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Improve Patient Engagement with
Five Public Health-Inspired Principles
̶̶ Marie Dunn & Maggie O'Keefe
© 2016 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Issue of Pa...
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The Issue of Pa...
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A Better Approa...
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A Better Approa...
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A Better Approa...
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A Better Approa...
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A Better Approa...
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A Better Approa...
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A Better Approa...
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A Better Approa...
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A Better Approa...
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Improve Patient Engagement with Five Public Health-Inspired Principles

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Patient engagement is critical as we move toward population health—as patients who engage in their own care by following medical recommendations and making healthy nutrition and lifestyle choices will have better outcomes and experiences.

There isn’t, however, a clear path to successful patient engagement. Fortunately, public health can lend several established principles that may help us better involve patients in their own care:

Using systematic, population-level solutions that require less individual effort.
Engaging patients on interpersonal and community levels as well as personal.
Identifying root-cause, assessing and capitalizing on strengths, and engaging stakeholders.
Using strategies from behavioral economics to help individuals make good choices.
Anticipating failure and learning from it.

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Improve Patient Engagement with Five Public Health-Inspired Principles

  1. 1. Improve Patient Engagement with Five Public Health-Inspired Principles ̶̶ Marie Dunn & Maggie O'Keefe
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Issue of Patient Engagement As the payment landscape evolves and financial responsibility for outcomes shifts to provider organizations, getting patients to make good choices where it comes to their health is a population health imperative. The fiscal importance of this work is critical. Even the “seemingly simple” step of taking medication is a huge societal challenge, with non-adherence costing $300 billion annually.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Issue of Patient Engagement As we move away from episodic payment, we’re not just encouraging patients to take medications and follow discharge instructions, but insisting they exercise, eat better, and smoke less. How many times have you heard a clinician ask, “How can I be responsible for outcomes when I have no way to control what my patient does at home?”
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement Avoid Asking Patients to Do Too Much Too many patient engagement initiatives start with the premise that we need to find strategies to get patients to do more; we believe this approach is deeply flawed. If we look to the field of public health, which has long managed populations of patients, the most effective strategies to improve population health pair behavior change with systematic interventions.
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement Avoid Asking Patients to Do Too Much For example: While reductions in motor vehicle fatalities are partially due to improved seat belt usage, systematic changes outside the individual’s control, like safer vehicles and roadways, played a larger role. From this point of view, population health managers face a dual challenge: improving strategies for engaging individuals in behavior change, while systematically preventing illness at the population level.
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement A Population-Focused Approach Public health teaches us that systematic, population-focused efforts are often more effective than those that target individuals. To underscore the importance of systematic interventions, consider cholera. Initially, medical opinion concurred with the public: The disease was a judgment from God and those who were “intemperate, imprudent and filthy were predisposed to this most dreadful disease.”
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement A Population-Focused Approach Later, the medical community came to accept that filth caused cholera and asked individuals to do their part: Clean yourselves, clean your homes, and clean often. This was also not very effective. It’s easy to see in retrospect that these are hard problems to tackle without clean water and sanitation infrastructure available In other words, systematic, population- focused interventions.
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement A Population-Focused Approach We rarely compare cholera to chronic conditions like diabetes and heart failure. But when we look at those impacted, there are striking parallels. Chronic conditions—a big driver of healthcare spending and a focus in risk-based contracts— disproportionately impact poor minorities who live in the least-desirable areas of major cities. Income is a significant predictor of health: Impoverished adults die almost a decade earlier than individuals with incomes four times the federal poverty level ($11K annually).
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement What We Can Apply from Public Health Start with public health concepts and ask the question: Which of these are financially viable in today’s payment environment? In a fee-for-service environment, public health and healthcare managers typically had different fundamental goals. With public health thinking about patients over decades, and healthcare organizations focused on one acute episode or ambulatory visit, there was little opportunity to share strategies between the fields.
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement What We Can Apply from Public Health However, the advent of new payment models that make health systems responsible for populations of patients over much longer timeframes realigns these fields. Instead of asking how to improve our current patient engagement strategies that were developed in a tradition of treating illness, we should instead be asking which of public health’s strategies are fiscally viable today?
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement Five public health-inspired patient engagement principles: Consider these guiding principles as you develop patient engagement strategy and vet focused interventions: 1: Look for systematic, population-level solutions that require less individual effort. 2: Develop a multi-faceted approach to engage patients-individually and community wide. 3: Identify root-cause, assess and capitalize on strengths, and engage stakeholders 4: Use strategies from behavioral economics to help individuals make good choices 5: Anticipate failure and learn from it
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement 1: Look for systematic, population-level solutions that require less individual effort. Taking a page from public health’s Health Impact Pyramid, consider strategies for population level in addition to focusing on individuals? Population level strategies often bring the benefit of requiring less individual effort. Adding a park to a neighborhood might get a community outside and exercising more.
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement 2: Develop a multi-faceted approach to engage patients- individually and community wide The socio-ecologic model teaches us that hitting a problem from all angles is likely to be far more effective than just addressing one. Successes in smoking cessation came not just from individual education alone but strategies like taxes, restaurant bans, and public campaigns that make it not only harder to smoke, but less socially acceptable.
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement 3: Identify root-cause, assess and capitalize on strengths, and engage stakeholders Make sure you understand the root cause of the problem for both individual and community wide intervention. Asking someone to weigh themselves daily when they can’t stand steadily on a scale becomes an impossible task. Create opportunities to engage patients to provide feedback at the individual level.
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement 4: Use strategies from behavioral economics to help individuals make good choices Behavioral economics shows that individuals struggle to make good choices. For example, we struggle to weigh costs and benefits that are separated across time, such as a cigarette today versus lung cancer decades from now. Industries like tobacco and junk food make a lot of money by exploiting this fact.
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Better Approach to Patient Engagement 5: Anticipate failure and learn from it Data and a quality improvement mindset are key. Knowing there is no one-size-fits- all approach, build an infrastructure that anticipates failure. How to use data to measure baselines and monitor success so you can recognize and scale successes and abandon programs that don’t work? The quality improvement mindset of plan, do, study, act is highly relevant to this work.
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Analytics Are Critical to Patient Engagement Analytics should play a key role in helping you to not only prioritize key focus areas, but to assess return on investment, help guide improvements, and make the financial case for this work. A well-considered patient engagement strategy uses data to ensure efforts are focused on solutions that employ interventions with the greatest bang for the buck.
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Analytics Are Critical to Patient Engagement Have you identified the populations that require the most support and engagement? Have you assessed your interventions to determine if they’re financially viable? What’s the likely return on your investment and in what timeframe? Can you use data to build the case for getting paid for that service? > > > >
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Aim for Less Individual Effort Always consider opportunities to employ population-focused or systematic interventions that require less individual effort. Think of the patient’s mindshare for engagement as a highly valuable but limited resource; use it wisely. While we have a tremendous amount to learn viable population health strategies, we save ourselves a lot of heartache if we stand on the shoulders of giants in the field of public health as we build these new competencies.
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  21. 21. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. Improve Patient Engagement with Five Public Health-Inspired Principles Quality Data Is Essential for Doctors Concerned with Patient Engagement Dr. Ed Corbett, Deputy CMO From Care Management to Population Health Management Brent Dover, President Population Health Management: One Example That Shows Why It Really Matters Kathleen Merkley, DNP, APRN, Sr. VP Clinical Improvement Line What is Population Health and How Does it Compare to Public Health? Leslie Hough Falk, Customer Engagement, VP Population Health in Three Paragraphs Dale Sanders, Executive VP of Software
  22. 22. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com Marie Dunn joined Health Catalyst in September 2014. Prior to Health Catalyst, Marie worked for The Advisory Board Company in Washington, DC. Marie completed her undergraduate work at the University of Virginia and graduate work at Harvard School of Public Health. Maggie O'keefe joined Health Catalyst in July 2015 as Associate Director, Accountable Care. Prior to coming to Health Catalyst, she worked for CCNC Services as a Clinical Data Analyst. Maggie has a Master’s degree in Social and Behavioral Sciences from the Harvard School of Public Health and a Bachelor’s degree in Religious Studies from Yale University.

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