The Blockbuster Drug of the Century: An Engaged Patient

Patient engagement continues to be big news. Meaningful Use’s Stage 2 final rule has patient and family engagement at its very core. And, based on solicited feedback, the ONC reduced patient engagement measures from 10% to 5%, showing it may be the hardest goal of Meaningful Use to achieve.

So why, oh why, is patient engagement such a big part of MU and the Medicare shared-savings program for ACOs?

All this is so different for healthcare providers. It’s like a great restaurant learning that their new business is going to be – in addition to continuing to provide a great in-restaurant experience – teaching people how to cook at home. What? This isn’t what we do!  It’s impossible!

Actually, it’s surprising that it has taken us this long to focus on patient engagement because the results we have thus far are nothing short of astounding. If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.

Let’s first take a look at the evidence, and then see where we can go from here.

First, the evidence for blockbuster drugs. In Dr. Eric Topol’s book “The Creative Destruction of Medicine,” he takes a deep look at the evidence for statins, possibly the biggest group of blockbuster drugs the last 20 years. Statins are a requirement of Meaningful Use Stage 1 clinical quality measures, as well as key measures for the CMS hospital quality measures used by many organizations, internal and external to the hospital, to grade the quality of care at a hospital. Prescribing statins, in many instances, is no longer optional. Topol states that “of every 100 patients taking Lipitor to prevent a heart attack one patient was helped, 99 were not.”  These drugs cost $4 per day per patient and $1500 per year. While they are great at lowering cholesterol, it remains unclear that they do much to prevent heart attacks.

Now let’s take a look at a 2009 Kaiser study of coordinated cardiac care. Compared to those not enrolled in the study, coordinated care “patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program.” And, “clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent.”

“Recognizing the importance of early treatment and intervention, every patient who presented with CAD was enrolled in the program for both short- and long-term care.

“Physicians, nurses and pharmacists, using proven CAD risk-reduction strategies, work collaboratively with CAD patients to coordinate care. Activities such as lifestyle modification, medication management, patient education, laboratory results monitoring, and management of adverse events are all coordinated across a multifunctional team.”

Can you imagine what the headlines would be if a new cardiac drug showed this kind of effectiveness?

Patients were actively engaged, physicians were coordinated, and ongoing monitoring was taking place.

Certainly statin use was part of the monitoring they described, which leads me to believe that the strange discrepancy we see between lowering cholesterol and fewer heart attacks may lie somewhere in patient engagement and behavior change. When we have more data through Meaningful Use and accountable care, I suspect we’ll be able to see this answer and what the relationship might be.

A similar example at the VA’s Coordinated Care and HomeTelehealth (TELEMEDICINE and e-HEALTH.  DEC 2008; VOL.14 (10): 1118-1126) program (h/t to Mark Blatt, MD, Global Medical Director at Intel) showed similarly stunning results about coordinated care for chronic disease management, including:

  • 19.74% reduction in hospital admissions
  • 25.31% reduction in bed days of care
  • 86% patient satisfaction
  • $1,600 average cost per patient per year, compared to $13,121 for primary care and $77,745 for nursing home care
  • 20% to 57% reduction in the need to be treated for the chronic diseases studied, including diabetes, COPD, heart failure, PTSD, and depression

Can you imagine if a drug reduced the need to go to the hospital by this amount? Again, it would be malpractice not to use it.

Healthcare must be built on a foundation of Health IT-supported care coordination and patient engagement, there is no other way to consistently and quickly scale improvements and care, and to accelerate the overall learning of the health care system.

As Topol points out, this is the path to real, personalized medicine, and away from the population-based studies and results that we’ve seen with statins. Medicine and the people it treats are complex adaptive systems; we need a complex adaptive systems approach to medicine because each person reacts differently. We can only treat the population for so long and get great results; we need to use data and engagement to continuously learn how to improve care for each individual.

So how do we get there? Engagement is just the very first step of what I think will become a new science of behavioral economics and behavior change in healthcare. It’s no accident that in both the examples here, the providers and the payers were tightly aligned, because the economics have to be aligned before any of this will work. ACOs are a positive step. Based on the results above, there’s plenty of potential for shared settings, if it’s done right. To do it right, we’ll need experts from other domains who have been honing their skills and engaging people for years.

Ultimately, we’re talking about cultural and behavior change. There are many resources available from other disciplines to help healthcare move to where it needs to be in terms of patient engagement and understanding consumer behavior and medicine as a complex, adaptive system. There are some great minds working in this space, including behavioral economists, user experience designers, community leaders, interaction designers, software developers and game designers, risk managers, data scientists, and actuaries.

In my next article, I’ll review where we can find them and how we can put them to work with caregivers and patients on stuff that matters. We can’t afford not to. ♦

leonardMore from Leonard Kish

@leonardkish

The following two tabs change content below.
Leonard is Principal and Co-Founder at VivaPhi, an agency that solves multi-disciplinary business problems involving data science, software, biomedical science, behavioral science, health care, product design, community development, marketing, consumer engagement and organizational design. He has been quoted in Forbes and other top-tier publications for thought leadership on patient and consumer engagement. In addition to his role at VivaPhi, he is Chair of the Marketing and Communications Group for the Collaborative Health Consortium. Prior to VivaPhi he held the position of Vice President of Operations at Capitis Healthcare International as well as executive positions with several startups. He started his career as a software requirements analyst on Qwest Communication’s highest priority IT project while earning a triad of advanced degrees from the University of Colorado. These included an MBA, a Master’s of Science in Information Systems and a Master’s in Biomedical Sciences (Thesis on System Dynamics in Parkinson’s Disease). Leonard earned a Bachelor’s in Zoology from Miami University in Oxford, Ohio. He’s interested in how systems evolve, and how to help them evolve, in a variety of unique contexts. Connect with Leonard: @leonardkish, LinkedIn and Google+

Comments

Loading Facebook Comments ...
Loading Disqus Comments ...

48 Responses to The Blockbuster Drug of the Century: An Engaged Patient

  1. Jen McDonough September 3, 2012 at 7:07 pm #

    “cultural and behavior change” – never easy, but so worth it. As a mom of a child with a chronic medical condition, I not only want to let our healthcare system know that it saves money when we use systems to save money, but it also eases the burden on patients. Wow, to have systems in place to help not only patients and their families, but also our healthcare community – that sounds like a win/win to me.
    MANY thanks for posting this interesting article.
    Live Beyond Awesome.
    Jen
    Twitter: @TheJenMcDonough

  2. Catherine Simmons September 6, 2012 at 10:42 am #

    I’m sure that many would agree that this is common sense, but resources are limited and the existing medical model just doesn’t allow for it. Professionals don’t have the time to implement it. Maybe it really is time to shake up the system and integrate disciplines, providing networks of support. It seems we need to re-learn how to build community support structures.

Trackbacks/Pingbacks

  1. “Patient Engagement is the Blockbuster Drug of the Century” « iHT2 Blog - September 10, 2012

    […] the statins blockbuster with the patient engagement “blockbuster”. [See Kish's full article here.] First, the evidence for blockbuster drugs. In Dr. Eric Topol’s book “The Creative Destruction […]

  2. "Patient Engagement is the Blockbuster Drug of the Century" - The Doctor Weighs In | The Doctor Weighs In - September 10, 2012

    […] the statins blockbuster with the patient engagement “blockbuster”. [See Kish's full article here.] First, the evidence for blockbuster drugs. In Dr. Eric Topol’s book “The Creative Destruction […]

  3. The Promise of a Little Blue Button « Chilmark Research - September 11, 2012

    […] of having access to and control of their PHI for as we move to more capitated models of care, the engaged patient may indeed be the miracle drug to rescue our healthcare system from financial collapse. Share […]

  4. Improving the patient experience, patient engagement | Provider Finance Associates - November 8, 2012

    […] saved thousands of lives by writing “THE BLOCKBUSTER DRUG OF THE CENTURY: AN ENGAGED PATIENT”: http://www.hl7standards.com/blog/2012/08/28/drug-of-the-century/.  This post should be read by every practicing physician.  We tip our hat to Mr. Kish for his […]

  5. Truly Distasteful Things Doctors Get Us to Do in the Name of Health - The Doctor Weighs In | The Doctor Weighs In - December 9, 2012

    […] on 12/1/2012 Dave Chase, Forbes Contributor and CEO, Avado Leonard Kish recently wrote about the role patient engagement will play in future reimbursement models in healthcare. In it, he outlined the expected pushback from healthcare providers when they are […]

  6. The Patient Engagement Pill: Lessons From Epilepsy – Health Affairs Blog - February 7, 2013

    […] Leonard Kish recently called patient engagement “the blockbuster drug” of the century. It’s an exciting idea and an apt label that raises an interesting question: what would an “engagement pill” actually look like? . […]

  7. Money and Power Embrace Patient Engagement - Forbes - February 18, 2013

    […] has been called “the blockbuster drug of the century” (the phrase comes from Health IT expert Leonard Kish) for its potential to improve the quality of care and lower […]

  8. Money and Power Embrace Patient Engagement | Stock Market News - Business & Tech News - February 23, 2013

    […] has been called “the blockbuster drug of the century” (the phrase comes from Health IT expert Leonard Kish) for its potential to improve the quality of care and lower […]

  9. Big Silo-busting, Startup-unleashing Healthcare Move by Federal Government | TechCrunch - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  10. Big Silo-busting, Startup-unleashing Healthcare Move by Federal Government | SafetyFist.com - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  11. Big Silo-busting, Startup-unleashing Healthcare Move by Federal Government | TechKudos - February 27, 2013

    […] devotes this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  12. Big Silo-busting, Startup-unleashing Healthcare Move by Federal Government | Mr Gee - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  13. Big Silo-busting, Startup-unleashing Healthcare Move by Federal Government | Crowdfunding News - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  14. Big Silo-busting, Startup-unleashing Healthcare Move by Federal Government | MoreDailyFeeds - February 27, 2013

    […] devotes this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  15. Big Silo-Busting, Startup-Unleashing Healthcare Move By Federal Government | CrowdBacon – The Startup Blog - February 27, 2013

    […] devotes this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  16. Big Silo-Busting, Startup-Unleashing Healthcare Move By Federal Government | Krantenkoppen Tech - February 27, 2013

    […] devotes this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  17. Big Silo-busting, Startup-unleashing Healthcare Move by Federal Government | fd4y.com - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement”. The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  18. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move | SafetyFist.com - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  19. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move | 5 For Business - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  20. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move : Blog - February 27, 2013

    […] devotes this month’s announcement to a “New Era of Patient Engagement.” The reason is patient rendezvous has been called a blockbuster drug of a century for a surpassing impact on improving health outcomes. Patient rendezvous is tangible as “actions […]

  21. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move | Easy Nulled Script - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  22. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move | CrowdBacon – The Startup Blog - February 27, 2013

    […] devotes this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  23. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move | Krantenkoppen Tech - February 27, 2013

    […] devotes this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  24. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move - Entrepreneur News | Australian Society of Entrepreneurs - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  25. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move - About all - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as […]

  26. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move - February 27, 2013

    […] devotes this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  27. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as […]

  28. Federal Government Makes Silo-Busting, Startup-Unleashing Healthcare Move | Crowdfunding News - February 27, 2013

    […] this month’s publication to the “New Era of Patient Engagement.” The reason is patient engagement has been called the blockbuster drug of the century for its profound impact on improving health outcomes. Patient engagement is defined as “actions […]

  29. Snowflakes and bitch-slaps at the ePharma Summit - March 8, 2013

    […] If you need help wrangling internet and social rules for pharma out of the FDA, tell us – patients – what you want to accomplish, and let us storm the castle. Embrace the snowflakes. Avoid the bitch-slaps. Help create better global health. Patients are the only real blockbuster drug left in the 21st century. […]

  30. Patient Engagement: Too Important to Become a Buzz-Phrase | - March 11, 2013

    […] few years.  Late last year, a well-known health IT consultant dubbed patient engagement the “blockbuster drug of the century.”  Lofty praise, indeed. […]

  31. Money and Power Embrace Patient Engagement - The Doctor Weighs In | The Doctor Weighs In - April 5, 2013

    […] has been called “the blockbuster drug of the century” (the phrase comes from Health IT expert Leonard Kish) for its potential to improve the quality of care and lower […]

  32. Patient engagement: IBM’s portal solution | Industry View - May 3, 2013

    […] have better health outcomes, while at the same time have lower overall health costs. In his August 2012 article, Leonard Kish references studies from Kaiser and the VA that showed significant improvements in […]

  33. Driving innovation in health through the use of open data: Health Datapalooza, Year 4 | Health Populi - June 5, 2013

    […] In the $3 trillion economy that is American health care, the role of information technology is central to transforming this huge piece of U.S. fiscal activity. This week convened the fourth annual Health Datapalooza (HDP) in Washington DC, with the underlying theme, “health engagement is the blockbuster drug of the 21st century” (quoting Leonard Kish). […]

  34. Patient Privacy Rights » Todd Park: Patient engagement will ‘vastly’ improve healthcare - June 13, 2013

    […] to get patients access to their records,” Park said. “Patient engagement–to quote Leonard Kish–may be the blockbuster drug of the 21st Century. This will vastly improve our healthcare […]

  35. Patient Engagement: Too Important to Become a Buzz-Phrase | The TheraVid Blog - June 14, 2013

    […] few years.  Late last year, a well-known health IT consultant dubbed patient engagement the “blockbuster drug of the century.”  Lofty praise, indeed. […]

  36. medclerkships.com “Patient Engagement is the Blockbuster Drug of the Century” » medclerkships.com - July 11, 2013

    […] Kish compares the statins blockbuster with the patient engagement “blockbuster”. [See Kish's full article here.] […]

  37. The Blockbuster Drug of the Century: An Engaged... - July 22, 2013

    […] Patient engagement sounds like a utopian, out-of-touch goal of Meaningful Use. But there is truth in numbers, and they show that engagement is a must.  […]

  38. Special – #HITsm blog post – August 2, 2013 | hcldr - August 9, 2013

    […] I encourage you to read Kish’s excellent HL7 Standards blog post on this subject here. […]

  39. Be a Part of the Blue Button Movement HIT Security | HIT Security - August 12, 2013

    […] “If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it,” Leonard Kish. […]

  40. Patient Engagement and Stage 2 Meaningful Use - Kentucky REC - August 12, 2013

    […] has been called “the Block-Buster Drug of the Century” and the “One Secret to True Healthcare […]

  41. Be a Part of the Blue Button Movement AmbulatorySurgeryCenter.Info - August 13, 2013

    […] “If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it,” Leonard Kish. […]

  42. Patient Engagement: Blockbuster Drug Or Snake Oil? - AnuragP - August 19, 2013

    […] The idea of patient engagement as a “blockbuster drug” was originally coined by Leonard Kish last August (here). […]

  43. Patient Engagement: Blockbuster Drug Or Snake Oil? | The Doctor Weighs In - August 28, 2013

    […] The idea of patient engagement as a “blockbuster drug” was originally coined by Leonard Kish last August (here).  […]

  44. Let the Metrics Define Patient EngagementTransformative Health - August 29, 2013

    […] it has been equated to a “blockbuster drug” that offers tangible benefits in terms of improved and measurable health outcomes while reducing […]

  45. Patient Engagement Key to Improved Health Outcomes, but What Is It? | Memotext Blog - September 4, 2013

    […] L. 2012. The blockbuster drug of the century: an engaged patient. Available at: http://www.hl7standards.com/blog/2012/08/28/drug-of-the-century/, accessed on June 20, […]

  46. The Physical Therapy Patient Management Process | The TheraVid Blog - September 11, 2013

    […] that lead Leonard Kish to pen the now infamous proclamation that patient engagement is the “blockbuster drug” of the century.  It’s no secret that a patient who is more involved, more engaged, in their […]