I’m pleased to share two recent articles by our team that were published in the latest issue of The Journal of Ambulatory Care Management.

The first article, “Perspectives on How to Engage Consumers in Health System Transformation,” suggests that consumers and their health advocates can be valuable sources of expertise for policy makers and health care organizations looking to improve health care delivery. This article breaks out the steps in engagement, including tactics for recruiting consumers, tools for soliciting input from consumers on issues of health system transformation, and examples of supporting consumers in deepening their involvement. The work of Medicare Rights Center, Ohio Consumer Voice for Integrated Care, Pennsylvania Health Access Network, and Rhode Island Organizing Project are mentioned.

The second article, “Competing Visions for Consumer Engagement in the Dawn of the Trump Administration,” explores two distinct models of consumer engagement – one which sees patients as partners in health care decision-making and a second that focuses on financial incentives and penalties for patients. These two models use overlapping language to describe very different things. While the models could potentially co-exist in some circumstances, for patients with complex health and social needs these models are in direct conflict. For example, high cost-sharing has been demonstrated to result in underutilization of high-value services, particularly for low-income patients. Furthermore, a paradigm in which patients are asked to “shop” for low prices is problematic when patients have complex needs that benefit from coordinated care and longitudinal follow-up with a care team.

We are especially honored that this article was published with five commentaries from thought leaders in the field, namely:

  • Judith Hibbard, DrPH, who suggests patient activation as a way of assessing the effectiveness of engagement, and who reminds us that we must work to reach patients wherever they are on the spectrum of activation.
  • David Lansky, PhD, who discusses the forces that have impeded progress in consumerism, and suggests value-based insurance design (VBID) as a bridge between the two paradigms.
  • John Rother, JD and Larry McNeely, MPA, who also discuss the opportunities of VBID and highlight the critical importance of protecting health care coverage to any conversation about consumer engagement.
  • Jessica Mittler, PhD, who provides valuable historical context and deepens our understanding of the different frameworks in which consumer engagement is situated.

  • Lynn Quincy, MA, who reminds us that these two paradigms are not equal when it comes to evidence, noting the lack of evidence that high-deductible health plans improve health outcomes, patient satisfaction, or the use of high-value care.

We appreciate the Journal’s focus on consumer engagement for its 40th anniversary edition. We echo the call of the Journal’s editor, Dr. Norbert Goldfield, for “a relentless focus on improving consumer engagement” and hope these articles help to advance the conversation around this this critical set of issues.