As we mark significant milestones in our changing healthcare landscape, much of the dialogue continues to focus on the goals of payers and providers. Yet the goals of a third group are just as important. In order to truly transform care delivery in coming years, our efforts must include patients — their needs, interests, and engagement — at every step.
For the first time, the Affordable Care Act (ACA) will give millions of low-income Americans real choice in their health care. This will require a shift in how we’ve done business for decades. It will also create challenges, as the patient population begins to look very different from that of the past.
These newly eligible patients and their preferences are at the center of a series of surveys commissioned by Blue Shield of California Foundation. The research brings the voices of low-income patients into the conversation about the reshaping of our healthcare system. Each survey polled Californians ages 19-64, with household incomes below 200 percent of the federal poverty level, and asked about their needs, experiences, and aspirations related to their own health and care.
The latest survey findings, just released as part of the Foundation’s “Building Better Health Care for Low-Income Californians” report reveal where these patients turn for health information today and how they communicate with physicians and other health professionals. The findings highlight issues as well as opportunities. For example, results indicate that only 28 percent of these individuals feel they have clear, accessible information to make decisions about their health, leaving more than seven in 10 wanting more information from their providers if it is easier to find and understand.
Historically underserved, many of these patients have faced major barriers in accessing care and finding a consistent provider. For medical information, they typically turn to other, less trusted sources. The survey found that nearly four in 10 people rely on media and the internet when they have health questions or concerns – equal to the number of patients who seek out physicians or other providers.
The survey results clearly show that communication and information are fundamental to strong provider-patient relationships, and that bond pays measurable dividends in how highly patients rate their quality of care. For low-income patients, this directly correlates with their confidence in their ability to make good healthcare decisions. Such data on the factors that drive “engagement” turn it into more than a healthcare buzzword, as Dr. Leslie Kernisan recently noted in her column on the Health Care Blog.
True patient engagement will also increasingly require the use of new communication tools and technologies. In fact, seven in 10 low-income Californians with email or mobile texting capabilities say they would be interested in using them to communicate with their healthcare providers. The same is true for new approaches and alternative care models like team-based care, which the survey identifies as having a particularly positive impact on helping patients feel connected and informed.
Navigating the post-ACA landscape and dealing with the expected influx of patients will not be easy for providers, especially those working in primary care within lower-income communities. They may be hard pressed to take the time needed to develop a relationship and discuss important issues with patients in order to educate them and understand their perspectives. But doing these things well is essential if healthcare reform is going to work. Providers who grasp this will be the ones who ultimately survive and succeed.
This may yet be our greatest test — whether we can effectively listen to and engage the individuals we aim to serve, so that together we can bring about a vastly improved system of care for all.
Peter Long is president and CEO, Blue Shield of California Foundation.
