Lead Support Major Support Additional Support 100% Access HealthColumbu s Board & Staff Individual & Corporate Donations Patient-Centered Primary Care Collaborative of Central Ohio September 6, 2013 Learning Session Learning Topic: Improve patient engagement in the use of evidence-based health care and shared decision making Welcome! Please save the following dates for future learning sessions (8:30- 10:30AM): •December 6, 2013 •April 4, 2014 •August 22, 2014 •December 5, 2014 www.accesshealthcolumbus.org
Transcript
Lead Support Major Support Additional Support100% Access
HealthColumbus Board & Staff
Individual & CorporateDonations
Patient-Centered Primary Care Collaborative of Central Ohio
September 6, 2013 Learning Session
Learning Topic: Improve patient engagement in the use of evidence-based health care and shared
decision making
Welcome!
Please save the following dates for future learning sessions (8:30-10:30AM):•December 6, 2013•April 4, 2014•August 22, 2014•December 5, 2014
www.accesshealthcolumbus.org
Today’s Objectives
AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement
EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams
SHARE actionable next steps for advancing provider-based patient
engagement in Central Ohio using Choosing Wisely as a good place to start!
LEARN from your perspectives!
Building off learning from the past two sessions...
Collaborative Approach for Improving Patient-Centered Primary Care
WHY?
• The need to improve patient-centered primary care as the foundation of accountable health care delivery to achieve better care, better health, better value
WHAT?
• Improve patient-centered primary care in private practice, hospital-affiliated, and federally qualified health centers serving patients with Commercial insurance, Medicaid, Medicare, and the uninsured
Collaborative Improvement Activities Coordinated by Access HealthColumbus
Improving Primary Care
in Central Ohio
Primary Care Delivery
Transformation
Provider-based Patient
Engagement
Sharing Learning and Results from
Collective Impact
Provider-based Quality
Reporting
Source: Engaging Patients and Families in the Medical Home, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, June 2010
Provider-based Patient Engagement Projects
EMERGING PROJECT:
Open Clinician Notesan initiative that
invites patients to review their visit
notes written by their doctors, nurses, or
other clinicians
www.myopennotes.org
EMERGING PROJECT:
Choosing Wiselyan initiative for
engaging clinicians and patients in
important conversations
necessary to ensure the right care is delivered at the
Primary Care Improvements• Access and continuity• Continuous improvement driven by data• Coordination of care across the medical neighborhood• Optimal use of health information technology• Planned care for chronic conditions & preventative care• Patient and caregiver engagement• Risk-stratified care management• Sustained by enhanced, accountable payments in
a multi-payer environment
Traditional health care based on
fee-for-service
AIM Better health Better care Better value
why?
Source: Unlikely Partners Find Common Ground on Curbing Health Care Costs, Robert Wood Johnson Foundation, April 2013
why?
PATIENTS & FAMILIES• Fear and uncertainty
• Health literacy
• Provider reactions
Barriers: What can hinder patient and family engagement?
PROVIDERS• Professional norms and
experiences
• Fear of litigation
• Perceived level of effort
AHRQ: Guide to Patient and Family Engagement: Environmental Scan Report, May 2012
Evidence is emerging on the value of patient engagement/activation
COLLABORATION BETWEEN PATIENTS , FAMILIES & PROVIDERS• Better health outcomes• Lower health costs• Improved satisfaction for providers, patients, and families
Source: Health Affairs, February 2013
Is Patient Engagement the next “Blockbuster Drug”?
What could happen that would make patient engagement a standard of care in Central Ohio?
What could be different?
Patient and caregiver voices and perspectives embedded in
quality improvement initiatives
Clinicians fully utilizing their potential as the three most
More patients have improved health status and economic
productivity
Purchasers provide incentives to primary care teams to
accelerate patient engagement as a standard of care
Patients with lower activation associated with higher costs(per capita billed costs)
Source: Health Affairs, February 2013
All patients(n=33,163)
Hyperlipidemia(n=10,515)
Hypertension(n=12,175)
Asthma(n=3,347)
Diabetes(n=4,253)
Lowest Activation
$4,679 $6,089 $7,687 $6,581 $8,474
Highest Activation
$4,320 $5,454 $6,750 $5,442 $7,901
As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined populations, knowing patients’ ability and willingness to
manage their health will be a relevant piece of information integral to health care providers’ ability to
improve outcomes and lower costs.
$359 x 11,000,000 people in Ohio = real value
why?
CURRENT NORMskepticism and distrust
FUTURE NORMPrimary care teams and
patients/parents/caregivers have the important conversations
necessary to ensure the right care is delivered at the right time
Patients/Parents/Caregivers
Phys
ician
s & C
are T
eam
s
Purchasers/Employers/Health Plans
evidence-based care is viewed as rationing my care
evid
ence
-bas
ed st
anda
rds
impo
sed
by o
ther
s
difficult to align benefits and
payment with evidence-based
medicine
engaged in shared decision-making to improve health and lower costsre
warde
d fo
r bett
er ca
re/o
utco
mes
bas
ed o
n
natio
nal p
rovid
er-d
efine
d ev
iden
ce
align benefits and payments with
provider-defined evidence
Patients/Parents/Caregivers
Purchasers/Employers/Health Plans
Phys
ician
s & Ca
re Te
ams
Today’s Objectives
AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement
EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams
SHARE actionable next steps for advancing provider-based patient
engagement in Central Ohio using Choosing Wisely as a good place to start!
LEARN from your perspectives!
Building off learning from the past two sessions...
Source: 2012 Survey of U.S. Health Care Consumers: Five-Year Look Back, Deloitte
• 2012 marks the fifth year for the Deloitte Center for Health Solutions’ survey of U.S. adult health care consumers about their interest in and ability to operate in a consumer health care market.
• These annual online surveys have queried up to 4,000 adults per year in various age, health status, income, and insurance groups to identify the degree to which consumers are prepared to engage with the health care system.
Consumer engagement with the health care system is a work in progress
Source: 2012 Survey of U.S. Health Care Consumers: Five-Year Look Back, Deloitte
Source: 2012 Survey of U.S. Health Care Consumers: Five-Year Look Back, Deloitte
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
“My health doesn’t worry me, so I’m not as engaged with the system, focused onprevention, or interested in online resources as others. I’m cost-conscious, think that the health care system could improve, and amgenerally just not interested right now.”
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
“I’m happy with my health plan, hospitals, and doctors and see no reason to compare or switch. I trust my doctors to tell me what I need to know and make good treatment decisions for me. I follow-through with what my doctors recommend and I try to take good care of myself.”
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
“I like to learn as much as I can online and amvery interested in innovative health technologies. I am generally happy with the care I get from my doctor, but am also open to alternative providers and different care settings. Making smart, informed health decisions is important to me”
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
“Taking care of my health is a priority for me – I use a lot of health care services and products, try to make informed decisions in partnership with my doctor, and do my best to adhere to treatment plans. I am highly informed throughusing online information and tools.”
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
“I’m independent – I like to make decisions onmy own, prefer doctors who use alternativeapproaches/natural therapies, and switchmedicines more often than most. I’m not verysatisfied with the doctors, hospitals, and health plan I’ve used. I’d like to customize my own plan.”
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
“In pursuit of good value – I switch health plansand doctors, use retail clinics, order medications online, and travel for care more often than most. I am cost-conscious and improving or maintainingmy health is a priority. I am open to alternatives.”
Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012
use attwifi if needed
Which of the six health care consumer
segments do YOU most identify
with?
Primary care teams and patients having the important conversations necessary to ensure the right care is delivered at the right time based on physician-developed evidence-based recommendations
What is Choosing Wisely®?
• Initiative of ABIM Foundation
• Trusted resources—including more than 50 national medical specialty societies, 17 consumer groups, including Consumer Reports
• Choosing Wisely encourages conversations between patients and physicians
280+ physician-developed evidence-based recommendations for better health, better care, and lower cost
• American Academy of Allergy, Asthma & Immunology• American Academy of Family Physicians• American College of Cardiology• American College of Physicians• American College of Radiology• American Gastroenterological Association• American Society of Clinical Oncology• American Society of Nephrology• American Society of Nuclear Cardiology• American Academy of Family Physicians• American Academy of Hospice and Palliative Medicine• American Academy of Neurology• American Academy of Ophthalmology• American Academy of Otolaryngology-Head and Neck Surgery• American Academy of Pediatrics• American College of Obstetricians and Gynecologists• American College of Rheumatology• American Geriatrics Society• American Society for Clinical Pathology• American Society of Echocardiography• American Urological Association• Society of Cardiovascular Computed Tomography• Society of Hospital Medicine• Society of Nuclear Medicine and Molecular Imaging• Society of Thoracic Surgeons• Society for Vascular Medicine
Specialty societies who have released recommendations
• American Academy of Dermatology• American Academy of Family Physicians**• American Academy of Orthopaedic Surgeons• American Association for Pediatric
Ophthalmology and Strabismus• American College of Chest Physicians• American College of Emergency Physicians• American College of Rheumatology*• American College of Surgeons• American Geriatrics Society*• American Headache Society• AMDA – Dedicated to Long Term Care Medicine• American Society of Clinical Oncology*• American Society of Hematology• American Society for Radiation Oncology• American Thoracic Society• The Endocrine Society• Heart Rhythm Society• North American Spine Society• Society of Critical Care Medicine• Society of General Internal Medicine
Specialty societies releasing recommendations in late 2013
*Releasing a second list**Releasing a third list
• Change mindsets and attitudes• Legitimize a conversation with patients about
mindful use of health care resources• Gives physicians and patients a common
language to speak about using evidence-based medicine
• This is a good place to start.
The Courage of Choosing Wisely®
What activity is emerging in
Central Ohio?
Choosing Wisely Project – Planned Approach for 2013-2014
• Measure change in clinical variability based on a set of Choosing Wisely recommendations
Primary Care Teamsprivate practices,
hospital-affiliated practices, and federally qualified health centers
• Measure change in patient awareness and readiness towards using evidence-based health care and engaging in shared decision-making with health care teams
Patients
selected from participating primary care practices via a simple application process
• Survey on value of presentations and webinarsSpecialty Care Teams
raise awareness on Choosing Wisely recommendations
• Document results from organizational activitiesPartnersemployers, health coalitions,
health plans, retirement systems, public health
Purpose: to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams
b) Participating primary care teams extend invitation to patients
c) Patients with interest complete online application
d) GOOD PLACE TO START -- Identify 4 patient groups based on application & insurance status (commercial, Medicare, Medicaid, uninsured)
Q1/2014Pre-measure
patient attitudes and
awareness
Host series of patient learning
workshops for each of the 4
patient groups
Mid YearHost learning session with all patients and their
health care teams
Q4/2014Post-measure
patient attitudes and
awareness
Host learning session with all patients and their
health care teams
Online Patient Networking & Support Portal
Today’s Objectives
AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement
EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams
SHARE actionable next steps for advancing provider-based patient
engagement in Central Ohio using Choosing Wisely as a good place to start!
LEARN from your perspectives!
Building off learning from the past two sessions...
To help us advance the Choosing Wisely project andPatient Learning Collaborative approach in Central Ohio….
We invite you as a healthcare consumer to participate in one of the following co-learning stations:
Station Host ToolA Gretchen Gunderson
Krista Stock• Measuring change in consumer awareness and
attitudes on evidence-based health care• Providing consumers with actionable tools
B John Leite & Bruce Wilson
Patient Networking & Support Portal Private with moderation (via login) Public with moderated private group (Facebook) Public (Twitter)
C Jeff Biehl Raising awareness on Value-based Insurance Design for consumers with commercial insurance
Today’s Objectives
AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement
EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams
SHARE actionable next steps for advancing provider-based patient
engagement in Central Ohio using Choosing Wisely as a good place to start!
LEARN from your perspectives!
Building off learning from the past two sessions...
Choosing Wisely Project – Planned Approach for 2013-2014
• Measure change in clinical variability based on a set of Choosing Wisely recommendations
Primary Care Teamsprivate practices,
hospital-affiliated practices, and federally qualified health centers
• Measure change in patient awareness and readiness towards using evidence-based health care and engaging in shared decision-making with health care teams
Patients
selected from participating primary care practices via a simple application process
• Survey on value of presentations and webinarsSpecialty Care Teams
raise awareness on Choosing Wisely recommendations
• Document results from organizational activitiesPartnersemployers, health coalitions,
health plans, retirement systems, public health
Purpose: to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams
