The Jewish Healthcare Foundation (JHF), through its supporting organization the Pittsburgh Regional Health Initiative (PRHI), has been working at the Triple Aim (better health, better health care, and lower cost) for seventeen years. We have tried introducing Lean in hospitals, promoting patient-centered medical homes, advocating for public reporting on the quality and cost of care, and mounting demonstration projects to prove that there are better ways to deliver care that meet the goals of the Triple Aim. So far, we aren’t moving the needle much at all.
As I look to the future, I have some hope that value-based purchasing, which rewards quality of care through payment incentives and transparency (and, someday, “systems thinking” additions to medical and health professions education) will have a measurable impact. But right now, at the JHF and the PRHI, we are enthusiastic about the potential of informed and activated patients to make significant progress. I envision activated patients who are responsible for defining, implementing, and advancing their own health goals in collaboration with a willing primary care provider.
Such a consumer accepts ownership and responsibility for lifestyle choices and seeks information about their health care options (weighing treatment interventions, the relative cost and quality of providers, and the opportunities for improving their quality of life). Recent studies have shown that many consumers—in fact, the vast majority, are now eager to make the major decisions about their health care. The passive, “compliant,” disempowered patient may become a relic of the past. In a large 2014 survey by the Altarum Institute, only 7 percent of consumers want the doctor to make decisions for them, a whopping 68 percent want to make decisions with their doctors, and 24 percent want complete control over decision making!
The other critical part of this new equation—the redistribution of responsibility between patient and physician—requires a willing and collaborative provider. In addition, as consumers and employees assume more personal out-of-pocket costs for their health care via high-deductible health plans, their incentive to actively engage and choose wisely becomes even more immediate. Currently, about 25 percent of consumers pay deductibles that are much more than $1,000, but that number is rapidly rising. Some employees now pay $10,000 out-of-pocket. The activated patient can help the United States achieve better population health; eliminate unnecessary treatments and diagnostics; and reduce waste, error, and inefficiencies.
The JHF board of trustees approved a three-year, $1,119,000 grant to establish the Center for Health Information Activation (CHIA). CHIA will advance, appropriately, the application of credible information by consumers and their families to establish and manage their health goals. In an era of unprecedented accessibility to health information—a symmetry of knowledge use in which patients and doctors take an active role in patients’ care—one could envision a new relationship defined by a patient and primary care provider research team, working together to advance health goals.
CHIA hopes to be a neutral, trusted resource (1) to engage consumers in locating and accessing credible information and (2) to bring awareness of health apps, online communities, case studies, new research findings, cost/quality ratings, treatment options, and unnecessary or unproven interventions. Its mission is to listen to doctors, primary care providers, and consumers to understand what information is valuable and desired, how it can be obtained and then presented and managed in the formal treatment encounter, how the patient can pursue his or her health goals outside the office format, and how progress can be measured and shared with the consumer, providers, and policy makers.
In late July, we held two kick-off events for local physicians and patient advocates. The objective was to consider and listen to the voices of key stakeholders to find better ways to deliver care, form treatment partnerships, and accommodate the wishes of patients with the real-life situations of the providers. Collaborations that are mutually satisfying may require new payment methods and communication tools for formal and informal encounters, ongoing status assessments, education of health professionals, and clinical teamwork.
At the events, we heard interesting stories of how physicians are currently restructuring their practices by providing orientations for new patients, offering new services (including group visits and education sessions), helping patients define their personal health goals, actively encouraging patients to review recent research and use Internet resources, communicating regularly via social media, and preparing for their in-office encounters more productively.
The JHF in partnership with the Josiah Macy Jr. Foundation sponsored a public television documentary “The Empowered Patient.” The documentary features, among others, Paul Getsy, who suddenly lost hearing in his right ear. Getsy’s doctors had hit a wall, so he went to work on the problem himself: he researched the latest technological advances and clinical trials and discovered SoundBite, a recently approved device that transmits sound waves from the mouth to the undamaged hearing nerve. Getsy brought his research to his doctor, who found the device promising and helped him secure a SoundBite.
While Getsy took the initiative to understand his condition and identify the best action plan to address it, he needed a receptive doctor to bring his hard work to fruition. Mark Roberts, a practicing internist and chairman of the Department of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health, is spot-on in the documentary when he says: “I gave up a long time ago the notion that I know more than my patients do about every aspect of their diseases. But I can partner with patients to provide them with the context and framework on which to hang their knowledge.”
The JHF and the PRHI want to advance the activation of good information to inform better collaborations between consumers and providers, to shape more satisfying relationships based on a symmetry of access to information and ideas (and on mutual respect), to listen to all the players and understand their roadblocks and hesitancies, to work in partnership to improve the outcomes of care, and to remove waste and error from the system.
The JHF seeks other foundations, consumer advocacy groups, health professions educators, thought leaders and national associations in health care, health information technology entrepreneurs, and even product developers who want to engage in a similar mission.
The Health Affairs February 2013 issue has the theme “New Era of Patient Engagement.” Read the Table of Contents here.