The Brave New Universe of Health Care Reform and Patient Engagement

April 9, 2013

In the new health care universe, we are now “e-patients,” newly empowered and behaving as consumers. E-patients are plugged in, online and crowdsourcing their diagnosis, treatment options and support groups.

The impetus is now on providers and health care organizations to work with communicators to develop new consumer-oriented strategies that engage patients, facilitate conversations with them and equip their health care toolbox with the goals of improved prevention strategies and long-term health outcomes.

But nagging questions remain.

What is the return on investment? If you build it, then will they come? What do we gain, and what do we lose? How should practitioners and professionals facilitate this shift in the patient communities they serve, particularly by leveraging online engagement strategies?

The nexus: engagement and social media

There is a seismic shift taking place in the patient–health care professional relationship — arguably the most significant shift in 30 years — as 2010’s Affordable Care Act rolls out in earnest later this year. The act has ushered in sweeping federal and state-by-state policy changes. A whole new lexicon confronts us, and old phrases such as patient engagement, meaningful use, empowerment, crowdsourcing, personalized, predictive, CCOs, ACOs, prevention, participatory, mobilization, portals and accountability have new meaning.

A global budget model looks to replace traditional fee-for-service care models, and at the heart of the reform is more-effective management of the health of populations. Provider compensation under this global, pooled resource model is impacted and dependent on patients better managing and maintaining their own health.

Technology has come to the forefront. In November, Information Week said that more than two-thirds (69 percent) of U.S. primary care physicians reported using electronic health records (EHRs) in 2012. With or without EHRs, providers, clinics, hospitals and patient organizations can and must engage patients and mobilize information across care settings.

To qualify for the federal financial incentives to defray the cost of the purchase, installation and implementation of EHR systems, providers, hospitals and applicable health organizations must comply with Meaningful Use rules as determined by the Centers for Medicare and Medicaid Services (CMS).

Last summer, CMS created provisions that “require eligible professionals and hospitals to increase their efforts to share data electronically with patients.” Eligible hospitals and providers must make data accessible to their patients, using digital platforms. At a minimum, they predict that these provisions will encourage greater patient engagement.

While many of these technological advances were well underway prior to the passage of the Affordable Care Act, there has never been a specific focus on the sharing of information with patients.

One of the act’s most innovative elements was opening the door for states to implement local, market-based health insurance exchanges in order to provide affordable health insurance to the currently uninsured or underinsured. Oregon is among 25 states implementing such public-private market solutions. The impact will be a tidal wave of this new brand of consumer, one who must go out into the open market to get educated, evaluate their health coverage and purchase it.

Market dynamics are now meeting consumers’ broadening use of social media and online engagement to find and share online information, and to make important health care and economic decisions. Patients are now consumers. Health care providers and policymakers must think in new ways about the platforms of information that must be available to this new Patient 2.0. 

Does engagement really matter?

I participated in a recent social media effort on health care called the “State of Reform,” and a question arose asking, “Is more media better?” We discussed this topic with some digital media colleagues at a consumer engagement session, and their answer, put simply, was “yes.”

But questions still abound from provider groups, health care institutions and organizations that are moving at a predictably slower pace to engage with social platforms. I queried a top health care executive who is a physician leader with one of Oregon’s largest multispecialty practice groups and asked him if his clinic had developed a patient portal and whether it was effective. “Are patients using it?” he pondered.

He and his fellow practitioners weren’t fully sure about how patients might interact with the technology.
This physician leader may just barely be at the tipping point. Is there really a return on investment for providers, systems and patients in upping the social media exchange game?

A recent report by the national Bipartisan Policy Center called “Improving Quality and Reducing Costs in Health Care: Engaging Consumers Using Electronic Tools” showed clear value in patient engagement.

Among the report’s findings:

  • Patient-centered communication and engagement drive lower costs, better outcomes and better patient experiences in health care.
  • Patients involved more closely in clinical decision making report less pain and faster recovery, are more likely to adhere to medical recommendations and carry out more health-related behavior change.
  • Patient-centered communication and engagement are also associated with fewer diagnostic tests and referrals. Informed patients are less likely than other patients to choose elective surgery.

But the communication goes beyond Twitter, Facebook and email. Return on investment is also evident in patients’ use of electronic tools, such as secure electronic messaging between patients and their clinicians, home monitoring for chronically ill patients and online portals to allow patients to obtain their own health record information.

New models of care are emerging in lock step, including patient-centered medical homes, boutique/concierge clinics and remote access via telehealth applications. The report noted that these examples “can significantly expand and improve the effectiveness of traditional patient engagement activities.”

Patient 2.0

If providers and communicators are seeing this as the dawn of two-way communication, then they are still behind the curve.

Welcome to Patient 2.0’s new model of three-way communication: Patient to doctor, doctor to patient, patient to the world. Clearly, a new patient is emerging?— one that doesn’t care about the privacy protections of HIPAA.

Recent research published by the Pew Internet & American Life Project and the California HealthCare Foundation shows that consumers are seeking and sharing health information online at a rapidly expanding rate:

  • Family Caregivers Online found that eight out of 10 caregivers have access to the Internet. Of these, 88 percent look online for health information, outpacing other Internet users on every surveyed health topic.
  • In a 2012 report, Health Topics noted that symptoms and treatments continue to dominate Internet users’ health searches. Food safety, drug safety and pregnancy information are among the most searched topics online.
  • The “Chronic Disease and the Internet” report in 2010 showed that American adults living with chronic disease are significantly less likely than healthy adults to have access to the Internet (62 percent vs. 81 percent). However, this report reveals that once online, individuals with chronic diseases take advantage of social media at a greater rate to share what they know and learn from their peers.

What is particularly interesting about the emerging Patient 2.0 is how he or she has drastically increased reliance on peer-to-peer recommendations. More than half of the respondents in a 2010 Pew study relied on fellow patients, friends and family for qualified intel about everyday health issues such as emotional support and quick remedies.

Brave new world

The answer to the age-old question “If you build it, will they come?” is maybe — with the right strategy.

As communicators know, there must be dedicated vigilance to the quality of information shared, tracked and monitored. 

Several best practices and models of patient engagement are now tried, tested and proven successful. Smart practitioners, provider organizations and institutions are interweaving traditional patient engagement protocols with new-media approaches, recognizing patients are motivated in different ways.

Some new technologies are showing early success in engagement and return on investment. A well-known campaign that won the 2011 PRSA Silver Anvil Award was Text4Baby, a free service that texts medical information to new and expectant mothers based on their baby’s due date or date of birth.

These weekly text messages give women information about their child’s development, when to visit the doctor, how to best care for their baby and how to manage the different challenges of pregnancy and parenthood.

And early successes in many efforts are gaining steam:

  • New EHR technology platforms allow patients to check in wirelessly either from home or at the clinic using the iPad platform, resulting in reduced costs in data entry and paper shredding, and increased medical office productivity.
  • A campaign by Roche Diabetes Care called the “Big Blue Test” utilized patients’ online activity by leveraging peer pressure to show the impact of exercise on blood sugar levels. In a matter of a few days, more than 8,000 people took the test and posted their results.
  • The Palo Alto Medical Foundation allowed diabetic patients to use a wireless home glucometer to upload readings through a smartphone to their doctor’s EHR system, resulting in decreased blood sugar levels and increased medication compliance.
  •  Hubbub Health has created an online gamification approach to drive engagement and change behaviors for a target audience, such as an employer group. Employees use the portal to lose weight and manage other health practices with their peers.

Indeed, social and digital engagement will soon be the norm with Patient 2.0, and the overriding influence may be that patients will demand accessibility with their provider, with a better, more-informed perspective and greater influence over their own medical decision making. In short, we’ll see greater empowerment and decision support.

So from the multiple perspectives of shared responsibility and the emerging interconnectedness, is there value here? Yes, of course, says Dan Zenka, APR, the Prostate Cancer Foundation’s senior vice president of communications.

Doctors diagnosed Zenka with prostate cancer in April 2010. He took to social media by blogging at Now that he has personal experience, he finds many men who, like himself, are seeking treatment information, support and camaraderie.

He encourages them to go online and share their experiences and feelings with others.
“The benefit is that patients are getting educated with more quality data,” he says. “I’ve spent three years telling men to talk about it. It’s healthy. It’s empowering. I encourage them to find a forum so they know they’re not alone.”

Dianne Danowski Smith, APR, Fellow PRSA
Dianne Danowski Smith, APR, Fellow PRSA, is vice president of Publix Northwest PR + PA, an affiliate of Todd Myers Communications Inc. You can follow her on Twitter @DiannePublixPR.


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