Turning the Battleship Toward Engagement

Every once in a while, a snippet of information surfaces that reinforces in no uncertain terms exactly how big a battleship the healthcare industry has to turn around.

In a Minneapolis Star-Tribune story about the recent launch of Better, a mobile health app and related concierge service – the personal service is for those customers willing to pay a $50 monthly fee – being co-launched by the Mayo Clinic, one two-sentence paragraph stood out from all others as though it had been fashioned from pink neon:

"The venture is the latest example of Mayo’s efforts to diversify its business model and build loyalty among consumers. Those efforts are being driven, in part, by healthcare overhaul measures that could trim Mayo’s revenue by at least 20 percent."

Twenty percent. I know a lot of businesses for whom a 20 percent drop would be catastrophic, if not fatal. And it's no secret a lot of hospitals are scrambling madly, trying to find partners or new business models just to stay afloat, let alone thrive.

Better is just one of thousands of new mobile apps, of course, most started on a shoestring and a prayer, and a few, like Better and Cleveland Clinic's Today, newly available for iPhone and Android in addition to iPad, meant to leverage "famous brand" healthcare organizations. Mayo Clinic's Paul Limburg, M.D., told the Star-Tribune. “We have been challenged by our board and our president and CEO to think about how can we make Mayo Clinic knowledge available to anyone, anywhere, any time. And this is a very nice, novel way for us to reach out in that direction."

But do patients really want novelty? Will a woman recently diagnosed with breast cancer in Rochester, N.Y., really make it a priority to seek out information from Rochester, Minn., on her smartphone? Will a man with heart failure in Cleveland, Tenn., do the same with a platform housed in Cleveland, Ohio? Especially if those platforms are acknowledged marketing extensions of organizations fighting tooth and nail for pieces of a shrinking pie?

I attended a conference many years ago in which a physician said the relationship between a doctor and patient needed to be considered as something different and more profound than a contractual relationship – that it was more of a covenant than a contract. A noble sentiment, that, but once you get past the exam room and introduce the host of other people a patient encounters in a hospital – nurses, other specialist physicians, housekeeping staff, registration and billing personnel – then throw in the insurance component on top of it, the idea of the covenant is stretched awfully thin. We're at an epochal crossroads in the way relationships between patients and the healthcare industry will be defined, but there doesn't seem to be an epochal shift in the amount of respect patients are getting.

There is a yawning, gaping, gargantuan hole in the way the entire industry is approaching the role of the patient in the age of accountable care and high deductibles, and I am skeptical that mobile apps from far-afield healthcare systems will fill that hole in any meaningful way. It's a matter I've given a whole lot of thought to for a long time. I remember doing hours of research on prostate cancer, using numbers similar to the numbers in my original biopsy results to search out likely treatment options. Patient community sites didn't add much quantitative knowledge, at least not quickly. Hospital sites offered some, but not enough, quantitative information. Some linked to more, but also steered me toward "making an appointment."

There was, and still is, a dearth of ways for patients to conveniently get quality, unbiased information. It's out there, but there's a lack of curation, a lack of strategy, and above all, a lack of the financial resources that truly speak to a patient needing it. I know – after my experience, I spoke to Patients Like Me co-founder Jamie Heywood; I exchanged emails with "e-Patient Dave" deBronkart about curating pages of data like study results for patients. The money wasn't there. It still isn't – in her blog, patient advocate Regina Holliday recently wrote of being asked to speak at the 2014 HIMSS conference, but being told she'd have to foot her own bill for travel and lodging. How much money is spent on HIMSS booths and exhibits every year? And amid all the talk about "engaging the patient," one of the few people with a national reputation for it is asked to pony up her own Motel 6 money?

So forgive me if I'm underwhelmed by all the hoohah over the "convenience" of the many data platforms now emanating from places with vested interests in holding onto that 20 percent of revenue they may lose. You want a happy patient, don't overbook your doctors and watch the part of "Miracle on 34th Street" where Kris Kringle recommends the store across the street when Macy's didn't have an item.

There is a glimmer of hope. The Patient-Centered Outcomes Research Institute is funding projects like an app for caregivers of stroke survivors, because the developers of the platforms out there haven't really done their homework – “At one point, I did a Google search for caregiver apps and found Web sites that listed suggestions for caregivers, but for the most part, I just haven’t found them that useful,” one stroke survivor's wife said. And, Atlanta-based Piedmont Healthcare recently announced it was going to launch an internally-housed physician review platform on its own Web site.

"Unlike ratings posted on independent healthcare review websites – including Healthgrades, RateMDs, Vitals and Yelp – the reviews posted on piedmont.org are written by verified Piedmont patients," the system said in announcing the feature. "While no patient name or information is revealed due to privacy laws, consumers can be confident the information provided in the reviews came from actual patients like them."

Perhaps most telling about the the relationship between provider organizations and patients today, Piedmont's chief marking officer, Matt Gove, said Piedmont was one of two – that's right, one of two – health systems in the entire U.S. that offered prospective patients this information.

There's a long way to go in nailing this patient engagement thing down. A long way.