Monday, March 3, 2014

Patient Engagement and Physician Entrepreneurs

On engagement, we’re already seeing that mobile users are more likely to be daily users than desktop users.

Mark Zuckerberg (born 1984), Facebook Founder

Be ready.  React to what the market wants.  And the market wants one-on-one real time engagement. Now that we have the tools to engage, I’ m going to continually fight for the end user.

Gary Vaynerchuck (born 1975), co-founder and CEO, social media brand consulting

For health care professionals, patient engagement is the holy grail of health care.  It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients.  It is easy to recognize an engaged patient – they do what their health care providers recommend.
Steven Wilkins, MPH,  Patent Engagement,  January 27, 2012,  Kevin Pho website

These days you hear a lot about patient engagement these days.  It is constantly being said that doctors, health plans, hospitals, and even government must engage with patients.   

Patients should be the center of the new health care universe. Engaging patients is the path to more efficient and effective  health care delivery, preventing disease,  fostering wellness,  persuading  patients to take their medications,  co-partnering  with them to carry out their treatment regimens.  Engaging patients is the holy grail.


But how?   Engaging patients take time, and if you’re a doctor, you may feel you have no time with all time consumed with  data entry, documentation, and complying with regulations.

There are those who say if doctors would only learn to talk to patients,  to listen to them,  ,  all would be well (“Can Doctors Be Taught to Talk to Patients,” New York Times", February 27, 2014). 

But talking and listening takes time,  and  doctors have little time  to meet their practices’ financial   bottomlines, to pay off your medical school debts, and to meet the demands of their employers and government for more efficiency, better outcomes, and more satisfied patients.
But there are ways to engage patients – to take the time and to enlarge the time you need to engage with them.  

These ways reside in the minds of physician entrepreneurs, who seek  deeper patient engagement.

More Personal Engagement Through More Direct Care

·         Drs. Josh Umbehr,  a family physician,  founded his Atlas MD concierge medical practice in 2010 in Wichita,  Kansas.  He was inspired to start it after reading Atlas Shrugged.  He now has two partners, and the practice is booming.  He calls his practice an insurance free direct care practice for which patients pay a monthly retainer.   The practice is based on these  ideas:  having time to spend more time with patients because it is free of regulations and 3rd party hassles;   using  innovative software that frees up time to spend with patients,  personalizing care by having only 600 patients and knowing their individual stories inside and out;  seeing patients either at the office or in their homes, whichever  patients prefer; promising to see patients on the day they call;  spending as much time with patients as needed;  giving patients their cell phone numbers so as to be constantly available; and by  offering direct care as inexpensively as possible. 

More Time Saved Through More Better Software Use

·         Family physicians,  Allen Wenner of Columbia, South Carolina, and John Bachman of the Mayo Clinic in Rochester, Minnesota, engage patients by encouraging patients to enter their personal histories and their reasons for seeing the doctor into a computer or Iphone from home, in the reception room, or wherever they might be.   The personal history, which usually takes about 10 minutes to complete, is called the Instant Medical History and may be obtained on the web at   It consists of clinical algorithms based on the patient’s age, gender, chief complaint,  symptoms, and family and social history. The patient responds to a series of Yes or No questions.   

      The output of the software is the patient’s history in narrative form.  The patient enters the exam room with this history, the doctor reads it, enters his findings, and the patient leaves the office with a complete medical history in hand.  This approach as several distinct advantages: it saves the doctor time by getting to the essence of the patient’s problem quickly in the patient’ s terms.   It engages the patient.  Is is useful for coding and billing purposes.   It is a complete history.  It saves 6 to 8 minutes for each patient visit.   It can be used as a basis for referral letters and as a justification for codes.. It reduces malpractice risks because it creating better understanding of what took place in the doctor’s office.  

Two Reform Movements – Team-Care and One-On-One Care

These physician entrepreneurs seek to advance the cause of personalized medicine.   Two complementary, sometimes contradictory, movements are at work in health reform.
  • ·         Consolidation of care into large organization – such as in hospitals,  large integrated health systems, and government-sponsored accountable care organizations, featuring “team-based care” by multiple health professionals.

  • ·         Decentralized care outside of these institutions by private physician entrepreneurs featuring one-on-one relationships in private offices and specialized doctor-own centers.

Room and Rationale For Both

There is room and rationales for both approaches.  Both require use of information technologies to document what is transpiring, justify the fees charged, and improve outcomes.    Some patients prefer the organization team method, others the more personal one-on-one method. Both may be entrepreneurial driven and require software to satisfy new generation of technological savvy patients who want  a deeper understanding of their sickness problems and wellness opportunities.

Tweet:  Physician entrepreneurs, using personal approaches to care and more advanced software, are changing the nature of healthcare.   

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