The success of value-based healthcare hinges on the active involvement and collaboration of all players, most importantly, the patient. Highlighted in our January newsletter article “The Essence of Patient Engagement” (click here for full article), provider organizations are taking on increasing risk, often in concert with health plans, ACOs or in alternative payment strategies. Connecting with patients at the right time and place is essential/
According to CDW Healthcare’s 2017 Patient Engagement Perspectives Study, 70% of patients say they have become more engaged with their healthcare during the past two years. They state that changes include joining a patient portal (74%), accessing healthcare information more frequently (69%) and speaking to a healthcare provider more frequently (69%). However, only 29% of patients surveyed would give their provider an “A” for their use of technology to interact with and engage patients, and 89% of patients would like to be able to more easily access their personal healthcare records.
Like any customer service, there are many drivers of interest and engagement, but in healthcare, our “consumers” span an age spectrum from newborns to centurions. No matter their age, all patients fall into some sort of “population” group. Providers are challenged to improve the health of populations, while remaining “person-centered”. This may be defined as “A partnership among practitioners, patients, and their families that ensures decisions respect patients’ wants, needs, and preferences, and that patients have the education and support they need to make decisions and participate in their own care” (PCPCC 2013 Managing Populations, Maximizing Technology).
Health coaching has proven an important strategy to build person-centered care into population health management. A key shift is moving from focusing on ONLY the low hanging fruit of older patients with established chronic conditions, to identifying and preventing chronic conditions in rising risk populations. However, reaching these populations require different approaches. Once we “sync” with patients and create a trusting relationship, there is great opportunity to improve the health of populations, one patient at a time.
This article is intended to bring perspective into the health coaching encounter. All patients have unique and personal motivations for life and health management. Once uncovered, there are relevant generational considerations to maintaining patient engagement over time. Keep these concepts in your back pocket and we will do well to check our biases when working with generations that may be quite different from our own. It has great transfer value into daily life encounters with family, friends and colleagues.
These patients (over 72 years of age) have spent the majority of their years without our current technology. They were often physically active during their lives, and many remember receiving healthcare long before there was health insurance. Some portion have put aside personal savings to cover unexpected healthcare needs (such as surgeries and emergent events). They are accustomed to the “expert role” and the paternalistic approach to healthcare, less likely to research health and believe that the “doctor knows best”. They may be unfamiliar and uncomfortable (at first) with newer approaches such as SMART goal-setting and shared decision-making.
According to the National Council on Aging, 92% of older adults have one chronic condition and 77% have at least two. The four chronic conditions of heart disease, cancer, stroke and diabetes, cause nearly 2/3 of all deaths. Health coaching can be a great source of support for these patients, and they tend to be highly loyal to their physicians once trust has been established. (Remember that many of their family physicians have long retired — the Marcus Welby type — and they are adapting to a younger healthcare workforce.) The health coach is often viewed (almost on a personal level) as a conduit to the physician. These patients often enjoy a good long conversation and it is best approached in person, with a family member or friend also present. Since goal-setting is a bit foreign, consider re-wording questions that bring out their interests and motivations in a way that can lead to specific action. Frequent follow-up, either in person, or telephonically, will ensure that they understood their treatment plan and are building the goals into daily activities. Special attention should be paid to medications and watching for early signs of health exacerbations (such as with heart failure).
75 million Americans make up the Baby-Boomer generation (born between 1946 and 1964) and they are threatening the capacity of the current healthcare system. Boomers see themselves as young and vibrant as they age and many are not retiring until well into their 70’s (either by choice, or by necessity). However, a recent study by the United Health Foundation found that boomers have “higher rates of obesity and diabetes” than the previous generation, mostly because of lower physical activity and availability of fast foods and incidence of eating out. 62% of persons aged 50-64 currently have at least one chronic condition. Boomers have greater longevity than their parents, but higher rates of hypertension, high cholesterol, diabetes and obesity (JAMA, Internal Medicine, March 2013). Unlike their parents, they are more willing to discuss mental health challenges such as depression, anxiety and substance use. Behavioral health issues in this generation, as well as those to follow, warrant considerable attention to identifying available resources. Health coaches can contribute by instilling a positive health future and partnering with patients to build hope and confidence in their self-management.
Baby boomers appreciate a “high touch” approach, desiring direct communication and relationship with physicians, coaches and the healthcare team. Although they were the first generation to experience the knowledge explosion through the worldwide web, there is some split (older boomers versus younger) in how technologically savvy they are. They may research their provider’s quality ratings (or ask their children to do so), and they recognize that healthcare is not equitable between institutions and not all institutions deliver high quality care. Because of the sheer number (and the increasing incidence of chronic diseases), coaches may benefit from exploring how personal communication can be expanded through electronic means and technology. Boomers are willing to use patient portals to obtain personal healthcare information and some may find motivation in tracking lifestyle management through mobile apps and electronic personal health records. This tends to be a personal choice, as AARP research reveals that only about 1/3 of seniors have an interest or understanding of these health management tools.
Boomers strive for “successful aging” which may include life transitions from home to assisted living and the use of community-based services to keep themselves active and engaged in life. They are keenly concerned with the burden that their health may have on their children. Coaches may wish to explore and understand local community resources that are available to this generation.
Gen Xers (ages 36-52 years) have grown up in an era of internet-available health information. They were the first to experience direct advertising for prescription drugs and consumer activism in health care. They are not likely to be passive in their healthcare decisions (if there is an issue), but as reported in a survey recently completed by MDVIP (2017), 32% of this population may actually AVOID seeing a primary care physician for fear of that they may learn. They wish to live a long life, but 2/3 acknowledge that they could do much more about exercising regularly, maintaining a healthy weight and managing stress. They could be missing the prediction that this generation may be the first to see a DECREASE in life expectancy. How can health coaches reach this age group?
Communicate with this group in transparent and immediate ways. For personal health information, patient portals and electronic communications work well. Gen X will have researched treatment options so they value evidence-based decisions. However, they believe that physicians and the healthcare team offer the best support, particularly if it can be aligned with their research and if a trusting relationship is built.
Thirst for knowledge. Gen Xers look to a variety of sources for information, including family members, coworkers, their doctors, pharmaceutical company websites, medical journals, television programs, news websites, and books. Be prepared for a conversation around “what is best” for them, and health coaches are particularly adept at honing in on personal motivations (thus choosing their path among many choices). Acknowledge their research and interest and identify the priorities that are unique to their life situations.
Ah the millennials — the invincibles. Surely this generation (age 18-35) will never die, or at least not before their time. However, when one carefully uncovers the healthcare concerns of this generation, it reveals depression , overweight and anxiety disorders. 54% of millennials report having been diagnosed with a chronic condition (Transamerica Center, 2016).
Affordability for health insurance (after age 26) is a major factor in this generation. Health coaches are likely to encounter this population when working with an employed population. However, they may encounter some if assigned to a state Medicaid program or a state insurance exchange program. If coaches are working in environments where patients are uninsured, they may benefit this generation by educating and connecting them to insurance options.
This generation may also choose public health opportunities (i.e. Planned Parenthood) for their healthcare needs if not covered through an employer health plan.
According to the Transamerica Center for Health Studies, Millennials are looking for healthcare services with shorter waiting times and often seek “after hours” care or same day services. They value telephonic or email consultations during evening and weekend hours and are the generation most interested in telehealth (skype or other synchronous communications) options. They will be attracted to patient portals or mobile apps that allow online appointment scheduling and email communications.
Health coaches may align with this generation through brief “progress checks” via email or text and connecting younger patients with modern technology and apps that track exercise, nutrition intake, and even medication delivery through technology-enabled devices such as insulin pumps. Management programs for Type 1 Diabetes are particularly adept in addressing the social and emotional considerations of the millennial population.
In summary, health coaches have a multitude of tools and technology-based applications that can assist in supporting and monitoring the self-management of patients with chronic conditions. However, these technologies, assessments and tools do not replace the human connection factor. “Engagement is about more than a tool; it’s a strategy like marketing and requires design. Engagement without a designer is like medicine without a doctor (Leonard Kish, Patient Engagement is a Strategy, Not a Tool, ebook, 2014)
True patient engagement is about relationship and developing trust over the long-haul. Health Coaches equipped with an understanding of generational preferences can have a significant impact on engaging patients across generations. This is a basic and fundamental principal of successful value-based healthcare.
Clinical Health Coach
Training & Partner Relations