Beyond the Buzz: The Myths and Realities

of Consumer and Patient Engagement

Date: 9/29/2015
Author: Peter Edelstein, MD, Chief Medical Officer at Elsevier

Guest blog post by Peter Edelstein, MD, Chief Medical Officer at

Elsevier on EMR & HIPAA Powered by HealthcareScene.com
September 29, 2015
www.emrandhipaa.com
Todays healthcare reform world is filled with buzzwords. Population Health
Management. Value-Based Care. Patient Engagement. I am in no way
suggesting that these topics do not play critical roles if we are to realize the
enormous potential of healthcare reform. However, if you ask ten people to define
any one of these buzzwords, youll receive twelve different definitions. And in a
world of threatening reimbursement penalties and expanding healthcare legislation,
the sooner that we come to some consensus on the basic meaning of these terms,
the sooner we can understand the associated myths and realities.
Relative to the patient population (that is, the general population), the population
of providers (doctors, nurses, and other clinicians) represents a fairly homogeneous
and small group to target with initial reform efforts. In addition, we are all painfully
aware of the unacceptable number of preventable deaths and complications which
occur at the hands of providers each and every day. Thus reform legislation has first
focused on reducing variability, elevating quality, and controlling the cost of care
delivery through programs focused on providers (hospitals and healthcare systems,
as well as the physicians, nurses, other clinicians who work in such institutions).
Again, this makes sense as a starting point. That said, to believe that we will achieve
our ultimate goals of evolving into a system dominated by preventative care and
outpatient and home health maintenance (leaving hospitals to serve only those
whose chronic conditions can no longer be controlled in the outpatient setting)
solely by changing how providers deliver care is a myth of epic proportions. Far-andaway our greatest opportunity to shift our populations health from reactive, acute,
and expensive to proactive, preventative, and cost-efficient is by directly engaging
and educating and empowering the general population of patients and future
patients themselves.
This perspective is based on two major realities. First, studies (as well as our own
experience) confirms that even individuals with chronic conditions spend on average
only a handful of hours annually in front of a professional care provider. (How
many hours did you or your spouse spend under the direct care of a provider in the
previous twelve months? For the overwhelming majority of you, the answer is less
than a couple.) Second, patients who demonstrate interest in and ownership of their
health have better clinical outcomes and reduced costs of care. In a nutshell, people
spend virtually all of their lives away from doctors, nurses, and hospitals, and as with
virtually any complex processes, those who are more involved and knowledgeable
have better outcomes.

About Peter Edelstein,

MD, FACS, FASCRS
Peter Edelstein, MD, is the Chief
Medical Officer at Elsevier. Edelstein
is board certified by the American
College of Surgeons and the
American Society of Colon and Rectal
Surgery. He has more than 35 years
of experience practicing medicine
and in healthcare administration.
Edelstein was in private practice for
several years before serving on the
surgical faculty at Stanford University,
where he focused on gastrointestinal,
oncologic and trauma surgery. He
then spent more than a decade as
an executive in the Silicon Valley
medical device industry. Edelsteins
most recent role was as Chief Medical
Officer for the healthcare business
at LexisNexis Risk Solutions, a Reed
Elsevier company. He is also the
author of the recently published
book, Own Your Cancer: A TakeCharge Guide for the Recently
Diagnosed & Those Who Love Them.

Now we come up against another reality: limited resources.

Hospitals and healthcare systems have limited staff and
finances, and Patient Engagement often draws the short
straw when competing with electronic health records,
computerized order sets, and other provider-specific support
solutions. But, as Ive suggested, de-prioritizing Patient
Engagement as less important or less impactful is a
myth which greatly limits our potential to increase the value
(elevate quality/reduce costs) of healthcare delivery. Thus,
the most important first step for healthcare stakeholders
to accept is the reality that assigning resources to Patient
Engagement must be as great a priority (if not greater) as
allocating staff and money to products and solutions which
target only traditional providers.
Once healthcare leaders accept the critical importance of
Patient Engagement, they again have to consider their limited
resources. It is another common and perilous myth when
trying to allocate resources and develop and implement
Patient Engagement strategies to consider all patients within
a healthcare systems catchment area as a homogeneous
population. The reality here is that not all individuals
have the same potential for or barriers to becoming
engaged patients. And understanding with which patient
subpopulations you can get the most bang for your buck is
a necessity which is often overlooked.
For example, any of us who have directly cared for a large
cohort of patients knows that there are some individuals
(comprising a patient subpopulation) who simply have no
intention of ever lifting a finger to care for themselves. I think
about the roughly 50% of Americans with chronic conditions
who fail to take their medications as prescribed. Or the
diabetics who simply cannot be troubled with checking their
blood sugars. Every provider can immediately call to mind
dozens of patients who, understanding how to better their
own health, simply refuse to do so. The reality is that as in all
areas of life, there are simply some people who just will not
engage, be accountable, take ownership. To waste valuable
resources trying to engage this patient subpopulation is
foolish, disillusioning for staff, and wasteful, and it is best to
quickly identify these individuals and accept that all you can
do is provide reactive care when they become ill.

Contact Us:
Online: ElsevierPatientEngagement.com
Phone: 866.416.6697

A second and large patient subpopulation is well worth the

resources and efforts to engage. These are the folks with
limited literacy and numeracy skills. Multiple studies have
demonstrated the inverse relationship between literacy and
healthcare outcomes. Thus, assigning resources to clearly
engage and educate these individuals so that they have
the knowledge and understanding necessary to engage is
worthwhile.
The third large patient subpopulation worth targeting is
comprised of people whose upbringing or culture serves as a
barrier to engagement. Perhaps the largest of these cohorts
is elderly Americans, many of whom were raised never to
question a physician or ask for clarification. Such patients
are unable to engage because they refuse to address their
lack of understanding of recommendations for their self care.
Another large faction are those who were raised in cultures
(often outside of the United States) where, as with elderly
Americans, the provider is God, never to be questioned.
Thus, these folks dont really understand what they can do
to improve their health, and they refuse to ask for further
clarification.
The reality for these two large patient subpopulations is that
the appropriate use of resources to understand and directly
address the obstacles to true engagement and education can
result in great successes.
In the end, our ability to achieve truly dramatic and
impactful healthcare reform depends to a great extent on
engaging and educating the patients of today and tomorrow.
Appreciating this reality, and understanding the realities
related to identifying patient subpopulations which can truly
be engaged and educated is the best approach to achieving
successful reform.

Beyond the Buzz: The Myths and Realities

of Consumer and Patient Engagement