental trends that may finally lead providers to make the same sorts of investments that Amazon, UPS and Fedex make today in analytics and workflow optimization platforms," Drouin said. "We strongly believe that with advent of new risk-based payment models, the provider are assuming risk, leading to a greater desire among the forward thinkers to invest in the kind of systems to be competitive."

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