Increasing patient engagement as a tool for improving care and outcomes has been a tough code to crack for the healthcare industry. This is particularly true in comparison to the consumer engagement models adopted by companies such as Facebook, Amazon, and Netflix.
“It’s unclear whether or not we’ll ever achieve comparable levels of success,” said Paul LeVine, VP for analytic services for TrialCard, speaking at the Formulary, Copay and Access Summit in San Francisco April 11-12. During his presentation, “If patient engagement is the holy grail we all seek, what does it really provide us?,” he urged the time has come to adjust expectations and design targeted, timely, and simple interventions to address the inherent barriers to patient engagement.
“It is not necessarily a reasonable comparison to say we should be as good as Facebook,” LeVine explained. “We are never going to get that. If we can adjust our expectations, be smart, and design the kind of targeted approaches that play to our strengths and where the patient needs it the most, we are probably going to be better off.”
LeVine opened his presentation with a quote from Health Affairs that defines patient engagement: “Engagement generally captures the notion that patients are involved in the process of their care — actively processing information, deciding how best to fit care into their lives, and acting on their decisions.”
However, there is no universally agreed upon definition of patient engagement, which may be part of the challenge facing the healthcare sector. IBM cites 22 different reasons that compel patients to engage. These include health conditions, health cost planning, accessibility and availability, medical management, and social interaction. Athenahealth offers a more streamlined perspective: “Patient engagement is active collaboration between patients and providers.”
There is evidence the use of portals is increasing, LeVine noted. 
74% of patients are able to pay their bills through portals, compared to only 56% in 2013
45% of patients scheduled appointments through portals, compared to 31% in 2013
44% of patients now refill their prescriptions through portals, compared to only 30% in 2013
63% of patients communicate with providers through portals, compared with 55% in 2014
37% of portals provide patient-generated health data, versus 14% in 2013 
While the portal adoption rate is increasing, it is only when one compares it to engagement statistics from consumer platforms such as Facebook, Netflix, and Amazon that the disparity becomes clear. For example:
67% of Facebook users check the social media platform at least once daily (Statista, 2017)
23% of Netflix users stream something every day (Leichtman, 2017)
35% of Amazon Prime users shop on the site every week (Walker Sands, 2016)
“Those are some real engagement numbers,” said LeVine. “There are major issues to explore there.”
Patient versus consumer engagement

Patient engagement differs significantly from consumer engagement. One dilemma facing the healthcare industry is that patients’ engagement is episodic by nature, noted LeVine. The consulting firm Deloitte identifies this in its 2015 consumer engagement report: Patients newly diagnosed are ravenous about finding out information about their condition, but that interest tails off once they are better educated. Similarly, functions such as choosing a PCP or a health plan – typical measures of engagement – are usually sporadic, rather than consistent ones.    
There are other hurdles to strong patient engagement, too. “Patients don’t necessarily want to be reminded about their health condition. A lot of people want to push it away for a while and not be engaged,” explained LeVine.
Also, healthcare providers and payers have to be mindful of the unintentional impediments they put in the way of engaging with patients. LeVine cited a case in which a woman was listed as a having a high-risk pregnancy. She became “the designated high-risk pregnancy lady,” and every time she checked her portal those are the first words she would see. This type of labeling can be a strong deterrent to an individual’s engagement with a payer’s or provider’s portal. 
The overarching question LeVine posed is, “Should we hold patient engagement to the same standard we use for consumer engagement?”
Despite some interesting outliers, there’s generally strong support for promoting engagement. According to Health Affairs, patient engagement is one strategy to achieve the “triple aim” of improved health outcomes, better patient care, and lower costs.
In a study conducted by Judith Hibbard at the University of Oregon, patients with the lowest activation scores — those who had few skills and the lowest rate of confidence in actively engaging in their own care — incurred costs of up to 21% higher than patients with the highest activation levels.
“Given its inherent limitations, what would we consider ideal attributes of a ‘patient engagement’ intervention?” LeVine asked.
He described a case study that looked into the inadequate use of co-pay cards and adherence. Conducted in 2016, the program used email and telephone interventions to re-engage diabetes patients. Using its QuickPath information platform, which connects HCPs, pharmacists, and payers with the patient through a variety of means, including smartphones, wearables, text, EHRs, and eWallet platforms, TrialCard was able to significantly improve the percentage of patients activating and using a co-pay card, from 19% to 34.5%.
Yet despite those improvements, LeVine believes more can be done. “We’re still not reaching enough patients because our methods aren’t fully aligned with the reasons for their lack of engagement,” he explained.
So how can payers and providers promote higher levels of activation from patients? LeVine pointed to the model used by the entertainment industry. For example, Netflix, he noted, has been highly successful in identifying consumer preferences and behavior through analytics. In fact, more than 80% of the movies and TV shows users watch on Netflix are discovered through the platform’s recommendation system, LeVine said, citing an article from Wired
Netflix is not alone in using sophisticated analytics to improve engagement. According to McKinsey & Co., 35% of Amazon’s revenue is generated by its recommendation engine.
“We need to get better behavioral analytics,” LeVine said. “These are the key models for understanding what motivates patients to act. We have to get a whole lot better at using some of those learning models (patient activation model, transtheoretical model, motivational interviewing, and others) as ways of improving that type of engagement.”
“The healthcare industry,” stressed LeVine, “is considerably less advanced in deploying these types of behavioral analytic strategies than the consumer sector – but that doesn’t mean we don’t know a lot about what motivates patient behavior. We just have more we need to learn.”