More than two years ago, Mass General launched their Ambulatory Practice of the Future, an innovative primary care clinic for employees and adult dependents. Developed as a Patient-Centered Medical home and ACO, today they support 3,000 enrolled patients with three doctors and two nurse practitioners.

This innovative practice was designed for and with patients for a better patient experience. Their experience begins with the initial greeting and extends through ongoing care interactions. There is a strong focus on patient education and empowerment. The care team collaborates to support each patient both in person and online. One of the goals of the practice is to reach patients where they are both physically and with their health.

Designed to Support Shared Decision Making

Once patients enter the welcoming and intimate care setting at The Ambulatory Practice of the Future (APF), they are ready to collaborate with their clinician. Sitting side by side, they review the medical record together and begin the discussion with health goals.

“We actually added a data field to the record called ‘Health and Life Balance Plan’ where we document  mutually agreed upon goal(s) for the coming weeks and months and then it is easily reviewed by the patient via their portal after the visit and in preparation for upcoming follow- up encounters”, explains Dr David Judge, Medical Director, Ambulatory Practice of the Future, Massachusetts General Hospital.

This collaborative approach has helped patients who have not historically been able to get engaged around a goal. Dr Judge shares a story about a 54 year old woman with diabetes who was reluctant to discuss next steps in management due to her fear of taking insulin. After allowing her to shape the goals with a focus on other areas of lifestyle management initially, coaching to realize some success and encouraging patience with the process, she has recently decided to proceed with insulin therapy.

Patient Engagement Tools

APF uses shared decision making videos developed by the Foundation for Informed Medical Decision Making to educate patients about screening tests and in managing specific medical issues such as prostate cancer.

Between their visits, patients can access the portal to view their medical information and communicate securely with their clinician. Although the care team can access the EMR from their mobile devices, APF expects that patients will be able to access their portal and records via mobile devices in the near future.

Patients can currently participate in an online visit with their care team. Dr Judge describes one of the complex patients that they monitor closely with frequent virtual visits.  “Mr. K is struggling with end stage renal failure, congestive heart failure and it has become difficult for him to come for office visits. Between scheduled virtual visits, emails from the patient and his wife and monitoring by visiting RNs, we are able to manage his needs fairly well with rare office visits.  We are on the verge of implementing true remote monitoring technologies but currently the patient or RN need to  report the measures (i.e. blood pressure, weight, blood sugar, PHQ 9 depression score, etc.).”

On the prevention side, several employees are using mobile apps to track their daily lifestyle choices regarding exercise and nutrition and sharing the information with their clinicians during their visits.

Future Path to Patient Engagement

During my panel at the recent Shared Decision Making Conference, Dr Judge spoke about some exciting new ways APF will be leveraging technology to engage their patients.

“We will be piloting the concept of 'apprenticeship' in which patients go through a more formal education process with coaching and demonstration of increased knowledge and skill to push the boundary on self management. We are developing programs tailored to specific medical conditions (i.e. HTN, DM and Depression). Goal setting for each patient helps the team to understand how to customize the program and to identify what specific barriers may be preventing success.”

“As we have done with diabetes, we expect that patients will learn not only to change their  lifestyle and make healthier choices but also adjust medication in the management of multiple chronic diseases. The care team will be able to monitor and assist but patients will truly drive their own care more effectively from day to day”, adds Dr Judge.

APF is starting a pilot soon using a mobile tablet that “allows very easy synchronous communication to transmit monitored blood pressure and to enable the patient and team to collaborate around lifestyle management and medication adjustment”. 

The term “apprenticeship” is being used by Dr. John Moore at MIT Media Lab. Dr Judge explains, “I think it appropriately describes the next step in the evolution of making shared decisions with patients. Beyond that is potentially a mastery of health and the potential for patient - to - patient support to grow.  We are hoping to launch both face- to -face and virtual peer to peer interactions in the near future.”  

While attending health care conferences, I often hear presenters describe their pilot programs and share what they have learned from new and expanded engagement initiatives delivered through online (social communities, social media, portal), mobile phone, telephone or email channels.

Many companies are in the “experimentation” phase. They are determined to discover the effectiveness of each channel in generating consumer awareness, interest and participation in their health and wellness.

When discussing their channel plans, I tend to hear companies say “once we have learned about how the channel can be leveraged, we will be ‘operationlizing’ it into our programs”.

During my conference panel last week on multi-channel engagement, I emphasized the importance of incorporating an interim phase to “Consumerize” the channel strategy before moving into the operations phase.

“Consumerizing” entails understanding the needs of each priority consumer group or segment (e.g. adult patients with diabetes, children with asthma) and determining how mobile for example can be utilized with other channels to meet their needs.  Specifically, companies need to determine the “role” that each channel plays such as enable access, educate, motivate, guide decision making, deliver emotional support or help with care collaboration.

With a clear understanding about the set of channels and how each one brings value to the consumer segment, providers/plans/employers can effectively orchestrate consumer engagement for maximum results.

Channel Challenges

This is not easy to do.  Channels are converging. For instance, consumers are using their desktop to upload pictures into a  social community and then getting messages on their mobile from the community.  They are receiving an email with a link into the online portal for their lab test results. Consumers are viewing mobile messages about preventative care with an option to click to connect for appointment scheduling.

With this convergence, the channels are becoming intertwined and integrated which brings complexity to planning, implementing and evaluating channel initiatives.

• Channel Planning:  Many organizations have separate committees for each channel (e.g. mobile, online/social media) planning their own strategy. Instead of looking at one channel, organizations need to take a more strategic and holistic view by starting with a consumer segment and understanding their channel preferences and behaviors in order to define the role that each channel can play in meeting their needs.
• Channel Implementation: Companies tend to spend more time thinking through the internal processes for sending content over these channels and not enough time thinking about how the consumer receives and interacts with it. They need to consider the information that is presented and captured within each channel and how it is shared across channels. All channels must be connected and synchronized to deliver the best consumer experience.
• Channel Evaluation: Although many organizations are still looking at engagement one channel or campaign at a time, it is essential to evaluate the effectiveness of the channel at the consumer segment level. Each channel needs to be evaluated based on the role it was designed to play for that specific segment.

Consumer- Centric Channel Strategy

Companies outside of the health care industry have a big head start. They have an established consumer segmentation approach. Consumer centric businesses in the financial services and hospitality industries are overlaying their channels onto their segmentation to deliver a relevant and meaningful consumer experience. These companies are also focused on driving consumer engagement. A colleague at a large financial services firm told me about the “O2O” trend and how they are focusing on optimizing the “online to offline” experience (e.g. using targeted social media to drive card members to an event).

There is so much that health care organizations can learn and they are beginning to look outside of the industry for new strategies.  Health care companies are starting to realize the powerful role that new channels and approaches can play in motivating consumers to take on more responsibility in managing their health and wellness. 

Let me tell you about Jack…

Last week, Jack celebrated his 54^th birthday with his wife and two teenage girls.  His daughter Alyssa told him to "try not to finish the cake when no one is looking”. Jack has packed on the pounds in the past few years and is currently 60+ pounds overweight. Alyssa teased her father about how many miles he will need to bike to work off the extra slices. Jack’s wife Joan is concerned since she knows that he is at risk for Diabetes.

Several months ago Jack complained to his doctor that he was disgusted with his weight and was ready to make a change. Over the last few years, Jack tried several diets but he still doesn't make the right dietary decisions. Jack told his doctor that he was considering bariatric surgery and asked for a referral to meet with a surgeon.  Maybe his doctor could have “prescribed information” for Jack such as watching a video on a weight loss approach which has been successful for others like Jack or signing up for a eNewsletter with tips to control his weight through diet and exercise from a "trusted source".

Jack’s Health Plan is after him to participate in their Pre- Diabetes Program but Jack would rather focus on other health issues. Jack can’t stop thinking about the bariatric surgery. He is worried about taking such a big step but does not know about other less invasive options. Jack is not aware of the “decision support tools” that his health plan has online since he has not been to the member portal in years. He also ignores the mass produced print and eNewsletters since they do not address his specific interests. He had to contact this health plan to obtain the referral to the specialist but has not received any information from them which will help him understand his options.

Jack’s employer launched a wellness incentive program with weekly on-site challenges offering rewards for his “steps”. Unfortunately, Jack travels frequently and misses these competitions. He bikes on weekends but that is not part of his employer’s wellness incentive program.

When he has time, Jack visits an online community of people interested in weight loss. Too bad this website does not have a sub-community of business travelers since this “segment” has the same challenges with eating out every meal and having limited time to work out.

There are many opportunities to step in to educate, engage and motivate Jack to follow the path to better health. What can you do to get to know and help Jack?

Overwhelmed. Anxious. Confused. Concerned. Conflicted.

And now you are asking me to sign up to attend your online weight loss seminar? Join your online cancer support group? Become a Facebook fan? Follow you on Twitter? Listen to your new podcast on staying healthy? Watch your latest video on risk factors for diabetes? Read your enewsletter loaded with tips for managing my cholesterol? You wonder why I am ignoring you if you are only trying to help me.

How about sending me information about the health issue that is my highest priority? And giving me tools to help me make decisions about which treatment to choose? 

Engagement looks very different when viewed through the eyes of the consumer. It is essential for healthcare organizations to gain the consumer’s perspective about ways to engage them before investing their limited resources (money & people) in portals, social media and mobile initiatives.

Although your company can benefit from reading the latest industry research to understand trends and participation in these emerging technologies, your set of customers are very different than the general populations surveyed. Your customers have a unique demographic, set of health needs and technology comfort.  You must understand their evolving needs before determining the steps to engage them.

In this series, I will lead you down different paths to see how innovative organizations are engaging their target consumers in their health.