Narrative Dx #004: Why Patient Engagement Strategies Keep Missing the Point
Welcome to Narrative Dx, my new series on Narrative Strategy for Healthcare. I'm performing story surgery on the healthcare industry — with an occasional tangent into life sciences and biotech. Let's dive in.
If your title is VP of Patient Engagement, I want to argue you may be solving the wrong problem. Engagement was never the goal. Access was.
A few years ago I had an extraordinary conversation with the chief strategy officer of a Fortune 5 company. We were talking about why people struggle to engage with healthcare. Taking medication on schedule. Booking an annual visit. Basic stuff.
Meanwhile “wellness” has no engagement problem at all. His argument: people show up for anything tied to vanity and status. Botox. Detox teas. ED treatments. All of it promises a visible outcome that makes you more attractive. Statins and inhalers don’t exactly scream main character energy.
Vanity is real. But I pushed back with a different theory: healthcare doesn’t engage people because it isn’t tangible. Call it health literacy if you want, but I think it’s deeper than that. When you can’t see or feel what’s happening at the microscopic level, why would you care? A whiter smile is tangible. A lower A1C is not.
Years later, GLP-1s are a few taps away and at-home testing kits are stacked at the drugstore checkout. Something bigger is going on than tangibility. Vanity still plays a part. But I think the real driver is agency. Dignity, even. The thing that makes healthcare engaging isn’t a visible result. It’s not needing to ask permission.
Take reproductive care. The pill arrived in 1960, and even then you needed a prescription. It still handed women agency over their own reproductive health for the first time. By 2023 the FDA approved Opill, the first over-the-counter option. Removing the prescription barrier alone drove birth control usage up by 31.8 percent.
Or take the pregnancy test. Before 1978, you sat in a waiting room while someone else decided when to tell you something about your own body. Waiting for information about yourself isn’t engaging. Waiting for someone else to hand you the ability to act on it is worse.
The pattern holds: remove the barrier, and self-enabled care becomes the default. This isn’t the same thing as engagement. Engagement asks people to show up more for the healthcare system. Self-enabled care lets people need the system less, for less, less often.
Here’s the problem for anyone with “Patient Engagement” in their title. Most engagement strategy is still built on the old theory: get people to log into the portal, open the app, respond to the reminder. Every metric on the dashboard is a proxy for showing up more. But your own patients are voting with their feet, and they’re voting for less friction, not more touch points. They’re getting tests done at home instead of the lab. Refilling GLP-1s through a telehealth app instead of a specialist referral. Reading their own results before the portal notification even lands.
None of that is disengagement. It’s engagement that finally looks the way your patients actually wanted it to look, and it’s happening in channels your dashboard doesn’t measure.
The mandate isn’t dead. It’s aimed at the wrong target. The job was never to get patients to engage with the system more. It’s to get out of the way faster. Every barrier you remove is a form of engagement your current metrics can’t see, and won’t credit you for, until someone rewrites what the job is actually measuring.
I’m Ari Mostov. I help healthtech and medtech leaders close the gap between what patients actually want and what their engagement strategy still assumes. More soon in this series, Narrative Dx.