POPULATION HEALTH
thought leaders in
identifying
implementation tactics
What Role Do Patient Engagement Strategies
Play in Promoting Population Health? July 31, 2014
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Webinar Presenters
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Linda Tiano, Member, Epstein Becker Green and EBG Advisors (moderator)
Ben Gardner, Founder and President, Linkwell Health
Kathleen Fraser, RN-BC, MSN, MHA, CCM, CRRN, Case Management Society of America National President, 2014-2016
POPULATION HEALTH thought leaders in
Identifying implementation tactics
This session will examine different approaches that have been used to target, engage and modify individual behaviors towards a healthier lifestyle. The speakers will highlight key examples of ways to engage high-risk and chronically ill groups to achieve meaningful clinical and financial outcomes. In addition, panelists will discuss:
Methods to promote better eating and exercise
Avenues to promote healthy behaviors and to address chronic disease head-on
Strategies to benchmark positive changes in targeted populations and provide meaningful feedback loops to patients
Ways to improve medication adherence
Approaches to optimize provider involvement in patient care over the continuum
Consumer engagement and leveraging marketing strategies to focus on health and target populations with chronic conditions
Presentation Overview
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POPULATION HEALTH thought leaders in
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Rise in Chronic Conditions
– 25.8 million people in the U.S. (8.3% of the population have diabetes)
– If current trends continue, one in three U.S. adults will have diabetes by 2050
– Over one third of U.S. adults and 17% of children are obese
Financial Cost
– The total costs (direct and indirect) of diabetes in 2008 was $174 billion
– In 2008, overall medical care costs related to obesity for U.S. were as high as $157 billion
– Obese individuals had medical costs that were $1,429 higher than the cost of people with normal body weight
Chronic Conditions and Financial Burdens
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Source: CDC
POPULATION HEALTH thought leaders in
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Lifestyle is the #1 Risk Factor for Chronic
Conditions
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POPULATION HEALTH thought leaders in
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Purchasing candy: – Almost two times more likely to purchase
Russell Stover’s candy
– One and a half times more likely to purchase Mounds
– Almost one and a half times more like to purchase a York Peppermint Patty
More likely to eat dessert: – Almost one and a half times more like to purchase Pepperidge Farm
Three Layer cake
Consuming frozen food: – Nearly 40% more likely to purchase frozen French fries
– 17% more likely to consume frozen dinners
What Americans with Chronic Conditions are Eating
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MRI 2013 doublebase, Chronic = diabetic, hypertension, and obesity, than the average US population
POPULATION HEALTH thought leaders in
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Consumer Packaged Goods (CPG)
Marketing
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1899 Today
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A permanent 100 calorie reduction in daily intake would eliminate approximately 71.2 million cases of overweight/obesity and save $58 billion annually.
Impact of Calorie Reductions
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Category Bad For You Calories Better for You Calories Change
Breakfast Eggs 70 Fat Free Egg Beaters 30
Snack Bar Snickers Candy Bar 280 Extend Bar 150
Beverage Orange Juice 150 Trop 50 50
Sweetener Sugar 15 Truvia 0
Salty Snack Potato Chips 150 Baked Lays 110
Butter Butter 100 Smart Balance 45
Entrée Stouffers Chicken Alfredo 410 Lean Cuisine Chicken Fettuccine 280
Snack Mrs. Field's Cookies 370 Murrays Sugar Free Cookies 150
Total 1545 815 -730
Healthcare Analytics, Thomson Reuters
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U.S. Diet/Weight Loss Industry Trend
1990 - $30 billion market value in US
2010 -$60.5 billion market in US
U.S. Obesity Trend
1990 – 22%
2010 – 36%
Most Diets are Unsuccessful: Unrealistic Lifestyle Changes
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Survey: Most Americans are Weight Conscious, April 2011
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What do consumers understand?
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What do consumers want to read?
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What health plans want consumers to read…
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Linkwell’s Approach to Engagement
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Ongoing Message Drives Behavior Change
* Percent change in healthy spend year-over-year: test vs. control
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Coupons Incentivize Better Purchases
* Percent change in healthy spend year-over-year: test vs. control
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Content with Coupons Drive Healthy Eating
* Percent change in healthy spend year-over-year: test vs. control
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POPULATION HEALTH thought leaders in
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Increase in Health Plan Perception – 16% more consumers rated their health plan excellent/very good
Ongoing Communication – Majority of consumers want ongoing communication from their
health plan
Increase in consumer engagement – 58% of consumers planned to take action/redeem a coupon after
receiving a Linkwell mailing
Increase in Communications Appeal – 8 in 10 health plan members like receiving mailings
The Result
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Medication Adherence
“Drugs don’t work in patients who don’t take them.” - C. Everett Koop, Former United States Surgeon General
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A cluster of behaviors
Simultaneously affected by multiple factors
The extent to which a person’s behavior—taking medication, following a diet, or making healthy lifestyle changes—corresponds with agreed-upon recommendations from a health care provider
What is adherence?
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Source: http://apps.who.int/iris/bitstream/10665/42682/1/9241545992.pdf
POPULATION HEALTH thought leaders in
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Medication Adherence: The patient’s conformance with the provider’s recommendation with respect to timing, dosage and frequency of medication-taking during the prescribed length of time
Compliance: Patient’s passive following of provider’s orders
Persistence: Duration of time patient takes medication, from initiation to discontinuation of therapy
Concordance: Wider concept from prescribing communication/consultation to patient in support of medication taking.
Medication Adherence
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Source: http://www.effectivehealthcare.ahrq.gov/ehc/products/296/1248/EvidenceReport208_CQGMedAdherence_FinalReport_20120905.pdf
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One in three patients fails to fill their prescriptions
Approximately three of four Americans report they do not
consistently take their medications as directed
Sixty percent of patients cannot correctly name their medications
and up to 20% of patients take medications prescribed for others
Between 30 and 70% of medication-related hospital admissions in
the U.S. are due to poor adherence
Approximately one-fourth of all nursing home admissions are related
to improper medication self-administration
Average adherence rates are between 50-65% in those with common
chronic conditions such as diabetes and hypertension
Facts
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Source: Case Management Adherence Guide, 2012
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The Cost of Non-Adherence
Source: http://pharmacy.ucsd.edu/pmt/mtm/benefits.shtml
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High out-of-pocket costs, especially for patients on multiple prescriptions for chronic conditions.
Lack of care coordination, follow-up and shared decision-making.
Complex or burdensome treatment regimens or multiple prescribed medications.
Co-morbidities, such as severe and persistent mental illness.
Side effects of prescribed medications, whether real or perceived.
Personal factors, including lifestyle, culture and belief system
Causes of Poor Medication Adherence
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Source: Adherence to Medication Lars Osterberg, M.D., and Terrence Blaschke, M.D. N Engl J Med 2005; 353:487-497August 4, 2005DOI: 10.1056/NEJMra050100
POPULATION HEALTH thought leaders in
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Low socioeconomic status - independent predictor of low adherence
– Low health literacy
– Unemployment
– Lack of experience with health care system
– Poor access to health care
– Competing priorities – food vs. medications
Reading level single strongest predictor of practical asthma knowledge
Racial disparities
– Cultural beliefs vs. inequality
Age
– Does not relate independently
– Focus should be on beliefs about their illness
Socioeconomic Factors
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Source: Case Management Adherence Guide, 2012
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One of the most direct ways to study the cost-effectiveness of medicines is to compare total health care costs and utilization for patient populations who are using prescription drugs appropriately versus those who are not. Researchers have found relationships between taking medications as prescribed and lower health care costs, as well as the converse relationship of not taking medications as prescribed and steeper health care costs.
Quantifying the Cost-Effectiveness
of Medication Adherence
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Source: http://spacinternational.com/pdf/adher.pdf
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Average Annual Spending Related to Diabetes
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Lack of provider awareness and knowledge about adherence
Lack of tools to assist health care professionals in evaluating and intervening in adherence problems
Lack of tools to help the patient develop adaptive health behaviors and change ineffective or harmful behaviors
Gaps in the provision of care
Suboptimal communication between patients and health professionals
Health Care System
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Source: Case Management Adherence Guide, 2012
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Health care providers have a vital role in:
Stressing the importance of taking medications as prescribed
Monitoring and helping patients avoid or reduce unpleasant side effects that may compromise adherence
Helping to keep patients more generally well-informed about their health conditions
The Role of Health Care Providers
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Improve Care Coordination
Enhance Patient Engagement and Education
Utilize Case Management, Counseling and Medication Management
Expand Screening and Assessment
Invest in Health IT Infrastructure
Improving Medication Adherence
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Clinicians should actively discuss adherence issues with patients (e.g. comprehension, adverse events, acceptance of illness) and monitor patient adherence.
External reinforcements:
– Reminder notes
– Pair pill-taking with routine daily activity (e.g. eating breakfast)
– Engage family members/significant others to support adherence
Use simple dosing regiments (e.g., agents requiring less-frequent dosing or long-acting formulations)
Strategies to Increase Medication
Adherence
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POPULATION HEALTH thought leaders in
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Behavior related:
– Forgetfulness of patients
• Daily alerts
• 90-day medication supplies
• Automatic renewals
Clinical (Questions or concerns about medications):
– Pharmacy consultation
– Linguistically and culturally important
Cost related:
– Payment assistance programs
– Lower cost medication alternatives
– Lower cost pharmacy option
Interventions Should be
Patient-Tailored
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Impart Knowledge – Involve, Advise, Inform
Empowerment - Is giving the patient freedom of choice appropriate?
Simplify the Regimen – Match regiment to patient’s activities of daily living
Modify Patient Beliefs and Behavior – Ensure that patients understand their risks and consequences if
they don’t adhere to medication regimens
– Address fears and concerns
Provide Communication and Trust* – Active listening, emotional support, use plain language
– Elicit patient’s input in treatment decisions
Strategies to Increase Medication
Adherence
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*Source: http://www.acpm.org/?MedAdherTT_ClinRef
POPULATION HEALTH thought leaders in
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Self-report
Ask about adherence behavior at every visit
Periodically review patient’s medication containers, noting renewal dates
Evaluating Adherence
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Introduce team-based care: – Collaborate with pharmacists and/or nurses
– Educate patients on how to take medications
– Monitor by pill box
Improve access and communication: – Offer patients the opportunity to contact the provider’s office with
any questions
– Use telemedicine, particularly in rural areas
Use technologies and analytical services that facilitate measuring and improved adherence
Overcoming Challenges or Barriers
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Having a clear understanding of how the use of technology impacts patients is critical for care managers and other providers if they want to effectively engage their patients and improve clinical outcomes.
Patient Communications
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Source: 2012 Health IT Survey Series, Trend Report #5: Patient Engagement Strategies
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POPULATION HEALTH thought leaders in
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Knowing the types of technology patients currently use, as well as where IT trends are headed, can help providers, care managers and other health care professionals target their outreach strategies to get and keep patients engaged.
In an increasingly mobile and technology-driven society, providers and their patients now have the ability to utilize tools that were previously unavailable or underutilized in order to open a two-way line of communication with their patients, thereby creating a deeper level of engagement that allows patients to become more meaningfully involved in their own care.
Trends in Engagement Strategies
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POPULATION HEALTH
thought leaders in
identifying
implementation tactics
Linda Tiano
Epstein Becker Green
(202) 861-0900
Ben Gardner
Founder and President
Linkwell Health
1227 25th Street, NW
Washington, DC 20037
www.ebglaw.com
Kathleen Fraser
National President (2014-2016)
Case Management Society of America