"No one ever thinks about the fact that the whole relationship that's built around the patient and the physician starts at that office visit or that encounter," Martin says.
"No one's trying to structure that, yet there's been plenty of literature to suggest that patient satisfaction, literacy, and understanding the issues actually dictates their compliance. It dictates their follow-through. It dictates everything they do after leaving that office, that drives cost. That plan that's generated in the office is the biggest driver of cost, but no one's just looking at that simple relationship."
In a CYA healthcare culture, just getting doctors to justify tests and procedures to patients during those consultations will save money. The clinical trial, still being designed, will focus on diseases such as abdominal pain or lower back pain, comparing participating doctors to a control group of doctors who won't be using the Passport to Trust techniques, comparing the number of lab tests and radiological scans ordered. But Freedman admits it won't be easy showing changes in cost in a short time.
So the first trial will almost certainly be followed by others. NextJ is providing the current funding for the digitization of Passport to Trust, but Freedman envisions applying to the Robert Wood Johnson Foundation or the Commonwealth Fund for additional funding. The clinical trial will last a year. "We have had many conversations with different stakeholders—insurers, employers, other healthcare groups, physicians, PBMs," he says.
Imagining a patient population that is truly informed, engaged, and passionate about their care is surely one of the brass rings of everything we write about at HealthLeaders. In the rush to implement Meaningful Use, patient engagement is not at the top of many health executives' plates today. But sooner or later, it will be. The office encounter should be a conversation, not just a data download. Efforts like Passport to Trust will be leading the way.