The Business Case for Patient and

Consumer Engagement
Date: 1/1/2016
Elsevier Clinical Solutions

This is the first of a series of issue briefs on patient and consumer engagement
from Elsevier Clinical Solutions. This issue brief focuses on making the business
case for patient and consumer engagement especially as it relates to the services
of hospitals, health systems, medical groups and payers. Subsequent issue briefs
will zero in on implementation of patient and consumer engagement, team-based
collaboration for patient engagement and new and emerging patient and
consumer engagement trends. For more information on patient engagement
solutions, visit elsevierpatientengagement.com.
Patient and consumer engagement are structured around sustainable behavior
change of patients, family members, caregivers and healthcare consumers. As a
discipline, process and strategic priority, engagement flows throughout the
continuum of care from hospitals, health systems and physician practices to
labs, imaging centers, pharmacies, retirement centers and long-term care facilities.
Patient and consumer engagement embraces the ecosystem of lifestyle and care
choices promoted via education, business, media and the community. Schools,
churches, restaurants, retail stores, sports facilities and fitness centers can
reinforce, accelerate or torpedo patient and consumer engagement, according to
Sonika Mathur, Senior Vice President, Patient Engagement, Elsevier.
It takes a village to inform, educate, engage and empower patients, families and
consumers to take charge of their health and healthcare, as well as the health and
healthcare of their families and the public, she says. Healthcare organizations
have the knowledge and clout to mobilize the village, improving outcomes and
controlling costs.
Engagement also guides patients and consumers to knowledge and
understanding of their own health, the process of healthcare and the ways of the
healthcare system, noted Dr. Peter Edelstein, Chief Medical Officer, Elsevier
Clinical Solutions.
Engagement transforms patients and consumers into advocates and champions
for their own health and the health of friends, family members and the entire public,
says Dr. Edelstein. When patients and consumers experience authentic education
and empowerment, they become their own best providers.

About Peter Edelstein,

MD, FACS, FASCRS
Peter Edelstein, MD, is the Chief
Medical Officer at Elsevier. Edelstein
is board certified by the American
College of Surgeons and the
American Society of Colon and
Rectal Surgery. He has more than
35 years of experience practicing
medicine and in healthcare
administration.
Edelstein was in private practice
for several years before serving on
the surgical faculty at Stanford
University, where he focused
on gastrointestinal, oncologic
and trauma surgery. He then
spent more than a decade as an
executive in the Silicon Valley
medical device industry. Edelsteins
most recent role was as Chief
Medical Officer for the healthcare
business at LexisNexis Risk
Solutions, a Reed Elsevier
company. He is also the author of
the recently published book, Own
Your Cancer: A Take-Charge Guide
for the Recently Diagnosed & Those
Who Love Them.

Healthcare organizations committed to the planning, design, implementation,

monitoring and evaluation of patient and consumer engagement initiatives can
build a business case through the following strategies:

Scope out patient and consumer engagement.

When patients and

consumers experience
authentic education
and empowerment,
they become their
own best providers.
Dr. Peter Edelstein

Operating without a broadly accepted definition of patient and consumer

engagement has serious consequences, says Dr. Edelstein. Lack of clarity
allows the healthcare system to deny resources, projects and programs
required to engage patients and consumers over the long term.
Hes convinced that patient and consumer engagement will emerge as
invaluable strategies for improving the value of healthcare (quality divided
by cost) but only if the industry hospitals, health systems, medical groups,
and payers reaches consensus.
To that end, Dr. Edelstein advises those tasked with pitching the business case
for patient and consumer engagement to C-suite and board members to
address the following issues:
Definitions: What are the most popular or accepted definitions
for patient and consumer engagement? Which definition will
we use for this discussion?
Rationale: Why should an organization implement or
re-engineer patient and consumer engagement? What are
the potential benefits, results and outcomes of doing so?
Myths: What are the most common myths and stereotypes
of patient and consumer engagement? What are the
corresponding realities?
Barriers: What are the barriers to patient and consumer
engagement? How can they be managed or overcome?
People: Who will contribute to patient and consumer
engagement? Who will participate in planning, vendor
selection, implementation and evaluation?
Cost: How much must we invest in patient and consumer
engagement over time? Whats the short and long-term ROI?
Strategy: What principles or strategies will guide
implementation, measurement and evaluation of patient and
consumer engagement?
Results: What are the likely results and outcomes of patient
and consumer engagement?
Lessons: What can we learn and assimilate from high
performers in patient and consumer engagement?

Secure C-Suite and board buy-in for patient and consumer engagement.
Secure short-term and extended financial, clinical and operational support for patient and
consumer engagement, education and empowerment from C-suite executives, including
CEOs, COOs, CFOs, CTOs, CIOs, CMIOs, CNOs and CNIOs.
Other vital chief officers and senior executives include those responsible for engagement,
experience, innovation, transformation, population health, accountable care, marketing,
clinical integration, data analytics, reputation management or performance management.
Organizations may want to expand the responsibilities of existing senior executives to
include patient and consumer engagement or recruit and develop professionals to fill the
roles of chief engagement officer or vice president, patient engagement. Others may
decide to position patient and consumer engagement under existing divisions and
departments, including marketing, accountable care or population health management.

Link patient, family and consumer engagement to population health

management, value-based accountable care and other strategic initiatives.
Population health and patient, family and consumer engagement are closely connected and
often overlap, according to Mathur. Patient, family and consumer engagement are the
bookends of population health management, she says. Just as bookends support books
on a library shelf, so patient and consumer engagement support population health
management.
The consequences of postponing patient and consumer engagement are dire. Providers
that minimize or ignore engagement will fail in their quest to manage the health of
populations and deliver value-based, accountable care, says Mathur. Patient and
consumer engagement are indispensable to health system transformation.

Explore the principles that will support the organizations

patient and consumer engagement initiatives.

Just as bookends
support books on a
library shelf, so patient
and consumer
engagement support
population health
management.
Sonika Mathur
Senior Vice President,
Patient Engagement, Elsevier

C-suite executives and board members may not need a full-blown implementation plan, but
they want to review the principles, values and strategies that will support patient and
consumer engagement initiatives. Consider elaborating on concepts like the following:
Continuum of care and living: Our program will integrate engagement, education and
empowerment into the expanding continuum of care. We will provide information,
education and advice across every continuum of care setting and beyond in homes,
automobiles, workplaces and other environments where individuals and families are willing
to access, assimilate and act upon healthcare content. We will pursue engagement
through the complex ecosystem that shapes the health and lifestyle choices of patients,
families and consumers.
Healthcare journey: Our program will deliver engagement, education and empowerment
no matter where the patient, family member or consumer stands in the healthcare journey:
information gathering, knowledge sharing or decision making on prevention, symptoms
3

Secure short-term
and extended
financial, clinical
and operational
support for patient
and consumer
engagement,
education and
empowerment from
C-suite executives.

and diagnostic testing, treatment, recovery and self-care.

Personalized delivery: Our program will customize and personalize the healthcare
information and knowledge sharing experience. We will make adjustments for comorbidities, health literacy and numeracy, education, ethnicity, culture and other
social determinants of health as defined by the Institute of Medicine.
Empowerment: Our program will help patients, family members, caregivers and
consumers understand and take charge of their health and healthcare across the
care continuum and throughout the lifecycle. We will guide patients and consumers
from non-engagement to engagement, education and authentic empowerment.
Clinician alignment: Our program will mobilize clinicians physicians, nurses and
allied health professionals to engage, educate and empower patients, families and
consumers. We will blend macro engagement strategies involving social, print and
online media with face-to-face interactions involving physicians, nurses, allied
health professionals and others members of the village.
External expertise: Our program will rely on consultants and solution providers
that provide the right information in the right format at the right time or teachable
moment to the right patient. We will investigate securing patient engagement,
education and empowerment solutions from a single vendor with expertise in
patient data collection, risk stratification and content development and dissemination.

Explore and expand upon the evidence for patient

and consumer engagement.
Positive engagement outcomes are already supported by research. Engaged patients
have better outcomes, quality of life and reduced costs, according to four case studies
in the February 2013 issue of Health Affairs.1
Patients who are activated meaning that they have the knowledge, skill and
willingness to manage their health and healthcare have much better health outcomes
and lower costs than patients who are less activated, according to research from
Judith Hibbard of the University of Oregon and her colleagues. 2
Activated patients are more likely to do the following:
Use medical resources and information
Eat a healthy diet, maintain a healthy weight, and exercise regularly
Possess normal blood pressure, cholesterol and HbA1c
Adhere to treatment regimens and recommendations
Better manage a chronic disease
Complete post-op physical therapy
Undergo preventive screenings
Patients with the lowest activation scores tend to lack the knowledge, skill and
confidence required for engagement and self-management of health and healthcare.
They are more likely to experience inpatient admissions, emergency department use
and re-use and readmissions within 30 days of discharge.
1 http://healthaffairs.org/blog/2013/02/04/february-health-affairs-issue-new-era-of-patient-engagement
2 http://content.healthaffairs.org/content/32/2/216.abstract

They also incur costs significantly higher than those with the highest activation scores,
leading Hibbard to suggest that healthcare organizations assess activation scores and
engage patients to improve patient outcomes and lower costs. Among the specific
findings of her research:
Patients with the lowest activation scores had predicted average
healthcare costs that were eight percent higher than costs for
patients with the highest activation scores.
Among patients with high cholesterol, those with the lowest
activation scores had 12 percent higher predicted costs compared
with patients with the highest activation scores. For patients with
asthma, those with the lowest activation had 21 percent higher costs.
In the first half of 2011, patients with the lowest activation had 21
percent higher costs than patients with the highest activation.
Research completed in 2015 reveals that when patient activation
levels change, health outcomes and costs change too. 3 Higher
patient activation levels are associated with better clinical indicators,
more healthy behaviors, and greater use of womens preventive screening tests, as
well as lower costs two years later.
Among other evidence points on the link between patient engagement and lower costs,
better outcomes and an improved patient experience are the following:

See other issue

briefs online at

ElsevierPatientEngagement.com

Patient and consumer engagement will result in fewer diagnostic tests.4

Engaged patients and consumers will adhere to prescribed medical treatments. 5
Engaged family members will improve a patients functional status and accelerate
recovery. 6
Engaged patients will become more satisfied, knowledgeable and empowered. 7
Patient engagement will increase provider satisfaction.8
Patient engagement will help prevent admissions and reduce readmissions. 9
And dont forget the ripple effect. Engaged patients and consumers who become their
own best healthcare advocates and champions will emerge as healthcare advocates and
champions for family members and close friends, says Dr. Edelstein.
While demonstrating the impact of engagement on patients, consumers and providers,
be sure to discuss the role of engagement in fulfilling strategic imperatives, advises
Mathur. Such strategies may include patient satisfaction and experience, accountable,
value-based care and reimbursement, population health, clinical integration, and
performance management. Among the engagement issues to address in a conversation
about population health are the following:

3 http://content.healthaffairs.org/content/34/3/431
4 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466928
5 http://content.healthaffairs.org/content/29/7/1310.full and http://www.ncbi.nlm.nih.gov/pubmed/11841136
6 http://www.ncbi.nlm.nih.gov/pubmed/11032203
7 http://appliedresearch.cancer.gov/areas/pcc/communication/pcc_monograph.pdf
8 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495336
9 http://www.the-hospitalist.org/article/patient-activation-measure-tool-helps-patients-avoid-hospital-readmissions

 Whats the optimal relationship between patient and consumer engagement and
population health?
How do patient and consumer engagement contribute to effective population
health management?
How does the absence or weakness of a patient and consumer strategy stymie
population health management?
How could enhanced patient and consumer engagement initiatives improve the
management of chronic diseases: CHF, COPD, asthma and diabetes?
How could we re-engineer existing engagement initiatives to improve population
health outcomes?

Forward to the Future

Popular technologies like patient portals, mobile devices and electronic health
records contribute to patient and consumer engagement, education and
empowerment. Total engagement however, calls for enterprise-wide shifts in
attitudes, beliefs, values and culture. Only then will patients and consumers
appreciate the value of taking charge of their health and healthcare. Only then
will they have the knowledge, skill and motivation to sustain behavior change
and lead healthier lives.
The next issue brief in this patient engagement series from Elsevier will focus on
how healthcare organizations can plan and implement patient and consumer
engagement programs.
For more information on patient engagement solutions from Elsevier, visit
elsevierpatientengagement.com.

The Business Case for Patient and

Consumer Engagement
Contact Us:
Online: ElsevierPatientEngagement.com
Phone: 866.416.6697

Date: 1/1/2016
Author: Elsevier Clinical Solutions
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