. . . “In the developed world, patient disengagement has become the new killer disease —not the lack of diagnostic devices, trained physicians or efficacious treatment options. Patients are actively choosing to discontinue treatment despite doctors’ recommendations to the contrary, and this is severely compromising population health and our ability to pay for healthcare . . .
Chapter 2: The Business of Healthcare—Where is the Money? [Extract]
The value of healthcare
If it costs $5 billion to bring a new product to market,[i] in a market of 50 million patients, with 10% market share, and a goal of 3:1 ROI, then, to a pharmaceutical company, the value of a patient is $3,000 per annum. If “value” to a health plan is the average annual premium received from large employers for coverage, then the value is around $6,251 per patient.[ii] If “value” is what the hospital collects for one inpatient day of care, then value of the patient is $1,791.[iii] However we look at it, the value equation in healthcare is determined by patients’ responses to, and within, the system.
Chapter 3: The Science of Patient Management [Extract]
Why, in a highly emotive and consequential disease such as breast cancer, would patients not be fully engaged in protecting themselves against a recurrence of cancer? Human behavior, and the decision-making behind it, is complex. Creating a change in behavior requires some acceptance of the evidence that describes the structure and processes that guide human decision-making. Advances in digital imaging over the years have provided opportunity to explore some of the intricacies of the brain-behavior relationship. At some levels, behavior is routine and automatic, while at other levels it requires forethought and planning.
Chapter 4: Hitting the Misses—A Challenge to the Status Quo [Extract]
By holding strong to these barriers, we remain in the status quo and are prevented from progressing patient engagement and population health at affordable levels. Each of these barriers will be discussed:
- Misapplication of claims-based models;
- Misinterpretation of segmentation models, and;
- Misunderstanding of patients.
After these three barriers are discussed, solutions are offered. Chapter 5 introduces an alternative, science-based approach and outlines a process for developing a scientific strategy for patient management. Chapter 6 details how this scientific approach shapes effective program design (the right interventions). Chapter 7 discusses how to apply this approach to identifying and profiling risk profiles (the right people in the right interventions). Chapter 8 outlines how to analyze the impact of this type of approach on the business of healthcare.
PART III – Charting a Course to Improved Engagement and Outcomes [Extract]
Step-by-step approach for building and executing a science-based approach
Commercial strategy or health engagement efforts are only as strong as the foundation on which they are built. What follows is a step-by-step process on how to use science, particularly cognitive science and the mechanism of how patients think, to navigate us from concept to design, development, execution and measurement. The steps are presented in Figure 1.
Figure 1: Process map for a science-based patient management strategy
Each of the four process milestones—(1) Develop the scientific platform, (2) Design the solution with a defined Mechanism of Action (MOA), (3) Identify business relevant segments, (4) Measure progress to goals—is discussed in the next four chapters.
Chapter 6: Designing a Solution With a Defined MOA—The Right Intervention [Extract]
Know the ROI before you spend
A reliable cognitive model will also state how far the ROI can be driven by each cognitive factor. For example, for every dollar spent on communication of a stronger predictor, up to an 8:1 ROI can be expected, compared to communication of a weaker factor, where a 2:1 ROI might be expected. This is based on the total dollar return projected by closing the gap from baseline behavior to desired behavior (or more correctly, by closing 90% of the gap, per the model’s power). Let’s unpack this in a little more detail.
Chapter 7: Identifying the High-Risk Segments—The Right Patients
The average cost of patients diagnosed with type 2 diabetes is $11,700 per annum[i], according to United Healthcare. Unfortunately, over 60%[ii] of these patients will escalate from mild disease to mild/moderate, costing an average of $18,000 per annum. Thirty one percent will continue to escalate to moderate diabetes[iii] costing $25,000 per annum, and 17% will escalate to severe diabetes[iv] costing $20,700 per annum[v]. The value of patient management strategy lies in detecting these 22% of patients before they experience disease complications and reach the higher bounds of costs of care. Therefore the business imperative operates on how we isolate these 22% of patients early enough to direct them away from their predictable future and secure more moderate outcomes for them.
Chapter 10: Translating Patient-Centricity
into Population Management
A large focus of this book has been on patients’ levels of engagement within the healthcare system. But to be clear, the purpose of patient engagement is to support the effective delivery of interventions on a broad-enough scale to improve population health. The focus on improved engagement is really part of a bigger strategic goal of improving health outcomes with enough vigor to create an impact at a population level. This is why health outcomes define how the scientific approach gets applied (Chapter 9). It is why health outcomes define what we do with patients we have profiled (Chapter 8). And it is why health outcomes, rather than surrogate markers such as household income, ethnicity, or personality segments, define the targets for intervention (Chapter 7). The further away any part of the process gets from the actual business goal of improved outcomes, the more our ability to reach that goal is stifled.