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Arlen’s Substack
The patient hierarchy of involvement

The patient hierarchy of involvement

Arlen Meyers, MD, MBA's avatar
Arlen Meyers, MD, MBA
Jul 03, 2025
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Arlen’s Substack
Arlen’s Substack
The patient hierarchy of involvement
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Patients interact with disparate elements of the sick care system at differing levels of intensity and motivation. Big business has grown around getting patients more involved to improve their health and insurance IQs that, theoretically, would lower costs, improve outcomes, and enable and empower them to make better use of scarce resources.

According to the Agency for Healthcare Research and Quality, 36% of the U.S. population lacks the health literacy skills required to navigate the healthcare system independently and accurately. The result of this lack of knowledge and understanding about health conditions and available services leads to several negative outcomes. At-risk populations are unable to follow through with self-care activities, have difficulty understanding medication administration instructions and adhering to treatment plans, have a lower utilization of preventive services, experience increased hospitalizations and healthcare costs, and have worse health outcomes and increased mortality.

Few clinicians and even fewer clinicicans are data literate and data dexterous.

Patients seem to evolve along a hierarchy of involvement.

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