Marc Pierson at Consumer Centric Health, Models for Change '11
Consumer-Centric Health Models for Change ‘11
Ecosystems forSupported Behavior Change The Holy Grail? Questions & Speculations Marc Pierson, MD PEACEHEALTH Whatcom County, WA
Speculations about:“ DISRUPTING our minds before INNOVATING?“ Community health ecosystems?“ Networks„relationships?“ Flourishing together?“ Supporting technologies?
Why the growinginterest in behavior change? “ Payment for outcomes, especially population health outcomes.
Who is “we”? Where is “home”?“ For the sake of what?“ Who is in this together?“ The problem space is larger than our organizations. It is at least the size of our communities.--Read from introduction to John McKnight’s THE CARELESS SOCIETY, Community and it’s Counterfeit
BETWEENLife occurs in the large spaces“ Between visits“ Between organizations“ Between EMRsWhich organizations and technology will support people in between?
PERSON’S HOME“ Where almost all decisions and actions occur“ Where medications are taken or not“ Where diets and exercise occur or not“ Needs information and decision support
Why Behavior Change MattersThis chart shows the determinants of health and their contribution to premature death.
114 yrs of MISSION, VISION, VALUES“ MISSION ELEMENTS ” …Personal and Community Health“ VALUE ELEMENTS ” Respect, Stewardship, Collaboration, & Social Justice“ VISION ” 1990 Seamless care across the whole community ” 2006 Every patient will have safe, evidence based, compassionate care, every touch,
PeaceHealth/Whatcom Background“ Accountable Care Community 1993-1997“ RWJF / IHI Pursuing Perfection 2001- 2006“ Direct input from patients => ✴Navigator Coaches ✴Shared Care Plan (like a “FaceBook for Health”) - MS HealthVault, WA Health Record Banks, CMS Transitions of Care“ Accountable Care Community--2010...
ConciergeFunction? ‣ Is her concierge the patients’ “navigator coach”?
Root Cause / Solution?“ Positive Health outcomes <= High Patient Activation Measure <= Positivity Ratio >3:1“ HOW to flourish (how to < Negative emotions and > Positive emotions)“ Science of feelings and emotions- - “Broaden and Build”, Barbara Fredrickson.
Care Networks?“ Who cares? Really? Who really cares? -- John McKnight“ The “Health Family”?“ The “Health Neighborhood”?
DisruptiveInnovation? “ Three disruptive business cases “ Third is likely the most important and most disruptive: NETWORK MODEL
BEHAVIOR -- Skinner and/or Barbara Fredrickson?“ Mechanics and gadgets? and / or“ Approaches and tools for socially constructed Meaning--CARE? Who will choose go jump into who’s Skinnerian box?
FEAR & ANXIETY“ Are inevitable and useful“ Kill creativity“ Narrow choices“ Limit problem solving“ Add to illness burden
Patient Activation Measure (PAM)“ Predicts health outcomes and costs“ Person’s perceived ability to address their own health issues“ 4 levels
Human Flourishing“ Measurable“ Understood“ Actionable“ Core to “activation”
Broaden & Build“ Positive emotions open our minds.“ Positive thinkers literally see more of the world around them and are more likely to find innovative solutions to problems.
Leverage Points?“ Patient Activation Measure“ Measured positivity ratio with interventions / actions“ Work place“ Neighborhoods“ Friends (‘health family‛)“ Self
Pivotal Roles?“ Health care professionals?“ Educators?“ Ministers?“ Employers?“ Community organizers?“ ‚Health family‛?“ All together?
Community?“ Not “population” -- a number, an abstraction“ Rather people in Community working together for their shared - Health - Wellbeing
Connection?“ More than e-connectivity“ More than proximity“ Flourishing together
Positivity Ratio > 3:1“ Individuals?“ Families?“ Work units?“ Organizations?“ Neighborhoods?
Innovation“ Context matters, specific: Ecosystem? - Hospitals, Providers, Payers, Employers - Citizens/Actors/Patients -- “health families” - Schools, churches, associations - Technologies in place“ How to introduce inventions and get adoption within a complex health ecosystem
Ecosystem Technology?“ Support flourishing“ “Affectors”“ Sense makers, meaning makers“ Awareness of how we are doing“ Real time measures & feedback“ Reminders“ Meaningful connections & coordination
ECOSYSTEM ECHNOLOGY: “ Shared Care PlanCongral’s Coordination Suite “ Calendar with SMS & E-mail Alerts “ Care Manager Dashboard “ Transition Coordinator„driving calendar “ Direct Coordinator„driving calendar “ Integration with MS HealthVault & MS Community Connect platforms
The Coordination, Rules,Seamless (plugin-like) insertion Analytics and Messages areof SCP platform into any EMR or implemented via platforms HIE solution to improve public API coordination of care Mobile Mobile Apps Apps Coordination Rules, Analytics, MessagesPatien Secure Messaging Using NHIN Direct Provid ts ers EMR DEVICES 1 - N CLAIMS DATA DEVICES 1 - N CDR LABS DEVICES HV N 1- DEVICES 1 - N Ecosystem IMAGING Applications PHARMACY
Calendar, Rules , Messaging 33 & Alerts Choose pre-set rules oralerts or build your own tobetter manage the health of you and your family