Prioritizing measurable clinical outcomes, defining an evidence-based, codified patient journey, and incenting strict adherence to treatment plans have been the base for many patient engagement initiatives. These seem to be logical ways to improve outcomes, reduce costs and encourage patients to follow post-care plans mapped to a journey designed to yield specific clinical measures. Yet despite the industry’s focus on patient centricity, the healthcare industry is still struggling to realize the promise of effective engagement.
According to recent research conducted by Cognizant and ReD Associates, many of the healthcare industry’s efforts to engage patients are based upon an array of faulty assumptions grounded in a cold system of care that calls for patient engagement to prioritize measurable outcomes, reinforce one-size-fits-all patient journeys, and reduce the risk of patients deviating from treatment plans.
How Patients Want to Be Engaged
Insights from the research demonstrate that the patients who are successful in their healing journey adopt their own ways of engaging with the healthcare system – what we describe as a “warm” care model.
To engage patients on their own terms, healthcare organizations will need to develop tools, processes, and practitioners that help patients define and achieve life goals; offer truly personalized guidance, and empower patients to take charge of their healing.
1. Help me measure healing according to my life goals.
Almost 85% of the respondents said clinical metrics did not reflect their experience of healing, so initiatives aligned to purely clinical goals will be less effective. Instead, organizations should base engagement strategies on goals meaningful to patients, whether their objective is to play soccer again, push a cart through the grocery store or sit on the floor with a grandchild. Such goals can be linked to underlying clinical measures and digital tools can help patients set milestones and measure progress toward reaching their goals.
2. Help me optimize my quality of life
Patients reported their treatment plans often were difficult to follow and did not offer real choices appropriate for their situations. Today’s technology, including smartphones and tablets, can offer contextualized recommendations and guidance based on a specific patient’s goals, lifestyle, abilities, and resources that are backed with artificial intelligence (AI), machine learning and analytics that “know” a specific patient. With easy-to-access, practical, and realistic guidance about how to fit care into their lives, the study found patients were three and a half times more likely to follow their treatment plan.
3. Help me get information from my peers
Only a little more than one-third of the respondents said they read the boilerplate drug and follow-up information given out by physicians. Patients more often turn to their peers for experience-based insights and recommendations. Instead of discouraging this practice, an engagement program must help patients access, triangulate and evaluate peer-supplied data.
4. Help me personalize my healing journey.
Patients don’t have steady forward momentum when it comes to healing, yet these are the journeys the industry has mapped. Engagement programs must be flexible and recognize that patients may pause or even take a few steps back in their healing process. The key is to provide personalized nudges that help the patient resume forward progress toward their goal.
5. Help me minimize the impact of my illness.
Healthcare’s mantra is to minimize what’s asked of patients—to keep requests simple in hopes of improving adherence. Yet the survey showed patients and caregivers will put a great deal of effort into minimizing the effects of illness. They do so by taking steps that make practical sense for them. Rigid programs designed to reduce complexity and guesswork and compel strict adherence to wind up making patients feel disempowered. Engagement strategies must incorporate patient-created solutions and health management skills.
6. Help me share my story.
The study showed that almost 70% of the respondents had not heard from their primary care provider outside of a scheduled visit in the last two years. That’s a long time in which the details of a patient’s personal health story accrue. Engagement tools need to capture these narratives that don’t fit neatly into electronic health records, provide a mechanism for two way communication between the patient and healthcare provider, and flag potential areas of concern.
7. Help me intelligently adjust through experimentation.
In line with making health management fit into their lives, patients experiment with the best ways to accomplish that, going through a process of trial and error. Of respondents taking prescription drugs, for example, 47 percent experimented with the timing and dosages of their prescriptions. Engagement programs could provide patients with personalized guidance through their experiments, such as providing plain language explanations of safe timings for drug dosages.
8. Help me see the cause and effect.
While patients said they measure their healing by how their bodies feel, engagement tools can help them see the links between those feelings and their actions, whether that’s taking a lower dosage of a drug or adding a physical therapy exercise to their day.
9. Help me connect and heal within my circle of care.
Most patients don’t travel alone on their healing journeys. Their healing is influenced by relationships at home and in the community as well as in their healthcare system. Engagement tools should help patients connect to and gain support from these systems.
A Digitally Powered Holistic Approach to Engagement
When designing effective engagement, it’s important to understand these patient efforts to warm their care are part of a whole. It won’t work to enable patients to set goals, but then fail to offer them real choices in how to meet the goals of integrating their care into their lifestyles. Similarly, overlaying one or two tactics, such as storytelling and connections, into a cold engagement system that does not offer personalized, contextual advice won’t achieve optimal outcome improvement.
The good news is that digital technologies can enable healthcare organizations to build these warm care components into their engagement solutions. Digital technologies, from AI to augmented reality, are inherently adaptive and scalable. An algorithm can learn what’s normal for a single patient based on actual activity and provide feedback to both the physician and patient. Connected products and spaces will increasingly help patients carry out self-monitoring activities at home. These tools are advancing exponentially and gaining consumer—and FDA—acceptance, such as theAliveCor Kardia Band™ for the Apple watch that takes an EKG on-demand.
Yet before investing in technology or writing any code, healthcare organizations must first understand the qualities of engagement patients want: patient-defined goals, individualized guidance, and empowering choices and tools. Ensuring experience design incorporates these meaningfully is the best way to ensure digital engagement investments are effective and achieve optimal engagement outcomes.
Co-written by Peter Borden, Chief Digital Officer, Healthcare, Cognizant, and Charlotte Vangsgaard, Partner at ReD Associates
*The Healing Study was conducted by Cognizant Technology Solutions and ReD Associates over five months in 2017. Researchers used ethnographic methods to immerse themselves in people’s everyday lives, visiting people in their homes, shadowing them at the doctor’s office, taking part in their daily routines. The research team did fieldwork with 30-plus “respondent ecologies” — gaining insight into the lives not just of individuals but also of those the family members, friends and colleagues around them. Patient recruitment was for the most prevalent and costly conditions. The qualitative research’s insights were validated using a quantitative survey (N=5,068). A subset of the respondents (approximately 1800) answered a more in-depth version of the survey.