Patient Engagement

Patient Engagement and Behavioral Insights—What People Want Is Health

Article · March 7, 2016

In 2004, Blockbuster Video had a market capitalization of more than $5 billion, with 9,000 stores nationwide staffed by 60,000 employees. In 2010, the company declared bankruptcy before being dissolved. Like many once-proud firms before it, Blockbuster was a victim of its inability to recognize that emerging technologies had enabled a seismic shift in what consumers were demanding — in Blockbuster’s case, the convenience of being able to pick movies from the comfort of their own homes via Netflix.

Many companies in many industries have made this same mistake, focusing on what they can easily produce instead of what their customers want. Health care providers tend to focus on providing health services as opposed to producing health. Engaging patients will be easier if we give them more of what they want: better health rather than more health services.

Health care in the United States is at an important juncture. We have seen amazing scientific advances in the past century, but despite spending far more than any other country on health care services, outcomes within the United States for many portions of the population remain poor. Experts have estimated that only 10% of premature mortality in the U.S. may be due to suboptimal quality of health services provision. A much larger share — perhaps as much as 40% — is due to behavioral determinants of health.

Health care providers traditionally regarded health behaviors as out of their sphere of influence and medical training. However, recent improvements in technology, advances in behavioral science, and shifts in health financing create exciting new possibilities to change this.

We are in the midst of amazing advances in wearable and wireless technologies that can monitor blood pressure, step counts, sleep patterns, and all sorts of other physiologic parameters and behaviors. While high acuity medical care will always need to be delivered in acute care settings, the wearables/wireless market is projected to grow to $50 billion by 2018. A new ecosystem of wearable and wireless technologies, patient engagement strategies, and provider feedback could manage chronic disease far more efficiently than our current approach of using episodic clinic visits.

However, for such devices to realize their potential to both measure and influence behavior and outcomes, they will need to overcome end-user inertia and create feedback loops with patients that motivate action and sustain engagement. This is where advances in behavioral science can make enormous and as yet mostly unrealized contributions to medicine. Feedback loops can be created that are effective in keeping patients and providers alike engaged — for example, by alerting a physician office when a patient has markedly abnormal blood sugar or blood pressure, thereby allowing the clinicians to focus on patients at high risk without intervention. More broadly, behavioral science can provide important guidance in helping to improve “choice environments,” such as the choice of health plans or providers for patients, through systematic and thoughtful application of defaults to patient and provider decision making, and in the alignment of patient and provider incentives towards improving health.

People often fail to recognize that the current health care delivery system contains a lot of embedded defaults and incentives, and many of these steer both patients and providers in undesirable directions. Fee-for-service payment is often held up as an example of bad incentives, but there are also positive examples. Penn Medicine recently changed physicians’ defaults toward prescribing generics; overnight, the generic prescribing rate went from 40—90% to 99%. Many insurance benefit designs could be significantly improved by making them simpler, such as eliminating inscrutable concepts like coinsurance in favor of copayments — which consumers show they understand — and tying patient cost-sharing to both the value of the services provided and improved health behaviors.

The key to designing a better health care system is to recognize that what patients want is to be healthy, not consume health services. Through technology that centers care provision around the convenience of patients rather than providers, simplified and improved choice environments, and incentives designed to keep people healthy rather than treat them only when they get sick, providers will improve their chances of improving the health of the U.S. population.

As Lead Advisor for the Patient Engagement theme on NEJM Catalyst, I am pleased to kick off an ongoing series of articles, case studies, interviews, and other contributions from leaders dedicated to improving patient engagement. Please look here often for new ideas, and offer your own. Together we can make a real difference in how patients and providers collaborate, in improving health outcomes, and in improving the U.S. health care delivery system.

New call for submissions ­to NEJM Catalyst

Now inviting longform articles

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Patient Engagement
Bilazarian01_pullquote patient engagement both sides of the bed

Patient Engagement from Both Sides of the Bed

When patients and families are included in medical rounds as valued members of the team, the quality of care improves.

Ten Guiding Principles for Patient-Centered Care as Described by Mountain States Health Alliance to consider with patient-centered outcomes research (PCOR)

Complementary Approaches to Patient Engagement in Patient-Centered Outcomes Research

It’s important for providers to understand and apply the key principles foundational to patient-centered outcomes research efforts.

Selected Advantages of Improved Patient Electronic Access to Health Data

Patient-Led Data Sharing — A New Paradigm for Electronic Health Data

The pieces are in place for a truly disruptive shift in how patients can access and use their own clinical data to improve their health.

Collapse of Two Online Health Communities as Result of Removal of Users Starting from Superusers

Online “Superusers” as Allies of the Health Care Workforce

Three proposed steps for integrating peer-driven online health communities with traditional services to improve health outcomes for people with chronic conditions.

The PEACE Project - Patient Experience for Acute Care Elders at Sarasota Memorial Hospital

The PEACE Project

Improving the acute care experience for our eldest patients.

Rabson01_pullquote barriers to patient engagement in primary care practices

What Does It Take to Increase Patient Engagement in Primary Care Settings?

Massachusetts primary care practices are beginning to invest in programs to increase patient engagement, but these strategies can be challenging to implement and remain underutilized and undervalued.

Many Barriers to Engaging Patients in Treatment for Obesity

Survey Snapshot: Approaches to Address Clinician and Societal Roles in Obesity

The obesity problem is getting larger and larger. Some solutions lie beyond the traditional medical setting.

Esch01_pullquote patient activation

OpenNotes, Patient Narratives, and Their Transformative Effects on Patient-Centered Care

The development of standardized tools and techniques are enhancing the ability of providers to interact with patients, but true patient engagement requires a common understanding of its theoretical foundation and an open mind for including patients’ needs and beliefs — in their language — as part of each encounter.

Patients and PCPs Hold Primary Responsibility for Addressing Obesity

Patient Engagement Survey: The Failure of Obesity Efforts and the Collective Nature of Solutions

Patients hold responsibility for their actions, but providers’ approaches to address obesity often fall short as well.

Items from the Shared Decision-Making Process Survey for Elective Surgical Procedures - patient decision aids - decision quality - informed consent

Shared Decision-Making: Staying Focused on the Ultimate Goal

Despite growing acceptance and enthusiasm for patient involvement in their health care decisions, clinicians, at times, lose focus on the ultimate goal of shared decision-making: better health decisions from the informed patient’s perspective.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Patient Incentives

68 Articles

Online “Superusers” as Allies of the…

Three proposed steps for integrating peer-driven online health communities with traditional services to improve health…

Patient-Centered Care

245 Articles

Engaging Stakeholders to Produce Sustainable Change…

How an initiative designed to improve patient outcomes and satisfaction while containing costs led to…

Patients As Customers

123 Articles

Patient Engagement from Both Sides of…

When patients and families are included in medical rounds as valued members of the team,…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now