Research shows that highly activated patients have lower rates of hospitalization and emergency department visits. So how can hospitals and health systems increase patient engagement and improve the patient-provide experience? This often-overlooked resource can play a central role.

Globally, healthcare is in transition. Multiple factors are contributing to this transition, including an aging population and expenses that are growing faster in the healthcare sector than in any other. In addition, the global coronavirus pandemic has shown that the internet can be used in many ways to support the routine delivery of healthcare services, thereby potentially avoiding contact with a Covid-19-positive individual. A common thread in all of this change is the need to engage patients differently. But what is the evidence to support that such engagement translates to improved outcomes or a better patient experience?

In an article published in Health Affairs, researchers Judith Hibbard and Jessica Greene review some of the published data regarding patient engagement as it relates to outcomes, the patient experience, and costs.¹ It is important to note that engagement is more than a nebulous concept and has dimensions that include patient activation, which is quantifiable using the Patient Activation Measure. In their review, Hibbard and Greene discuss the relationship between high activation scores and positive behavioral changes, which are associated with better clinical outcomes for patients with chronic conditions. They define patient engagement more broadly, using the term “to denote a broader concept that includes activation; the interventions designed to increase activation; and patients’ resulting behavior, such as obtaining preventive care or engaging in regular physical exercise. The focus on activation and engagement rather than compliance recognizes that patients manage their health on their own the vast majority of the time, making decisions daily that affect their health and costs.”

An important part of the article relates to the authors’ review of the impact of patient engagement on the patient experience. Studies have shown that, when surveyed, patients who are more highly activated report more positive patient experiences than do patients with lower activation scores. Having a better patient experience likely helps to support patient engagement and contribute to higher activation. But what about the bottom line? Does it contribute to lower healthcare costs?

As Hibbard and Greene noted, “Several studies have reported that after disease severity and demographic characteristics were controlled for, highly activated patients had lower rates of costly use such as hospitalizations and emergency department visits, compared to less activated patients.” So, patient activation — and, more broadly, patient engagement — appears to be central to achieving the goals of the Quadruple Aim. But how does this relate to part of the healthcare delivery process?

Let’s consider how provision of diagnostic services from the clinical lab can engage patients and providers differently. Having to wait or have repeated visits to complete a care episode can be highly frustrating for patients. Clinical laboratories can help decrease the need for such return visits by providing diagnostic pathways that only do the testing needed and do not require providers to make the choice of A) ordering a large battery of tests (contributing to cost), or B) having the patient return for further testing if they order a minimal number of tests and one or more of those results is positive (leading to a poorer patient experience). Clinical labs can provide appropriate alerts to providers to assist with diagnostic ordering decisions, so that providers can spend less time searching for results and more time in direct face-to-face patient care (improving both the provider and patient experience). Clinical labs can help track results across the continuum of care (from outpatient to inpatient to skilled nursing facility) by appropriately supporting care delivery in the community across the continuum (decreasing costs related to non–value-added repeat testing). Finally, clinical labs can directly impact the patient experience by appropriately supporting patient service centers, which are convenient and efficient for patients to visit.

Patient engagement is critical to achieving better financial and clinical outcomes for hospitals and healthcare systems. The clinical laboratory can play a central role in engaging both patients and providers to improve their experience.

¹ Judith H. Hibbard and Jessica Greene, “What the Evidence Shows About Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data on Costs,” Health Affairs 32, no. 2 (February 2013): https://doi.org/10.1377/hlthaff.2012.1061.