Employer Clinic, Employer Health Benefits

RxStewardship: E is for Engagement

Week 5 – R X S T E W A R D S H I P


E is for Engagement

Health care terminology has always been interesting to me. Borborygmus (stomach growling) is one of my favorite unique sounding words that is just fun to say. Most proper medical terms are precise and refer to very specific pathology, symptoms, procedures or medications. However, this preciseness has not translated to healthcare administration where many phrases are commonly used but lack concise or even agreed upon definitions. Terms such as “wellness”, “population health” or even “compliance” tend to fall into this category. Another term that has eluded a standardized definition is “engagement”. At Northwind, we talk a lot about engagement so we thought it might be helpful to put additional context behind our use of the word.


The current concept of patient engagement can likely be traced back to the 2001 Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century. The purpose of the report was to address challenges many patients faced when trying to navigate a complicated health system that often valued a one size fits all approach over patient buy-in, understanding or convenience. The report envisioned a ‘patient-centered’ system that provided care that was ‘respectful of and responsive to individual patient preferences’ and resulted in patients understanding their care plan in an effort to increase their ability to follow treatment regimens.

In the intervening years engagement has been the topic of countless presentations, articles, conferences, books and panel discussions. Companies have been created to assist organizations with tactics such as patient portals, social media campaigns, wearable health devices and program development. Engagement has even served as its own outcome metric. The National Committee for Quality Assurance, among other organizations, has deemed a variety of assessments measuring patient engagement as a requirement for certification. Medical providers, benefits directors and IT executives all claim a certain level of ownership in creating ‘engaged patients’ even if they do not agree on what that means.

From our perspective, the conceptual framework of patient engagement that was put forward in a Health Affairs Policy Brief seems particularly poignant. The authors first outlined “patient activation” as the patient’s knowledge, skills, ability and willingness to manage their own health care. They then defined “patient engagement” as a broader concept that combines patient activation with interventions designed to promote positive patient behavior. As Michelle Noteboom summarized in a subsequent Healthcare IT News article, “In other words, the patient is willing and able to participate in [their] care and someone is providing ‘interventions’ to promote that participation.”


With so much mindshare devoted to characterizing patient engagement, it is logical to ask the question – is engagement all that important? In a word, yes. Using the concepts of patient activation and engagement as defined above, a randomized, year-long study of over 60,000 patients demonstrated that those with the highest activation scores, even after adjusting for health status and other health-related factors, had 21% lower medical costs as compared to a peer group with the lowest activation scores. In addition, patients who were provided enhanced programmatic support experienced 12.5% less inpatient admissions, 2.6% less emergency department visits and 9.9% fewer surgeries.


At Northwind, we have a variety of programs and services available to assist our partners in providing patients with the knowledge and skills needed to create activation. These include resource guides, medication education, compliance packaging, patient care apps and a team of pharmacists available for personal consultation as needed. We also offer patient engagement opportunities through our chronic disease clinical blueprints which provide care navigation assistance for patients and providers alike. These blueprints cover everything from program development and patient enrollment through outcomes measurements.

If you want to learn more about driving outcomes through our patient engagement strategies – let’s have a conversation!

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