A Bed's Eye View of Health Reform
 

A Bed's Eye View of Health Reform

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MSL Washington DC SVP Chuck Alston gave this presentation in April 2013 at QualitySync II, a Medicare quality improvement conference in Virginia committed to "Transforming Care Through Innovation". ...

MSL Washington DC SVP Chuck Alston gave this presentation in April 2013 at QualitySync II, a Medicare quality improvement conference in Virginia committed to "Transforming Care Through Innovation". Chuck presented to an audience of health care providers his best research-based thinking into communications and engagement with consumers and patients in the wake of the Affordable Care Act and the general restructuring of health care delivery in the United States.

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  • What the Healthcare World Looks Like to Patients New reforms, coupled with the increasing complexities of medical treatments, have propelled a wave of innovations to raise the quality and lower the cost of healthcare – all with significant implications for the way providers communicate with patients and their families. Now more than ever, it is important to engage patients as they navigate today’s new healthcare landscape. By connecting with the public in the right way, providers can offer the guidance needed for patients and their families to become more knowledgeable consumers, which ultimately leads to better health outcomes.  Participants in this session will be able to: Assess the impact of healthcare reform on patients’ understanding of the new medical landscape.Understand the role providers play in improved patient knowledge and the benefits of engagement and the new healthcare delivery and payment reforms.Evaluate research-based findings for improving provider-patient communication.Identify strategies to increase patient knowledge and improve health outcomes based on new emphasis to drive behavior change toward wellness, access to preventive care, and medication adherence.
  • This is a map of the world before Columbus sailed the ocean blue.Like Columbus, we are venturing off the known mapADVANCEAs I hope to show, that’s where much of health care communications is right now1/6 of economyRestructuring – not fast enough for payers, too fast forsmeproviders, bewildering to patients – more than models threatened, holds potential personal threatPeople don’t’ want to think about health care way payers are, providers are being forced to, and how some wish consumers would
  • The first lesson
  • The goobledygook lingo of heath care reform the way it appears to consumers
  • TeamsValue etcAre laden with baggage unapparent on the surface
  • Let me pause here a second and let you soak some of this inOn the left, some of those terms on the previous slideOn theright, what people think ofwhen they hear those terms
  • Such is the pull of physician care that majorities of those who have an initial preference for a doctor over another care provider hold thatposition even if it means appointments are briefer (73 percent say that’s worth the tradeoff), the doctor doesn’t know them as well (60 percent),or it’s harder to get an appointment (56 percent).• While doctors are present, continuity is lacking. Two-thirds of patients say they don’t see the same care provider every time they visit their facility. Nearly six in 10 of them would prefer more regular contact with the same caregiver – a desire that helps open the door to considerationof alternatives.• For many, preference for a doctor falls short of a demand. One-third have no preference for a doctor over a nurse or physician’s assistant,and more are open to non-doctor care under specific circumstances. Among those who initially prefer a doctor, nearly four in 10 shift theirpreference to a non-physician provider if it means it’s easier to get an appointment. And just 23 percent of all low-income Californians prefera doctor across every condition tested.• Openness to non-doctor alternatives rises in some groups, for example among younger patients and those in better health. And among peoplewho don’t currently see the same care provider each time, a not insubstantial four in 10 are content with that arrangement. Insight can begained from closer examination of this and other more flexible patient populations, provided in the full report that follows.
  • As always, as communicators we seek to meet consumers where they are –not where we wish them to be – and then craft strategies for taking them where we want to go.Reiterate These were developed as defensive messages – not to take the story to the public, but to respond if asked. We can see that in first takeaway.This is not a conversation most consumers want to engage in. The focus groups made it abundantly clear that consumers do not want to think or talk about how, when or why their healthcare providers are paid. Little to no knowledge about how the current reimbursement process works, and linking money or payment to their health andhealth care makes them uncomfortable at best, very angry at worst.Especially in this economy, the notion that physicians should be paid differently to do high quality work or go the extra mile to give their patients the care they need is a non-starter. The messages in this report therefore, are best used reactively rather than proactively.
  • Find better ways to pay for careMake sure the way insurance pays for health care is consistent with way you want to receive itMaking sure every dollar is spent wisely
  • As part of a yearlong trial, primary care doctors at three major, diverse health centers -- Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center-- invited their patients to read their visit notes online. 105 doctors and more than 19,000 patients participated in OpenNotes. After 12 months, doctors and patients reported on their experiences:
  • OpenNotes: ResultsAs part of a yearlong trial, primary care doctors at three major, diverse health centers around the country invited their patients to read their visit notes online. 105 doctors and more than 19,000 patients participated in OpenNotes. After 12 months, doctors and patients reported on their experiences:  Patients Were Enthusiastic Patients used the notesOf those with notes available, 84% of Beth Israel Deaconess Medical Center patients and 92% of Geisinger Health System patients opened at least one note. At Harborview Medical Center, where patients were using the portal for the first time, 47% opened at least one note. And 20-42% (depending on the site) shared their notes with someone else, usually family members or relatives.  They reported important benefits77-85% reported better understanding of their health and medical conditions. 77-87% felt more in control of their care. 70-72% said they took better care of themselves. 60-78% reported doing better with taking their medications.  They did not feel overwhelmedVery few patients (1-8%) reported being confused, worried, or offended by what they read in their doctors’ notes.
  • Scientific information from researchThe training and experience of health professionalsPatient’s goals, concerns, preferencesEach element is complementary and important to the right health decision for each individual patient Patients and providers should communicate about all three

A Bed's Eye View of Health Reform A Bed's Eye View of Health Reform Presentation Transcript

  • © 2011 MSLGROUP SLIDE 1 Chuck Alston Senior Vice President/Director of Public Affairs MSL Washington DC What Patients See When They Look at the New Landscape of Health Care Delivery Presentation to VHQC April 9, 2013 A BED'S EYE VIEW OF HEALTH REFORM
  • © 2011 MSLGROUP SLIDE 2 Today’s Takeaways • How to talk about the changes in health care delivery and not scare people • The rewards of genuine patient engagement • Communicating medical evidence with shared decision-making • Why patients may start acting like consumers
  • © 2011 MSLGROUP SLIDE 3
  • © 2011 MSLGROUP SLIDE 4 Take Care With How You Talk About Health Care WE MEAN WELL, BUT SOUND SCARY
  • © 2011 MSLGROUP SLIDE 5 The Way “We” Talk About Health Care
  • © 2011 MSLGROUP SLIDE 6 Do They Hear What You (Think You) Say? The new landscape of delivery and payment reform is covered with language landmines
  • © 2011 MSLGROUP SLIDE 7 Come Again? What You Say What They Hear Medical home Nursing home, home health, end of life Medical decision support End-of-life decisions Guidelines or treatment guidelines Restrictive, rigid, limited, driven by cost Integrated health care delivery system Bureaucratic, industry language, meaning unclear Integrated care Bureaucratic, industry language, meaning unclear Multispecialty medical group Bureaucratic, industry language, meaning unclear, trying to do too much, low quality, limited choice of specialists to choose from Best practices Bureaucratic, meaning unclear, insincere, cookie-cutter care, not tailored to the individual Evidence-based medicine Impersonal, one size fits all Accountable Something will go wrong, minimal care, buzz word Source: Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1):8-16. 2009.
  • © 2011 MSLGROUP SLIDE 8 A Few Choice Words About Medical Homes ―It just sounds like a nursing home.‖ -- Boston focus group participant ―First you go to a medical home, and then you go to the funeral home.‖ -- Edina, MN focus group participant ―It just gives me the creeps.‖ -- Edina, MN focus group participant Source: Ross M, Igus T, Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal. 2009;13(1):8-16.
  • © 2011 MSLGROUP SLIDE 9 Lost in Translation ―Of course the system is integrated. There are black and white patients.‖ -- Participant in focus group conducted for MSL client ―I know my doctor is high-quality. He has Town & Country in the waiting room.‖ -- Participant in 2007 focus group for the Robert Wood Johnson Foundation
  • © 2011 MSLGROUP SLIDE 10 REFORM Reform Fatigue • Improvements, sure • Changes, maybe • But please, no more reform
  • © 2011 MSLGROUP SLIDE 11 Beware of the “Team Trap” Messages about ―teams‖ can create more concern than comfort Sources: Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1):8–16. 2009. Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) Photo: The Medical Group, Beverly, MA.
  • © 2011 MSLGROUP SLIDE 12 Who’s in Charge? Concerns recede when it is clear the doctor is calling the signals Sources: Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1):8–16. 2009. Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
  • © 2011 MSLGROUP SLIDE 13 You Want to Go Where with My Health Care? THE JOURNEY FROM VOLUME TO VALUE
  • © 2011 MSLGROUP SLIDE 14 From Volume to Value This mantra works for: What could be wrong with that?
  • © 2011 MSLGROUP SLIDE 15 Just Ask Them They think Valuis a four letter word
  • © 2011 MSLGROUP SLIDE 16 People equate value with ―bargain-basement pricing‖ not high-quality care What Value Looks Like
  • © 2011 MSLGROUP SLIDE 17 Health Care: I Don’t Want to Buy in Bulk Tested statement: “Here in our community, we are looking at ways to improve the health care that we all receive, so that we get more for the money we spend. That includes making sure that doctors understand that we want to pay for the right care, not tests that we do not need or other unnecessary procedures.” Charlotte, N.C., woman: ―More for the money, I don't know, it sounds like you are buying bulk.‖ Source: Focus group held in Charlotte, N.C. for the Robert Wood Johnson Foundation, 1 March 2011.
  • © 2011 MSLGROUP SLIDE 18 VALU = Rationing, Poor Quality • ―Eliminating waste,‖ ―increasing efficiency‖ or even ―saving money‖ sparks fear of rationing care that they want – and feel they need – but that may be expensive • Feelings that care will be cheapened, or that time with physician will be cut or – worst of all – that the care that they want could be curtailed is threatening. It shuts down the conversation. • The premise of VBID programs — the use of high quality providers or evidenced-based procedures leading to lower costs — is counterintuitive to employees’ perceptions that lower cost equals lower quality Sources: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) Employee Health Engagement: Identifying the Triggers and Barriers to Engaging Employees in Their Health Benefits and Wellness Programs. Chicago, Ill: Midwest Business Group on Health, 2011.
  • © 2011 MSLGROUP SLIDE 19 • Consumer beliefs:  Quality tracks cost -- higher priced care must be better  More care must be better  Agency theory – doctors have my interests at heart  When it comes to my health care, sky’s the limit • Third-party payment system – patients only see their portion of the costs* * Let’s talk more about this later! Summary: Barriers to Communicating Value
  • © 2011 MSLGROUP SLIDE 20 Park Your ACO in a Medical Home Garage Takeaways: Consumers resist being consumers when it comes to their health care • Consumers don’t want to talk about delivery system typology, or how doctors and hospitals are paid • They don’t know volume from value, and don’t want to • The get mad that money influences the way care is delivered Conclusion: Put the ―We’re Your New Hometown ACO Campaign‖ on hold
  • © 2011 MSLGROUP SLIDE 21 The Path to Patient-centered Messaging SO WHAT, WHO CARES, WHAT’S IN IT FOR ME?
  • © 2011 MSLGROUP SLIDE 22 The Problem with My Health Care is… • Uneasy relationship with my doctor • Doctor is pressed, encounter feels rushed, questions go unanswered • Lack of clear, trustworthy information • Too many mistakes, too much miscommunication that can make things go wrong Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
  • © 2011 MSLGROUP SLIDE 23 The Conversation About Care Starts Here
  • © 2011 MSLGROUP SLIDE 24 What Do Patients Want? • More time with their physicians Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
  • © 2011 MSLGROUP SLIDE 25 What Do Patients Want? • More time with their physicians • Better coordinated care Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
  • © 2011 MSLGROUP SLIDE 26 What Do Patients Want? • More time with their physicians • Better coordinated care • To not pay more Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
  • © 2011 MSLGROUP SLIDE 27 What Do Patients Want? An ACO wrapped around a medical home. (Just don’t call it that.)
  • © 2011 MSLGROUP SLIDE 28 The ABCs of Delivery Reform Communications ENOUGH ABOUT WHAT NOT TO SAY
  • © 2011 MSLGROUP SLIDE 29 “It’s All About Me” • Patients want to hear what’s in it for them • Messaging about payment or delivery should focus on patient benefits • Position the benefits as ―improving care coordination,‖ ―increasing preventive care,‖ ―improving the doctor-patient relationship‖ and "improving communication across doctors‖ • Offer ―solutions‖ to problems they see • If you must talk about money, talk about spending health care dollars wisely, not saving money Source: “Talking About Health Care Payment Reform with U.S. Consumers.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011.
  • © 2011 MSLGROUP SLIDE 30 Example: Red Flag over the Revolving Door • Hospitals are on red alert to reduce readmissions to avoid Medicare penalties • Do not make these efforts sound like you want to ration or take away care So: • DON’T focus messaging on keeping people out of the hospital • DO focus messaging on the solution—improving care for patients when they return home—because it will be seen as a benefit
  • © 2011 MSLGROUP SLIDE 31 How to Say It We want to find better ways to care for you to improve your care and make sure you get the best care possible • Improving communication, coordination among doctors, nurses, others • Getting you all the preventive care you need • Making sure you get right medications and tests • Helping you make appointments easily, fill out forms once, take tests once, so you do not have to repeat yourself over and over • Providing high-quality care, tailored just for you, based on best medical evidence and your doctor’s recommendation Source: “Talking About Health Care Payment Reform with U.S. Consumers.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011.
  • © 2011 MSLGROUP SLIDE 32 How to Say It We want you to have: • A stronger relationship with your doctor • More time with your doctor • All your concerns addressed • No decision made about you without you – patient involvement • An understanding of your follow-up care • After-hours help, alternatives to the emergency room Source: “Talking About Health Care Payment Reform with U.S. Consumers.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011.
  • © 2011 MSLGROUP SLIDE 33 If You Have to Talk About Reimbursement Don’t Talk about… Instead… How doctors are paid How insurance companies pay for care MDs giving too many tests because of system incentives Right now, insurance companies pay doctors based on how many patients they can squeeze in a day or how many different procedures they do “Reward” or “incentivize” Make sure the way insurance pays for health care is consistent with way you want to receive it; High-quality care, tailored for you Getting the “wrong” tests Getting the right tests Getting “unnecessary” tests Getting same test “twice” or tests you don’t need Source: “Talking About Health Care Payment Reform with U.S. Consumers.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011.
  • © 2011 MSLGROUP SLIDE 34 The Blockbuster Drug of the Century PATIENT ENGAGEMENT
  • © 2011 MSLGROUP SLIDE 35 Framing question
  • © 2011 MSLGROUP SLIDE 36
  • © 2011 MSLGROUP SLIDE 37 • Better health outcomes • Better experience of care • Lower health care costs Characteristics of Effective Interventions • Utilized peer support • Changed the social environment • Increased patient skills • Tailored support to the individual’s level of activation The RIO on Better Patient Engagement Source: Greene J and Hibbard J. “What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs.” Health Affairs. 32(2): 207-214. February 2013
  • © 2011 MSLGROUP SLIDE 38 Engaging Patients with Visit Notes By reading their notes, patients: • Better remember what is discussed during visits • Feel more in control of their care • Are more likely to take medications as prescribed • Can share notes with their caregivers, better equipping them to stay up to date with visit events and help enact the recommended treatment plan Source: Delbanco T, et al. “Inviting Patients To Read Their Doctors’ Notes: A Quasi-Experimental Study And A Look Ahead.” Annals of Internal Medicine. 157(7): 461-470. October 2012
  • © 2011 MSLGROUP SLIDE 39 Even the Doctors Don’t Mind “Weeks after my visit, I thought, wasn’t I supposed to look into something? I went online immediately. Good thing! It was a precancerous skin lesion my doctor wanted removed (I did).” -- Patient “I felt like my care was safer, as I knew that patients would be able to update me if I didn’t get it right. I also felt great about partnering with my patients, and the increased openness.” -- Doctor Source: http://www.myopennotes.org/wp-content/uploads/2012/10/OpenNotes-Results-Fact-Sheet.pdf
  • © 2011 MSLGROUP SLIDE 40 A Multidimensional Framework For Patient And Family Engagement In Health And Health Care. Carman K L et al. Health Aff 2013;32:223-231 Engagement: More Than You May Think Source: Carmen K, et al. “Patient And Family Engagement: A Framework For Understanding The Elements And Developing Interventions And Policies.” Health Affairs. 32(2): 223-231. February 2013
  • © 2011 MSLGROUP SLIDE 41 Put Evidence in the Context of Shared Decision-making COMMUNICATING ABOUT MEDICAL EVIDENCE
  • © 2011 MSLGROUP SLIDE 42 People want to be involved in decision-making • Especially about surgery or medications Patients want doctors to communicate options • People trust their doctors and want more time to talk/listen People value results of comparative effectiveness research • Regardless of politics, patients see deep value in CER • Their fear, however, is that money will ultimately drive decisions and/or their preferred treatment will be off limits. Nothing About Me Without Me Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 43 What Patients Want from Doctors Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 44 The Care They Want v. The Care They Get Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 45 Making an informed decision about the care that’s right for you Put Evidence Under an Umbrella Concept
  • © 2011 MSLGROUP SLIDE 46 Elements of an Informed Medical Decision Medical Evidence Clinician Expertise Patient Goals & Concerns Informed Medical Decision Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 47 People Value All 3 Elements Strongly Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 48 Tap into motivations: • Getting the best care possible • You know yourself best • Improving the MD/patient relationship • Increasing knowledge about health and treatments Part of getting the best possible care is having a doctor who listens to you, answers your questions, and includes you in decisions about what treatments are best for you. Shared Decision-making Messaging Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 49 Satisfaction Linked to Shared Decisions Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 50 Finding Language that Resonates
  • © 2011 MSLGROUP SLIDE 51 “meaning one of the discs…” Participants appreciate the explanation of what is wrong—describing what a herniated disc means. “number of options” Participants like options, particularly when it comes to surgery. If there are options for treatment, they want to hear about them. A few crossed out “a number of” because only two options were presented. “scientific evidence” Many like that the physician reports on the scientific evidence—they want to know what evidence exists. “Medical evidence” tends to work better than “scientific evidence”, however. Also, adding “recent” or “up-to-date” modifiers may help for some who wonder how recent the evidence is. “carries risk” Risks are a key component of treatment options that consumers want to hear. “no guarantees” Knowing that there is “no guarantee” is a key factor that would weigh in the decision process. Additionally, the phrase resonates with participants who appreciate the honesty in a discussion. “outcomes…will be better if you lose a bit of weight” Some participants like this because it is truthful, while others like it because they prefer to take steps on their own prior to medical intervention. “my opinion is…” The doctor’s recommendation is key, although a few do not like the word “opinion”, which feels uncertain. “My experience’ or “my recommendation” may be a better word choice. “the decision needs to be yours” Again, participants want to be integrally involved in making decisions, so many like hearing this from their doctor “is there information I can give you” Participants like this gesture, and feel it is an opening to ask questions. An improvement might be asking directly: “Do you have any questions right now that I can help answer?” “How do you feel about all of this?” “What are your thoughts and concerns?” Why Certain Language Resonates Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012
  • © 2011 MSLGROUP SLIDE 52 Making sure you get the best possible care starts with you and your doctor making the best decision for you. Your doctor can help you understand what types of care work best for your condition, based on medical evidence. Because there are always new treatments, doctors use this evidence to keep up with which work best. Your doctor’s experience helps him/her evaluate and apply the evidence to your situation. The doctor also needs to listen to you so he/she understands your values, preferences and goals. This is important because every patient is different, and when there are options, it is important for the doctor to know what is important to you. Best Framing Language
  • © 2011 MSLGROUP SLIDE 53 Spending My Money is Another Matter PATIENTS AS CONSUMERS
  • © 2011 MSLGROUP SLIDE 54
  • © 2011 MSLGROUP SLIDE 55 High Deductibles Will Drive Consumerism Health plans increasingly have high deductibles
  • © 2011 MSLGROUP SLIDE 56 Price Seekers Altarum Institute Spring/Summer 2012 Altarum Survey of Consumer Health Care Opinion • Who is most likely to ask about the price of care? Younger age, Lower income, Higher insurance deductible, Recent hospitalization, More experience using computers and smartphones, and Not being an impulse shopper in other aspects of life. • Neither health status nor gender was predictive of asking about price.
  • © 2011 MSLGROUP SLIDE 57 Growing Demand for Price Transparency
  • © 2011 MSLGROUP SLIDE 58 The Research Behind Today’s Presentation RESOURCES
  • © 2011 MSLGROUP SLIDE 59 • Alston C, et al. ―Communicating with Patients on Health Care Evidence.‖ Washington, D.C.: Institute of Medicine. September 2012. • Bechtel C and Ness D. ―If You Build It, Will They Come? Designing Truly Patient-Centered Health Care.‖ Health Affairs. 29(5): 914-920. May 2010. • Carmen K, et al. ―Evidence That Consumers are Skeptical about Evidence-based Health Care.‖ Health Affairs. 29(7): 1400-1406. July 2010. • Carmen K, et al. ―Patient And Family Engagement: A Framework For Understanding The Elements And Developing Interventions And Policies.‖ Health Affairs. 32(2): 223-231. February 2013. • Coulter A. ―Patient Engagement—What Works?‖ Journal of Ambulatory Care Management. 35(2): 80-89. April-June 2012. • Delbanco T, et al. ―Inviting Patients To Read Their Doctors’ Notes: A Quasi-Experimental Study And A Look Ahead.‖ Annals of Internal Medicine. 157(7): 461-470. October 2012. • Gerber A, et al. ―A National Survey Reveals Public Skepticism About Research-Based Treatment Guidelines.‖ Health Affairs. 29(10): 1882-1884. October 2010. • Greene J and Hibbard J. ―What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs.‖ Health Affairs. 32(2): 207-214. February 2013. • Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1): 8–16. 2009. • “Talking About Health Care Payment Reform with U.S. Consumers.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) • ―Talking with Physicians about Improving Payment and Reimbursement.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) To Learn More
  • © 2011 MSLGROUP SLIDE 60 To Follow Up Chuck Alston chuck.alston@mslgroup.com