The promise of health reform initiatives and legislation to improve care will only be achieved with increased engagement of individuals, according to the Center for Advancing Health’s (CFAH) landmark report, Snapshot of People’s Engagement in Their Health Care. This statement comes out of CFAH’s analysis of 31 surveys gauging how people ‘do’ health that is, the sum of actions individuals take to obtain the greatest benefit from the health care services available to them, or health engagement. The Center identified 10 categories that, together, account for health engagement actions; these are identified as the “10 commandments of health engagement” in the chart, and include seeking knowledge, planning and organizing, communicating, and making good decisions about health. Judith Hibberd of the University of Oregon innovated the Patient Activation Measure which assesses whether people understand the need to take active roles in health care, and how well they think they do this role. Hibberd found that only 2 in 5 adults believe they can fully participate in their care, but were still uncertain they would be confident if put into a stressful situation. CFAH dissects each of the ten engagement areas and identifies tactics health citizens can take to benefit, what’s at stake, and how people now handle the issue. For example, in the category of “Pay for Health Care:” To benefit, people must compare insurance coverage options, match to personal values and preferences, and select coverage; ascertain cost and benefit coverage restrictions and variables in co-pays; adjust coverage when life changes occur; keep receipts for all out of pocket payments. What’s at stake is that health consumers are likely “to pay more for less” if they seek care without using available information to inform their choices. “Less” means poorer quality, fewer services covered by insurance, and unnecessary out of pocket expenses or higher costs for similar services. What actions people now take are highly variable: 1 in 3 people with Internet access compared options before making decisions; 30% of Americans spent time on paperwork or disputes concerning medical bills and insurance; only 9% of people used information comparing the quality of health insurance plans in 2008. Thus, CFAH finds that relatively few people “actively act” to lower the costs of health care. Health Populi’s Hot Points: Dr. Charles Safran has said, “patients are the most under-utilized resource” in the U.S. health system. Another take on lack of health engagement comes from Gary Belfield of the National Health Service in the UK who believes that, “the patient owns the chronic disease.” Connecting the dots between people and their personal commitment to engagement in health isn’t a straight line. The interplay of socioeconomic, demographic, cultural and logistical factors for each individual complicates the matter. Ask any Weight Watchers mentor, any doctor working with a patient to manage high blood pressure medication adherence, any diabetes educator managing a panel of Type 2 diabetics, and you’ll hear the evidence of just how hard health engagement is to do. Perhaps it’s best to think of health engagement as a process, a journey, more than and end in itself: a one-day-at-a-time personal evolution for health citizens. That’s why the emerging micro-decision and nudge approaches are going to prove to be so important as tools for this trek. There is no bending of health cost curves, no achievement of optimal health outcomes, no maximizing public health without full-on engagement by health citizens. The ten areas of engagement identified by CFAH provide a comprehensive, wise, tactical road-map for people and policymakers to use for achieving true health reform. Whatever sound health policies might come out of Congress, State houses, or employer health plans can be easily undermined by us individual health citizens ourselves. Over the next two years, stay tuned to 10 deep-dive papers from CFAH that address each of the categories of health engagement. These will be useful Trip-Tiks for all of our health journeys that lay ahead.]]>
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Jane Sarasohn-Kahn, MA, MHSA