Moving patients to act: Digital health practices to spur engagement

BOSTON—Patient engagement is easier said than done, and stakeholders are in ongoing pursuit of the right incentives to motivate patients to take ownership of their health.

“We’ve been trying to figure out combining the right incentives to the right data,” said Sean Penwell, MD, chief medical officer at Seechange Health—a six-year-old company that works with United Healthcare to build tools for creating personalized action plans—speaking at mHealth + Telehealth World 2014 on July 23.

While they have seen some success with cash equivalent gift cards or health savings to encourage patients to follow personalized action plans, premium rebates have not worked. The company continually looks to behavioral science to better guide its tools' development, he said.

Maulik Majmudar, MD, associate director of the healthcare transformation lab at Massachusetts General Hospital, is working to engage clinicians in developing innovations that leverage technology to better engage patients in their care.

One area the lab is looking at is re-engineering the follow-up visit in the cardiac space so it can be done remotely and asynchronously and “as a way to open up the bottleneck for capacity,” he said. Asynchronous visits “resonate well with patients,” and help engage them in possible remote monitoring programs if they are at risk of a cardiac event, he said.

At the Veterans Health Administration, leaders are planning to release a mobile app this fall to motivate healthy changes by turning it into a team challenge—which syncs well with the mentality of many in the military, said Neil C. Evans, MD, co-director of connected health within the VHA Office of Informatics and Analytics. The agency’s connected health, or telehealth service, serves 8.9 million patients, of which 3.1 reside in rural areas.

The veterans are asked to join a team based on the military branch they had served in, and then set smart, achievable health goals and track outcomes. “As they achieve points, those points go toward the team. Those who serve in the military are very team-based, and we want to take that psychology to improve their health as well,” Evans said.

The case for mHealth to spur change may be overstated. When it comes to wearable health tools, 80 percent of patients stop using them after 10 days, said Nina M. Antoniotti, RN, MBA, PhD, telehealth director at the Marshfield Clinic in Wisconsin—which operates a telehealth program that currently serves 75 sites.

In the end, it’s not about tools but “all about compliance,” she said. “It’s about looking at what changes core belief systems and what motivates patients to change.” Health coaches and care coordination are integral to this.

At Marshfield, staff offer patient activation surveys and conduct motivational interviews to gauge whether patients are truly motivated to change. Resources go to the patients most likely to change, Antoniotti said.

Chat rooms also were discussed as engines to promote engagement, but panelists agreed they need to be monitored rigorously.

But in the end, Evans cautioned against overcomplicating mHealth. Often it’s the really simple apps that engage patients, he said, citing the success of VHA's prescription refill app and the summary of care app. Also he said as VHA rolls out its Open Notes mobile app to allow patients to review their medical notes, he expects to see positive outcomes.

“We should focus on some of the basics,” he said.