This interview is the first in a series of brief chats between CFAH president and founder, Jessie Gruman and experts—our CFAH William Ziff Fellows—who have devoted their careers to understanding and encouraging people’s engagement in their health and health care.
Dale Shaller, Principal of Shaller Consulting Group, a health policy analysis and management consulting practice, thinks that “patient portals in Electronic Health Records offer a glimpse of hope” for increasing people’s engagement in their health care.
Mr. Shaller has devoted nearly three decades to the design, implementation, and evaluation of health care quality measurement and improvement programs, with a focus on listening to the voice of the patient and promoting methods for engaging consumers in managing their health and health care.
Gruman: What is the biggest challenge you think people now face in engaging in their health and care?
Shaller: The challenges haven’t changed, but for some people they have been intensified by growing personal financial burdens, just trying to make it through the week, legislative stalemates that threaten public programs and the dismal job situation. The slumping economy affects insurance status and uncertainty rises along with that.
Gruman: What is one significant point of leverage for increasing people’s engagement?
Shaller: Patient portals in Electronic Health Records offer a glimpse of hope, especially to health care organizations and researchers who survey patients: we’ll be connected to portals and be able to ask good questions and hopefully get better response rates; caregivers will be more likely to follow up because it will all be easy, virtual and cool.
But I think it is a small segment of the population who will actually do this. One thing I do a lot in my survey implementation work is to encourage provider organizations to think about communicating with their patients in this way. But I have watched some groups spend months building a data field just so they can capture patients’ email addresses – and this is a HUGE LEAP for them. We have to calibrate our expectations.
Gruman: You work a lot on the public reporting of quality data. Anything new there?
Shaller: I learned a lot from pulling together a paper for AHRQ on context-driven strategies to engage people in using public reports on the quality of providers last fall.
The wisdom of report developers is getting better in terms of targeting and not just publishing the data they can easily get their hands on. Now they are thinking about what kind of information and choice contexts would actually help people make these decisions. This is being considered more and more. It is clear that they need to meet people half-way. The public is beginning to pay attention to this.
Gruman: What’s your sense of progress in our (patients’) use of reports of the quality of hospitals and health plans, for example?
Shaller: I still struggle with the degree to which public reporting can ever make a significant difference. So much comes down to economics and incentives. Rewarding providers for systems thinking and changing their approaches requires incentives. There is a role for financial incentives on the side of patients as well. As long as the incentives are fairly put together and are not just cost-shifting and they don’t penalize individuals, incentives can nudge people by raising the stakes that people have in how they act on their own behalf.
Everyone pays for this anyway. People pay more directly when they are engaged – less directly when they are not. There is no free lunch. Targeting incentives can be done more thoughtfully so they are fair and are directed toward more healthful behaviors.
Additional Interviews with our Ziff Fellows on the challenges of patient engagement:
- Trudy Lieberman, journalist for more than 40 years and contributing editor of the Columbia Journalism Review
- Connie Davis, geriatric nurse practitioner and health care consultant
- Molly Mettler, Senior Vice President for Healthwise
- David Sobel, Medical Director of Patient Education and Health Promotion for The Permanente Medical Group
- Kate Lorig, Professor at the Stanford University School of Medicine and Director of the Stanford Patient Education Research Center
- Shoshanna Sofaer, Robert P. Luciano Professor of Health Care Policy at the School of Public Affairs, Baruch College
- Judith Hibbard, Professor of Health Policy at University of Oregon & lead author of the Patient Activation Measure (PAM)
- Carol Alter, Director of Policy and Community Outreach and an Associate Professor in the Georgetown University Department of Psychiatry
Tags: CFAH William Ziff Fellows, patient engagement
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Aftershock:
The Center for Advancing Health is funded by
this “So much comes down to economics and incentives” probably can’t be underlined/said enough in these discussions of relationships between patients and providers where there are large financial organizations/stakes at work in the background. but also that as we have learned, or one hopes we have learned, rationality is not the organizing logic of markets, as with all matters human we are largely driven by more gut-oriented reactions than that.
ps, any way to keep from getting comments stuck in the moderation void?