Published in Northwest Regional Primary Care Association Health Center News, March 2013 Edition
The Challenges of Engaging Patients
We are influenced by our peer groups, impacted by the powerful marketing messages of massive corporations that want us to buy their products, and sometimes stuck in counterproductive behavioral patterns. Even if we want to change, our ability to implement the right actions for our health can be difficult without support. Exercise routines, if even initiated, are often difficult to maintain. 55% of people who do begin exercise routines abandon them for a multitude of reasons. For a growing number of patients, this problem is compounded by their socioeconomic status. The fast food dollar menu may seem to be the best option for people who are challenged by money, work, transportation and time.
You probably have seen the CDC slides more than once that show the rising tide of obesity and diabetes from 1994 to 2009. I was taken aback the first time I heard Jason Cunningham, the Medical Director of West County Health Centers, say that obesity was spreading socially. It was an eye opener to think that, where we see obese people, we will see more because they influence all of the people around them. At least 40% of the determinants of premature death can be attributed to behavior.
It’s no mystery then that healthcare providers face an uphill battle when attempting to engage their patients to achieve better health outcomes. Almost everyone I speak with believes we are going to see value-based care become the standard, with providers on the hook for how healthy their patients are. Like a huge freighter ship at sea, overall patient health isn’t going to turn around over night, and healthcare providers are going to need to do something dramatically different to achieve new results in difficult patient populations.
The obvious way to reduce healthcare costs is to keep people healthy rather than treating acute conditions. Healthcare leaders across the country agree that reimbursements are realigning to move from treating sick patients to a model of prevention. Rewarding providers on outcomes rather than just production seems obvious, and to me it is one of the key points of the Affordable Care Act.
Here in California the math is a no-brainer based on the data from the Office of Statewide Planning and Development. On average it costs $17,700 per day for an inpatient stay, $2,100 for an emergency department visit, and $120 for an office visit. It makes perfect sense to direct patients into preventive primary care visits as much as possible. However, there is a growing physician shortage (60,000 short by 2015 in California), so it isn’t going to be easy to address the new influx of patients and achieve better health outcomes at the same time. Conversely, to compound the issues, let’s not forget that no matter what healthcare providers do, at the end of the day, the issues of patient self-accountability will play into at least 40% of the equation for success.
How are healthcare providers using technology to solve these challenges?
A provider-directed, private and secure social platform for healthcare is an innovative way to engage patients beyond the exam room. I’m not talking about a private group on Facebook or patients from across the country sharing their own ideas about their diseases or conditions in platforms that are unattended by qualified professionals. WellFX is truly a platform that offers providers the ability to share the right information with the right people at the right time. It is designed to be the hub of the patient-centered medical home from a communications standpoint.
If it takes a village to raise a child, then it makes sense that it would take a community to help people get and stay healthy. By harnessing our intrinsic need for social interaction, we discover the opportunity to radically change the way providers engage their patients. Imagine the power of being able to preempt bad behavior just by being connected beyond the four walls of the exam room, and harnessing the power of the group to reinforce the right decisions in the right moment.
Providers who invest in this concept will reap the rewards of this exciting new model. Innovators like Columbia Valley Community Health in Wenatchee, WA have already started. The tool to produce better ongoing provider-patient engagement, patient compliance, improved health outcomes, and potential shared savings is available today.
WellFX and Region X
Northwest Regional Primary Care Association expressed interest in learning more about the WellFX platform while it was still in development. After several presentations to the PCA management and board, staff undertook a due diligence study with the goal of determining: whether the WellFX product did what it was advertised as doing; whether it was well designed, well executed, and positioned for growth, and whether it might be beneficial for community health centers in Region X.
With the able assistance of an experienced third party tech evaluator, the PCA set about evaluating the technical viability of WellFX, its security, the quality and “friendliness” of its user interface, its marketability to health centers, its likely longevity in the marketplace, and the reliability of the claims about its projected impact on health outcomes.
The results of the study, shared with WellFX, included the following:
– WellFX is accessible in both English and Spanish
– The platform will be familiar to those already using Facebook, blogs or web forums and is easy to manage at the signup phase.
– Managing patient groups and health content appears to be straightforward and simple for the CHC staff.
– The health center will have to invest some ongoing staff time into developing the patient groups, although the level of effort required can vary from clinic to clinic.
– “WellFX has the potential to deliver expected value,” which is to improve patient engagement through community, education, patient action and loyalty. At the time of the study WellFX had not been deployed broadly enough to know it actual impact.
– “From a privacy perspective, the information design of WellFX mitigates HIPAA concerns.”
– The system is technically viable, built of well-known, industry-tested parts and should therefore be easily maintained.
– The system can handle the expected load and is designed to scale on demand as needed.
-“Privacy is handled well… there is no access to HIPAA-related data.”
NWRPCA’s consultant commented further: “The first experience for a patient has been well thought out. It’s easy to get signed in with nearly no configuration; the patient should be able to engage right away. The basic and most important concepts (reading posts and commenting) are clear and obvious. The more advanced concepts like chatting, adjusting privacy settings, and creating albums to manage uploads are also relatively straightforward.
“On initial setup, the WellFX team helps the health center integrate with the system so that all of the center’s patients are in the system. From there, a health center admin can move individuals or collections of people into and out of groups that they’ve created. The experience is straightforward and can be done with a minimum amount of training. The most complex part is actually outside of the WellFX system, and that’s in working out which groups the clinic will have, choosing who will administer and moderate them, and deciding who will manage the content.”
The study by NWRPCA also noted that the branding on the site is the health center’s brand, so the patient immediately recognizes his or her own medical home upon entering. If a patient group includes, for example, diabetes patients from several different health centers, each person sees a recognizable, friendly logo when he or she enters the system.
Data from WellFX is not pushed into the electronic health record (EHR). However, the company has developed a unique dashboard for monitoring data generated by group or individual activity.
NWRPCA followed up the initial due diligence study with two free informational webinars, to present the product and gauge member reaction. Webinars were interactive, allowing participants to offer input and feedback during and after the presentation. Thirty-five percent of the membership, representing all four states, participated in the webinars.
The general conclusions NWRPCA staff drew from member input was that: 1) Region X is in need of a comprehensive Patient Engagement initiative, 2) Members seemed open to the general concept of engaging patients through social media, and 3) the overall response to WellFX seemed positive.
The PCA board is now considering its options for undertaking a regional patient engagement initiative that includes a WellFX option for health centers. However, Region X health centers may opt to investigate WellFX on their own if they wish. One member, Columbia Valley Community Health in Wenatchee, has already done so.
On May 19, 2013, Columbia Valley staff will join WellFX to present a 90-minute informational session and demonstration at NWRPCA’s Annual Spring Primary Care Conference in Anchorage. All interested conference-goers are encouraged to register for the session.