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by using the questions box. A follow-up e-mail will be sent to all
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Today’s topic
Patient Engagement: A Key Strategy for Population Health Management
Tammy Richards
Operations director,
patient and clinical
engagement,
Intermountain
Healthcare,
Salt Lake City
Dr. Thomas Graf
Chief medical officer
for population health,
Geisinger Health System,
Danville, Pa.
Kristin Carman
Vice president, director,
Center for Patient and
Consumer Engagement,
American Institutes for
Research,
Washington

Housekeeping
1. Viewer Window 2. Control Panel

Now speaking...
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Maureen McKinney
Editorial programs manager,
Modern Healthcare

Now speaking...
Please use the questions box on your webinar dashboard
to submit comments to our moderator
Kristin Carman
VP, director, Center for Patient and Consumer
Engagement, American Institutes for Research

AMERICAN INSTITUTES FOR RESEARCH
1
Goals
• Define patient and family engagement
• Discuss the benefits of patient and family
engagement
• Explain why we created a roadmap to
patient and family engagement
• A Roadmap for Patient and Family
Engagement in Healthcare Practice and
Research: Change Strategies

AMERICAN INSTITUTES FOR RESEARCH
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A working definition for patient
and family engagement
Patients, families, their representatives, and
health professionals
Working in active partnership
At various levels across the health care system
To improve health and health care
Carman et al., “Patient and Family Engagement: A Framework for
Understanding the Elements and Developing Interventions and Policies”
Health Affairs, 32, no.2 (2013):223-231

Who: Patients, families,
providers, systems
Public policies and culture
Health care organizations and systems
Clinicians and
health care
providers
Family and friends
AMERICAN INSTITUTES FOR RESEARCH
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Patients

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AMERICAN INSTITUTES FOR RESEARCH
Partnership and
shared leadership
4
What: Working in active
partnership
• Partnership and shared leadership involves real
culture change, which means:
– Leadership commitment
– Provider / patient education
– Potential changes to workflows, policies, and
procedures

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Where: At various levels

How does patient and family
engagement differ from patient
activation?
• Patient activation: an “individual’s knowledge,
skill, and confidence for managing his/her own
health and health care”
• How is that different from patient and family
engagement?
• Focuses on the individual
• Does not look at behavior
• Does not address the individual’s external context
• Is one aspect of person’s ability to engage in care
AMERICAN INSTITUTES FOR RESEARCH
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Who can benefit from patient
and family engagement?
• Patients and families
– Improved health outcomes
– Better experiences of care
• Clinicians and health care providers
– Improved satisfaction and retention
• Health care organizations and systems
– Competitive edge
– Standards, reimbursement, and requirements
AMERICAN INSTITUTES FOR RESEARCH
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AMERICAN INSTITUTES FOR RESEARCH
8
Our Goals
• Develop a unified roadmap for practice and
research
• Move from what-ifs to action
• Build on existing work and use multiple inputs
• Convene a multidisciplinary group of key
stakeholders

What did we ask participants to
do?
• Develop vision for the field – build physical roadmaps
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– Milestones and destinations
– Strategies and tactics
– Factors that affect progress
– Timing: today, tomorrow, future

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The Roadmap

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8 Change Strategies
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Change Strategies: Preparing for
Engagement
Patient and Family Preparation
Educate, prepare, and empower patients and families to
engage effectively in their health and healthcare
What can we do? Implement patient-centered tools to
support shared decision making
Clinician and Leadership Preparation
Educate, prepare, and empower clinicians and
healthcare leaders to partner effectively with patients
and families
What can we do? Develop standardized patient and
family engagement competencies
AMERICAN INSTITUTES FOR RESEARCH
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Care and System Redesign
Redesign system processes, policies, and structures to provide
opportunities for and support of partnerships between patients,
families, and the healthcare team
What can we do? Restructure care
processes to support shared
decision making. Document the
process, including the content of
discussion about risks, benefits, and
patient goals, values, and
preferences.
AMERICAN INSTITUTES FOR RESEARCH
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More information
AIR’s Center for Patient and Consumer
Engagement
http://aircpce.org
Coming September 23rd-
Roadmap to Patient and Family Engagement
in Health Care Practice and Research
www.patientfamilyengagement.org/roadmap
AMERICAN INSTITUTES FOR RESEARCH
15

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Tammy Richards
Operations director, patient and clinical engagement
Intermountain Healthcare

Patient Engagement
Vision & Definition
Vision: To build a patient-centered, value-oriented model for
engaging patients.
Definition: The effective partnership between the patient, the
family and the healthcare team to collaboratively achieve the
patient’s health-related goals.

HCAHPS Care Transitions Questions
42.6%
Intermountain Healthcare System Scores
57.9% (PR=94) 59.8%
51.2%
68.0% (PR=93)
73.0% (PR=92)
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
During this hospital stay, staff took my
preferences and those of my family or caregiver
into account in deciding what my health care
needs would be when I left.
When I left the hospital, I had a good
understanding of the things I was responsible for
in managing my health.
When I left the hospital, I clearly understood the
purpose for taking each of my medications.
NRC 50th percentile top box score Intermountain YTD top box score

Deloitte Report: State of Engagement
Comparison: 2008 and 2012

Opting out of CCM (Example)
337 pts
169 pts
40 pts
Current “Opt Out” Rate = 42%

National Levels of Literacy
Basic
22%
Below Basic
14%
Intermediate
52%
Proficient
12%
Basic
Below Basic
Intermediate
Proficient

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Dr. Thomas Graf
Chief medical officer for population health
Geisinger Health System

“Let us bear in mind that the most important individual after all is the
patient. Our paramount thought must be to provide him means by which he
can have skilled diagnostic and therapeutic service in as complete form as
may be indicated in a given case, in the shortest possible time consistent
with thoroughness, and at the least cost to him.” HL Foss, MD
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Not for reuse or distribution without permission
Geisinger Health System Confidential and Proprietary
11/4/1950 1

The Functional Components
of Population Health
Cultural
Transformation
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Value Driven
Population Care
ProvenHealth®
Navigator, Clinical
Redesign
Value Driven Post-
Acute Care:
TOC, SNFist
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Geisinger Health System Confidential and Proprietary
Value Driven
Acute Care:
Proven Care
Acute
Data Driven
Care and
Leadership
Evolutions
Value Driven
Specialty Care:
PHN Integration
Value Driven Actuarial and Operational Informatics

Clinical Foci for Population Care
Heal • Teach • Discover • Serve
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Not for reuse or distribution without permission
Geisinger Health System Confidential and Proprietary
Automated
prevention for all
patients
• Physician
Directed,
Team
Delivered
• Patient and
Family
Activated
Care
Multi-chronic
Disease
Chronic
Disease
WWeellll
Concentrated Care
• Technology
enabled RN
support
• High Touch
• High Tech
Enhanced Systems of
Care
• Proactive Monitored
• Office Based
• Mobile Accelerated

Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Not for reuse or distribution without permission
Geisinger Health System Confidential and Proprietary

What is OpenNotes?
In OpenNotes, doctors use a secure Internet portal
to invite patients to review notes following an office
visit.
The heart of OpenNotes is to:
• Involve patients far more actively in all aspects
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Not for reuse or distribution without permission
Geisinger Health System Confidential and Proprietary
of care
• Improve communication between the doctor and
patient
• Encourage patients to share information with
others, including those who care for them
• Help prevent mistakes
5
5

Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Not for reuse or distribution without permission
Geisinger Health System Confidential and Proprietary

CHANGE
“Every few hundred years, throughout Western
history, a sharp transformation has occurred.
In a matter of decades, society altogether
rearranges itself: its world view, its basic values,
its social and political structures, its arts, its key
institutions. Fifty years later, a new world exists,
and the people born into that world cannot even
imagine the world in which their grandparents
lived and into which their own parents were born.
Our age is such a period of transformation.”
Heal • Teach • Discover • Serve
Copyright Geisinger Health System 2014
Not for reuse or distribution without permission
Geisinger Health System Confidential and Proprietary
7
Peter Drucker, “Managing in a Time of Great Change”

Patient Engagement: A Key Strategy for Population Health Management
Today’s panelists...
Tammy Richards
Operations director,
patient and clinical
engagement,
Intermountain Healthcare,
Salt Lake City
TODAY’S MODERATOR
Maureen McKinney
Editorial programs
manager,
Modern Healthcare
Kristin Carman
Vice president, director,
Center for Patient and
Consumer Engagement,
American Institutes
for Research,
Washington
Dr. Thomas Graf
Chief medical officer
for population health,
Geisinger Health System,
Danville, Pa.
During today’s discussion, feel free to submit questions at any time by using the questions box.

Thank you...
... for attending today’s editorial webinar on patient engagement and population health management.
We also thank our panelists, Kristin Carman, vice president, director, Center for Patient and Consumer
Engagement, American Institutes for Research,Washington; Dr. Thomas Graf, chief medical officer for
population health, Geisinger Health System, Danville, Pa.; and Tammy Richards, operations director,
patient and clinical engagement, Intermountain Healthcare, Salt Lake City.
Expect a follow-up e-mail within two weeks. For more information,
send an e-mail to webinars@modernhealthcare.com
Register now for Modern Healthcare’s next virtual conference, “Building Tomorrow’s Delivery Model,” set for
Wednesday, Oct. 15. For more information, please visit modernhealthcare.com/building