Patient Engagement: What’s in It for Your Private Practice?October 28, 2013 by Melissa McCormack
The phrase “patient engagement” seems ubiquitous these days. Meaningful use Stage 2 requires it, bloggers tout it and there’s even a growing body of academic research about its benefits. Most of the discourse focuses on how patient engagement impacts patient health or overall costs to the US health system.
But despite all the attention patient engagement gets, little is said about tangible benefits for medical practices. So I talked to doctors who have mastered the patient relationship to learn more about what it is and how it can benefit doctors. Turns out, getting your patients engaged could make you more money, make your patients happier and boost your job satisfaction to boot.
A Strategy for Patient Partnership
Before understanding why patient engagement benefits your practice, it’s important to understand what it is and how it works. A key thing to note is that “engagement” itself isn’t the end goal. Instead, it can be thought of as a tool for transforming the doctor-patient relationship.
For Judith Hibbard, Dr.P.H. – Professor of Health Policy at the University of Oregon, Clinical Professor in the Department of Public Health and Preventive Medicine at the Oregon Health and Sciences University, and recognized expert on consumerism in healthcare – that transformation takes the form of “patient activation.” She describes activated patients as those who have “the knowledge, skill and confidence to manage their healthcare.”
Dr. Hibbard developed the Patient Activation Measure (PAM), a 100-point scale used to assess a patient’s level of activation. The score is based on such determinations as whether patients can demonstrate an understanding of why they’re taking a particular medication, or whether patients feel comfortable voicing concerns even when the doctor does not ask about their concerns. For Dr. Hibbard, activation is the ultimate goal and engagement is a tool for reaching it.
Dr. Danny Sands is Assistant Clinical Professor of Medicine at Harvard Medical School. He’s also a practicing physician and patient evangelist who, during his tenure at Beth Israel Deaconess, developed one of the nation’s first patient portals. He echoes the idea that patient engagement isn’t the be-all end-all. For him, the ultimate goal is “participatory medicine.” Not unlike patient activation, participatory medicine has to do with changing the care ecosystem to get patients interested in maintaining their health outside of clinical office visits.
Ultimately, engagement refers to activities undertaken to create a sort of partnership between doctors and patients. The physician brings necessary medical expertise. The patient brings the knowledge of his or her own symptoms and experiences, and the ability to act on a treatment plan.
It Gets Patients Active Outside of Appointments
The activities you could undertake to create this “partnership” with your patients are virtually limitless, but my conversations unearthed a couple of recurring themes. Broadly, the idea is to get your patients thinking about their health even when they’re not in your office.
Encourage External Research
For Dr. Sands, the key to getting patients engaged is knowledge. He recommends encouraging patients to seek out information about their conditions themselves, rather than relying solely on you.
He provides a few tips:
- Ask patients whether they go online for health information. (He makes this part of his annual history and physical examination.)
- For patients who say yes, ask what websites they find valuable.
- Use what you learn from those patients to share helpful websites with others.
- Give homework assignments: encourage patients to do some reading on their own and bring questions to their next visit. For example, for a patient newly diagnosed with Type 2 diabetes, you could direct them to the Mayo Clinic’s online summary of the condition to read about complications, risk factors and treatments.
Dr. Sands says this type of dialogue “provides [patients] with a sort of tacit approval that you’re okay with them getting information from other places besides you. And that leads to honest disclosures in the future.” Acting on their own behalf also makes patients feel empowered. Plus, your implicit acknowledgement that you don’t know everything makes you less intimidating, which makes patients more willing to accept that they can have a partnership with you.
Make Communication Easier
It will be difficult for your patients to be engaged in their health care if they don’t feel they can engage with your practice. Tools such as patient portals allow patients to schedule appointments and view test results online and/or send direct, secure messages to your practice. These features make it easier for your patients to connect with your practice, and by extention feel more in control of addressing their health needs.
Some doctors worry about letting their patients send direct messages. Will you have to dedicate extra time to responding to those messages? Will patients try to use a message in lieu of an office visit? Most often, the answer is no.
Dr. Sands’ research in developing Beth Israel’s patient portal found that for every 100 patients using a portal, you can expect to receive about 20 total messages per month, and on average those messages take less time to respond to (two minutes) than the average phone call (five minutes). Additionally, studies have indicated that patients who utilize direct messaging tools don’t visit the office less frequently.
It Makes Your Practice More Profitable
Understanding what patient engagement is and how it works is important, but the more complicated part of the equation is its impact. How specifically will engaging patients affect your practice?
Cost Benefits From Improved Outcomes
A commonly-cited benefit of patient engagement is lowered costs. That usually refers to lower costs in the U.S. health system as a whole, which manifest most obviously in decreased hospital readmission rates and emergency department utilization.
This is because engaged patients tend to have better outcomes. Dr. Leslie Kernisan is a clinical instructor at the University of California, San Francisco (UCSF) who also practices geriatric medicine. As Dr. Kernisan explains, patients are more likely to follow through on treatment plans when they’re engaged, making them more likely to achieve health goals – and less likely to need emergency hospitalization.
If you’re one of many practices already transitioning toward value-based reimbursement, then you’ll see a direct financial gain as a result of a more engaged patient base with improved outcomes. “The more that payment models are linked with outcome, the more important engagement is,” says Dr. Hibbard.
That’s not to say practices still operating under fee-for-service payment models won’t see financial benefits from improved patient engagement, too. Read on.
Higher Billing Rates
Another benefit your practice can reap from treating more engaged patients is optimized office time. Dr. Sands points out that patients who better understand their conditions and are active in managing their own health usually don’t return over and over again for the same low-intensity problems.
That means you’re not spending countless appointments addressing the same low-intensity issues you’ve addressed with the patient many times before. Instead, you can spend your office time on more complex clinical issues – which means that, on average, you could be billing at a higher level.
More Appointments and Reduced No-Shows
If your patient engagement initiatives include a patient portal or other online appointment-setting feature, you’ll likely see a scheduling benefit.
Dr. Kernisan describes patient engagement as “reducing the friction” for patients at the various touch points they have with you. For example, patients often dread the phone call, she says, not wanting to sit on hold to make, re-schedule or cancel appointments. Offering online scheduling is one way to reduce that friction.
When patients can manage appointments easily and at their convenience, they’ll be more likely to come in for preventive care. This tends to improve outcomes – but it also means you’re scheduling a visit that otherwise might not have happened, which is a plus for practices that are paid by the visit.
Your no-shows should decline as well. Dr. Kernisan points out that when patients don’t have to spend valuable time on hold to reschedule or cancel appointments, they’re less likely to simply not show up. That means you don’t have unexpected empty slots in your day. If your practice’s income depends on getting and keeping slots filled, this benefits your bottom line.
Attracting and Retaining Patients
Patient satisfaction flourishes when patients see themselves as active partners in their care. Dr. Kernisan, Dr. Hibbard and Dr. Sands all echoed this sentiment: engaged patients are happier patients.
When patients can schedule appointments or communicate with you more easily, feel that you value them as partners in their own care, and when their health benefits from their more active role, they’re happier with your practice. This helps you keep existing patients coming back for more.
“It can be a loyalty selling point,” says Dr. Kernisan. It also helps you attract new patients. Existing happy patients may recommend you to friends or colleagues. Moreover, public reports on your practice, such as those provided to Medicare patients through Physician Compare, could also lead to an influx of new patients.
It Makes Your Work More Fulfilling
Your bottom line is important – but so is your personal and professional fulfillment, especially when nearly half of all physicians are experiencing symptoms of burnout. That’s another area where patient engagement can be a boon. Patients aren’t the only ones whose satisfaction increases as a results of engagement. Chances are you’ll be happier, too.
Dr. Sands sets up the following scenario: “Imagine a patient who is not engaged and is just sort of a passive spectator to their own health,” he says. “You go through this exercise where you have ridiculous conversations with them. You’re telling them things over and over again, they’re not following your advice…it’s just not satisfying.”
Making your patients feel like partners in their own healthcare can change that. Dr. Kernisan explains, “It’s like any kind of working relationship. You often get better results when both parties feels like they have buy-in and have been heard.” When your patients are engaged, they’re more responsive and you’re less likely to feel like you’re spinning your wheels.
Dr. Hibbard points out that helping your patients achieve desired health outcomes is a point of professional pride. Think about it this way: the overarching goal of medicine is, loosely, to heal. You can’t do that effectively if you’re the only one interested in reaching that goal. Encouraging your patients to communicate with you, ask questions, do their own research and be active participants in their care makes you more likely to achieve the basic goals of medicine. And that’s bound to be professionally satisfying.
Whereas historically the physician has shouldered most of the burden of getting patients “well,” a fully engaged patient shares that responsibility. Think of it as delegating some of your workload to the patient. Not only does this keep patients healthier and happier, but it can mean increased profitability for your practice and higher satisfaction for you, too.