The Evolving “Engaged” Patient

Does your hospital approach patient engagement like auto dealership service departments treat customer satisfaction surveys?

Telling your patients that anything less than a 10 means failing won’t help them or you. Patient engagement has evolved far beyond the HCAHPS survey. Not only are patients helping each other, but AHRQ, MIT and even BMJ are getting involved. Here are the major trends in patient partnership that help consumers help themselves – and you.

Patient Engagement 201

We know that engaged patients improve both the quality and safety of care. But how to engage them? AHRQ released an evidence-based guide explaining how to develop patient councils, front-line patient communication, and discharge planning engagement. But other organizations are taking it to the next level.

First, the Knight Foundation is currently funding a contest to develop strategies for harnessing data and information for community health. The 39 finalists under review include:

  • A project to evaluate, in publicly understandable ways, the real-time relationships between ACA health plan enrollment, costs and outcomes;
  • A diabetes monitoring tool that visually tells an individual’s story of cause, effect, and treatment outcomes; and
  • A crowd-sourced local healthcare pricing map.

The MIT Media Lab is making it personal with patient self-management apps that include conditions from CHF to hypertension to epilepsy. These are sophisticated apps that simplify patient management and self-care, as patients are already engaged with their smartphones.

Second, ProPublica is telling stories to help providers understand why harm happens and its effects on patients. As one patient harm survivor asks, “How is it possible to move past medical harm when every single aspect of life is impacted by it?”That is a question to consider in terms of prevention strategies and apologies. If you want to engage patients, tell them both how you are making them safer, and how sorry you are if an error occurs.

Large-Scale Shared Decision-Making

Leading healthcare organizations are moving beyond the individual shared decision-making relationship between doctor and patient. They now actively seek input from combined groups of patients and providers on what they really want from healthcare in the future. That includes everything from treatment unknowns to whether they think you should prioritize erecting a new building or decreasing central line infections.

For example, Ministry Saint Michael’s Hospital developed a new understanding of breast cancer patients’ priorities when they formed a patient advisory council to help their patient navigators understand what women want. For the first time, navigators realized that women need to evaluate options and benefits from their entire families’ perspective, not just their own.

The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care gathered patients and experts together earlier this year to consider how patients could advance healthcare. The key takeaways: 1) engaged patients are a prerequisite for high-quality, low-cost care that leads to better health, but 2) patient engagement, and the ability to engage patients, are learned skills, not On/Off buttons. Trusted translators of quality and cost information, which make value easily understandable for patients, are critical in developing meaningful patient engagement.

Even BMJ is devising a strategy to directly partner with patients. For the first time, the journal wants patient input on research questions to answer and perspectives to include within their publication. They will no longer rely on physicians to speak for their patients.

Help patients help themselves, and you. Focus on next-generation engagement strategies to put patients front and center in healthcare.

4 New Physician Partnership Trends

Is your organization ready to re-focus its physician alignment goals?

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Physician alignment is changing. Current healthcare trends – the transition from volume- to value-based reimbursement, the increasingly crucial role of patient engagement – have transformed the definition of a high-value physician relationship. Is your organization ready for these four pivotal physician partnership trends?

As you know, healthcare – and the roles within it – are evolving. The cast of characters are shifting, as former bit players take on more central roles. Physicians now find themselves participating in new and vital partnerships:

Interdisciplinary Teams: Collaboration doesn’t come naturally to physicians. Working within physician teams was a ground-breaking step for some. But now, they must adapt further and team with other healthcare professionals to put patient outcomes first. At Spectrum Health System, for example, cardiologists are expected to develop multi-faceted patient care plans in concert with a team of nurses, social workers and therapists. If they don’t share information and respect their colleagues’ input, they are asked to leave the group. Spectrum is serious; if you want to go your own way, especially with high-risk patients in the cardiovascular ICU, then go away.

  1. Patient Partnership: An editorial in BMJ claims, “Healthcare won’t get better until patients play a leading role in fixing it.” That thinking drives the patient engagement movement, but patients can’t do it alone. That’s why BMJ has moved beyond articles on shared decision-making to actively inviting a joint clinician/patient panel to develop a patient partnership strategy. Similarly, the ABIM Foundation developed the Choosing Wisely campaign to alert patients to ineffective or unnecessary care that they should question, and doctor-patient discussions led to a database of uncertain treatment effects in need of investigation. How can your physicians partner with their patients to improve their outcomes and quality of life?
  2. Dollar-Based Primary Care: New survey results confirm that your hospital’s future success depends upon primary care physicians, beyond their pivotal role in ACOs and medical homes. For the first time, a tri-annual Merritt Hawkins survey shows primary care physicians generate more average hospital revenue than specialists ($1.57 million versus $1.42 million). Those amounts don’t even consider the indirect revenue PCPs generate through referrals to specialists, counting only admissions, tests and procedures. Within individual specialties, family practice revenue ranks just below orthopedics and interventional cardiology, at $2.07 million. In fact, over the last decade, PCP-generated revenue has jumped 23%, while specialist revenue has declined 10%.
  3. Employed and Engaged: Driven by healthcare reform, more and more physicians are opting for employment over private practice. A recent survey confirms there has been a nearly 75% increase in the number of hospital-employed physicians since 2000. But to make it a happy and profitable alliance, your hospital has to do more than buy physician practices. Previously independent physicians who lose their business autonomy face frustration if they aren’t given decision-making responsibility in other areas of their professional lives.  Engage them by giving them key roles on committees, and in policy-making, recruitment and other strategic decisions. Your care quality will benefit too.

Redefine your high-value physician relationships. Align your physicians with a patient-centered world where new partnerships define the future of healthcare.

Meaningful Use Goes Back to School

How can your physicians earn Meaningful Use incentives by keeping your patients healthy and engaged?

As our children prepare to head back to the classroom, remind the adults in students’ lives to do their own health homework, using the information and capabilities inherent in your Meaningful Use-certified EHR.  By doing so, your physicians also expand their EHR skillsets and value. In the process, you can reap three important benefits:

1. Keep Your Population Healthy:  As a recent study on obesity confirms, we need to have effective conversations with our doctors to boost awareness of health problems. Send a helpful reminder to your patients to take care of themselves, their kids and their grandkids. They may have a teenager who requires a pre-enrollment physical, or they themselves may need an eye exam or a cancer screening.  By jogging their memories, you meet many of the Medicare and Medicaid Meaningful Use program objectives to improve quality and population health while engaging patients and families in their care. Make these routine checkups part of their back-to-school preparations:  new clothes, school supplies, lunch bags, transportation arrangements, and a doctor’s appointment.

2. Make Your Physicians’ EHR Use Meaningful:  Demonstrate the financial and clinical utility of EHRs to your physicians, who many times don’t plan for ROI from them. When screening and immunization reminders are targeted towards those under 5 or over 65 years of age, they qualify for Meaningful Use incentive consideration.  In fact, CPM Healthgrades supported one hospital’s efforts to successfully transform its pre-existing screenings and immunizations reminder program into a Meaningful Use patient reminder program that reaped $1 million in incentive payments.  It accomplished this goal by applying and documenting protocols for specific patient messaging and timing triggers.

Analyze your data to identify applicable patient populations for Meaningful Use-eligible physicians, and send them relevant and educational reminders. Babies need regular checkups and young children need vaccinations, while seniors may require heart disease, diabetes or colon cancer screening or perhaps a flu or pneumonia vaccination. By engaging specific patients, this same hospital also helped 91% of its physicians achieve Stage 1 Meaningful Use criteria.

3. Reap Downstream Revenue: Your organization will reap additional ROI from downstream revenue generated by newly-diagnosed patients. For example, a new diabetic may also be obese and have heart disease. He will make appointments with GI and cardiovascular specialists, and will need nutritional, exercise and general lifestyle counseling. He may undergo a bariatric or heart procedure. These elements support your fee-for-service business. Through continued reminders and care coordination, you can also increase this patient’s compliance and enhance your care quality metrics. These measures enhance your value-based reimbursement.

Use your EHR to engage both your patients and physicians, and make meaningful health reminders an integral part of the back-to-school ritual.

Quality Matters: Obesity as Disease: What Does it Mean for Your Hospital?

What does the AMA’s recent recognition of obesity as a disease mean for your hospital? The decision has both short- and long-term implications for your clinical programs, population health and fiscal wellness.

Disease Management

First and foremost, the disease classification should encourage physicians to talk with their patients about obesity. In one study of 5,500 government health survey participants, nearly 33% of obese and 55% of overweight respondents had never been informed by their doctor that they were overweight. Perhaps to encourage frank doctor-patient discussions, the AMA not only defined obesity as a disease, but also lowered the threshold of disease to a BMI of 30; CMS defines obesity as a BMI or 35 or greater.

For patients, with awareness comes action. The same study revealed that overweight or obese patients who had weight discussions with their doctors were more likely to have realistic perceptions of their weight problems, to want to lose weight, and to have recently tried to do so. That can have a positive effect on obesity’s common co-morbidities like high cholesterol, high blood pressure and diabetes.

Expanded Treatment Options

Soon after the AMA’s declaration of obesity as a disease, the Treat and Reduce Obesity Act was introduced in Congress, focusing on Medicare reimbursement for weight-management prescriptions and behavioral counseling. If it passes, more commercial insurers may also expand pharmaceutical coverage and cover obesity treatments.

Enhanced coverage can benefit your bottom line in the short term from high-revenue surgeries. But if you don’t have a comprehensive long-term disease management program for ongoing patient support,  the enhanced focus on expanded obesity care can be financially damaging under an ACO model.  As patient demand for services will also increase under the new disease classification, it is imperative that they understand the risks, benefits, and permanent lifestyle changes involved, and have the expert support they need.

Preferred Surgeries

Perhaps the most interesting potential effect of the “obesity as disease” paradigm – and the widespread insurance coverage that will likely follow – is the implications for preferred bariatric surgeries. For example, there are significant weight loss, nutritional and complication differences between gastric bypass and banding or stapling procedures.

Bypass results in greater weight loss, but can cause vitamin deficiencies and is associated with a 1.5-4 times higher in-hospital complication rate than banding or stapling procedures in Healthgrades Bariatric Surgery Report 2013. But each procedure has been shown to resolve obesity co-morbidities like type 2 diabetes, sleep apnea, high cholesterol and high blood pressure. Further, studies show that altered digestion, not fat loss, appears to affect blood sugar control and other metabolic factors the most.

If public policy shifts to weight loss versus health indicators, does reimbursement policy follow?  In other words, does the decision matrix for preferred surgeries switch to one of reimbursement necessity versus personalized patient-centered outcomes?

As the newest chronic disease forges ahead, plan your clinical services around population and fiscal health: provide the comprehensive, high-quality bariatric services more patients will demand.

4 Ways to Show Women You Value Their Care

Here’s the bad news: Healthcare is one of two industries with which women are most dissatisfied.

While the financial services industry takes the top prize in female frustration, according to a study of over 12,000 women, healthcare has significant room for improvement. The good news is there are specific techniques to improve women’s experience while simultaneously improving the quality of care you provide.  How can your hospital show women their care matters? Four ways:

  1. Teach It: Does your organization offer female-specific patient education? Women are looking for companies that care about them, and teaching them about their unique health risks is a great place to start. For example, despite women typically faring better than men with heart failure and COPD, there is a persistent heart attack outcomes gap. Show women how to bridge it by recognizing heart attack symptoms unique to women and being assertive with doctors about their condition. Or lower pregnant women’s risk of having an inadvisable C-section by teaching them about the associated risks and alternative childbirth techniques.
  2. Train for It: It’s not just female patients who don’t understand their unique health symptoms and risks. Many times your physicians don’t either. Demonstrate you are truly listening to women’s specific health needs by training your medical staff on female-specific symptoms and evidence-based treatments.  For example, when women have a heart attack they are less likely than men to get surgery, whether bypass or angioplasty, and have 43.5% and 33.2% higher mortality rates, respectively, when they do. Train your physicians to recognize female-specific heart attack symptoms and treat them as aggressively as they would male symptoms, so women receive interventions earlier, when they are more likely to survive them.
  3. Practice It: Does your hospital ensure its OB/GYNs have expertise in the latest recommended surgical techniques? For example, Healthgrades Women’s Health Report 2013 reveals that only 30% of hysterectomies are performed laparoscopically. That’s despite the lower surgical risks, shorter length of stay and faster recovery times associated with vaginal and laparoscopic hysterectomies. A recent study demonstrates this disconnect, showing that 84% of gynecological surgeons perform open hysterectomies most often, but only 8% would choose them first for themselves or a spouse. No wonder 41% of women are dissatisfied with their doctors.
  4. Prove It: Promote your hospital’s superior women’s health outcomes. Women want to do business with healthcare organizations that enable them to take better care of themselves and protect their health. Yet, according to the book Too Busy to Shop, nearly two-thirds of them feel misunderstood by healthcare marketers. They are asking you to stop telling them how much you care, and start proving it. For example, Healthgrades 2013 Women’s Health Excellence Award recipients have 55% lower mortality rates and 21% lower complication rates over 15 procedures and conditions.

Show women their needs matter – let them know you put quality women’s healthcare first.

How Women are “Leaning In” to Their Healthcare

What does it mean for women to “lean in” to women’s health?

Women have long been the primary family healthcare decision-makers. But they are now starting to follow Facebook COO Sheryl Sandberg’s advice to “lean in”, and not just within their careers. They are taking responsibility for their health and owning their healthcare decisions. How do they accomplish these goals?

Leveraging Online Health

Women are leveraging their family decision-making role to own their own healthcare more assertively than men. According to a recent Pew Internet report, significantly more female (79%) than male (65%) internet users search for health information online. Women are also more likely to research specific diseases, conditions, treatments and procedures online than men. They value health knowledge, and recognize that taking responsibility for their health means understanding the risks and potential complications of their care.

But they don’t stop there. Fully 40% of women go online to diagnose a condition, compared to only 30% of men. Then 55% of them follow up with a healthcare professional afterwards, compared to 50% of men. In other words, they empower themselves with information first, then seek out medical expertise.

Sharing Primary Care Desires

An American Association of Family Physicians poll illuminates women’s frustrations with outpatient medical care. They find it confusing, redundant, uncommunicative, inconsistent and effort-intensive. So what do they want?

·         68% want same-day appointments with their primary care physician

·         63% want a real relationship with their primary care physician

·         63% want a medical home where all their chronic conditions can be managed in one place

·         60% want technologies to share their health information among doctors

·         51% want to communicate electronically with their doctors

In short, women want centralized, coordinated, informed, and thoughtful care. They are demanding the same type of information and value they encounter in other industries.

Going Social

When it comes to social networking, women are power users. According to the Pew Internet Project, 71% of women use social networking sites versus 62% of men. More and more of them are turning to social media for healthcare as well. Approximately one in four adults turn to others with the same condition for support, while slightly more have read or viewed another’s experience online. As the social healthcare phenomenon grows, building a relationship with women via social media will mean having engaging content and a quality brand to share.

As moms, women value their ability to help other moms through personal recommendations for products and services. By “leaning in” to their own healthcare, they extend this natural tendency to help other women help themselves. The National Heart, Lung, and Blood Institute recognized this trend by dedicating American Heart Month 2013 to celebrating stories of women taking action: protecting their hearts and inspiring others to make heart-healthy lifestyle changes.

Women are “leaning in” and taking responsibility for owning their health. Will you adapt your care to meet them?

Quality Matters: Why Women’s Outcomes are Different – And How to Change Them

1980’s business fashion trends aside, women aren’t small men – their clinical outcomes prove it. How can your hospital improve women’s outcomes?

Women’s health outcomes are impacted by different diseases, symptoms, social situations, and psychological needs compared to men. Here’s how you can optimize them.

Diseases: What does your hospital know about gestational diabetes management? Carolyn Hax had gestational diabetes during her second pregnancy, so she indicated she was diabetic on her hospital registration form. The morning after she delivered, her breakfast tray arrived from the hospital kitchen on schedule. It contained a huge, gooey, blood glucose-spiking cinnamon bun with orange juice on the side. The kitchen didn’t consider it a mistake, despite increasing Hax’s risk of developing lifelong Type 2 diabetes. Perhaps the food service staff, like some physicians, thought her diabetic risk ended with childbirth.

Symptoms: According to a 2001 Institute of Medicine report, every cell has a sex. That may help explain women’s different disease symptoms and outcomes. So do gender-variant disease incidence, severity, time of onset, and treatment. For example, a recent study indicates that, compared to men, women are prescribed more drugs, have poorer adherence, and do not always receive appropriate prescriptions. How do women fare in two of the three leading causes of death, heart disease and stroke?

  • Heart Disease: The #1 killer of women in every major developed country, female heart disease deaths even outstrip those of males. Research has consistently shown that women fare worse than men in cardiovascular disease treatment. They experience delays in care, potentially due to a focus on male-prevalent symptoms, and are more likely to die prior to arriving at the hospital than men.
    For example, women typically have more non-specific complaints like abdominal pain, achiness, anxiety and lightheadedness; these symptoms do not align with men’s specific complaints of radiating chest pain, tightness, and pressure. Women are also more likely not to receive recommended preventive and followup care. Educate both your clinical team and female consumers to be vigilant in monitoring and treating female-specific heart complaints.
  • Stroke: Women account for more strokes than men, and also have higher mortality rates. Pregnancy increases stroke risk. By 2050, stroke mortality is forecast to be 30% higher in women than in men – and the increased risk is not all explained by women stroke patients being older and having more co-morbidities. Women may present with different stroke symptoms than men, including the sudden appearance of face and limb pain, hiccups, nausea, general weakness, chest pain, shortness of breath, and palpitations.
    Once in the hospital, women have a 10% lower chance of receiving evidence-based stroke care than men, including the use of tPA and statins. They are also more likely to have atrial fibrillation after a stroke, which is associated with a 4-5x increased risk of an ensuing ischemic stroke. Clinical team and consumer education on female stroke concerns can lower women’s skyrocketing mortality rates.

Social Situations: Many women juggle more than one full-time job, both outside the home and as a family caregiver within it. As a result, their interpretation of their own health emergencies can suffer. For instance, only half of women surveyed in one study said they would call 911 if they experienced heart attack symptoms. Educate your female consumers to recognize emergent symptoms and take appropriate action. Also, design efficient post-discharge care plans that include clear written instructions for role-reversed family members who will now be caring for the caregiver.

Psychological Needs: Emotions can impact outcomes. Two to three times more women suffer from depression. Also, as women typically feel more need to connect with others, they are more impacted by an impersonal health care experience. For example, a recent study indicates women notice clinical quality aspects more than men, especially communication and cleanliness. According to another study, women associate cancer care quality more with trust in their doctors than with adherence to clinical guidelines. Teach your clinicians to communicate and connect with their patients, and remember to include emotional health needs in discharge instructions – your female patients’ outcomes may depend on it.

When it comes to health care, what’s best for men and women is often different. To optimize your female patients’ health, make your hospital’s care gender-specific.

Attend our free webinar today: Evidence-Based Management Practices to Drive Quality Patient Outcomes and Financial Success

There is still time to attend our free webinar today!

Our speakers are  Lynn McVey, President & CEO, and Mitch Schuteris, Marketing Manager at Meadowlands Hospital and Medical Center in New Jersey. They were invited to speak as industry experts at our annual HealthShare event this past May and we wanted to share their informative presentation with those that were not able to attend. This presentation will provide great insights and direction to think about for your own organization. Below is the description of what you’ll learn:

Attendees will receive an evidence-based management (EBM) workbook tool to jumpstart their EBM initiative at their hospitals. education, mentoring, daily “data diving” (oversight), critical-thinking and reporting of the findings will be discussed which is essential to eliminate practice variations, and roll-out a successful and standardized management practice in all hospital departments.

When: Thursday, July 18, 2013

2:00 ET/11:00 PT

REGISTER HERE

If you can’t join us live today, make sure to register anyway and you will be notified of when the presentation is uploaded to our website for you to view on demand. We hope to see you!

Can Treating Post-Hospital Syndrome Prevent Readmissions?

There is a hidden threat to your value-based payment strategy, according to a recent New England Journal of Medicine article: post-hospital syndrome. What exactly is this condition? More importantly, how can you minimize its severity, or even prevent it?

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What It Is: Post-hospital syndrome, according to Yale Professor of Medicine Harlan Krumholz, MD, MS, is an “acquired, transient period of vulnerability” patients experience after hospitalization. During this window, they are not only recovering from the illness for which they were hospitalized, but are also at risk for a variety of adverse events due to the hospitalization itself.

Why It Matters: Nearly 20% of discharged Medicare patients are readmitted within 30 days, and as a recent study revealed, it is for conditions that oftentimes seem unrelated to the original admitting diagnosis, or its severity. Readmitting diagnoses vary widely, from heart failure, pneumonia and COPD, to trauma, GI conditions, infections, metabolic issues and mental illness. So what can your hospital possibly do to avoid readmission penalties?

There’s good news. While these diagnoses may be unrelated to the original reason for hospitalization, they can be directly attributed to common hospitalization and post-discharge experiences themselves. That includes sleep deprivation, circadian rhythm disturbances, malnutrition, pain, deconditioning, stress and confusion. In short, this constellation of signs and symptoms is treatable.

How to Minimize or Prevent It: Post-hospital syndrome is a nosocomial condition. That means minimizing or preventing it is fundamentally within your organization’s control. The ways to do so are very familiar. Encouraging patient activity is good practice, while quiet, good food, pain control, and quality communication are common patient experience factors. The 2013 Healthgrades Patient Experience Report indicates patient experience depends mostly upon good communication and pain control, making it tempting to focus solely on those areas. But noise abatement, quality nutrition and patient physical conditioning efforts may actually be useful predictors of clinical outcomes.

Keeping your hospital quieter at night doesn’t require plush carpeting and acoustic ceiling tiles. Merely requesting that your clinicians use hushed voices, close patients’ doors and keep lighting low can help. Or consider offering earplugs to sensitive patients.

Similarly, proactively inquiring not only about patient dietary requirements, but also preferences, can maximize nutritional intake. Many hospitals now offer room service menus, ensuring patients receive food choices they are most likely to eat. Offering dietician services pre-discharge can also help keep patients from coming back sooner than you’d like. For example, one study indicates weight loss and decrease in blood albumin within 30 days post-discharge are the greatest predictors of non-elective readmissions. So in the short-term, advise your patients to pack more protein and calories into their diets.

Starting to improve patients’ physical conditioning can be as simple as encouraging them to get out of bed or walk down the hall as much as possible. For those who are bed-bound, sharing their risks and offering mitigation strategies can also be effective. For example, patients’ lung function post-cardiac bypass surgery directly affects their risk for pneumonia, so inform them of that link when encouraging them to use their spirometers vigorously and often.

Until recently many readmissions were thought to be inevitable. But you can potentially prevent them by adding post-hospital syndrome to your value-based payment equation.

Attend our free webinar today! Strategies for Navigating a Successful Partnership

Henry Ford Health System has been a client of CPM for 9 years and was an Innovation Round presenter at our annual HealthShare event in May. Due to the success of their presentation, we brought them back to conduct a webinar on their topic.

This session will discuss the evolution of a client-partner relationship and how growth and changes in both organizations have played a role in Henry Ford’s marketing success. Learn also about various challenges along the way, from data issues to changing team members and resolution. This session will begin with getting things started and cover strategies for maintaining a successful relationship.

Spots are still available, so register now!

2:00 PM ET/ 11:00 AM PT