I had made a terrible mistake, resulting from a fascination with technological possibilities in the world of “big data.” I was leading a team working on a large research project in Europe, attempting to build predictive targeting models to identify patients who were at risk for a catastrophic clinical episode but were asymptomatic or undiagnosed. We had full access to detailed clinical data, and we assembled an elite team of scientists and mathematicians to help develop our models. One of our data scientists asked an innocent question: “Are we allowed to ask the patients a couple of questions?” We had never considered that option.
“Great strides can be made simply with email, secure web, and text/mobile messaging”
The insights gained from patient responses were just as effective as those from extensive clinical profiles— and collected at a fraction of the cost and effort. This experience forced me to look back at 20 years in clinical informatics, big data, analytics, and population health, and pose three questions to myself:
• How much do I really know about patients and their needs?
• Do I ask patients the important questions about their needs and concerns?
• Who else is really good at this?
“Getting to Know All About You”
Generally, healthcare is not very good at developing a deep, broad understanding of the individual consumer—their home and social environment, family, profession, daily habits and lifestyle, and their real motivation and sense of purpose. Patients are seen, on average, just over 2.5 times per year. And on average, actual face time with a physician totals about 15 minutes per encounter.
Contrast this with the world of digital marketing. Each of us generates a “cloud” of data that is continuously studied: which websites we visit, how much time we spend on them, what we search for, what content captures our attention, who our friends are, where we live, our income, what we buy, who lives in our household, what car we drive, our hobbies.
Survey after survey confirms that although we have concerns about misuse of such information, we really want service providers to get better at collecting it. We vote with clicks, and we continue to disclose more information with greater frequency.
The Social Determinants of Health
So what does this have to do with patient health and wellness? Everything. Or at least 60 percent of everything. By and large, our overall level of health is not attributable to healthcare. Rather, it is mostly a function of our choices, behavior, lifestyle, and socio-environmental circumstances.
Our social relationships, the health status of those around us, and our daily activities and the like are even more important to our level of health than our biological predispositions or specific treatments. Addressing this is the new frontier in medicine. It is the revolution of the everyday, rather than a miracle stemming from genomics, immunotherapy, or nanotechnology.
Communication As the Next Clinical Intervention
What mechanism should we use to influence behavior, given resource constraints and the need to scale it to the entire population—not just the top 10 percent of the risk spectrum? To take a cue from retail and online marketing, the answer, of course, is communication. Targeted communications can be engineered around factors that influence choice, and can be tested and optimized for content, tone, and channel or medium—the verifiable dimensions that other industries fine-tune to get consumers to respond. Costs are minimal. Communication is infinitely scalable, it can be personalized, and messages can be delivered with sufficient frequency to make a difference during the 363 days that patients are not in a physician’s office.
Study after study confirms that risk of strokes, congestive heart failures, diabetes, and COPD—as well as smoking, substance abuse, and behavioral health—can be dramatically affected when patients commit fully to working with providers to improve their health.
Seizing the Opportunity
Leveraging the “consumer cloud” to better understand people and engage them with personalized, relevant communications to influence their behavior and health outcomes is not futuristic. It doesn’t even necessarily require large clinical data integration projects or consumer adoption of proprietary applications. Great strides can be made simply with email, secure web, and text/mobile messaging. The point is to get started. I encourage leaders to think about five key factors for driving success in consumer engagement:
• Start asking!
Learn more about your patients and community by asking about their lives and how you can better support them.
• Bring together marketing and technology expertise
Assemble an interdisciplinary team of clinical leaders, technology experts, and marketing resources to identify where the needle can move, to obsessively fixate on understanding the patient, and to figure out smart, testable ways to improve engagement using messages that will be meaningful to consumers.
• Test, improve, expand
“Monolithic” thinking can be the death of any initiative. Select a target population, select clear endpoints for the initiative(e.g., patient response rates, enrollment in a lifestyle program, better control of blood glucose, etc.), test, measure, and expand. This strategy will position you as a caring partner, regardless of the reimbursement model.
• Think about the other 363 days between encounters
How can you provide meaningful support, at least once a week, to build “behavioral momentum” between encounters? Monthly newsletters or semiannual checkups simply aren’t frequent enough to do any good.
• Motivate through positive engagement
Consumers avoid bad news and negative feedback. Badgering people for non compliance will not work. Your goal is to build a trusted relationship, so that they want to be more transparent and embrace the support you provide.
Medical research and technology have accomplished a lot in the last 50 years. We are now challenged to shift our focus from treating disease to creating health. This requires a new partnership between patients and providers, in which we leverage full knowledge of the individual and their needs and provide them with tools, information, and support to create meaningful, lasting change. And this change begins with us—the provider and technology community—deciding that it is our first priority and that we will support one another to make it happen.