The rise of patient activated healthcare
The COVID-19 vaccine rollout has shown its potential and challenges
By all measures, the speed of COVID-19 vaccinations in the US to date has been disappointing to say the least. The country fell well short of its goal of 20m vaccinations by the end of 2020 (only reaching 3m), and has yet to surpass a 7-day average of 1m shots per day. More frustratingly, only 47% of the shots distributed to states have been administered, suggesting a substantial inventory of vaccines in waiting and the possibility of precious doses expiring unused. Globally, the US trails a number of countries, including Israel, UAE, Bahrain, and the UK, in achieving immunity.
Plenty of articles have been written on causes of the rollout issues, including a lack of federal coordination, underfunded local health departments, lingering vaccine hesitancy, and overly strict state guidelines. I’m not going to cover what’s already been written — instead, my goal is to lay out a new, cohesive framework for understanding the challenges we’re seeing, and use it to propose solutions.
Healthcare is shifting from being provider-driven to patient activated
One important reason healthcare is unique as an industry is because the relationship between consumers/patients and healthcare providers is an unusual market. Healthcare has traditionally been provider-driven, meaning providers conduct procedures and make decisions with relatively little input from patients. There are situations, of course, where patients may be asked to choose between different care pathways or treatment options, but compared to the typical consumer market, patients have very little say.
The democratization of information in the digital age has primed a shift to “patient activated” healthcare. This concept of patient activation, defined as patients’ willingness and ability to take independent actions to manage their health and care, has long been of interest to healthcare providers, as research has shown that highly activated patients have better health outcomes, care experiences, and lower costs. Nonetheless, digital technology has given this concept new meaning, by providing unprecedented access and scalability.
Early indicators of this shift can be seen in several areas of digital health that are driven by proactive patient interest rather than traditional provider recommendations. Digital pharmacies like Ro, Hims, and Nurx have tapped into patient demand for popular but hard to obtain medications like erectile dysfunction pills and anti-depressants. Wearables like the Apple Watch, Oura Ring, WHOOP, and Fitbit allow patients to gain insight into health-related metrics like heart rate variability, steps per day and sleep quality. Well-being applications like Calm and Headspace give patients the ability to learn and practice mindfulness without classes or therapy.
One way to think about the impact that patient activation can have on healthcare is to focus on areas that meet these two pre-requisites:
First, patient activation requires genuine demand from patients to take control of a certain aspect of their health. Digital pharmacies rely on patients wanting to obtain specific prescription medications, wearables require patient interest and curiosity in tracking certain metrics, and well-being applications depend on patients believing that using these platforms everyday will improve their health.
Second, patients need to be empowered to know how to better manage a certain aspect of their health. To date, digital pharmacies have focused on offering medications for conditions that are largely self-diagnosable, because patients can come to the table with specific needs already in mind. Wearables require that patients are able to meaningfully interpret the data that’s captured and use it to improve their health. Well-being applications rely on patients having a base level of knowledge about how the “therapeutic modality” works, whether it’s mindfulness, meditation, or something else.
Rollout of COVID-19 vaccines is an opportunity and test for patient activation
The rollout of COVID-19 vaccines meets both requirements — patient demand for vaccines, considering their remarkable efficacy, is unprecedented, and patient empowerment, considering the resources being marshaled to overcome the pandemic, is readily achievable. Successful patient activation wouldn’t just be convenient in this case; it would save lives, by harnessing patient demand into getting people vaccinated as quickly as possible.
The rollout is also a test of whether the US healthcare system truly understands how to facilitate and achieve patient activation. If you look at the 3 countries leading in vaccination speed so far (Israel, UAE, and Bahrain), all have highly centralized healthcare systems, with national health databases that officials can use to identify eligible patients and get them vaccinated as quickly as possible. America’s healthcare system is the opposite, being highly decentralized between state and national policymakers, private and public payers, and various points of care. Even if US officials wanted to take a more top-down approach, there are many things they simply wouldn’t be able to do, making the bottom-up, patient-activated approach particularly important.
Empowering patients requires simplicity above all
So far, we are failing this test. In the first few weeks, there was a lot of confusion around how vaccination phases were going to work — who would be eligible to receive a shot in each phase, when each phase was scheduled to start, and how the phases would vary between states. Now that many states have broadened eligibility to all people aged 65+, patients are struggling to figure out simple questions like where they should go to get a vaccine and how they can sign up for an appointment. In New York, the NY Times released an article last week titled “How to Get the Coronavirus Vaccine in New York City” to try and clear up the confusion. In California, a group of volunteers have built a website with crowd-sourced data on which providers are currently administering vaccines.
Numerous state and local health departments have tried incorporating technology into their vaccine rollout plans, and some have faulted tech problems for causing the rollout issues to date. While this is true to an extent, it is symptomatic of a larger challenge. Putting aside technical glitches, the greater issue is that we are failing to properly empower patients on how they can get vaccinated as soon as possible, and thereby hindering patient activation. Empowering patients isn’t just about running mass media campaigns, or launching websites for vaccinations, or outlining eligibility for each phase — it’s about thinking through the patient vaccination experience from end-to-end and making it as simple and (dare I say) enjoyable as possible.
A couple tangible suggestions follow from this. First, simplicity is key with how the rollout is structured. While it is important to phase vaccinations so that we can prioritize high risk populations, it should not come at the expense of overall vaccination speed. Eligibility for each phase should focus on criteria that are easy to verify rather than those that require lots of information. It is worth noting that the rollout phases in both Israel and West Virginia (the #1 state in the US in vaccinations per capita) are solely based on age and employment.
This theme of simplicity should extend to the use of digital technology in the rollout as well. Public health departments should adopt the mantra of less is more and learn from the tech industry’s obsession with UI/UX. States shouldn’t build multiple websites (NYC alone has 4) if they can achieve their goals with one, and every single screen or step that’s not absolutely required for patients to book a vaccine appointment should be cut.
Lastly, not all people are equally digitally savvy, so we can’t look to technology for all the answers, especially for underserved communities. The focus should be on meeting people where they are, and leveraging existing infrastructure where needed to do so — not just pharmacies, but also churches, grocery stores, and schools.
Too often in healthcare, we take for granted the idea that if we build it, they will come. Thanks to the wonders of science and human ingenuity, we’ve developed two life-saving COVID-19 vaccines in record time. It’s time to stop assuming that patients will figure out how to get a shot on their own and start empowering them with the information they need to get vaccinated as soon as possible.
Gillette Stadium has been used just outside of Boston to vaccinate health care providers in recent weeks. Amazon contracting with allied health providers and venues that can handle large groups of people can scale this effectively in weeks. Amazon Prime already covers over half of US households. The National Guard can offer scale, but Amazon can launch a mobile app that coordinates the process and serves as a passport to confirm dates of vaccination and lot number for each person vaccinated.