Patient Engagement: a dynamic phenomenon, an evolving concept

 -patient engagement

The notion of patient engagement is in its infancy, but we know it’s already having significant economic impact for payers. Getting patients engaged in their own healthcare minimizes complications and lowers overall health care costs.

Patient engagement is an evolving concept. One that we are looking forward to discussing at the Healthcare Payers Transformation Assembly over the next two days.

We have already witnessed how patient engagement can help payers offset losses from the Affordable Care Act exchanges. Late last year, the CMS announced the creation of their own Person and Family Engagement Strategy.

“This Strategy emphasizes that person and family engagement goes beyond informed consent. It is about including the patients voice in policy and program planning,” The CMS Blog states. “It is about building a care relationship based on trust and inclusion of patients’ beliefs, values, preferences, and culture which can even lead to a reduction in healthcare disparities. Healthcare decision-making should not always be limited to the patient and provider. It is essential to include family members, caregivers, and close friends in the conversation about health when the patient desires inclusion of others.”

CMS’ initiative works to bring patients and their families into the clinical decision-making process alongside their physicians. It is based on the idea that personalizing patient engagement strategies for high-risk populations and their caregivers can reduce complications, improve treatment adherence, and reduce healthcare spending. This high-touch approach also leads to greater satisfaction among the payer’s members.

By expanding the healthcare provider’s reach beyond the clinical walls, personalizing communications, and keeping at-risk populations healthier, payers can benefit from this sound business practice. Determining the best options to support your providers in integrating a sound patient engagement tool requires a thoughtful approach in consideration of ease of use, integration, and fit into providers’ current workflows.

What are the benefits of Patient Engagement?

Advancing the patient experience

Patient engagement policies not only cut costs but also improve the patient experience.

Optum, the information technology company and sponsor of Healthcare Payers Transformation Assembly, has been working to improve the patient experience on the insurance side in a partnership with health information network Availity. Their plan is to bring greater accuracy to medical insurance claims and, thereby, decrease the number of appeals, according to a company press release. Their solution will provide providers with clear notifications when errors need to be fixed or when more information is needed to prevent claim denials. This is expected to boost the patient experience by minimizing payment problems.

“Availity offers a single point of engagement for health plans and care providers, which leads to improved payment turnaround and more accurate claims submissions. We are delighted to have been selected by Optum to connect its industry-leading ACE solution to our broad national network of health plans,” Russ Thomas, CEO of Availity, said in a public statement.

Public and private payers investing in IT systems

Strengthening health information technology is a priority for both private payers and public programs like Medicaid. The Centers for Medicare & Medicaid Services (CMS) has previously reported that its annual investment in state Medicaid information technology is above $5 billion.

This spend is necessary to evolve IT systems in order to meet the needs of both healthcare providers as well as beneficiaries. Regulations stimulate states to innovate their Medicaid IT systems and follow industry practices.

Stronger health information exchange will benefit payers, providers, and patients alike. Greater access to personal medical data and electronic patient records also benefits consumers by empowering them to take ownership of their medical histories.

“Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage to nearly 72 million Americans, and are consistently growing as more states choose to expand coverage. With over 30 states currently redesigning their Medicaid eligibility and/or claims processing and information retrieval systems, 2016 will the most active year to date for Medicaid growth and new IT business prospects. CMS and states want to make the most of this opportunity,” CMS stated.

“The Medicaid program is undergoing tremendous change, such as a growing emphasis on managed care, offering home and community-based services to seniors and people with disabilities, and developing new models of delivery system reform to improve health outcomes while controlling costs. State Medicaid agencies are hungry for innovation and have pioneered new IT adoption. They were early adopters of Health Information Technology and have issued more than $10.2 billion in incentive payments to providers for adopted and meaningfully used electronic health records.”

How patient engagement cuts costs

As previously stated, patient engagement solutions will cut costs and benefit payers.

According to a brief from Health Affairs and the Robert Wood Johnson Foundation, greater patient involvement in their own medical care brings better health outcomes and decreased healthcare spending.

The majority of healthcare organizations are working on patient engagement, often through the use of educational initiatives.

As the above chart indicates, healthy patient behaviors will aid the payer industry’s efforts to cut costs. For example, empowering patients to understand their own medical needs could lead to many seeking preventive care early.

Patient Engagement is not without its challenges, There is a significant gap in health literacy. Many physicians do not provide patients with the information they need to make decisions about their own medical care. Also, information that is provided is often not provided in a way that can be digested by the patient.

The provider community is also working to leverage shared decision-making and patient engagement. This is especially important when discussing end-of-life care. Doctors must communicate effectively with elderly patients about their preferences.


What is clear is that providing patient, or consumers, with complete and accurate medical information, is vital for patient engagement initiatives to succeed.


Healthcare Payers Transformation AssemblyThanks to everyone joining us at the Healthcare Payers Transformation Assembly over the next 2 days.

The Millennium Alliance is pleased to announce that application for the second 2017 Healthcare Payers Transformation Assembly is now open. North America’s most prominent IT and business leaders from the Healthcare Insurance industry will be gathering on December 7-8, 2017, to discuss how to adapt to the industry’s customer-centric makeover.

At the May edition, we were joined by industry heavyweights like Henry Chao, Retired CIO & CTO, Centers for Medicare & Medicaid Services, to discuss the technological advances in genomics, personalized healthcare, AI (and more!), coupled with consumer demand for greater price transparency, have changed the face of healthcare in North America. The need for the Healthcare Insurance industry to adapt has never been greater.

Across a series of executive education roundtables, keynote presentations, collaborative think tanks, educational workshops, and networking sessions offering insight into industry-specific topics and trends, we will be taking these conversations one step further, helping you stay one step ahead.

This is not just another “Healthcare” event. Spaces are reserved for the best in the business. Enquire about attendance here!


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