Health Experiences
Peter Heywood wrote this on January 21, 2015 / no comments

Landor Creative Champs_MINT02Patient engagement remains one of the most prevalent ideas bandied about in healthcare today. It and “patient-centered” are two phrases I’d like to expunge from the lexicon.

Don’t get me wrong. Patient engagement and patient-centered care are imperatives for healthcare. More than enough has been written about the transactional and unresponsive nature of healthcare, and a good dose of consumer-centricity is needed in a sector which tends to treat the patient as fuel, not a customer.

Let’s focus on patient engagement today.

As the theory goes, people who are more engaged in their care will ask better questions, take some responsibility for their actions and see better outcomes. Engaged patients who are trending to Type 2 Diabetes, for example, will better adhere to the regimen prescribed by their doctors. They may download apps or buy devices that help then manage diet, monitor blood sugar or exercise more. And, it is hoped, they will never progress to diabetes, saving them and the system a lifetime and the costs of managing the disease.

The same logic and expected outcomes can be applied to people who already have chronic diseases or those who simply (simply!) want to stay healthy.

So where’s my problem with this? The issue is not about being engaged, but about taking ownership.

My personal view is that “patient engagement” has been appropriated by those who want to window-dress the delivery of care. They use the phrase to describe “features” bolted on to existing systems to make them appear friendlier, while not doing the heavy lifting required to truly change processes and attitudes to put the patient in charge.

One example of this is the “patient portal.” Meaningful Use required certified EHRs to include a patient portal, and portals have also appeared on hospital web sites (Cleveland Clinic MyChart), payer web sites (United’s MyUHC) and, of course, the myriad dashboards that accompany all of the health and wellness apps out there.

Yet these dashboards, in particular those associated with physicians and hospitals, present the providers’ view of what they think the patient needs to see. It’s like the providers are “rewarding” the patient with a glimpse into their own records, as opposed to giving them control. With due regard for the challenges of information security, none present a consolidated and useful view of the consumer’s relationship to all of healthcare. None are managed by the consumer.

There was an interesting recent post by Brian Manning (@bcmanning) at Responding to a tweet by Vince Kuraitis who was grumbling about the multiple portals he and his wife have to manage (“patient enragement, not engagement”!), Manning suggested that consumers are looking for healthcare equivalent of

The idea itself is a nice one. Mint lets you bring your financial information from multiple providers into one easy-to-use dashboard. The information becomes yours. You’re more than engaged, you’ve got control (or at least know where you’re out of control).

It raises the next question, however. Who might be behind a Health Mint?

One of the business drivers behind the creation of a patient portal is that it will become the default destination for the consumer for all things healthcare. Imagine the revenue opportunities of all those eyeballs! Of all those people using my portal for life-central issues!

I’m not convinced. I don’t think consumers are going to give pride of place, or the “daily relevance” to a portal because it helps them quantify themselves, or has some version of their health record. But – and taking a page from Mint – they might do so for a site that helps them manage their health finances.

The world of healthcare payments is becoming a bewildering place for consumers. Well, it was always been bewildering but outside of the consumer’s purview, Now – with public and private exchanges, new levels of plans, high-deductible plans, HSAs, co-pays, incentives and more – consumers need help not only selecting the right plan but also managing their personal outlay. One of the reasons why healthcare costs appear to be leveling off is that the consumer is assuming a greater and greater burden for the costs of care, off the books of the payers. By choice or not, the consumer is becoming engaged in – is owning – her healthcare spend.

There are many sites now that help consumers and employers select the right plans (CastLight, Maxwell Health, Benefitter). There are also sites that provide price information and ratings (see what Blue Cross Blue Shield of North Carolina is doing to open up opaque pricing on that front).

But no one – yet – has pulled it all together and enabled the consumer to manage the entire healthcare spend, like a Health Mint. Someone will, and the interesting thing is that such a site will also become the place for your fitness dashboards, your health record, your ratings dashboard and more. It will (sorry, fitness dashboards) be the aggregator.

Imagine, for instance, how monitor-based evidence on progress on your fitness fed into your Health Mint dashboard could start to affect your payments. Or how your Health Mint could recommend wellness services to purchase with your HSA because your plan and available funds permit it. Or how it could match a recommended disease management plan with the most cost-effective insurance, local health services and self-monitoring devices, all with the peace of mind that you can afford it

Sure, the integration will be a challenge, but consumers aren’t going to flock to a dozen different sites to manage their health – they’re going to want to go to a single place, one they feel they have control over. So keep an eye on the sites that connect consumers’ physical and mental health to their financial health. They’re going to earn the right to be the dashboard.

Peter Heywood wrote this on January 21, 2015 / no comments

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