The Missing Headline: Where's the Patient in Patient-Centered Care?

Today's headlines reflect the impact of more than 133 million people living with chronic conditions such as heart disease, diabetes and depression in a fragmented, acute health care system, but they don't tell the whole story of the 1.3 trillion dollar chronic care problem.  Although the magnitude of chronic conditions has not gone unnoticed, the solution has. 

The medical home is a proposed model designed to repair chronic conditions care. The medical home supports a changed reimbursement system that will empower physicians to offer physically and financially accessible care. The model also values disease prevention, identification and intervention.  Primary care physicians would serve as an access point and navigator to the health care system to stitch together primary and specialty care. This concept has evolved into the Advanced Medical Home and then the Patient-Centered Medical Home to represent a more holistic view. However, a very important piece is missing from each iteration of the model: the patient.

Physicians do not have the time or the training to help individuals reverse years of poor habits in an office visit. In the current health care system, the physician has only 15 to 20 minutes  on average to take a history, perform a physical exam, prescribe or adjust medication, explain side effects and proper dosage, and educate on the specific chronic conditions. The few remaining seconds, if there are any, are used to answer questions and empower the patient to adopt the positive, healthy behaviors necessary to prevent chronic disease complications or progression. A collaborative patient-physician relationship is imperative. Even if a person with a chronic illness sees their physician each month, this still leaves 353 days during which the patient is solely accountable for the daily decisions that affect his or her chronic disease management.  After people leave the doctor's office, how will they be empowered to act on their doctor's recommendations?

Because chronic conditions are managed outside of the doctor's office, employers cannot rely only on physicians to reverse the negative trends. Many of the direct medical costs associated with managing and monitoring chronic conditions have been shifted to employers. Chronic conditions negatively impact employees’ effectiveness at work, through reduced productivity (presenteeism) or work-days lost due to illness (absenteeism), which indirectly increase employer’s costs. Employers not only have a vested interest in adopting health promotion initiatives; they are also well-positioned to explore novel solutions to promote employee health and wellbeing.  Since people spend around eight hours of each weekday at work, the workplace is situated as a much more effective location than the doctor’s office for implementing wellness interventions. 

The solution an organization chooses to employ must extend beyond the office walls and into the person's day-to-day life.  In the past, this has meant traditional disease management with nurse call centers.  An industry analysis - conducted by Triple Tree - challenged the health industry to create new approaches to address difficult behavior change that can truly impact costs and improve health. They cited the importance of an affordable, seamlessly integrated approach that focuses on both psychosocial and physical health. Scalable, digital solutions that replace or augment traditional call centers can lead to a greater level of self-management of chronic conditions and real-time communication, which can reduce expenses and administrative tasks.

Technology-based solutions, like digital health coaching, provide a low-cost, behavioral intervention that are designed to mitigate the potential negative impacts of chronic conditions.  Technology-based solutions can be scaled to an entire patient population, customized to focus on the specific health needs of individual patients, and accessed confidentially at the convenience of the patient with 24/7 availability. These characteristics enable online interventions to reach those individuals who may not otherwise seek help from other sources.  These types of tools and resources empower patients to be more active in managing their chronic conditions by receiving health coaching to improve treatment and medication adherence, to adopt healthier nutrition habits, and to make positive lifestyle changes. Additionally, patients learn how to better communicate with their health care providers, which can help make visits to the doctor’s office more effective. 

Over 37,300 people have participated in the HealthMedia® Care® for Your Health program, a digital health coaching program designed to help participants learn the skills necessary to manage a chronic condition.  In a 180-day post-program survey , respondents (N=3,038) reported that they

• Were better able to manage their health (91 percent)
• Had improved their health (87 percent)
• Had improved communication with their health care provider (89 percent)

The initial outcomes data suggest that even modest, positive results can make a significant difference in quality of life across a large participant population. This effect can be amplified given that digital health coaching interventions can be scaled to reach participant populations of any size.   

Technology-based solutions can be a valuable component in a Patient-Centered Medical Home system. In addition to empowering patients to actively participate in the management of their chronic health conditions, online interventions can help doctors remotely monitor a patient’s progress, enabling health care providers to make recommendations or changes to a patient’s treatment regimen in between office visits.

The Patient-Centered Medical Home model aims to improve the care of individuals with chronic health conditions by providing defragmented and affordable health care. For example, stronger affiliations between primary care and specialty care physicians can lead to a more unified and cost-efficient delivery of health care. Additionally, it is vital to include the patient as a partner in the Patient-Centered Medical Home relationship. The incorporation of new technologies, such as digital health coaching, can prove essential in educating individuals about their chronic conditions. Patients that are taught chronic condition self-management behaviors, and are able to communicate actively with their doctors, are more likely to be successful partners in the Patient-Centered Medical Home system.

1. DMAA: The Care Continuum Alliance. (2008). The Medical Home and Population Health Improvement: Common Ground.
2. Travelin, J.M., Ruchinskas, R., D'Alonzo, G.E. (2005) Patient-Physician Communication: Why and How. JAOA, 105, p. 13-18.
3. N=3,038; From HealthMedia® Proprietary Database, 2010

About The Author

Danielle L. Giuseffi, MPH is a Research Associate for the Behavior Science and Data Analytics Group at Wellness & Prevention, Inc., a Johnson & Johnson company.  Danielle's role allows her to utilize novel research to enhance participation and engagement in digital health coaching programs.  Danielle received a Bachelor of Science in Biology from the University of South Dakota and a Master of Public Health degree in Health Behavior Health Education from the University of Michigan School of Public Health.