In the world of population health and wellness, engagement happens when an individual is an active participant in improving or maintaining their health. It often requires more than office visit notes for a patient to let go of unhealthy habits, and it takes more than a water cooler conversation for wellness to occupy the minds of employees. In 2013, Health Affairs published an excellent article that defined engagement as “active partnership.” A literature review funded by the Agency for Healthcare Research and Quality (AHRQ) concurs. Researchers concluded, “Patient engagement can be defined as the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or experiences of care.”
Optimal health occurs when individuals, families, friends, health professionals, and communities work together to achieve a common goal, and personalization is essential. Population health and wellness professionals must consider an “individual’s knowledge, skill, and confidence for managing his/her own health and health care,” according to Health Affairs. They must also be aware of and accommodate the individual’s willingness to make needed changes.
It makes sense that individuals who participate in healthy behaviors experience improved health, and research has confirmed this. Active involvement is key to improved health, as individuals who are engaged in caring for their health have healthier habits, adhere to treatment plans, use emergency services less often, and have a higher quality of life. One survey found that employees who are engaged in their workforce wellness programs are more likely to have healthy behaviors, be loyal to their jobs, and be motivated and productive at work. Patients who actively participate in their health, including decision-making, also have better outcomes and lower costs.
Population health managers spend a lot of time thinking up ways to entice individuals to become active participants in healthy behaviors—and with good reason. Only one-third of patients are highly engaged in their health, according to a New England Journal of Medicine Catalyst Insights survey on patient engagement. However, according to a Health Affairs Health Policy Brief, “People actively involved in their health and health care tend to have better outcomes—and, some evidence suggests, lower costs.” Engagement may involve “both process and behavior” and be influenced by:
Population health and wellness professionals now walk the tightrope between knowing too much and too little. Genomics and precision medicine can help predict disease and an individual’s response to interventions and treatment. Consumer data and data from wearables such as fitness trackers can reveal much about an individual’s preferences, habits, and motivations. Increasingly, individuals are willing to share type of data with their healthcare teams.
However, the healthcare sector is under persistent cyberattack. More than 11 million individuals were affected by healthcare breaches in 2018. Healthcare security lags behind all other sectors, according to the tenth annual Online Trust Audit & Honor Roll. A population health team must include cybersecurity and privacy specialists, such as a dedicated security officer and privacy officer, that ensure all processes, policies, and procedures are in place—and followed. Verification by an independent accrediting board is also advisable. This will ensure populations that their data are kept confidential.
Health and wellness professionals use big data and AI to stratify populations. Useful data include self-reported data gathered from a health risk assessment (HRA) or doctor’s office visit, neighborhood statistics, and consumer details. Information such as where a person lives (their ZIP code) and where they go to church wields more sway in a person’s health than genetics. As former Surgeon General Regina Benjamin observed, health “occurs where we live, where we work, where we play, and where we pray.” A recent study found that care coordination and community outreach interventions could reduce health costs and improve health outcomes.
Successful population health management relies on an engaged population—one in which individuals are active participants in both decision-making and follow-through in behaviors that will improve their health and wellness. This differs from compliance, where an individual simply follows orders. Engaged individuals seek out the best approach for their optimal health. This is similar to a precision medicine model in which patients are partners in their care.