There is no argument that today’s healthcare providers operate in an extremely challenging environment. Reimbursement continues to decrease while, at the same time, the industry’s focus on outcomes requires more intensive patient interactions both inside and outside of their facilities. The strategic imperative to do better with less is driving healthcare organizations to evaluate all aspects of their operating models.
One area receiving much attention is patient engagement. There is widespread agreement that more effectively engaging with patients and their loved ones before, during and after an episode of care is needed to ensure they understand and comply with their plan of care. That is one factor that can improve outcomes. The fact is that more than 90% of adults in the US own a cell phone and most have it with them and turned on 22 hours out of every day. As such, healthcare providers are increasingly recognizing the opportunity to take advantage of the mobile phone’s ubiquity as a cost-efficient and effective means to improve patient engagement.
While there are a number of ways the cell phone can be leveraged for patient engagement purposes, innovative organizations are deploying a “text-first” strategy. This approach uses text messaging – a fundamental feature that is pre-enabled on virtually all cell phones – as the first and primary means for gathering a patient’s health status and delivering precisely timed and customized education, instructions, and alerts. As more secure and richer interactions (e.g., videos, pictures) are required, hyperlinks are embedded within the text message that provide a gateway to resources on the mobile web (e.g., patient portals, secure web applications).
The perception that mobile communication is only for young people oftentimes causes decision makers to dismiss this channel as a viable alternative for engaging seniors. While cell phone ownership for adults 65-plus is lower than average (76%, according to a 2013 Pew Research Center study), this still represents the vast majority of the population. As a result of CareWire’s extensive work with seniors, we have found that more than half of this population actively engages through text messaging. There are plenty of reasons to believe that these numbers will only improve – particularly as the baby boomers continue to age – making the cell phone and text messaging a powerful patient engagement tool for the senior demographic.
Another factor to consider when evaluating text-first patient engagement is the important role that a senior’s loved ones play in supporting their care. For example, in situations when an adult-child has caregiving responsibilities for their aging parent it is as important for them to be engaged as the primary patient. Imagine the scenario where the caregiver receives the same messages and calls to action as the primary patient. They are not only kept informed and educated, but also offers the added opportunity (and benefit) of the caregiver to reinforce the information through their day-to-day interactions with that patient. This aspect of the engagement strategy can be quite powerful and a key driver of improved outcomes.
To illustrate the effectiveness of a text-first patient engagement strategy for seniors, consider a total joint replacement that includes a brief stay in a rehab setting. From surgery preparation to recovery and beyond, there are a myriad of opportunities to communicate with the patient and their loved ones that when combined can contribute to an improved outcome:
Surgery Preparation:
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Schedule text reminders and request confirmation for all appointments leading up to and including surgery.
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Conduct a secure risk assessment to gather critical information that informs the treatment plan.
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Reinforce education and provide precisely timed instructions (e.g., sending a text the night before reminding the patient not to eat or drink after midnight).
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Provide day of surgery instructions including wayfinding information, what to bring, and the exact time to arrive.
Day of Surgery:
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Send periodic texts that communicate with loved ones about surgical status.
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Alert loved ones when they should return to the family consult area.
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Securely communicate treatment plan instructions.
Recovery/In Patient Rehab Stay (Date of Surgery + 30 days):
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Securely gathering patient reported health status such as pain score and flexion.
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Send reminders and instructions for required supplemental, independent exercises.
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General recovery reminders and tips.
Post Recovery:
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Text alerts when it is time to take medication.
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Periodic check-in messaging that includes a number to call with any questions or concerns.
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Patient satisfaction surveys.
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Ongoing wellness messaging tips for staying active and healthy.
Given the dynamic nature of any episode of care, these interactions can be a mix of automatic messages and on-demand messages that are triggered by a member of the professional care team. To further enhance communication, business rules can be applied that alert the care team if any information provided by the patient is outside of a pre-defined criteria or if the patient/loved one has any questions or concerns that they would like to discuss.
The possibilities for engaging patients and their loved ones through this communication channel are endless and the benefits to both patients and providers are many. Healthcare providers appreciate the cost efficiency, effectiveness and flexibility of this channel.
Patients and their loved ones receive timely and relevant information that can easily be referenced as questions arise. Avoidable delays and complications can be prevented – a source of frustration for patients and their families.
In today’s environment, a thoughtfully architected mobile engagement program should be a part of any patient communication and engagement strategy. They are highly effective – even for senior patient populations – can be launched quickly, and are inexpensive when compared to other mHealth alternatives.
Ken Saitow is the president and CEO of CareWire Inc. He was previously a managing director in Huron Consulting Group’s Healthcare Practice.
