View
619
Download
0
Category
Tags:
Preview:
Citation preview
Plain Talk with US Consumers and Patients:
Achieving the Triple Aim
Presentation by Susan Dentzer
Senior Policy Adviser to the Robert Wood Johnson Foundation
To Maximus Plain Talk Conference – March 12, 2015
This Presentation at a Glance
Achieving the Triple Aim: Needed now more than ever
How do we talk with patients/consumers about
Changes in insurance coverage, delivery and payment
Appropriateness of care
Cost and quality of care
Being proactive about their health and care
“Plain Talk” is necessary but not sufficient; other strategies
to improve communication also important
Case Examples
Some conclusions
The Triple Aim
Better health
Better health care
Lower cost
Core principle at heart of
Affordable Care Act and major
U.S. payment and delivery
system reform efforts that
have followed
Better communication central
to achieving these goals
Donald Berwick, MD
Former Administrator
Centers for Medicare
and Medicaid Services
Scope of the Communications
Problem
Nearly 9 in 10 adults have
difficulty using everyday
health information broadly
available in health care
facilities, communities,
media
Source: Health Literacy: A Prescription
to End Confusion. Institute of
Medicine, 2004
“Universal Precautions” Approach
Adopted from infectious
disease field
Notion that clear
communication should be
basis for all exchanges of
health information
Source: National Action Plan to Improve
Health Literacy, 2010
But the Problem Cuts Two Ways
75 percent of orthopedic
surgeons surveyed believed
that they communicated
satisfactorily with patients
Only 21% of their patients
reported satisfactory
communication with their
doctors
Source: JR Tongue et al, Journal of Bone Joint
Surgery Am. 2005; 87:652-658
Explaining health insurance coverage
Many enrolling in coverage under ACA have obtained it for
first time
When explaining health coverage to consumers, critical to
confirm that they understood what was said – e.g.,
“deductible,” “co-pay”
Ideally should explain back concepts in their own words
(teach-back method)
If they still don’t understand, use other concepts to convey
meaning
Source: IOM Discussion Paper, K Patel et al, “Helping Consumers Understand and
Use Health Insurance in 2014.”
Realities of Patient-Physician
Communication
Source: The Decisions Study: Medical Decision Making, 2010,
30 Supplement I
Shared Decision Making
“A collaborative process that
allows patients and their
providers to make health
care decisions together…
“..taking into account the
best available scientific
evidence …
“..as well as the patient’s
values and preferences.”
Incorporated into Affordable
Care Act, but as yet not
widespread
Source: informedmedicaldecisions.org
Patients Want Shared Decision Making But
Are Afraid
Focus groups run by Dominick Frosch and colleagues at
Palo Alto Medical Foundation
Patients strongly embraced shared decision making but felt
trapped in “socially sanctioned roles” – e.g., deference to
physicians
Found many physicians authoritarian
Feared being categorized as “difficult” patients
Source: DL Frosch et al, Health Aff, May 2012, vol. 31 no. 5, pp. 1030-1038
Shared Decision Making at Group Health
Over six months, use of decision aids associated with
26 percent fewer hip replacement surgeries
38 percent fewer knee replacements
12-21 percent lower costs
Source: D Arterburn et al, Health Affairs, September 2012
Angelo Volandes & Aretha Davis,
Harvard Medical School
Advance Care Planning Decisions
Videos at acpdecisions.org
“Choosing Wisely” Survey,
2014 73 percent of physicians said the
frequency of unnecessary tests and
procedures is a “very or somewhat
serious problem.”
53 percent say that even if they
know a medical test is
unnecessary, they order it if a
patient insists.
72 percent of physicians say the
average medical doctor prescribes
an unnecessary test or procedure
at least once a week.
(PS: They blame malpractice)
“Choosing Wisely” Campaign
Launched by American Board of Internal Medicine
Foundation
More than 35 specialty societies participating
Developed lists: Five Things Physicians and Patients
Should Question – for each
Examples: colonoscopy; imaging for a headache; pre-term
induction of labor; white blood cell growth factors or
colony-stimulating factors (CSFs) to boost white blood cells
during cancer chemotherapy
www.choosingwisely.org
Patient Engagement and Activation
Engagement = actions that
people take for their health or
health care
Activation = understanding
own role in care process and
having knowledge, skills and
confidence to take it on
Increasingly understood as a
distinguishable factor in
achieving Triple Aim
Patient Activation Measure
Gauges the knowledge, skills and confidence essential to
managing one’s own health and healthcare
13-item questionnaire; patients rate selves on a scale
Statements include
“When all is said and done, I am the person who is responsible
for managing my health condition.
“I am confident that I can take actions that will help prevent
or minimize some symptoms or problems associated with my
health condition.
“I know what each of my prescribed medications do.”
Measure segments consumers into one of four progressively
higher activation levels
Patient Activation Measure
Patient activation and the “3 M’s”
It can be measured
It can be moved – patients’ low scores can be improved via
engagement over time
It matters – the degree to which patients are activated
predicts their factors such as their success in medication
adherence, use of emergency department, and their
likelihood of having avoidable readmissions
Source: JH Hibbard, J Greene, Health Aff, Feb. 2013 vol 32 no. 2, 207-214
Engaging the Seriously Disabled
Minnesota-based Courage
Kenney Rehabilitation
Institute serves disabled
and injured
Has substantially raised
Patients’ Activation
Measure scores
Reducing hospital stays
for this population by 71%
Disruptive Technologies
Digital health, mhealth
(mobile), apps
Pushing care out of
institutions and into homes
and offices
Enabling more self care
Engaging patients and
enhancing sense of
knowledge, confidence,
activation
Physicians and founders Tom Delbanco and Jan Walker,
Beth Israel Deaconess Medical Center, Boston
Started giving patients access to physicians’ notes through EHRs
12-month pilot of patients at Beth Israel Deaconess,
Geisinger, and Harborview Medical Center, Seattle WA
77-87 percent of patients who opened at least one note
reported feeling more in control of their care
Source: Annals of Internal Medicine, Oct. 2012
New entrants into health care: Apple
Apple Health dashboard allows
consumers to compile and view health
care information
Apple’s HealthKit: new platform for
health apps
Apple Watch has heart rate sensors;
annual sales of 485 million predicted
Link with Epic EHR
Exploring incorporation of blood pressure
and glucose monitoring into iPhone
Big White Wall
• Safe online community
• Professionally led support groups
• Ability to speak to clinician in real time
• Affiliations with National Health Service in England; Kaiser Permanente• See video at http://www.bigwhitewall.com/landing-pages/landingV3.aspx#.VPiBKLPF-yw
“The good physician treats the disease; the great
physician treats the patient who has the disease.”
--William Osler, one of four founding professors of
Johns Hopkins Hospital
Recommended