Sosena Kebede, MD, MPH, CHC
Founder, Executive Consultant, HealthCare Engagement, LLC
United States has the highest healthcare expenditure than any other nation on earth. Although we use more diagnostic tests than other industrialized nations, pay more to doctors, more to pharmaceuticals and use up to 8% of our total healthcare expenditure for healthcare administration (compared to 3% in other high-income countries)  provider burn out and disillusionment with the profession are on the rise .
With this backdrop, the healthcare system is under an unprecedented pressure from many angles to transform itself. Several government and institutionally sponsored endeavors are underway to cut cost, address population health needs and improve the patient experience-the so-called Triple Aims.
In the scramble to achieve the Triple Aims, industries from all sectors are jumping into the “innovation” bandwagon to reinvent how we do healthcare. The digital market is presenting itself as the indispensable innovative solution to all that ails the healthcare system. Even the government has caught the innovation fever and CMS now has an Innovation Center that solicits and rewards new care delivery and payment models that can help to achieve the Triple Aims.
Many would agree that no one has more at stake in the outcome of healthcare transformation than patients/ communities who are the end users of health services. Yet, only few patients and patient-advocates have an opportunity to meaningfully participate in this battle everyone seems to be waging presumably on their behalf.
Patients from lower socio-economic status are particularly alienated from the chance to advocate for themselves. To date, there has been little effort to formally document what vulnerable communities prioritize in terms of healthcare services they receive. In a pilot study done in Baltimore, Maryland we surveyed a small number of community members with a “What Matters to Patients” questionnaire. One of the notable findings from this study was community members rated the humanistic qualities of their physicians almost in par with their physician’s credentials. This result was presented at the annual International Forum for Quality and Safety in Healthcare in Kuala Lumpur, Malaysia (August 2017). Given the small size of this survey (N=32), no definitive conclusion can be drawn from this finding however a larger observational study to explore what matters to patients including those from lower socio-economic status is under way.
Research shows that when physicians actively engage patients in their own care patients can help reduce healthcare associated harm and improve their health outcomes and satisfaction . Unless we make efforts now to make the community an integral part of the healthcare redesign process, our innovations will recreate a model that perpetuates expensive but suboptimal healthcare system that is riddled with patient dissatisfaction, and health care disparities.
The complex process of transformation will take the input of many stakeholders and there will be neither quick nor perfect fixes. However, making patients and communities an integral part of this journey and especially empowering marginalized portions of the population for effective involvement is not only the right thing to do but the right way to doing it.
- Papanicolas, L. R. Woskie, and A. K. Jha, “Health Care Spending in the United States and Other High-Income Countries,” Journal of the American Medical Association, March 13, 2018 319(10):1024–39.
- del Carmen MG, Herman J, Rao S, et al. Trends and factors associated with physician burnout at a multispecialty academic faculty practice organization [published online March 15, 2019]. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.0554
- “Health Policy Brief: Patient Engagement,” Health Affairs, February 14, 2013.