For the April 4 installment of Under the Boughs, our host Lee Huntsman—University of Washington President Emeritus and health care visionary—talked with two esteemed experts who operate at the frontier of patient engagement.
The topic was "Patients as Agents of Change in Health Care: Myth or Opportunity?" The panelists:
- Wendy Sue Swanson MD, MBE – Pediatrician, Chief of Digital Innovation at Seattle Children’s Hospital, KING5 News medical correspondent
- Connie Phelps – VP of Hospital Solutions at Wildflower Health
Huntsman, Swanson and Phelps set out to tackle an aspect of health care the series had not covered before—the patient. They started with several questions: Is there a consumer of health care? Will the individuals being engaged actually drive change? And does it make sense to think of people who use health care as “consumers”?
The Journey to Consumerism
“[At Wildflower] we’re very focused on engaging people before they become patients, and influencing their care and decisions and raising the health literacy at large through mobile,” Phelps said.
Dr. Swanson said she now works in the patient-provider relationship space, as well as in direct service to patients. “I don’t like thinking about people as consumers but […] we have to think about the money and where it’s moving and how we’re moving it as well.” In addition to her role as a general pediatrician she is also the Chief of Digital Innovation at Seattle Children’s. Over time, her team has moved into the peer-to-peer health care movement to talk more directly to parents, “[using] evidence and research in order to influence how they acquire, seek and gain information and make decisions”—innovations that get to the heart of consumerism in health care. Her team’s work now weds peer-to-peer health education with expert education at the bedside. Her team has even developed new technologies to give people the resources they need to build community.
Swanson said, however, that patient-centeredness needs to take everyone into account – including patients, their families and the providers who deliver care—a model she calls “dual centricity.”
Paternalism and Consumerism in Health Care
“We all go to the doctor when we’re in pain or when we’re anxious about something,” Swanson said. “But we’re all different in how active we want to be [in determining our own care plan]. There’s an art to [asking], who are you [the patient] as a person.” She said the attenuation to patient satisfaction is one useful outcome from the move to consumerism. “But there’s an illusion you’re getting great quality health care when you’re getting great quality service.” She said large academic health centers can help there, as well as startups. “There are all these different players, and the startups that are saying ‘We’re going to help you connect and run this yourself and get what you need and give you information on what the best way forward is’ are really important in keeping us all in check.”
For Phelps, she now thinks of her role at Wildflower as a form of person engagement. “We need to reach people before they become patients and help them become patients,” she said. “The important thing is to catch consumers’ attention early, and get them engaged in their own health care, and sometimes that takes an event,” Phelps said, adding “It’s important to create those relationships while they are still consumers” to better manage the relationships long term.
Huntsman asked his guests to talk about how providers are responding to the new climate of patient-centered consumerism in health care.
“Providers are doing what they have always done,” said Swanson. “They stand on their feet in their knowledge of what they need to get done when they walk in the exam room, and then accommodating based on how much they know about that person who’s there and adjusting to [their needs],” she said. “But ultimately providers are overwhelmed and desperate for better ways to do it.” She said the convenience patients appreciate in their retail experiences creates cognitive dissonance that the tools we have for health care don’t work the same way. And providers are being subjected—because of the persistence of the fee-for-service model—to extreme pressures to commodify every interaction with patients.
Phelps said provider organizations are responding to tools like those Wildflower creates by trying to balance the desire to maintain the physicians’ workflow while preparing patients to have an effective visit. “What we’re trying to do is guide the patient or consumer or person through their health care,” she said, “and along the way we collect information that can help their primary caregivers as well.” She sees the movement to value-based care as a lever hospitals can use to go down that path.
Aligning Incentives in a Consumerist Model
The move to value would seem to complicate the relationship between providers and patients. “What we see from a consumer level is that there is always someone making health decisions in the home,” said Phelps—that’s the person she calls the Chief Health Officer of the Home. “We need to make sure we provide an overview for the entire family and daily guidance,” Phelps said. “And we also need to make that content shareable.” Like Swanson, Phelps said that the key here is driving consumers to reliable resources that can help reduce unnecessary utilization and help all caregivers—including those in the home—operate at their optimum efficiency.
Swanson said that what should not be lost in the move to consumerism and value is the relationships. “How will we preserve the love affair that exists between a patient and the doctor they trust?” she asked. She said the task of building intimacy will remain a primary challenge even if mediated primarily through tools like Alexa and other technologies.
Still Space for Innovations
“The thing that’s making the most impact from my perspective is collapsing the silos of care on the back end to make the experience seamless,” said Phelps. She said large self-insured employers are piloting new solutions for their employees—solutions that increase the ease of navigation of the health care system and address issues like transparency.
“What we have that we didn’t use to have in health care is each other,” Swanson said. “Ultimately these social networking peer-to-per sites are revolutionizing how we make decisions.” She said that the wealth of health data consumers can access—including diagnostic tests—is a resource that can be curated to improve the patient experience, often with positive results.
Phelps said that their research about patient engagement shows that even a referral to an app can be regarded as an innovation, in that it improves outcomes, primarily because of the participation of trusted providers. Swanson added that now the task is to incentivize providers to become experts in existing outside solutions so that they can deliver them to patients.
The first audience question focused on privacy. “We all live on a spectrum of what we’re comfortable with, with privacy,” Swanson said. “It’s scary when coverage for pre-existing conditions may not exist.” She said a big challenge is allowing people to share information without allowing individuals to be victimized by it. Phelps added that to create a personalized experience, some data has to be shared, but that these decisions can still be patient or member driven. “Most people, to get healthier or better, will risk it,” said Swanson.
Direct primary care was discussed as a model that can tell us something very important about consumerism. Swanson compared that to concierge medicine, and cautioned not to confuse great service with great medicine. While she said that it is courageous to get rid of the intermediation in the patient/doctor relationship, that model probably doesn’t work for the most vulnerable.
For the final question, an online viewer asked if any aspect of care should not be digitized or “consumerized”. Swanson quickly pointed to beginning and end of life care. Empathy, integrity and honesty are key human factors in those interactions, she said. “Digital channels are thready and thin, they will never replace the [human experience].”
“What nurses do at bedside to educate and heal and support and cure, that’s not going to go away,” she said. “Hands-on [examination] matters at particular times of worry and anxiety, and I would suggest at birth […] and at death.” She said the key targets for digitization can be redundancy and waste, along with decision and diagnosis support.
The full video of the event is available on the Cambia Grove YouTube channel.
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