The term "patient engagement" has become a kind of catchall, encompassing everything from platforms intended to make scheduling more efficient to portal interfaces to access electronic health records. Many current healthcare IT offerings are not proving effective at engagement, nor do health delivery systems really have a clear idea of how to use them, experts assert.

However, some HIT startups see opportunities to both better engage patients in their care and improve providers' care delivery. Some mainstream providers already are incorporating these new offerings in their health IT strategies. 

"Providers lack a patient engagement strategy," says Gregg Malkary, managing director for Spyglass Consulting. "In one of the studies we did, 88 percent of the providers we spoke with expressed concern that they lack a strategy as a whole to support patient engagement.”

The lack of a strategy is particularly glaring when it comes to using mobile technologies, which Malkary calls, “The holy grail. But we are in the earliest stages of trying to understand what technologies are available, how different patient populations would want to use them, and how they could be integrated within clinical care process and systems."

Also See: Portals Not Achieving True Patient Engagement

However hazy current strategies may be, policy and market forces are aligning to assist health system executives in crafting engagement strategies that go beyond the first stabs at engagement. With the overall drive to shift healthcare reimbursement to value from volume, as well as other initiatives such as the new chronic care management (CCM) reimbursement from CMS, incentives are now emerging that mandate a more holistic approach to communicating with patients.

"We need to figure out a way to engage people, not patients," says Asif Khan, CEO of Chicago-based Caremerge, which recently launched a CCM platform that complements its existing senior care communication technology. "Once they're a patient, it's already too late."

Caremerge closed an oversubscribed $4 million funding round in January, and it espouses a philosophy that family members, as well as patients, need to be involved in care, especially when patients need substantial or complex care.

"When you really look at the Affordable Care Act and bundled payments, a lot of focus is on the highest acuity patients because you have to stop the bleeding," Khan said. "The challenge with engaging that group is that many are significantly old, and if you are really sick…you don't want to be engaged. Who else cares for that patient? It's the family. How do you engage those people? You need to give them something to help them have the power to take care of their mom or dad."

At the other end of life, San Francisco-based Wildflower Health, which recently closed a $5 million funding round, has reported success marketing its Due Date Plus mobile platform, which helps guide women through pregnancy with educational and clinical resources, such as click-to-call capabilities that enable patients to contact a nurse immediately with questions or concerns.

Wildflower CEO Leah Sparks says the underlying principle behind both its current product and future plans is to capture the "chief medical officer of the home" via platforms that encourage users to take action. At the same time, the product provides enterprise clients with ways to measure those actions, which also builds user loyalty.

"Our programs have some level of tools that are engaging from the perspective of helpful content and organizing tools, things that have nothing to do with healthcare ROI," Sparks says. "But they make that user feel like 'You are really helping me take care of my family,' which is an important place for health plans to establish themselves, because it's a gateway for gaining trust they never had."

Malkary’s firm is currently preparing a report on the climate around developments in remote patient monitoring. He says the confluence of value-based payment policies and the requirements of outcomes metrics are giving new momentum not only to data generated outside the walls of health systems but also mandating new business processes.

"Remote monitoring data, in and of itself, is absolutely useless," Malkary contends. "It has no context at all. We use it as a basis to triage the patient. We're lacking contextual information that surrounds the data, and therein lays the opportunity."

Others CCM vendors to watch:

*MD Revolution: The San Diego-based vendor's model includes a platform that syncs data from fitness devices, patients' medication regimens, and nutritional diaries, and employs metrics beyond barebones BMI measurements, such as visceral fat percentages and oxygen consumption. MDRevolution, founded in 2011, employs in-house nutritionists, fitness coaches, and nurses, and leverages incoming patient data to refine its machine learning algorithms to help "customize" health advice sent out. The company recently signed Memorial Hospital in Gulfport, Miss., as a client.

*Livongo Health: Chicago and Palo Alto, Calif.-based Livongo is pioneering real-time remote diabetes care through a partnership with Cerner, announced in 2014. This year, its momentum continued with accreditation from the American Association of Diabetes Educators and a $20 million funding round led by investment firm Kleiner Perkins Caulfield and Byers.

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