By Krista Burris, November 12, 2013
The importance of patient engagement is buttressed as healthcare transitions to outcomes-based models where patients’ involvement in their health is necessary to achieve the objectives of care delivery transformation. Empowering patients with tools and resources that enable individuals to better manage their healthcare needs is a promising approach to encourage patient accountability in improving their own health outcomes. However, the notion of patient engagement relies on the idea that once patients become engaged, they are well-informed enough to know how to interpret and act upon the health information presented to them; in other words to maximize the value of having patients engaged in their health, they actually have to have a good enough understanding of their health conditions, terminology, and treatment in order to make the appropriate decisions around their health needs.
The IOM defines health literacy as “ the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” According to a National Assessment of Adult Literacy report, it is found that approximately 36% of US adults have basic or below basic health literacy, resulting in an economic burden of $106 billion to $238 billion annually. The same report found that low-health literacy rates are almost double for underserved populations with approximately 62% of minorities, 53% of the uninsured and 60% of Medicaid beneficiaries having limited health literacy.
Given that individuals with low-health literacy tend to have poorer health outcomes and create costs in the system through the misallocation of resources (for example: more likely to forgo preventative care while more likely to be hospitalized), there are implications with respect to the coverage expansion provisions of the ACA that will bring millions in this demographic into the system. The virtue is that these individuals become somewhat more captive facilitating outreach and education efforts. The challenge is how to implement patient education policies efficiently to reduce the administrative burden of increasing demand with somewhat static supply in an already taxed infrastructure.
This is where I believe the unprecedented government and private market collaborations to foster efficiencies and innovations become hopeful. There is an incredible amount of effort in the digital and technology space to leverage the existing social and cultural norms of the mainstream including those in the low-health literacy demographics. For example, mHealth technologies that leverage the 91% mobile (56% smartphone) penetration rates among US adults making access to patient & health information, biosensors and tracking that use smartphone technology, and communication with providers nearly automated.
I recently started working with a non-profit start-up that does SMS patient education by disease condition, appointment, event, and medication reminders, as well as group messaging, all designed and tailored for low-income individuals. Early results are showing a positive impact on improving attendance of a chronic-disease self-management program through event reminders, and we will have more information on the improvement of knowledge and outcomes, along with the engagement aspect of the technology in early- to-mid 2014.
Patient engagement, though relatively early in its life-cycle, has shown promising results which lends itself to continued exploration and investments to determine how to best leverage effective approaches moving forward.
 Vernon, JA. Trujillo, A. Rosenbaum, S. DeBuono, B. “Low Health Literacy: Implications for National Health Policy” 2007.
 Smith, A. “Smartphone Ownership 2013” Pew Internet and American Life Project. 2013.