UnitedHealth Exec Offers 5 Tips on Patient Engagement

The giant health insurer has learned much from its consumer engagement program. Lewis G. Sandy, MD, senior vice president for clinical advancement at UnitedHealth Group, shares some practical lessons.

I consider myself an engaged patient. I keep my provider appointments, I ask questions, I'm honest about my efforts to improve my health, and I fill my prescriptions and take the medications as directed.

Yep, I definitely deserve a gold star. Alas, not all patients are like me. At one time that might not have mattered so much to payers or providers, but in the era of healthcare reform, recalcitrant patients can seriously mess up quality scores and outcomes. And that can translate to reduced income for physicians, hospitals, and payers.

So, patient engagement has emerged as a big part of the healthcare industry. The concept has been tweaked over the years. It's shifted from one-off efforts to encourage patients to complete health risk assessments or join gyms, to more deliberate data mining to close gaps in patient care and monitor high-risk patients.

Lewis G. Sandy, MD, senior vice president for clinical advancement at UnitedHealth Group, recently shared in Health Affairs some practical lessons the giant insurer has learned from its expansive consumer engagement program. In a telephone interview, he offered five tips for improving patient engagement:

1.Align with care delivery
Sandy says it is important to avoid siloed or one-off patient engagement programs that are disconnected from care delivery systems. UnitedHealth reached outside the healthcare industry for advice from industries such as banking and retail that have more experience with consumer messaging, especially the call to action.

"You have to have a program that is coherent to the person you are trying to engage," says Sandy. "If it is just a disconnected one-off program then the consumer has no way to understand how it fits into anything else they are doing with their health."

He adds that it is important to have the same message repeated and reinforced from multiple angles. UnitedHealth's HealtheNotes program, for example, sends simultaneous messages and reminders to the patient and doctor regarding important screenings such as diabetic eye screenings. "That way the doctor and patient can have a conversation about the same message."

2.Target the message
Sandy says, "you have to target the message not only for what is most important for health, but also for what is the most actionable for that consumer. What do we want people to focus on that will have a maximum impact on their health? How can we make this important step easy for the consumer to do?"

He points to the Rewards for Health program offered to the insurer's employees, who earn points for specific actions, such as having a health screening or lowering their cholesterol. By completing the health assessment the employees qualify for premium reductions of up to $1,200 per family.

3.Understand human behavior
Sandy says health plans can learn lessons from the world of behavioral economics. "People like feedback," says Sandy. Without feedback, filling out a health risk assessment is just a "nice activity."

To be effective, people need to know what their assessment responses mean for their health, where they stand, and what they need to do to improve. He notes that people also like to keep score, which is why the Rewards for Health program is based on points and provides report cards that track progress toward achieving incentives.

At the end of the day, wellness is about people feeling empowered to do the things that help them maintain and enhance their health. Sandy calls it "patient activation," which happens on what might be called a commitment continuum.

To activate change, he says, "you have to be precise in targeting the amount of information" to where the patient is on the continuum. For example, someone early in the continuum probably is not ready to activate change. Sandy says providing specific information and details at this point "will just go over their head."

4.Look beyond the medical model
The task to help people improve their health is not only within the confines of the physician-patient relationship. "We think that there are many other ways that other stakeholders can play a role in enhancing health."

For example, UnitedHealth has developed a model with the YMCA for a community-based weight management program for families. Join for Me began in 2010 and is now underway in 10 communities. It is an incentive that employers can offer to their workforce that is delivered at the community level rather than through the medical care system.

5.Keep tweaking
Implementing successful patient engagement requires ongoing refinement. Sandy says it is important to experiment and try new things especially as technology evolves and "new opportunities for engagement" present themselves.