With all the talk about patient engagement these days, one question lingers in the background: Just how much influence can – or should – a doctor have on patient adherence?
To wit: Once you send a patient home from the hospital or doctor's office with a set of instructions for continued care, how far can you go to make sure those instructions are followed?
The mHealth world is being flooded these days with platforms that promote doctor-patient communication and care management outside the office, allowing patients to check back in to make sure they know what they're supposed to be doing (fill these prescriptions, do those exercises, lay off the fatty foods, etc.) and caregivers to see if those directions are being followed, or if they need to be modified. Some are opting for the soft approach, marrying compliance to rewards or just showing the patient how much life would be better if he or she followed the rules. Others are taking a more hard-edged approach, in the form of raised insurance premiums or reduced benefits.
[mHealth masters Q&A: Wireless-Life Sciences Alliance CEO Rob McCray.]
But how forceful can a provider – or a payer, for that matter – be if they feel a consumer isn't holding up to his or her end of the deal? Should they be allowed to tap into a patient's personal devices to see if they're complying? Much like insurance companies send out investigators to target fraud, can they spy on their members to make sure they are exercising, eating right and taking the proper medications?
(Mr. Baker, we see from your FitBit that you did NOT take the minimum required steps yesterday, and your e-scale tells us you've gained a pound over the past week. Have you been spending too much time on the couch or indulging in an extra doughnut or two? That's not what we told you to do after your recent health scare ...)
It's a slippery slope, and one that few doctors would likely want to traverse. After all, they'll reason, they issue the prescriptions and hand out the instructions – if those rules aren't followed, the harm is done to the patient, not the doctor. Likewise, a payer might just boost the premiums for someone who isn’t complying and leave it at that.
But in a healthcare landscape almost crippled by waste and rising costs, and with a pending deficit of healthcare providers and surplus of elderly and people with chronic conditions, shouldn't we take a more forceful approach? In all honesty, one person's failure to adhere to medical directions ends up boosting expenses, creating more work that could have been avoided, and affecting far more than just that one patient.
In a similar vein, a business executive who's forking out huge sums of money for employee health insurance might want to be more forceful in getting those employees to toe the line on health and wellness. After all, a sick employee affects productivity, other employees (who have to cover for that employee) and, eventually, the bottom line. And can an employee be fired for not being healthy?
mHealth is giving healthcare providers and consumers all new avenues on which to connect and share healthcare data, and at present it's the consumer's right to decide whether to share his or her healthcare data with providers. But sooner or later a provider is going to cut services because it's just too expensive to deal with non-compliant patients, or a business will be forced to drop insurance (or even fold) because its employees just aren't staying healthy enough.
Then we may have to start wondering if healthcare is a right or a responsibility.