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February Health Affairs Issue: New Era Of Patient Engagement
The February issue  of Health Affairs, released today, explores a burgeoning field: activating and engaging patients in their health and health care. Research shows that more informed and empowered patients, who participate with their providers in making wise care decisions, have better health outcomes—and there’s some evidence that they even have lower health care costs.
“Even in an age of hype, calling something ‘the blockbuster drug of the century’ grabs our attention,” Susan Dentzer writes on her Editor’s page , quoting health information technology consultant Leonard Kish. “In this case, the “drug” is actually a concept –patient activation and engagement — that should have formed the heart of health care all along.”
The new Health Affairs issue was supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation.
Among the studies featured in the issue are the following:
Patients rated lowest in terms of their involvement with their care have substantially higher health costs than those rated more highly, at least in the short and medium term. Judith Hibbard of the University of Oregon and coauthors report  that patients with the lowest level of “activation” — that is, those most lacking in the skills and confidence to be actively engaged in their health care — have average costs from 8 percent to 21 percent higher than patients with the highest level of activation. Using the Patient Activation Measure that assesses beliefs, knowledge, and confidence in managing health-related tasks, Hibbard and her colleagues found that patient scores on a questionnaire that ranks patient activation predicted their overall care costs, even when adjusted by the severity of patients’ health conditions, age, sex, and income. The authors recommend that health delivery systems consider assessing these patient activation scores and helping patients become more engaged in their health and health care as a way to both improve patient outcomes and lower costs.
Online health care for common conditions typically cared for by primary care providers has the potential to help meet the “Triple Aim” of better health, better health care, and lower costs—and lead to more satisfying customer and patient experiences. Patrick Courneya of HealthPartners in Minneapolis and colleagues report  on the experience of HealthPartners’ online clinic, called “virtuwell.” Launched in 2010, virtuwell provides twenty-four-hour online access, diagnosis, and treatment (including prescriptions) by nurse practitioners for about forty simple conditions, such as sinus infections, urinary tract infections, and pink eye. The authors note that virtuwell is the first online service to be authorized for coverage under Medicare.
After 40,000 cases of patients using online care, HealthPartners saw an average savings of $88 per episode over traditional care settings, as well as evidence that the care was clinically effective; 98 percent of patients were willing to recommend the service. The authors caution that these findings may not apply to all online care models, but they recommend that policy makers examine various regulatory barriers that prevent expansion of these promising online practices.
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