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August 2018

Industry Perspectives: Patient Engagement — Five Points of Failure
By Drew Vaughn
For The Record
Vol. 30 No. 7 P. 6

As more health care providers become focused on the Triple Aim of providing a better quality of care, improving population health, and reducing costs, strategies surrounding the improvement of patient engagement have moved to the forefront. And yet the industry still lags fairly far behind the retail and financial sectors in terms of realizing the benefits of strong engagement.

It's not easy to move from a more traditional delivery model into a paradigm that embraces value-based care—one that encourages collaboration between providers and patients. Since the introduction of the Affordable Care Act, it could be argued that industry efforts in this area have been mired in a process of failing forward.

The good news is that, collectively, the industry is becoming more proficient at the cornerstones of this new health care model in which patient engagement arguably has the most impact. Another critical success factor is that interoperability must not limit information sharing to data and systems. It must also be transparent and capable of sharing lessons learned.

As a strategic consultant on many of these transformational projects within providers and payers, I've noticed that the same mistakes are being made as the industry strives to obtain stronger Medicare Star ratings and other objectives. Engagement is one area where understanding how and why certain common points of failure exist can have a tremendous impact on the success of an initiative.

This article highlights the five common points of failure most health care organizations experience when attempting patient engagement initiatives. The point is not to self-flagellate but to learn from the forward failings of peers and continue to add to our collective ability to provide better care for consumers, improve health outcomes, and lower costs.

Inadequate Patient Access to Information
HIPAA and other privacy-related regulations have trained providers to be extremely cautious when sharing information. Although this is essentially a good thing, when it comes to patients, a lack of information can hinder engagement. Add to that the possibility that physicians may be reticent to share notes or that access to an EHR may be ponderous, and it's easy to see why, for example, this may obstruct medication adherence.

Taking a careful, objective look at the availability of information can be a helpful step when beginning a campaign that requires strong engagement. Reviewing how and when patients may access a portal such as MyChart and determining areas to improve that access can be beneficial.

Tools such as OpenNotes have been found to be extremely helpful for these types of efforts. In fact, studies have shown that patients feel 80% more empowered by having this information from the physician and are more likely to take their medications as prescribed.

Tackling the Most Difficult Challenges First
Although it may be tempting to begin projects or engagement campaigns where return on investment is the highest, this is not always the best approach. Granted, providers may be eager to improve Medicare Star ratings by focusing their efforts on the areas that will have the most impact. However, the initial steps in a patient engagement initiative require a certain amount of learning based on how patients respond not only to the message itself but also the frequency and the channels used to send those messages. Failure on a large scale at this point could be damaging to future efforts if, for example, patients experience communication fatigue.

A better approach may be to choose a project with a small-to-medium range of impact. This could be quantified by the number of patients or members involved in the campaign or by the project's duration. Engagement efforts not only use but also create data in terms of individual preferences, responses, and other behaviors as patients respond to the outreach.

Using a lower-profile initiative to test assumptions about the right channels, times, and messages to reach the desired audience allows engagement tactics to be tested and adjusted. In addition, proven use cases can be developed a bit out of the limelight.

Once this "learning" has been achieved, it can be applied to larger efforts where the payoff will be much higher and the risk will be significantly lower because the organization did its homework.

Conducting Projects in a Silo
Beyond choosing an overly ambitious project, organizations may misstep by selecting an initiative that doesn't align with its overall patient engagement strategies. "Siloed" projects are more likely to fall into this trap. This problem exists even with small providers and plans.

Workplace silos are not unique to the health care industry—many organizations struggle with this issue no matter their business focus. In health care, however, the problem is intensified by the traditional way in which providers and plans have operated. In some cases, without a holistic view, the chosen project may not even be the correct starting point.

Data are often viewed as part of a competitive edge. As a result, information sharing—even between divisions of the same organization—has not been the norm. Although this has a profound impact on interoperability, it also can be extremely damaging to personalized engagement.

The more data in hand, the more personalization accelerates, reaching individuals based on their own preferences. Creating an overall engagement strategy that aligns each individual campaign is crucial to guaranteeing that key data are available to achieve personalized engagement. As mentioned previously, it also helps to share experiences gained from prior and simultaneous efforts.

Making Training a Low Priority
Ironically, a failure to involve staff members in patient engagement efforts is one of the most common reasons such projects come up short. The basic concept of engagement is that outreach is designed to trigger an inbound response, yet it's remarkable how many staff members lack the training or required information when that response actually occurs. When responses emanate from outside the expected experience—for example, a patient calls his or her provider with a question after receiving a digital message—the problem is magnified.

Designing a strong training plan for staff directly involved with the campaign and creating a comprehensive communication strategy for those impacted by the implementation can help capture responses more effectively. Keeping the organization abreast of the project's progress, its expected outcomes, and other parameters can empower staff and encourage ownership of its ultimate success.

Failing to Map the Complete Patient Journey
In many ways, patient engagement campaigns mirror the consumer buying cycle, whose typical path winds from acknowledging a problem and researching possible solutions to purchasing and postpurchase activities. In many cases, providers map out touchpoints focused only on the end goal, whether it's scheduling an annual mammogram or completing a survey. If the patient has not already acknowledged the problem or if there is a lack of health care literacy, all the motivation in the world will not create engagement.

Therefore, it's important to have a strong understanding of the stage at which the majority of the population are being reached. Trying to encourage the wrong action before the individual is ready can be disastrous. If an organization is unsure, it should assume the patients are less advanced rather than further along in the process. It will find out soon enough whether or not that assumption is correct.

How to Design a Patient Engagement Playbook
Beyond these five common points of failure, complexities within health care organizations may create other areas of learning that can be documented and applied to achieve greater success down the road. In many cases, developing a patient engagement "playbook" can help identify a common framework or roadmap for engagement projects within an organization. This information can be invaluable in helping to share lessons learned, customizing preexisting material from previous campaigns, assessing risk, and creating measurable, reasonable objectives.

A solid playbook can also identify ways to create stronger strategies for determining the best touchpoints, from timing to the messaging channel, and identify other potential impacts, including compliance requirements and technology challenges.

In the end, an engagement strategy that incorporates transparency, ensures access to critical information, and focuses on strong communication practices will help improve the results of projects both small and large.

— Drew Vaughn is a managing partner with Upton Hill, a management consulting firm focused on the health care industry.