A new buzzword popular among health care leaders is “patient engagement,” sometimes referred to as “beneficiary engagement” when referring to Medicare beneficiaries. What does this concept mean for kidney patients? In general, patient engagement refers to transforming patients from passive recipients of health care to active partners, with their providers, in self-management of their disease. We often hear from veteran dialysis patients that success in avoiding complications depends on the patient taking on an active role in his or her health care and working with clinicians on a “two-way street.”
While this kind of active engagement is certainly typical among the members and volunteer leaders of Dialysis Patient Citizens and the DPC Education Center, policymakers in Washington, DC fret that all too many Medicare beneficiaries with chronic illnesses fall into the passive category. Their worry is that passive patients don’t realize the full benefits of their health care, and experience complications too frequently, thereby driving up costs of the Medicare program. At the Center for Medicare and Medicaid Services (CMS), top leaders are talking about experimenting with new techniques to increase patient engagement.
Several dialysis patient engagement and empowerment pilot programs have been tested on a small scale at clinical sites all over the world. Some techniques show promise in “activating” ESRD patients through more intensive education efforts, and reinforcing the message so patients are more likely to act on the information. Reinforcement activities in these pilot programs included coaching, peer support and motivational interviewing.
An intriguing method of reinforcement that has not yet been tried in ESRD patients is incentive programs, where patients receive some monetary or other tangible benefit to motivate participation in health improvement activities. Incentive programs are currently being tested in several state Medicaid demonstrations. This concept is popular with economists, who believe that patients will be more motivated to reduce health care expenditures if they get to share in the savings.
The DPC Education Center is forming a Kidney Patient Engagement Advisory Committee to stay abreast of developments in this area. If you are interested in participating in this advisory group, please e-mail jwilliams@dialysispatients.org.
