Topical presentation of available frameworks for provider patient engagement

1. In Search of Patient Engagement
Presentation to National Medical Home Summit
February 28th 2012

2. In Search of Patient Engagement?

3. In Search of Patient Engagement?
Means
or
End?

4. It’s the message
Randomized control study for cancer patient
education materials
Times Logged On Portal Times Reviewed Data
Not at
Once More All At
20% than 26% Least
Once Once
4% 43%
Not at
All At
76% Least
Twice
31%
http://www.tandfonline.com/doi/abs/10.1080/10810730.2011.571338

5. Want More?
UPMC Study
• Portal use linked to patient
DISATISFACTION
• Portal non-use lined to
SATISFACTION
www.chcf.org/resources/download.aspx?id=%7BD030A73F...

6. In Search of Patient Engagement?

7. Measurement Framework
Patient Activation Measurement Scale (Hibbard 2005)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361049/

8. Consider Behavioral Economics
What’s it mean for Healthcare?
• How attributes are presented relatively (80% vs
Framing
20% fat)
Free • Higher worth placed on “free” stuff
• Making decisions and changes are always
Default
harder that doing nothing
Loss Aversion • Rather “not win” than lose
Social Influences • Peer pressure is stronger than we believe
Sources: Dan Ariely, Predictably Irrational

9. What Is It To You?

10. What is it to You?
• Meaningful
• Practical
• Measureable
• Process driven
• Outcomes related
• Patient centric
• Presents decision framework consistent
with the way people make decisions

11. A Definition
Center for Advancing Health
• “Actions individuals must take to obtain the greatest benefit from
the health care services available to them."
o focuses on behaviors of individuals, NOT professionals or
policies of institutions.
• Engagement is not synonymous with compliance.
o Compliance means obedience
o Engagement signifies that a person is involved in a process
o Individual harmonizes information, advice, needs, preferences
and abilities
• Definition is agnostic about the many factors that have been
shown to influence these behaviors
http://www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf

12. Definition
HIT Policy Committee
• Patient Activation
o Continues to manage his/her care
o Measurable health outcomes
o Has patient has been led in the “right direction” by his/her
healthcare provider regarding his/her plan of care.
• Patient Self-management
o Self-management resources and tools
o In accordance with patient preferences
o Self-management of health risk behaviors
o Seeks or manages preventive care
http://www.google.com/url?sa=t&rct=j&q=hit%20policy%20committee%20measure%20concepts&source=web&cd=2&v
ed=0CCYQFjAB&url=http%3A%2F%2Fhealthit.hhs.gov%2Fportal%2Fserver.pt%2Fgateway%2FPTARGS_0_11673_9
49211_0_0_18%2Frfc-measure-concept-
list.xls&ei=BDU5T_SNB6X20gHfqrmmCg&usg=AFQjCNE4lEnct_6adY8ctBwlb9r2hhduxA&cad=rja

13. Measurement
KP Health Connect
• Diabetes and HT patients
• Secure patient-MD email in “context of EHR”
o Average thread was 1.13 patient message and 1.16 provider
message
• Improved HEDIS measures for 11% of patients
• Up to 6.5 percentage improvement for glycemic, cholesterol, BP
screen and control
• Not randomized – other factors (HMO, continuity of care)
http://content.healthaffairs.org/content/29/7/1370.abstract

14. Measurement
Tailored Health Coaching to PAM

15. Measurement
Reduced Utilization and Costs
Utilization Charges
0% 0%
-5% -5%
-10% -10%
-11% -11% -10%
-15% -13% -15% -13%
-15% -15%
-20% -20%
-25% -22% IP ER -25%
-30% -28% -30% -27%
-35% -35%
-40% -40%
-39%
-45% -42% -45%
All < 65 65> All < 65 65>
From Khan S, et al. The Effect of the Vermont Diabetes Information System on Inpatient and Emergency Department Use:
Results from a Randomized Trial. Health Outcomes Research in Medicine 2010 1:61-66.
Page 15

16. MEASUREMENT
Reduction in total costs
Effect of PES Platform on Claims Paid
Lowess Smoothing
500
Claims Paid per Member
400
per Month ($)
300
200
Control
PES Group
100
-48 -36 -24 -12 0 12 24 36 48
Months
Vertical line represents the start date for PES group patients and a randomly chosen date for control patients

17. In Search of Patient Engagement
LinkedIn Group
http://www.linkedin.com/groups?gid=4121119&trk=hb_side_g

18. Summary Points
Patient Engagement is at the root of
major changes in healthcare today
An operating definition will emerge, and it will
involve outcomes
Plans and Providers will need to define
and adopt strategies for Patient
Engagement
18

19. Thank You
For more information:
Jim Rose
Senior Vice President, Business Development
Email: jim.rose@ptengage.com
Telephone: (703) 537-5050

20. About Patient Engagement Systems
Our Mission
To improve care by offering
technology that engages
primary care providers and
their patients to improve
the management of chronic
conditions in primary care
settings.
20

21. Rebirth of Disease Management
Results of the Medicare Support Health Disease
Management Pilot Program
• $400 million produced modest improvements in 14 of 40
process-of-care measures with no demonstrable savings
WHY?????
1. Poor experimental design in commercial findings
2. Lack of personalization in care/treatment plans
3. Population regressed to the mean (see #1)
4. Lack of real time information to manage chronic care
5. No integration with primary care
www.nejm.org/doi/full/10.1056/NEJMsa1011785