It's time to flip the healthcare engagement model

We think the current healthcare engagement model is very inefficient. We certainly aren't the only ones saying it...

by Phil Beene
President at Nudge, Host of The Nudgecast

But I'm guessing you aren't here to read about the many ways in which the healthcare system is broken and inefficient.

That's good because I didn't want to write about that either.

What I'd like to propose in this article may be a pretty fundamental change in the way you currently communicate with patients, but it's also a change that any health or healthcare business can start the process of implementing immediately.

I think all the tools you need to make healthcare engagement much more efficient are available to you now, and the rest of this post - plus the bonus analysis at the end - will explain why we feel that way, and what you can do about it.

But first, let's break down the problem with patient engagement.


The Broken Healthcare Engagement Model

When I say the "current healthcare engagement model is inefficient" I basically referring to all the old tried-and-true ways that healthcare institutions have always used to communicate with, and reach out to their patients.

So we're speaking the same language, here's a quick summary of what patient interactions (communication and engagement efforts) typically look like today:

  • Most all health-related communication in time-consuming scheduled appointments.
  • Every now and then there is a phone call, but primarily just to schedule the next appointment instead of providing any value in the moment.
  • The is some general outreach, email communications (or even snail mail brochures) with generic health-related information goes out to patients.
  • And there are very few touchpoints that attempt to provide quick, specific, and actionable (i.e. efficient) value that is relevant to the patient.

Aside: If you want a quick read on the difference between patient outreach vs. patient engagement you might like this post - "Outreach Is NOT Patient Engagement" - but to summarize: 'Outreach' is communication in one direction (like a brochure in the mail). 'Engagement' requires back-and-forth between two parties (like texting back-and-forth).

But don't just take my word for it. Consumers aren't very impressed with their healthcare provider's patient engagement efforts either.

Let's use the CDW 2017 Patient Engagement Perspective Study to see what consumers think of the current status of engagement practices in healthcare.

To save you some time, here are the 4 key findings flagged by Managed Care Executive:

  1.  Patients like online access (70% find it makes them more knowledgeable)
  2.  Patients and providers both like patient portals (i.e. personal login to see patient info)
  3.  Patients love mobile apps (83% of patients would be comfortable communicating with providers via mobile app)
  4. Patients aren't impressed with the status quo (only 29% give their providers an "A")

To elaborate on that last point:

"Just 29% of patient respondents say they would give their healthcare providers an “A” for their use of technology to interact with and engage patients, and 89% of patients would like to be able to more easily access their personal healthcare records, according to the study."

These are just 2 quick stats from a huge survey, but they point to the larger problem: the basic model providers use to engage patients and provide care is exactly upside-down.

Here's what I mean...


The Upside-Down Patient Engagement Model

From a 30,000 foot view the traditional health engagement model looks something like this:

Old Patient Engagement Model

The vast majority of engagement happens in scheduled "appointments".

In population health management it could be scheduled phone calls, but it's still scheduled communication with specific time requirements for both care team members and patients.

"Touchpoints" in this graphic represent one-directional communications like marketing outreach, anything sent via snail mail, most emails, or even text message alerts that are not personalized or contextualized to help with a patient's current goals or health status.

Finally, "nudges" are personalized, contextualized interactions that reference the patient's individual health goals or status and suggest actionable next steps to improve.

Simply put, we think making "nudges" the base of the healthcare engagement pyramid would create an efficient and effective system of health engagement and population health management that could fundamentally change healthcare for the better.

In other words, what if the model looked more like this?

Nudge Patient Engagement Model

This is the Nudge Health Engagement Model and it is an important part of the vision we are working so hard to realize.

From here I will walk you through a simple experiment that our Chief Science Officer Dr. Steve Feyrer-Melk ran a several weeks ago to illustrate the potential efficiency of flipping the healthcare engagement model on its head.

From there we will break down what this should mean for your engagement strategy, how you and your team allocate time, and how you can more efficiently provide value to patients/clients going forward.

To put it another way:

If you're interested in learning how your health engagement strategy significantly more efficient, then you should keep reading.



Dr Steve's Internal Validation Experiment

Dr. Steve sent us this brief summary his patient engagement experiment:

The setting is in a private cardiology practice in which Dr. Steve manages a lifestyle-focused health management program for those at high risk or rising risk for heart disease or a significant cardiac episode.


In an effort to see how long it would take to "touch" each patient I conducted an evaluation by sending "nudges" to my 85 patients.


The Clients/Patients have been in my Program for greater than 3 months and I have remained engaged with them via Nudge coaching software, Zoom Video, face-to-face sessions, etc.


1.  Open the Client/Patient main page (in coaching software).

2.  Scan Client/Patient summary data tiles (Activity, Hydration, Nutrition, Sleep, Indulgences, Custom Trackers, Weight, etc.)

3.  Scan Client/Patient personal notes and info if I needed to refresh my mind.

4.  Send a Nudge.



85 sent


Start 6:30am - Finish 10:10am with 3 Breaks totaling 15 minutes

Total Time:

220 minutes (3 hours and 40 minutes) - 15 minutes (breaks) = 205 min total

Average Time Per Nudge:

2 minutes and 25 seconds


Summarizing The Key Takeaways

Let's review to be clear about what Dr. Steve was able to accomplish in this experiment...

Dr. Steve was able to send his patients personalized, contextualized text-based messages (nudges) to 85 separate patients in one morning (under 4 hours).

The context and personalization in these messages was provided by past patient visits, digital coaching messaging interactions, and health tracking data that Dr. Steve's patients manually entered or synced into their Nudge app from Fitbits, Apple Health App, or various other consumer health apps and wearables.

While brief interactions with a practitioner via text-based messaging aren't always a direct replacement for in-person sessions, when the messages coming from the practitioner can be personalized to each patient and their current health goals or challenges, then that patient is getting a lot of value from the interaction.

We like to call these brief personalized messages that reference currently relevant personal health goals or data "nudges".

And because nudges don't require both patients and providers to sync up their schedules for a direct meeting, they can create enormous efficiencies across the population health management and patient care continuum.


Time Saving Nudges

Let's do a quick thought experiment...

Take a moment and really think about how much time and effort (and cost) go into every single in-person patient visit or client session that gets scheduled.

If you don't want to do all the research yourself, I'll show you exactly how much time (and cost) we do sink into in-person visits - plus how flipping the status quo healthcare engagement model on upside-down could make the healthcare system several times more efficient and effective.

See our bonus analysis of how much time can be saved by flipping your patient engagement model here.