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Population Health News

Online Patient Engagement Spikes When High Costs Are Involved

When online patient engagement offers a financial benefit to patients, they are much more likely to choose email over office visits.

By Jennifer Bresnick

- Patients who are financially responsibile for high out-of-pocket costs are significantly more likely to choose email and other online patient engagement methods over an expensive office visit to contact providers about their health concerns, finds a study published this month in the American Journal of Managed Care (AJMC)

Patient engagement and chronic disease management

Forty-six percent of patients who sent their providers an email said that online patient engagement tools were their first choice for contacting clinicians when they had one or more medical concerns, including questions about chronic disease management. 

More than a third of patients who communicated with their providers by email said that the activity reduced their phone contacts or in-person office visits, while a similar number said that keeping in touch with their providers through email helped to noticeably improve their health.

“Secure electronic messages offer patients and physicians an additional channel for communication and may serve as a unique mechanism for healthcare delivery,” says the study, conducted by researchers from Kaiser Permanente, the University of Tennessee, and Massachusetts General Hospital.

“Although recent estimates show that most physicians in the United States are not yet regularly communicating with their patients electronically, most patients indicate an interest in communicating directly with their healthcare providers online.”

The mismatch between patient interest in online communication and providers’ willingness or ability to deliver the capability to their clients is well documentedIn a recent poll, more than half of patients said they are unable to access their own EHR data through portals or other viewing tools, despite the fact that three-quarters of participants said that the ability to view their information would improve their knowledge of their own health and make communication with their providers easier.

For patients with chronic diseases, such as those participating in the AJMC study, constant contact with the healthcare system is a given.  While only three percent of the 1041 patients included in the study said that they would avoid contacting their provider all together if an email option wasn’t available, the ability to make chronic disease management a convenient and painless process has benefits for providers and patients alike.

The most immediate gains are likely to be financial.  As patient satisfaction scores and overall outcomes become more and more important to healthcare organizations participating in accountable care or value-based reimbursement arrangements, providers shouldering risk for population health management have a vested interest in trimming expensive office visits that turn out to be unnecessary.

Patients, too, are feeling the pinch in their pocketbooks as payers steadily increase deductibles and co-pays.  The study found that patients who had to pay more than $60 for a typical office visit were more than 20 percent more likely to choose email as their first method of contact than patients with lower up-front responsibilities.

Approximately 90 percent of patients who preferred email as their primary means of communication would opt to use the phone instead if they couldn’t message their providers, indicating a high willingness to keep an in-person visit as the last resort for resolving their concerns.  Just one percent said that they would head to the emergency department if they couldn’t get a quick response from their provider through email.

Indeed, the number of in-person office visits dropped drastically when email and phone contact was a primary option.  Thirty-six percent of patients said they trekked into the office less frequently when they could use email or phone calls instead.  Thirty-two percent said that remote care features helped them to improve their overall health.

The authors note that the availability of remote communication options may also have an impact on overall quality of life and convenience for patients. “Although our study focused only on out-of-pocket charges for healthcare services such as co-payments and deductibles, patients may have also had other unmeasured personal expenses for transportation, lost wages, childcare, et cetera associated with any healthcare encounter,” they write.

“Future studies should continue to examine the impact of patient-provider e-mail use on healthcare-seeking behavior, clinical care delivery work flow, and patient outcomes.”


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