Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Plain Talk with US Consumers and Patients:
Achieving the Triple Aim
Presentation by Susan Dentzer
Senior Policy Adviser to...
This Presentation at a Glance
 Achieving the Triple Aim: Needed now more than ever
 How do we talk with patients/consume...
The Triple Aim
 Better health
 Better health care
 Lower cost
 Core principle at heart of
Affordable Care Act and majo...
Scope of the Communications
Problem
 Nearly 9 in 10 adults have
difficulty using everyday
health information broadly
avai...
“Universal Precautions” Approach
 Adopted from infectious
disease field
 Notion that clear
communication should be
basis...
But the Problem Cuts Two Ways
 75 percent of orthopedic
surgeons surveyed believed
that they communicated
satisfactorily ...
Patient Engagement
First-ever
National
Quality
Strategy,
mandated
by the
ACA
Confusion over health insurance
Explaining health insurance coverage
 Many enrolling in coverage under ACA have obtained it for
first time
 When explain...
HealthCare.gov gets better – and clearer
Communicating with patients
about their care
Realities of Patient-Physician
Communication
Source: The Decisions Study: Medical Decision Making, 2010,
30 Supplement I
Patient Satisfaction on Physicians, University
of Utah
© 2014 Press Ganey
Associates, Inc.
Shared Decision Making
 “A collaborative process that
allows patients and their
providers to make health
care decisions t...
Patients Want Shared Decision Making But
Are Afraid
 Focus groups run by Dominick Frosch and colleagues at
Palo Alto Medi...
Shared Decision Making:
Process and Tools
Shared Decision Making at Group Health
 Over six months, use of decision aids associated with
26 percent fewer hip replac...
Angelo Volandes & Aretha Davis,
Harvard Medical School
Advance Care Planning Decisions
Videos at acpdecisions.org
Shared Decision Making at Mayo Clinic
Communicating with patients about
inappropriate care
“Choosing Wisely” Survey,
2014
 73 percent of physicians said the
frequency of unnecessary tests and
procedures is a “ver...
“Choosing Wisely” Campaign
 Launched by American Board of Internal Medicine
Foundation
 More than 35 specialty societies...
Activating patients about their health
and heath care
Patient Engagement and Activation
 Engagement = actions that
people take for their health or
health care
 Activation = u...
Patient Activation Measure
 Gauges the knowledge, skills and confidence essential to
managing one’s own health and health...
Patient Activation Measure
 Patient activation and the “3 M’s”
 It can be measured
 It can be moved – patients’ low sco...
Engaging the Seriously Disabled
 Minnesota-based Courage
Kenney Rehabilitation
Institute serves disabled
and injured
 Ha...
Technology to Support Communication and
Patient Engagement
Disruptive Technologies
 Digital health, mhealth
(mobile), apps
 Pushing care out of
institutions and into homes
and off...
Physicians and founders Tom Delbanco and Jan Walker,
Beth Israel Deaconess Medical Center, Boston
Started giving patients ...
 12-month pilot of patients at Beth Israel Deaconess,
Geisinger, and Harborview Medical Center, Seattle WA
 77-87 percen...
New entrants into health care: Apple
 Apple Health dashboard allows
consumers to compile and view health
care information...
“Symple” Symptom Tracker and
Health Diary
Natasha
Gajewski,
Founder,
Symple Health
Ease of communication
with doctors
Mobile Health: Text4Baby – free mobile text
messages
Big White Wall
• Safe online community
• Professionally led support groups
• Ability to speak to clinician in real time
• ...
Some conclusions
Context Matters
“Think like a wise man but communicate in
the language of the people.”
--William Butler Yeats
“The good physician treats the disease; the great
physician treats the patient who has the disease.”
--William Osler, one ...
The End
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Triple Aim
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Triple Aim
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Triple Aim
Upcoming SlideShare
Loading in …5
×

Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Triple Aim

1,609 views

Published on

Presented by Susan Dentzer, MA, on March 12, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.

Published in: Healthcare

Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Triple Aim

  1. 1. Plain Talk with US Consumers and Patients: Achieving the Triple Aim Presentation by Susan Dentzer Senior Policy Adviser to the Robert Wood Johnson Foundation To Maximus Plain Talk Conference – March 12, 2015
  2. 2. This Presentation at a Glance  Achieving the Triple Aim: Needed now more than ever  How do we talk with patients/consumers about  Changes in insurance coverage, delivery and payment  Appropriateness of care  Cost and quality of care  Being proactive about their health and care  “Plain Talk” is necessary but not sufficient; other strategies to improve communication also important  Case Examples  Some conclusions
  3. 3. The Triple Aim  Better health  Better health care  Lower cost  Core principle at heart of Affordable Care Act and major U.S. payment and delivery system reform efforts that have followed  Better communication central to achieving these goals Donald Berwick, MD Former Administrator Centers for Medicare and Medicaid Services
  4. 4. Scope of the Communications Problem  Nearly 9 in 10 adults have difficulty using everyday health information broadly available in health care facilities, communities, media  Source: Health Literacy: A Prescription to End Confusion. Institute of Medicine, 2004
  5. 5. “Universal Precautions” Approach  Adopted from infectious disease field  Notion that clear communication should be basis for all exchanges of health information  Source: National Action Plan to Improve Health Literacy, 2010
  6. 6. But the Problem Cuts Two Ways  75 percent of orthopedic surgeons surveyed believed that they communicated satisfactorily with patients  Only 21% of their patients reported satisfactory communication with their doctors  Source: JR Tongue et al, Journal of Bone Joint Surgery Am. 2005; 87:652-658
  7. 7. Patient Engagement First-ever National Quality Strategy, mandated by the ACA
  8. 8. Confusion over health insurance
  9. 9. Explaining health insurance coverage  Many enrolling in coverage under ACA have obtained it for first time  When explaining health coverage to consumers, critical to confirm that they understood what was said – e.g., “deductible,” “co-pay”  Ideally should explain back concepts in their own words (teach-back method)  If they still don’t understand, use other concepts to convey meaning  Source: IOM Discussion Paper, K Patel et al, “Helping Consumers Understand and Use Health Insurance in 2014.”
  10. 10. HealthCare.gov gets better – and clearer
  11. 11. Communicating with patients about their care
  12. 12. Realities of Patient-Physician Communication Source: The Decisions Study: Medical Decision Making, 2010, 30 Supplement I
  13. 13. Patient Satisfaction on Physicians, University of Utah © 2014 Press Ganey Associates, Inc.
  14. 14. Shared Decision Making  “A collaborative process that allows patients and their providers to make health care decisions together…  “..taking into account the best available scientific evidence …  “..as well as the patient’s values and preferences.”  Incorporated into Affordable Care Act, but as yet not widespread  Source: informedmedicaldecisions.org
  15. 15. Patients Want Shared Decision Making But Are Afraid  Focus groups run by Dominick Frosch and colleagues at Palo Alto Medical Foundation  Patients strongly embraced shared decision making but felt trapped in “socially sanctioned roles” – e.g., deference to physicians  Found many physicians authoritarian  Feared being categorized as “difficult” patients  Source: DL Frosch et al, Health Aff, May 2012, vol. 31 no. 5, pp. 1030-1038
  16. 16. Shared Decision Making: Process and Tools
  17. 17. Shared Decision Making at Group Health  Over six months, use of decision aids associated with 26 percent fewer hip replacement surgeries  38 percent fewer knee replacements  12-21 percent lower costs Source: D Arterburn et al, Health Affairs, September 2012
  18. 18. Angelo Volandes & Aretha Davis, Harvard Medical School Advance Care Planning Decisions Videos at acpdecisions.org
  19. 19. Shared Decision Making at Mayo Clinic
  20. 20. Communicating with patients about inappropriate care
  21. 21. “Choosing Wisely” Survey, 2014  73 percent of physicians said the frequency of unnecessary tests and procedures is a “very or somewhat serious problem.”  53 percent say that even if they know a medical test is unnecessary, they order it if a patient insists.  72 percent of physicians say the average medical doctor prescribes an unnecessary test or procedure at least once a week.  (PS: They blame malpractice)
  22. 22. “Choosing Wisely” Campaign  Launched by American Board of Internal Medicine Foundation  More than 35 specialty societies participating  Developed lists: Five Things Physicians and Patients Should Question – for each  Examples: colonoscopy; imaging for a headache; pre-term induction of labor; white blood cell growth factors or colony-stimulating factors (CSFs) to boost white blood cells during cancer chemotherapy  www.choosingwisely.org
  23. 23. Activating patients about their health and heath care
  24. 24. Patient Engagement and Activation  Engagement = actions that people take for their health or health care  Activation = understanding own role in care process and having knowledge, skills and confidence to take it on  Increasingly understood as a distinguishable factor in achieving Triple Aim
  25. 25. Patient Activation Measure  Gauges the knowledge, skills and confidence essential to managing one’s own health and healthcare  13-item questionnaire; patients rate selves on a scale  Statements include  “When all is said and done, I am the person who is responsible for managing my health condition.  “I am confident that I can take actions that will help prevent or minimize some symptoms or problems associated with my health condition.  “I know what each of my prescribed medications do.”  Measure segments consumers into one of four progressively higher activation levels
  26. 26. Patient Activation Measure  Patient activation and the “3 M’s”  It can be measured  It can be moved – patients’ low scores can be improved via engagement over time  It matters – the degree to which patients are activated predicts their factors such as their success in medication adherence, use of emergency department, and their likelihood of having avoidable readmissions  Source: JH Hibbard, J Greene, Health Aff, Feb. 2013 vol 32 no. 2, 207-214
  27. 27. Engaging the Seriously Disabled  Minnesota-based Courage Kenney Rehabilitation Institute serves disabled and injured  Has substantially raised Patients’ Activation Measure scores  Reducing hospital stays for this population by 71% 
  28. 28. Technology to Support Communication and Patient Engagement
  29. 29. Disruptive Technologies  Digital health, mhealth (mobile), apps  Pushing care out of institutions and into homes and offices  Enabling more self care  Engaging patients and enhancing sense of knowledge, confidence, activation
  30. 30. Physicians and founders Tom Delbanco and Jan Walker, Beth Israel Deaconess Medical Center, Boston Started giving patients access to physicians’ notes through EHRs
  31. 31.  12-month pilot of patients at Beth Israel Deaconess, Geisinger, and Harborview Medical Center, Seattle WA  77-87 percent of patients who opened at least one note reported feeling more in control of their care Source: Annals of Internal Medicine, Oct. 2012
  32. 32. New entrants into health care: Apple  Apple Health dashboard allows consumers to compile and view health care information  Apple’s HealthKit: new platform for health apps  Apple Watch has heart rate sensors; annual sales of 485 million predicted  Link with Epic EHR  Exploring incorporation of blood pressure and glucose monitoring into iPhone
  33. 33. “Symple” Symptom Tracker and Health Diary Natasha Gajewski, Founder, Symple Health
  34. 34. Ease of communication with doctors
  35. 35. Mobile Health: Text4Baby – free mobile text messages
  36. 36. Big White Wall • Safe online community • Professionally led support groups • Ability to speak to clinician in real time • Affiliations with National Health Service in England; Kaiser Permanente • See video at http://www.bigwhitewall.com/landing-pages/landingV3.aspx#.VPiBKLPF-yw
  37. 37. Some conclusions
  38. 38. Context Matters
  39. 39. “Think like a wise man but communicate in the language of the people.” --William Butler Yeats
  40. 40. “The good physician treats the disease; the great physician treats the patient who has the disease.” --William Osler, one of four founding professors of Johns Hopkins Hospital
  41. 41. The End

×