Putting patients at the centre of healthcare innovation
One of the most commonly cited complaints from patients centres around not being engaged in key decisions about their health. Patients want better communication, in language they can understand, so that they can take part in informed decision-making regarding appropriate treatments, medications and services that work for them as individuals. However, all too often, the traditional paternalistic model of healthcare delivery, ‘doctors know best’, ultimately leaves patients feeling left out of critical decisions about their care.
The digital shift
With the coronavirus pandemic continuing to touch upon every aspect of our lives, there has never been a more opportune time to consider the way in which we deliver health and care services. In the space of just a few months, healthcare providers have been able to rapidly transform services through the use of digital health technologies to support safe and effective care in the most challenging of circumstances - from greater use of remote consultations (online or by telephone) and the electronic prescribing service, to mobilising artificial intelligence (AI) and big data to track COVID-19 cases and develop vaccines.
But with the pandemic showing no signs of slowing and digital health technologies becoming more widely embedded, we must now build on this opportunity to design services with patient needs truly at their centre.
Putting patients first
Last year, new models of care being envisaged by NHS England included a ‘digital first’ option for most patients, allowing for longer and richer face to face consultations with clinicians for patients who needed or wanted it most. Clinicians would be supported by digital tools enabling real-time information and decision support when they needed it, and people would be supported through wearable devices and access to information about their well-being to better manage their own health.
Fast forward one year, and remote video consultation platforms approved by NHS Digital, including those from AccuRx and iPLATO, have demonstrated that there is demand for online patient communication systems, which can serve the needs of both patients and their GPs. Importantly, although virtual consultations will not suit every patient, by giving them the choice, GPs can free up appointments for face to face consultations for patients who most need or want them.
Other companies have also recognised the value of patient centricity in innovation development. For example, Aseptika have been working with hospitals to provide a self-care platform, Active+me, which helps to deliver rehabilitation for cardiac patients during the COVID-19 pandemic.
Their Active+me solution empowers patients to take charge of their own recovery, providing them with standard cardiac rehabilitation care guidance and medical monitors to take home and record their activity levels, blood pressure, weight and oxygen saturation. The data is then uploaded to an app and shared securely with clinicians at their pilot site in Addenbrooke’s Hospital, Cambridge.
Importantly, patients enrolled in the pilot were able to complete their programme without the need for face to face contact. The app made it easy to have regular access to data, motivating patients to monitor their diet and lifestyle and track trends over time, and shift the focus away from hospitals and into the community.
Beyond the pandemic, western societies can also learn from the principals of frugal innovation. These are deployed in the developing world where resources and infrastructure often require a more flexible approach. For example, as GE Healthcare have developed and marketed an affordable, battery-operated ECG machine for use in rural clinics in India and China, why would western economies struggling with economic constraints and recession not also want a simplified, cost-effective solution that offers a better patient experience with reduced travel and ease of access?
Given the ever-increasing costs of regulation, clinical trials and market access generally, companies could benefit from considering what a ‘minimally viable product’, which delivers the patient and user benefits without being over engineered, would look like.
If patients cannot clearly see the benefits to them, they can often be distrustful of new technology. However, if new digital solutions are co-produced with end users and citizens in mind, the technology itself can be improved, as well as their adoption and use in healthcare systems.
If advantages have also been clearly explained, patients will trust in these tools, allowing the benefits of reducing bureaucracy, releasing clinical time, improving patient safety and empowering patients to have more control over their health, to be ultimately realised.
How health plans can reduce healthcare inequalities
The COVID-19 pandemic has put inequalities accessing the healthcare system in the spotlight. Jim Clement, Vice President of Product & Services at cloud provider Inovalon, tells us that health plans play the most integral role in advancing the health equity movement.
Why did it a global pandemic to highlight the issue of healthcare inequities?
Health inequity in the US has been well understood by healthcare professionals for many years, but it has become more evident due to the COVID-19 pandemic. It wasn’t until the racial and ethnic differential seen in response to COVID-19 related infections, deaths and vaccinations that many Americans became acutely aware of the health inequity due to sociodemographic factors such as race, geography, education and income.
Fortunately, there’s now a growing health equity movement afoot in America which aims to improve public health and achieve equity in health status for all people by ensuring opportunities are available to attain the highest level of health. While the entire healthcare ecosystem is important to this transformation, it is health plans that arguably play the most integral role.
How can health plans help?
Achieving health equity means obstacles to health must be removed, including poverty, discrimination, powerlessness, and lack of access to the basics like physicians, hospitals, medicine, technology, and health education. This is not only a social justice initiative, but also a clear call to action for health plan organisations that are bearing the economic brunt of the costs due to health disparities.
Health plan organisations that recognise the alignment between efforts to improve health equity and broader member engagement initiatives will be in the best position to move the needle. Plans must also understand that the provision of medical services within hospital walls, physician offices and other health services providers is necessary, but not sufficient.
By recognising that health inequity also includes non-medical factors such as employment, income, housing, transportation, childcare, and more, plans will be better equipped to ensure their members are set up for success.
What do healthcare providers need to do generally to address inequities?
Outreach by both health plans and providers is critical to ensuring people have knowledge of available services, the reason those services are critical to their health, and options to access those services based on their unique circumstances. With both stakeholders beating the same drum, progress can be made quickly.
Given the impact of social determinants of health (SDOH), should healthcare providers take a more active role in addressing these, or other agencies?
While communicating with patients is critically important, what is truly required to address inequalities is helping patients take medical actions – like regular PCP visits, monitoring A1C and accepting health coaching – that are necessary to maximise their health, along with non-medical actions –like availing themselves of community resources that address homelessness, food insecurity and employment services.
The most progressive providers and payers have or are putting in place programs to address these non-medical issues. In addition, non-medical tools such as transportation services can certainly help drive the effectiveness of medical services.
How important is it to educate patients about their health and how can this be done?
Education is a social determinant of health and a key lever to be used to drive health equity. Patients who do not understand their medical conditions or the consequences of non-compliance with their treatment plans are prone to poor outcomes.
For health plans, understanding member needs is one of the biggest drivers of quality care. A continuous cycle of engagement through feedback and appropriate responses will provide health plans with an opportunity to uncover, discuss, and resolve problems faster.
Improving member outreach and engagement can be made easier with a programmatic approach involving four stages of intentional outreach: Getting to know your members, educating members, seeking feedback from members and gaining member loyalty. Each stage not only contributes to a better member experience but also to improved outcomes and higher satisfaction scores.
Now that the issue has come to the fore, what do you think things will look like in 5 years or so?
I predict that health plans that get member engagement, education and equity right will achieve better health and greater value, faster. Those who get it wrong or delay will suffer the consequences of competitive disadvantage and pay a larger share of the rising costs associated with health inequity.