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Healthcare Perspectives: Part 1 on Patient Engagement, Naveen Rao, Chilmark Research

Hear Naveen Rao of Chilmark Research discuss key findings from the Chilmark Research 2014/15 Clinical Patient Engagement Market Trends Report published February 2015.


Kevin: Hello everyone, welcome to Healthcare Perspectives brought to you by the West Corporation Healthcare Practice. This is where we discuss and explore strategies and tactics to improve patient engagement and activation, a cost at care continuum. I am your host Kevin Crane, welcome to the show.

Today we have the first episode in a two part series where we will be exploring a recent report from Chilmark Research on clinical patient engagement. Commercial organizations have long recognized the need to keep customers engaged and loyal. Now organizations in the healthcare space are feeling the pressure as well.

We'll be exploring all of that in the next couple episodes starting with my guest today Navin Rao, an analyst at Chilmark Research. I'm going to ask him to explain some of the findings in the report and what Chilmark has to say about it.

Stay tuned for episode two on patient engagement when I'll talk with Laura Bramschreiber, Vice President of marketing strategy for the West Healthcare Practice. We'll discuss her take on the report and what West is doing to help healthcare organizations improve patient engagement and activation. Now I'm pleased to welcome Navin Rao to the program. Navin is an analyst at Chilmark Research, a global research and advisory firm focused on healthcare information technology.

Navin, Chilmark has been looking at the notion of patient engagement quite closely. You just recently published an extensive report on clinical patient engagement. What were the key findings?

Navin: We looked at the market for patient engagement in a few different ways. The first thing we did was just looking at some of the trends that are shaping things today. We found there's really two main types of trends.

The first is a few pieces of healthcare law that are taking effect right now. One of them is the HITECH Act or as people commonly refer to it, the meaningful use program. That's really served as a first direct incentive as well as penalties for some of these healthcare organizations today to adopt and start to using healthcare IT tools. There are a handful of specific provisions around doing things to interact with patients using technology.

Then the other big piece of the law is the Health Reform law obviously known as the Affordable Care act or Obama care, whatever you want to call it but that really is starting to play a big role by introducing some changes to payment that are kind of reshaping the way that a provider or organization, so a hospital or a doctor's office.

It's really kind of reshaping the way that that kind of organization manages patients at a population level using numerous sources of data really with the focus on outcomes. So in that new context kind of leveraging patients by giving them a bigger role in their own care, giving them more information, more data, better tools, better access and so forth. That's becoming important and that's kind of a new ball game compared to how it's traditionally been.

Beyond that there are a few other big drivers that are really kind of market driven. One is simply what we call technology driven consumerism. It sounds a lot fancier than it is. The fact is that we can do a lot more with our smartphones in our day-to-day lives than we can compared to healthcare. The bar is really being raised and as a consumer, you know, I'm sure probably you and I probably use our smartphones on a day-to-day basis to manage pretty much every aspect of our life. That still hasn't really crossed over into healthcare yet.

Other things that are changing on the consumer side are the way that insurance benefits are being structured. So more than ever people who get coverage through work, they have what's called a high deductible health plan which they pay a set amount out of pocket before their coverage really kicks in. This is kind of pushing a new interest in, "Gee how much does this cost? What's the value to me as a consumer? How do I get the best access in the quickest time and so on and so forth?"

That's opening up the door for newer models that weren't really around 10, 15 years ago. Like if you walk into a pharmacy like a CVS or a Walgreens, you can get some care there. There are increasing number of apps that let you just talk with the doctor online through video chat. These are all kind of new options that are on the table today. So there's a lot of things that are kind of pushing the healthcare system towards basically reinventing the way that they're really interacting with their patients.

In terms of other findings, the second major aspect of what we looked at in our research was really looking at the technology. There are just tons of tools in different kinds of scenarios in which a healthcare system is going to interact with folks. So we organized and kind of categorized them in our report and we put them together under a number of what we're just calling use cases. Those use cases, we organize them into really three. We found that the three categories are kind of basic, what we're calling basic use cases, emerging use cases and then some more advanced ones.

What we found was that basic use cases which typically they've been around for about a decade or so. They are things like sharing lab results with your patients, sharing data with them that might have come out of a recent test, sending them emails, pushing them specific educational materials. It's kind of the basic bread and butter for what you're able to do using a digital platform.

These are almost entirely driven by what's called the patient portal which most of our listeners will be familiar with but basically it's just a secure login website where you go online, you have access to a couple of your different doctors, you can communicate with them, you can access your results and so on.

Beyond that some of the emerging use cases we found were really focused on kind of administrative convenience. Really kind of trying to treat patients as consumers. So that's letting them schedule appointments through the portal online, ordering refills or ordering a new medication online, paying your bills. It's really increasing a slightly advanced level of convenience compared to the way things have traditionally been.

Finally the advanced scenarios are the ones that I think a lot of people today are excited and that's really leveraging technology to kind of push the envelope with what's possible. If you think about the traditional way of accessing your doctor, you schedule an appointment and then you show up and then you wait for a few minutes and then you wait for a few more minutes and talk to a nurse. Then you see your doctor for five or six minutes then you go home and you do the whole thing again next year or in six months. That's completely changed now with the way that technology can really connect two folks on an instant basis between visits.

You can communicate using various apps and mobile technology. So some of the advanced used cases that we kind of uncovered in our research really were around using these kinds of mobile platforms. Think of a care plan, like a discharge plan once you leave the hospital or leave the doctor's office. We're able to turn those things today into kind of a digital format that really allows you to record if you're doing something you're supposed to be doing, when you're doing it, taking the medication, following up with the specific physical therapy, exercise for example. It doesn't really matter what it is but you're able to document that and send that data back to the doctor so they're able to kind of keep tabs on you even if you're not showing up for a visit.

Just like that there are other tools out there, with new wearable technology, things to connect your home in a way that enables the transmission of data. So things like Bluetooth scales, blood pressure monitors, glucometers are kind of evolving in a way that enables data collection in a pretty sophisticated way. Those three types of use cases were basically, that's kind of the market that's comprised today.

Kevin: Companies in the commercial space are focusing more and more attention on technologies and strategies to keep customers engaged and activated. Navin, now organizations in the healthcare space are doing that too. Where do you think the industry is headed with respect to patient engagement?

Navin: I think it's a really important question. I think in general I think there's a growing recognition that this is something that is important. That healthcare organizations are going to have to figure out the patient engagement puzzle. I think it remains to be seen what the response is going to look like. I think over the next few years, there's going to be a big shift towards this notion of more consumer friendly access.

This concept is kind of emerging of a new front door in the healthcare system. Again that's walking into a CVS or a Walgreens or downloading an app from Teladoc or in American Well and just kind of paying cash out of pocket to see the doctor as needed when you need. That is, I think, going to be putting some pressure on outpatient care especially primary care which kind of still enjoys this kind of old world role as gate keeper into the healthcare system.

That segment of the market is going to feel some pressure to keep up. I think if you look at most of the healthcare provider organizations today, their phone office operations, so kind of the administrative parts that interact with patients, it's pretty badly disconnected from what's happening in the clinical side of the house.

For example a patient today, typically you can expect this very messy process that might involve some interactive voice response like a robocall that leaves you a voice mail. You get some paper mailing sent to your house, you get some email messages through the portal and then when you do see your doctor sometimes you get spoken instructions that aren't written down anywhere. This is kind of the state of affairs today and it's almost seeming like the new tools are just piling on top rather than really being incorporated in a broader strategy. We're really kind of hoping that this gets cleaned up a little bit.

In our conversations with West, it seems that they've been doing some interesting work in this front with regards to just creating a more streamlined kind of engagement center that really improves the patient experience with the broader goal of improving the patient's adherence to medication, improving the patient satisfaction and boosting satisfaction scores and improving their participation in their care process.

Ultimately the goal, it's not a new one, it's just to improve the health outcomes. But it's let's get the patient on board so we're able to do that more effectively and let's kind of bring all the resources we have to bear in an intelligent way to get that done.

Kevin: What do you see as the biggest obstacles for organizations to develop and implement a patient engagement strategy and how can we overcome those obstacles?

Navin: That's a great question. Today there are numerous challenges. First and foremost just simply that given where we are today, our provider organizations, hospitals and big health organizations are simply just really busy. There are a lot of really big changes going on at every level, from payment and financing to competition heating up in local market places and then of course there's just a lot going on right now even just within the IT department.

One thing that we found as a specific, not an obstacle per se but just kind of this is acting as a little bit of a speed bump to patient engagement. It's that engagement is important but in the grander scheme of things it's usually taking a back seat today to other priorities. Even just from looking at adopting new clinical tools to get to that modal population level care, there's other investments that you have to make and other skills that you have to master as an organization that just come before engagement.

For example you need to be able to get the data on your population, then you have to have the wherewithal to slice it and dice it and put people into groups, assign them risk scores based on their illness, their age, what insurance coverage they have, whatever data and criteria that you have. It's a long term transformation and engagement isn't really the first car on the train.

In terms of other challenges, on the technology side, one thing that we found is that, and this is not a new finding for anyone who works in the healthcare IT space but just to be frank the level of interoperability that we have with data and information between different IT systems is just awful today. Electronic health records, E.H.R.s, they're not really built to create what we call the longitudinal record.

The longitudinal record is basically just a one stop shop. It's a central record that has all the persons' past and present information, care received at other facilities, care received before they may have moved into a certain area or gotten certain insurance coverage, claims data, clinical data and a mean patient generated data. E.H.R.s are just not built for that. That is acting as a specific kind of bottleneck to really get complete data and it's still driving inefficient care. It's driving extra tests and procedures. That's still lagging far behind the curve of where it needs especially given how much effort and how many resources have gone into that.

I think one other challenge that we saw specifically is there still is a big disconnect today between a person's health insurance and their doctor. In today's healthcare system, the way that a person makes decisions about their care, it's shifting towards a place where it does depend on the cost and the coverage and the timeliness and so forth. You have health plans that health insurance kind of dictating those terms and doctors are really operating in an entirely different world based on what they think is best for the patient but not necessarily taking into consideration the other factors that are going into a patient's decision calculus.

So that's a little bit of a disconnect and when it comes to putting engagement tools into place, if you don't build those tools and build those systems around how a patient actually behaves and where patients' actual needs are, it's not going to work out in the long term.

Then the final challenge I'll say that today, again kind of building off that unfortunate truth that healthcare organizations they're just very busy, there's a little bit of...we characterize it as almost a standoff. You have your healthcare organizations who traditionally have looked to their health IT vendors and really just their E.H.R. vendors as their primary technology suppliers.

Then if you talk to the E.H.R. vendors, they're really not thinking about patient engagement. They're not thinking about designing things for the patient. It's really at the clinical level, coming up with kind of compliant systems that will help organizations get incentive dollars, enabling better clinical decision support tools for clinicians. It's very focused on the clinical end user and not the patient end user.

The E.H.R vendors are saying well our clients aren't asking us to produce new tools aggressively and the doctors in hospitals are saying, well our E.H.R. vendors are not really rolling out these new tools aggressively so patient engagement is kind of caught in the middle and the consumer essentially is caught in the middle and they're not able to access these tools that they ought to be accessing.

Kevin: It sounds like the industry is really headed towards a more patient centric sort of set of acumen along with the innovation in things like social media and just access is really raising the bar in new and different ways but at the same time it sounds like a lot of technology, a lot of strategy, a lot of resources all need to be aligned and that's going to take some time and coordination. What do you recommend is the next best step for organizations looking to move forward with more thoughtful patient engagement strategies and more thoughtful technologies to support that?

Navin: That's a great question. So at the very end of our report we have a comprehensive set of conclusions and recommendations. I won't go through all of them here but some of them that rose to the top that really seemed to resonate with some of the folk who had a chance to read it.

First is, let's just be real. There are limited resources, there's limited time in the day, there's limited money in the budget that you can really bring to bear in this issue as a provider or organization and that's okay. We think that mastering patient engagement, it's not necessarily just about technology. It's always tempting to look at the latest greatest piece of technology and worry about how much it costs and if we can afford it but really I think there's an opportunity to use the tools that are already in place. Use the patient portal that you've already bought more effectively than you were at.

One little anecdote is that we found the use of secure email is one of the most basic use cases for patient engagement. The doctor can send the patient a note, the patient can respond and so on and so forth but just having that in place doesn't mean it's patient engagement. Every time the patient's discharged or every time there's a new diagnosis made, there's an opportunity to send a quick email and check in with the patient to see how they're doing, to see if they're responding to a medication the way they ought to be, to see if they have any concerns or side effects they want to report. It's just being proactive even with a tool as simple as email. That level of thinking just isn't really widespread today. The first recommendation would just be, leverage what you already have and think about it a different way.

Another recommendation is just we encourage everyone involved with this market and that includes the vendor side as well as healthcare organizations themselves to really get ahead of mobile technology. That's one kind of glaring shortcoming that we saw when we looked at some of the technology as well as kind of the state of mobile health and the provider side. It's really kind of sad how badly new products that are designed for today's healthcare care consumer are just leaving out mobile apps.

Usually there's a chance that it's not mobile optimized so when you pull something up on your screen, there's multiple logins on your phone. We just see mobile technology as kind of a one way street resisting the adoption and incorporation of new tools for the patient to use in their smartphone today, it's really just putting yourself at a competitive disadvantage moving into the future.

Again we use these phones for every other aspect of our life so let's just incorporate them into the mix in healthcare today.

Then this isn't really a specific recommendation but again there are specific ones in the report but I think the one I'll close on here is simply putting yourself in the consumer's shoes in trying to understand their world. There's so many tools that are out there today.

One phenomenon that's starting to unfold unfortunately is what we call portal sprawl and that's there are multiple portals, the insurance company gives you one, the doctor gives you one, if you've had a previous doctor in the past, perhaps you have an old outdated portal that no longer has fresh data but has the data that you had at that point. So if you're introducing new apps and new educational materials or new websites or new devices, new video visit tools and so on and so forth into the mix and you're not streamlining all those different offerings into kind of one central place or one central brand or under one umbrella, you're really making it difficult for the consumer to really do what you ultimately want them to do.

Kevin: Navin it's been great speaking with you today. We're almost out of time but before I let you go, where can our listeners go to access the Chilmark Research on clinical patient engagement?

Navin: Our website is simply It's On our front page the clinical patient engagement report should be right up at the top.

Kevin: That's Navin Rao an analyst with Chilmark Research. Navin thanks a lot for being my guest today.

Navin: Hey Kevin, thanks again for having me and again thanks to West for letting us take this opportunity to share some of our research.

Kevin: Thanks Navin. Go to to find the patient engagement report. Stay with us for episode two in this series about patient engagement when my guest will be Laura Bramschreiber, Vice President of marketing strategy for the West Healthcare Practice and we'll dig into the report even deeper and identify ways that organizations can take practical steps to improve patient engagement and activation. If you want to find out more just visit

That'll do it for this episode of Healthcare Perspectives brought to you by the West Corporation Healthcare Practice. For more information visit Join us next time when we continue to explore strategies and tactics to improve patient engagement and activation across the care continuum. I am Kevin Crane for West Corporation Healthcare Practice. Thanks for listening.