Patients who are more engaged in their health care–including making decisions with physicians and other healthcare professionals, understanding risks, benefits and alternatives to care and being activated to self-manage chronic conditions–have better health outcomes, according to studies released today in the February issue of Health Affairs.
But does this type of health care cost less? Yes, according to research conducted by Judith Hibbard at Minnesota’s Fairview Health Services. In an analysis of more than 30,000 patients, she and her fellow researchers found that patients who were least activated–the term that researchers use to describe patients’ willingness to play an active role in their care–had health care costs that were higher than those of patients who were actively involved in self-management and decisions about their care. These average costs were eight percent higher in these patients’ first year of care and up to 21 percent higher in their second year of care. Hibbard is doing additional research on this topic through a grant from the Gordon and Betty Moore Foundation. Another study by David Veroff and colleagues found that patients who received enhanced support for shared decision-making had 12.5 percent fewer hospital admissions and lower health care costs. *
“The evidence assembled in this issue of Health Affairs is a wake-up call for health care providers, who must recognize patient and family engagement as a top priority,” Bo-Linn said. “This collective research clearly demonstrates that we must do a better of job of helping patients and families to play an active role in their care, and we must redesign the health care system in ways that makes this possible.”
Researchers writing in the February issue of Health Affairs say that advocates and health care professionals recognize that the sector must develop new policies and approaches that strengthen patients’ roles in managing their care. Early indications suggest that online health care can play a role, according to research at HealthPartners in Minnesota. Studying patients who used the online clinic called virtuwell, researchers noted that 98 percent of users said they would recommend the site, and health care episodes managed through this online clinic cost an average of $88 less than care provided in traditional settings. *
Other methods for improving health outcomes while reducing costs include a focus on real-time learning, integrating care across teams and creating greater transparency, according to A CEO Checklist for High-Value Health Care, also covered in the February journal. *
Combining various approaches to improving patient care will be important, but implementing these approaches isn’t always easy. Dominick Frosch, a Moore Foundation fellow and author of research appearing in this February journal, said cultural changes must take place in health care if we’re to see increased levels of patient engagement. Decision aids–approaches for increasing patient engagement and facilitating shared decision-making–have been well researched and work, but aren’t being used routinely, Frosch said.
“Further involving patients in decision-making will mean some changes to how health care providers deliver care,” Frosch said. “Additional training, changes to team-based care models and incentives for adopting this new approach can go a long way toward enabling these changes in the current health care system.”
The Gordon and Betty Moore Foundation–along with the Robert Wood Johnson Foundation, the Patient-Centered Outcomes Research Institute and the California HealthCare Foundation–provided grant support for this patient-engagement issue of Health Affairs. In 2012 the foundation launched a new national Patient Care Program that seeks to eliminate all preventable harms to patients. The Moore Foundation expects to allocate a half billion dollars over ten years to work focused on both meaningfully engaging patients and their families in their own health care and developing a systems approach that optimally reconfigures interprofessional teams, processes and technology to be supportive of that engagement. Follow the program @MoorePatient.
The Gordon and Betty Moore Foundation is committed to making a meaningful difference in environmental conservation, patient care and scientific research. Intel co-founder Gordon Moore, and his wife Betty, established the foundation in 2000 to ignite bold ideas that create lasting change around the world and at home in the San Francisco Bay Area. Visit us at Moore.org or follow @MooreFound.
*Research is available at www.healthaffairs.org. Studies include:
- Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’ (This study is noted in the second paragraph of this release.)
- Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference-Sensitive Conditions (This study also is noted in the second paragraph of this release.)
- HealthPartners’ Online Clinic For Simple Conditions Delivers Savings Of $88 Per Episode And High Patient Approval (This study is noted in paragraph five.)
- Ten Strategies To Lower Costs, Improve Quality, And Engage Patients: The View From Leading Health System CEOs (This study is referenced in paragraph six.)
- An Effort To Spread Decision Aids In Five California Primary Care Practices Yielded Low Distribution, Highlighting Hurdles (This study is noted in the ninth paragraph.)