Powerpoint Presentation on how to treat Health Care Professionals when they are Patients.

1. WHEN PROVIDERS BECOME MEMBERS
Bernadette A Benta, MSHA, BSN, RN

2. Disease Management is a relatively young
discipline that is continuously evolving.
Interventions are moving away from simple care
management toward adoption of tested behavior
change strategies.
Programs are progressing from a focus on
discrete conditions toward population health
improvement. Models are adapting to better
engage physicians and other providers. These
shifts highlight the importance of understanding
and incorporating a variety of view points as the
disease management community works
together to shape future strategies and ideals

3. .
According to California Health Foundation about
45% of the U.S Population has a chronic health
condition. About half of them-about 60 million
people have co-morbidities. It is estimated that 150
million people will have at least one chronic
condition in 2015.
Number
2006
2015

4. Traditional physician training and
clinical practice focuses on meeting
the needs of individual patients,
whereas DM programs focus on
populations.
Understandably, the
two perspectives define different
priorities and approaches to care. It is
fortunate that
the roles of physicians and disease
management programs are
complementary, rather
than duplicative.

5. THE ROLE REVERSAL ISSUE
Health Care Professionals are taught strategies for
communicating with patients throughout the clinical encounter.
However, of course there are circumstances in which the
physician or nurse becomes the patient. This relationship at
times presents unique challenges.
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6. As is the case at the bedside or in the office setting, these
challenges also arise when the goal is to enroll and keep health care
providers engaged in Disease Management and other such
programs in Managed Care.
The term Provider=physician, nurse, or other health care
professional
The term Member=recipient of care, patient
The Provider-Member=the health care professional who is also the
recipient of care
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THE CARE DELIVERY SETTING OR METHOD

7. 7
REASONS BEHIND THE ISSUE
MAINTAINING BOUNDARIES BETWEEN RELATIONSHIPS WITH
COLLEAUGES OR BETWEEN ROLES AS
PROVIDERS/COLLEAGUE/FRIEND
AVOIDING ASSUMPTIONS ABOUT PATIENT (MEMBER)
KNOWLEDGE AND HEALTH BEHAVIORS
MANAGING PROVIDER-MEMBERS’ ACCESS TO INFORMAL
CONSULTATIONS, PERSONAL TEST RESULTS, AND OPINIONS
FROM OTHER COLLEAGUES

8. 8
THE MYRIAD OF THE REALTIONSHIPS PROVIDERS
HAD WITH THEIR PEER-MEMBERS CREATES
CONFUSION FOR THE THEM IN DETERMINING WHAT
THEIR ROLE WAS IN INTERACTING WITH THEM,
REGARDLESS OF THE SETTING.

9. STRATEGIES FOR ENGAGING PROVIDERS IN
DISEASE MANAGEMENT PROGRAMS
Ignore the provider-member’s background
Acknowledge the provider-member’s background and negotiate care
Allow the care to be driven primarily by the provider-member
Use evidence-based guidelines and best practices when
communicating and setting goals
Have representatives from the health plan’s Clinical team engage
with population in person for regularly scheduled informative
sessions about the programs
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10. ACKNOWLEDGE THE MEMBER’S
BACKGROUND AND NEGOTIATE CARE
Negotiating the care plan will probably take a little bit more effort in
some cases. For instance asking for input regarding what may have
worked in the past in addressing a health problem. Open
communication may allow the provider-member to choose how
much they wanted their own knowledge to affect the care they
received.
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11. CARE DRIVEN BY PRIMARILY BY THE MEMBER
A third strategy was to allow the provider-member to have the
majority of the control in health care decision-making. Participants
would go along with the requests of provider-member more than
they would with other members unless it was contradictory to their
philosophy of care. Our Care Team already uses SMART goals
which is based on the same concept.
This strategy often resulted in providers offering special favors for
their provider-members or altering their strategy of care to
accommodate the provider-member. It also may allow the provider-
members greater access to care outside of the structured medical
encounter than those who tended to ignore the background.
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12. CARE DRIVEN PRIMARILY BY THE MEMBER IN
OUR SETTING
FOR OUR DM, CM, AND ALC PROGRAMS IT IS ALWAYS THE
GOAL TO HAVE THE MEMBER BE FULLY PARTICIPATORY IN
THEIR CARE GOALS SO THIS MAY BE TO OUR ADVANTAGE AS
WE ALREADY USE THIS TECHNIQUE.
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13. EVIDENCE BASED PRACTICE
Health care professionals respond to what may is proven to be
effective and “cutting edge”.
Our Care Engine is driven by Evidence-Based Medicine
Additionally accessing clinical information based on evidence-based
practice, clinical guidelines, medical effectiveness, pharmaceutical
therapy, new technology, screening and preventive services,
outcomes research, and the National Guideline Clearinghouse is a
good idea.
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14. Key Question 1.
In adults with chronic medical illnesses and complex care
needs, is case management effective in improving:
Patient-centered outcomes, including mortality, quality of life, disease-
specific health outcomes, avoidance of nursing home placement, and
patient satisfaction with care?
Quality of care, as indicated by disease-specific process measures, receipt of
recommended health care services, adherence to therapy, missed
appointments, patient self-management, and changes in health behavior?
Resource utilization, including overall financial cost, hospitalization rates,
days in the hospital, emergency department use, and number of clinic
visits (including primary care and other provider visits)?
Clinical Questions Addressed to Consider
Hickam DH, Weiss JW, Guise J-M, et al. AHRQ Comparative Effectiveness Review No. 99.
Available at www.effectivehealthcare.ahrq.gov/case-management.cfm.

15. Clinical Questions Addressed by This
Comparative Effectiveness Review
Key Question 2. Does the effectiveness of case management
differ according to patient characteristics, including but not
limited to: particular medical conditions, number or type of co
morbidities, patient age and socioeconomic status, social
support, and/or level of formally assessed health risk?
Key Question 3. Does the effectiveness of case management
differ according to intervention characteristics, including but not
limited to practice or health care system setting; case manager
experience, training, or skills; case management intensity,
duration, and integration with other care providers; and the
specific functions performed by case managers?
Hickam DH, Weiss JW, Guise J-M, et al. AHRQ Comparative Effectiveness Review No. 99.
Available at www.effectivehealthcare.ahrq.gov/case-management.cfm.

16. There is the need for a practice-based champion with data
at hand that health care providers trust.
Just as peer groups are utilized for people suffering from
the same disease. Roundtables could be held with
provider-members and the clinical plan representatives.
The goal would be to build relationships with their “peers”
and have the program benefits discussed in these
settings. The opportunity for the provider-members to give
their input in this environment may foster engagement.
PEERS TALKING TO PEERS

17. The challenges associated with caring for a health care
professional tends to get easier with experience. Explicitly
communicating with the provider-member to ensure
boundaries are maintained, assumptions about the
provider-member are avoided, and ensuring that plan
provider access is properly managed are key to providing
quality of care to provider-members.
DISCUSSION

18. IN ADDITION TO ADOPTING THE STRATEGIES DISCUSSED,
TRAINING COULD BE PROVIDED TO PROVIDER-MEMBERS
ON AN ONGOING BASIS SO THAT THEY ARE AWARE OF THE
“BUY IN” OF THEIR PEERS. TRUST IS OFTEN FURTHER
FOSTERED WHEN FACE TO FACE INTERACTIONS ARE A
PART OF THE PROGRAM.
There is limited literature available on the challenges
health care providers face when caring for their peers.
Rather articles tend to be general reviews on providers
care-seeking behaviors.
CONCLUSION

19. http://www.lipidsonline.com
Sliverman JD, Kurtz S, Draper. Skills for communicating
with patients. Oxford, UK: Radcliffe Publishing, 2005
http://www.ahrq.gov
RESOURCES AND REFERENCES