Better patient engagement is a nearly universal goal for health care providers, but real barriers exist, say health care leaders and clinicians. Nearly two-thirds (63%) of respondents to NEJM Catalyst’s latest Insights Council survey on patient engagement call the time investment required by health teams the biggest challenge in designing patient engagement into care delivery.
The underlying issue is reimbursements, says Bertrand Ross, MD, FACC, FACP, Medical Director at Virginia-based Optima Health, a subsidiary of Sentara Healthcare providing health plan coverage to more than 450,000 members. “The problem is that incentives [for patient engagement] are not aligned. The time and effort to educate, motivate, and troubleshoot issues regarding patient engagement are not recompensed very well at present.” Create alignment, he says, and the time investment challenge will disappear.
Historically, Ross says, doctors have been somewhat hesitant to do the extra work to support patient engagement. “Doctors to some degree worry the changes will be too disruptive. How will physicians blend patient engagement into their [care delivery] workflow?” he says. For instance, he considers telehealth and telemedicine the future of care delivery and a form of patient engagement. Yet the valuation of the service is still up in the air because of the workflow changes that will be likely required. “This reimbursement issue is holding adoption back,” he says.
“There used to be a saying amongst waitresses in diners: ‘Not my job, not my table,’” Ross says. “[Physicians] need to realize that patient engagement is our job and our table. We all have to be involved in the design of health care delivery to ensure it works in terms of quality, productivity, and the overall mission.”
Kathryn Duevel, MD, MS, Medical Director of Quality and Innovation at ACMC Health, a multi-specialty health network with 100 physicians in Minnesota, agrees that incentives are part of the problem with getting physicians more deeply involved in improving patient engagement. Just over half of the survey respondents (52%) cite provider adoption as a challenge in designing patient engagement into care delivery.
Duevel expects the national shift to value-based payment to help. “Larger organizations have the capacity to invest in other processes, such as patient engagement, that don’t contribute directly to the fee-based system,” she says. “As we transition to a value-based system, the value of patient engagement starts to pay off and organizations with fewer resources can make the financial equation necessary to fund patient engagement work.”
Provider engagement is essential to patient engagement, Duevel says. Physicians must be given more time in their day, the tools for patient engagement cannot be onerous, and the results must prove meaningful. “Doctors — primarily primary care docs but also docs in general — are working way too many hours. They are getting crunched from all sides and the burnout rates show it,” she says. “That said, when physicians are given time to think about patient engagement, they think it’s worth it and can help them provide better care. It’s not that they don’t value it, they just don’t know where to fit it in.”
Patient engagement design is still a nascent field, says Marjan Bahador, MD, a critical care physician at Johns Hopkins Medicine, which is a part of Johns Hopkins Health System in Baltimore. “Bringing health to the hands of patients and looking at health problems from patients’ eyes is a new concept for medical professionals.”
Prior to joining Johns Hopkins, Bahador says she spent years studying patient engagement for a large health care software company. She observed a dual problem with patient engagement design: Doctors aren’t trained — either in school or on the job — about why patient engagement is important, and at the same time patients aren’t incentivized to be active participants, beyond improving their own health.
She warns against handing over too much design responsibility to patients, because of their lack of expertise. “Patient engagement design and build should be very much according to patients’ needs and the way patients want it to be done, but health care professionals and IT engineers need to be the ones to build it,” she says.
Yet 91% of survey respondents say the patient is the most important stakeholder in patient engagement design. Duevel believes that patients don’t need to be design experts to be a vital part of patient engagement design. “There is no one who knows better what the patient is interested in or values than the patient,” she says. “If you don’t have the patient perspective, you won’t be able to get them to effectively take in information.”