Meetings, conferences, strategies, articles and talk in healthcare are obsessively centered around the idea of patient engagement. Engagement is the new “buzz.” There are a couple of pivotal reasons. First, as provider organizations take on increasing risk, often in concert with health plans, in ACOs or in alternative payment strategies built around value, connecting with patients at the right time and place is essential. Establishing a sustainable relationship with attributed members, connecting to provide assessments and preventative services, and providing services in the timeliest manner to mitigate avoidable clinical exacerbations and cost – these have become potent driving motivations.
Second, many healthcare organizations have also experienced an epiphany – that the greatest underutilized resource in healthcare is likely the patient. Yes, often looked upon as the challenge when faced with the responsibility of population health, leading provider organizations have begun fostering and actively cultivating more vital partnerships with patients.
The realization that 69% of healthcare costs are driven by patient behaviors and that 95% of healthcare decisions occur outside the provider office are compelling parts of this logic. And, there is more. Evidence suggests that most care, especially for those with chronic conditions, is self-care. AHRQ has reported that 95% of diabetes care is just that – self-care. Ironically, patients have become the new opportunity in healthcare, not just the challenge. Achieving patient behavior change and inspiring greater patient accountability may be the real secret sauce for healthcare’s brighter future.
As healthcare organizations search for the optimum patient engagement, success is often elusive. All patient engagement is not the same. There are at least two distinctive levels of engagement that inform the effective approaches. First, practice level engagement — patient programs, services and care engagement initiatives aimed toward improved access, preventive and proactive care, care management — essential connection strategies that have defined “patient centeredness” for population health.
Second, a companion and much less common, is accountability level engagement – self-care, self-efficacy and psychological engagement focused upon inspired health behavior change and self-care skills development – essential activation strategies for population health.
Most healthcare professionals agree — patient behavior is both the leading challenge and the largest arena of opportunity for changing the landscape of health in this country. Toby Cosgrove, CEO of Cleveland Clinic, was asked in an interview on Meet the Press to identify one breakthrough opportunity that could move healthcare to a new level in this country? He didn’t tout better government support. He didn’t advocate more healthcare reform legislation. He said, “inspiring individuals to take more responsibility for their own health” would bring the most powerful result.
Teaching, telling and educating patients has not worked well. For more than 20 years, there has been well established, evidence based consensus guidelines for effectively managing Type 2 diabetes. Yet the annual cost of diagnosed diabetes in the U.S. exceeds $176B in direct medical costs. What providers know regarding such diabetes management is of limited value without patients actively participating in self-care and supporting behaviors.
Engaging patients at the accountability level is often hard work, and not the way most care givers and providers have been trained. We have been trained to “do, teach and tell.” Too long, that has been the expectation of healthcare professionals in relating to patients. Physicians, often skeptical that they can actually move or change patient behaviors, simply prescribe things like pills. Not much is required in terms of behavior change, and it is quicker for doctor and patient alike.
Achieving accountability level engagement is possible when healthcare professionals develop skills to help patients find their own motivation for change. Such skills enable healthcare professionals to ask, listen and inspire patients. It often involves a shift in style, process and communication – listening to patients and their unique needs versus a more paternalistic view of delivering patient care. It is partnering with patients – it is clinical health coaching.
Coaching is an evidence based science, particularly motivational interviewing. Proven in the clinical setting over the past decade, these coaching strategies have been found to effectively transform the conversation and the care management process. The result – demonstrated self-care skills, improved health behaviors and acceptance of personal accountability for health – exactly what healthcare has so long sought as a path to better outcomes.
Patient behaviors can change, especially when motivation is aligned with the unique nuances of their lives and interests. This is particularly evident for individuals with chronic conditions. Healthcare professionals with appropriate training and practiced skills are creating a world of difference by partnering with their patients with diabetes, heart failure, COPD and a host of other conditions. Positive outcomes in clinical measures, patient experience, cost and quality of life are reported from clinical practices which have effectively implemented coaching strategies.
As healthcare moves from volume to value, measurable patient outcomes will have ever increasing meaning. These outcomes will guide how our patients view healthcare as well as how we are reimbursed. Healthcare providers who recognize patients as a resource, who believe in their capacity for behavior change and who spark accountability level engagement will likely lead in this most notable profession. They will also improve the health lives of their patients in a profound and positive way.
William K. Appelgate, PhD, CPC
Founder and President
Clinical Health Coach