The mandate for healthcare consumer activation
By Omar Shoheiber and Neil Goldfarb
— Omar Shoheiber is managing partner of Guidemark Health. Neil Goldfarb is executive director of the Greater Philadelphia Business Coalition on Health.
The U.S. healthcare system is changing dramatically, and the magnitude and speed of change in healthcare delivery and financing have been overwhelming to all system stakeholders.
Consumers are particularly ill-equipped to cope with these changes. Health policy makers, providers, purchasers, insurers, manufacturers, and others are wrestling with how best to increase consumer engagement and activation to help consumers cope with and maximize the benefits of these changes. What are these changes and what could help activate consumers to make the best choices?
Healthcare exchanges offer consumers more choices
Under the Affordable Care Act, consumers have more choices than previously when it comes to choosing the benefit design that is best for them. Public healthcare exchanges have given consumers a menu of health-plan options at different price points. Some benefit consulting organizations and purchasers are now promoting private exchanges as a parallel mechanism for commercially-insured populations.
When one considers that making the appropriate benefit decision entails an analysis of plan affordability, expected health utilization, offered benefits, premiums, out-of-pocket costs, and provider networks, it is clear that this could be an overwhelming task for most individuals.
Healthcare stakeholders need to make suitable investments to ensure that consumers are making appropriate choices regarding plans and benefit packages. Concerns have been raised that consumers might buy lower levels of coverage to save on present-dollar premium costs, without considering the financial risk of future health events. Plus, consumers might delay or avoid seeking care when needed while they are covered under these plans.
Consumers who are more deliberate and seek information in order to make the correct health-benefit decision are more likely to be engaged and proactive with regard to their health.
Affordable Care Act emphasizes healthcare quality
For decades, Americans spent hundreds of billions of dollars on healthcare services without questioning the quality or true value of the services they received. With the introduction of the Affordable Care Act, policy makers have put an increasing emphasis on the quality of care provided. The Centers for Medicare and Medicaid Services and other payers are restructuring provider reimbursement to be tied to measurable quality metrics in the form of healthcare outcomes and patient satisfaction measures. This increased focus on measurable outcomes highlights the need to rethink the nature of the interaction between the healthcare system and the consumer. This interaction can no longer be episodic, but should be holistic and structured around wellness and patient engagement.
Provider incentives shift from focus on services to outcomes
The old model of provider compensation was structured around paying providers per unit of service provided. As a result, providers benefited from doing more procedures, ordering more tests, and generating more patient visits.
Under new models of “payment reform” (such as pay-for-performance, bundled payments, and global payment tied to population health management), an increasing percentage of provider compensation is being tied to improving healthcare outcomes and decreasing overall resource utilization.
Accountable care organizations (ACOs) have been formed throughout the country in which provider groups integrate and take on financial risk for the management of specific populations. In order to be successful, ACOs and other provider organizations facing these new compensation systems are thinking of new ways to engage patients. The “managed care backlash” of the 1980s demonstrated the importance of engaging consumers in the effort to maximize outcomes while using resources efficiently.
Technology eases access to health information
Consumers are more connected than ever before. Through the use of computers, mobile devices, and smart phones, and with the availability of health apps and wearable health and wellness devices, consumers are uniquely equipped to be engaged and activated when it comes to taking control of their healthcare. Consumer connectivity is a great opportunity for healthcare system stakeholders to put in place novel strategies to engage and activate the consumer; however, consumers will need help sorting through information sources of varying quality and reliability, and those who are less comfortable with technology may face increasing challenges and barriers.
What research tells us
Healthcare consumer (patient) activation refers to the consumers’ ability (knowledge and skill) and willingness to manage their own health and healthcare.
Judith Hibbard of the University of Oregon has developed a Patient Activation Measure (PAM) that assesses patients’ knowledge, skill, and confidence in managing their health and healthcare. The model describes 4 stages of activation that people pass through in the process of becoming fully competent managers of their own health and healthcare. These stages predict a number of health behaviors, such as diet and exercise, adherence with drug regimens, and using quality information for healthcare related decision-making.
Since the introduction of the PAM, a number of studies have looked at the correlation between patient activation and healthcare outcomes or costs. Findings from such studies revealed that activated patients are more likely to experience better health outcomes at lower costs compared with less activated consumers. Activated patients express better understanding of their disease, which translates to better knowledge of how to manage their disease and side effects of therapy.
No, we can’t ignore the healthcare consumer
Healthcare stakeholders must recommend new strategies to engage and activate the healthcare consumer. Additional research may help us understand how consumers make healthcare decisions, what influences their decisions, and how the system can help them make better decisions. This approach requires the collaboration of outcomes research, behavioral science, and medical marketing in order to analyze consumers’ beliefs, attitudes, and behaviors, design strategies to influence them and finally study their impact on health outcomes and cost of care. Current programs designed to improve health outcomes through provider driven initiatives and without a consumer activation component will yield sub-optimal results. medadnews
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How we drive healthcare consumer activation
In recognizing the need to enhance consumer activation, Guidemark Health has partnered with the Greater Philadelphia Business Coalition on Health (GPBCH) to develop a comprehensive program to drive consumer healthcare engagement and activation. Through the GPBCH, a regional coalition representing more than 1.4 million covered lives nationally, the program will be rolled out to individuals working for employers in the Philadelphia area who are members of the GPBCH.
The patient activation program is focused on enhancing consumers’ knowledge, skills, and attitudes in the following three areas:
• Understanding the healthcare system
• Living a healthy lifestyle
• How to engage the healthcare system
Some components of the program are disease-agnostic while others are being developed with the lens of consumers who have chronic diseases such as diabetes, asthma, cancer or heart failure, among others.
Guidemark and GPBCH are also working on a measurement and assessment plan to evaluate the impact of the patient engagement program on enhancing healthcare consumer (employee) activation.
The development and introduction of patient activation programs with employers has a number of logical advantages which will make the difference in our program’s success. These advantages include:
• Employers are highly motivated to drive better health outcomes and reduce overall costs because they carry the full burden of risk (direct medical cost and productivity loss associated with poor health).
• If consumer activation starts before health benefits are selected, it increases the likelihood of alignment between the benefit design and the needs of the consumer.
• Activation in health decision-making is being linked to job activation, performance, satisfaction, and retention.
• Employers can access the healthy population and others who have not yet engaged with the healthcare delivery system.
