Newtown, CT – February 3, 2017
After more than a decade, the chase for the active consumer is still on – In July 2001, Bob Galvin and I published a paper entitled “Creating, Connecting, and Supporting Active Consumers.” The abstract starts out with a sentence that is still true today: “Programs to turn patients into active consumers have not yet lived up to their sponsors’ expectations.” Employers, health plans and, increasingly, health systems, are still deploying tools and resources to engage consumer-patients in better managing their conditions and making more informed decisions. Today the discussions center on reducing low-value care and choosing high-value providers. The themes are identical even if the words are slightly different. Our now teenaged paper proposed a framework to segment consumers, recognizing that they have different characteristics and will therefore have different needs. The tools and resources they want at any given point in time have to take into account this segmentation. Failure to do so is likely to lead to program failure, and that’s essentially what our colleagues Chris Duke and Christine Stanik report in their recent research. In 2001, at the height of the dot com boom, we reviewed dozens of programs that had the features and capabilities identified by GE employees and dependents as critical to quality. Most of these are gone, or purchased by larger companies. Their founders, with whom we worked closely, have all moved on. Notably, David Shulkin (then leading DoctorQuality) is now headed to lead the VA; David Lansky (then leading FACCT) heads up the PBGH; Paul Keckley (then leading EBM Solutions) heads his own firm after having been at Deloitte and Navigant; and Suzanne Delbanco (then leading The Leapfrog Group) heads up Catalyst for Payment Reform. Given the careers of their leaders, we chose the tools well. But like many other employers we struggled to figure out if what we did worked.
What this means to you – At the time, and still today, we could try and measure changes in engagement, and that’s important because research shows that more engaged consumer-patients have better outcomes. We could also try and discern the impact on costs of care, although the lack of precision in those measures made it very hard. Tool vendors, of course, claim 3:1 returns, and without proof one way or another, who’s to say they’re wrong. This vexing question has remained vexing since then, but there now appears to be a way to definitely find out whether any consumer engagement tool is producing a desired effect. The key is to measure, at the same time and for the same patients, the level of engagement and costs of care, and monitor any changes over time. Of course, because most tools are specific to a condition or a medical intervention (such as a planned surgery), costs of care have to be modeled at the episode level. And ideally, you’d want a control group in addition to an intervention group. All of this is now practical and possible thanks to the Altarum Consumer Engagement Effectiveness Assessment. As an independent organization, Altarum can evaluate the effect of any consumer engagement tool or program and report it to the employer, the health plan, the vendor and the providers. In the sixteen years since we wrote our paper, countless billions have been spent on various activities to engage consumers, with more every day. Think about the costs of transparency tools, disease management programs, second opinions, centers of excellence, nurse navigators, and many more. How do you know they’re working on the segments of the population that need it most? How do you know that consumer-patient engagement is increasing where it counts? How do you know that episode costs are being positively impacted because avoidable complications are going down? If you don’t know for sure, now you can. Will you dare find out?