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A BED'S EYE VIEW OF HEALTH REFORM. The New Landscape and What it Means for Communicating with Patients. Chuck Alston Senior Vice President/Director of Public Affairs MSL Washington DC. Today’s Takeaways. How to talk about the changes in health care delivery and not scare people

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a bed s eye view of health reform

A BED'S EYE VIEW OF HEALTH REFORM

The New Landscape and What it Means for Communicating with Patients

Chuck Alston

Senior Vice President/Director of Public Affairs

MSL Washington DC

today s takeaways
Today’s Takeaways
  • How to talk about the changes in health care delivery and not scare people
  • The rewards of genuine patient engagement
  • Communicating medical evidence with shared decision-making
  • Why patients may start acting like consumers
we mean well but sound scary

We mean well, but sound scary

Take Care With How You Talk About Health Care

do they hear what you think you say
Do They Hear What You (Think You) Say?

The new landscape of delivery and payment reform is covered with language landmines

come again
Come Again?

Source: Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” ThePermanente Journal.13(1):8-16. 2009.

a few choice words about medical homes
A Few Choice Words About Medical Homes

“It just sounds like a nursing home.”

-- Boston focus group participant

“First you go to a medical home, and then you go

to the funeral home.”

-- Edina, MN focus group participant

“It just gives me the creeps.”

-- Edina, MN focus group participant

Source: Ross M, Igus T, Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” ThePermanente Journal. 2009;13(1):8-16.

lost in translation
Lost in Translation

“Of course the system is integrated. There are black and white patients.”

-- Participant in focus group conducted for MSL client

“I know my doctor is high-quality. He has Town & Country in the waiting room.”

-- Participant in 2007 focus group for the Robert Wood Johnson Foundation

slide10

Reform Fatigue

  • Improvements, sure
  • Changes, maybe
  • But please, no more reform

REFORM

beware of the team trap
Beware of the “Team Trap”

Messages about “teams” can create more concern than comfort

Sources:

  • Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” ThePermanente Journal.13(1):8–16. 2009.
  • Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
  • Photo: The Medical Group, Beverly, MA.
who s in charge
Who’s in Charge?

Concerns recede when it is clear the doctor is calling the signals

Sources:

  • Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” ThePermanente Journal.13(1):8–16. 2009.
  • Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
the journey from volume to value

The journey FROM Volume to value

You Want to Go Where with My Health Care?

from volume to value
From Volume to Value

This mantra works for:

What could be wrong with that?

just ask them
Just Ask Them

They think

Valu

is a four letter word

slide16

What Value Looks Like

People equate value with “bargain-basement pricing” not high-quality care

health care i don t want to buy in bulk
Health Care: I Don’t Want to Buy in Bulk

Tested statement:

“Here in our community, we are looking at ways to improve the health care that we all receive, so that we get more for the money we spend. That includes making sure that doctors understand that we want to pay for the right care, not tests that we do not need or other unnecessary procedures.”

Charlotte, N.C., woman:

“More for the money, I don't know, it sounds like you are buying bulk.”

Source:Focus group held in Charlotte, N.C. for the Robert Wood Johnson Foundation, 1 March 2011.

valu rationing poor quality
VALU = Rationing, Poor Quality
  • “Eliminating waste,” “increasing efficiency” or even “saving money” sparks fear of rationing care that they want – and feel they need – but that may be expensive
  • Feelings that care will be cheapened, or that time with physician will be cut or – worst of all – that the care that they want could be curtailed is threatening. It shuts down the conversation.
  • The premise of VBID programs — the use of high quality providers or evidenced-based procedures leading to lower costs — is counterintuitive to employees’ perceptions that lower cost equals lower quality

Sources: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)

  • Employee Health Engagement:Identifying the Triggers and Barriers to Engaging Employees in Their Health Benefits and Wellness Programs. Chicago, Ill: Midwest Business Group on Health, 2011.
summary barriers to communicating value
Summary: Barriers to Communicating Value
  • Consumer beliefs:
    • Quality tracks cost -- higher priced care must be better
    • More care must be better
    • Agency theory – doctors have my interests at heart
    • When it comes to my health care, sky’s the limit
  • Third-party payment system – patients only see their portion of the costs*

* Let’s talk more about this later!

park your aco in a medical home garage
Park Your ACO in a Medical Home Garage

Takeaways:Consumers resist being consumers when it comes to their health care

  • Consumers don’t want to talk about delivery system typology, or how doctors and hospitals are paid
  • They don’t know volume from value, and don’t want to
  • The get mad that money influences the way care is delivered

Conclusion: Put the “We’re Your New Hometown ACO Campaign” on hold

so what who cares what s in it for me

So what, who cares, what’s in it for me?

The Path to Patient-centered Messaging

the problem with my health care is
The Problem with My Health Care is…
  • Uneasy relationship with my doctor
  • Doctor is pressed, encounter feels rushed, questions go unanswered
  • Lack of clear, trustworthy information
  • Too many mistakes, too much miscommunication that can make things go wrong

Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)

the conversation about care starts here
The Conversation About Care Starts Here

The doctor-patient relationship is the foundation for messaging about quality improvement or delivery and payment reform. Start here and build out.

what do patients want
What Do Patients Want?
  • More time with their physicians
  • Better coordinated care
  • To not pay more

Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)

what do patients want1
What Do Patients Want?

An ACO wrapped around a medical home.

(Just don’t call it that.)

enough about what not to say

ENOUGH ABOUT WHAT NOT TO SAY

The ABCs of Delivery Reform Communications

it s all about me
“It’s All About Me”
  • Patients want to hear what’s in it for them
    • Messaging about payment or delivery should focus on patient benefits
    • Position the benefits as “improving care coordination,” “increasing preventive care,” “improving the doctor-patient relationship” and "improving communication across doctors”
  • Offer “solutions” to problems they see
  • If you must talk about money, talk about spending health care dollars wisely, not saving money

Source: “Talking About Health Care Payment Reform with U.S. Consumers.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011.

example red flag over the revolving door
Example: Red Flag over the Revolving Door
  • Hospitals are on red alert to reduce readmissions to avoid Medicare penalties
  • Do not make these efforts sound like you want to ration or take away care
  • So:
  • DON’T focus messaging on keeping people out of the hospital
  • DOfocus messaging on the solution—improving care for patients when they return home—because it will be seen as a benefit
how to say it
How to Say It

We want to find better ways to care for you to improve your care and make sure you get the best care possible

  • Improving communication, coordination among doctors, nurses, others
  • Getting you all the preventive care you need
  • Making sure you get right
  • medications and tests
  • Helping you make appointments easily, fill out forms once, take tests once, so you do not have to repeat yourself over and over
  • Providing high-quality care, tailored just for you, based on best medical evidence and your doctor’s recommendation

Source: “Talking About Health Care Payment Reform with U.S. Consumers.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011.

how to say it1
How to Say It

We want you to have:

  • A stronger relationship with your doctor
  • More time with your doctor
  • All your concerns addressed
  • No decision made about you without you – patient involvement
  • An understanding of your follow-up care
  • After-hours help, alternatives to the emergency room

Source: “Talking About Health Care Payment Reform with U.S. Consumers.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011.

if you have to talk about reimbursement
If You Have to Talk About Reimbursement

Source: “Talking About Health Care Payment Reform with U.S. Consumers.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011.

patient engagement

Patient engagement

The Blockbuster Drug of the Century

framing question
Framing question

When it comes to your patients, are you better off if you do things:

TO THEM?

FOR THEM?

OR WITH THEM?

framing question1
Framing question

When it comes to your patients, are you better off if you do things:

WITH THEM

the rio on better patient engagement
The RIO on Better Patient Engagement
  • Better health outcomes
  • Better experience of care
  • Lower health care costs

Characteristics of Effective Interventions

  • Utilized peer support
  • Changed the social environment
  • Increased patient skills
  • Tailored support to the individual’s level of activation

Source: Greene J and Hibbard J. “What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs.” Health Affairs. 32(2): 207-214. February 2013

engaging patients with visit notes
Engaging Patients with Visit Notes

By reading their notes, patients:

  • Better remember what is discussed during visits
  • Feel more in control of their care
  • Are more likely to take medications as prescribed
  • Can share notes with their caregivers, better equipping them to stay up to date with visit events and help enact the recommended treatment plan

Source: Delbanco T, et al. “Inviting Patients To Read Their Doctors’ Notes: A Quasi-Experimental Study And A Look Ahead.” Annals of Internal Medicine. 157(7): 461-470. October 2012

even the doctors don t mind
Even the Doctors Don’t Mind

“Weeks after my visit, I thought, wasn’t I supposed to look into something? I went online immediately. Good thing! It was a precancerous skin lesion my doctor wanted removed (I did).” -- Patient

“I felt like my care was safer, as I knew that patients would be able to update me if I didn’t get it right. I also felt great about partnering with my patients, and the increased openness.” -- Doctor

Source: http://www.myopennotes.org/wp-content/uploads/2012/10/OpenNotes-Results-Fact-Sheet.pdf

engagement more than you may think
Engagement: More Than You May Think

A Multidimensional Framework For Patient And Family Engagement

In Health And Health Care.

Carman K L et al. Health Aff 2013;32:223-231

Source: Carmen K, et al. “Patient And Family Engagement: A Framework For Understanding The Elements And Developing Interventions And Policies.” Health Affairs. 32(2): 223-231. February 2013

communicating about medical evidence

Communicating about medical evidence

Put Evidence in the Context of Shared Decision-making

nothing about m e without me
Nothing About Me Without Me

People want to be involved in decision-making

  • Especially about surgery or medications

Patients want doctors to communicate options

  • People trust their doctors and want more time to talk/listen

People value results of comparative effectiveness research

  • Regardless of politics, patients see deep value in CER
    • Their fear, however, is that money will ultimately drive decisions and/or their preferred treatment will be off limits.

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

the care they want v the care they get
The Care They Want v. The Care They Get

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

put evidence under an umbrella concept
Put Evidence Under an Umbrella Concept

Making an informed decision about the care that’s right for you

elements of an informed medical decision
Elements of an Informed Medical Decision

Medical Evidence

Informed Medical Decision

Clinician

Expertise

Patient Goals & Concerns

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

people value all 3 elements strongly
People Value All 3 Elements Strongly

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

what patients want to hear
What Patients Want to Hear
  • When discussing treatment options, patients want their doctor to use clear language and listen to the patient
  • Patients want to hear:
    • The truth about the diagnosis – no sugar-coating
    • All options for treatments
    • Risks and side effects of treatment options
    • What the diagnosis and treatment mean for future quality of life
    • Recommendations for a website or literature where the patient can learn more
    • Next steps
  • And for some:
    • How the illness or condition developed
    • A willingness for the patient to get a second opinion

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

nothing about me without me
Nothing About Me Without Me

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

shared decision making messaging
Shared Decision-making Messaging

Tap into motivations:

  • Getting the best care possible
  • You know yourself best
  • Improving the MD/patient relationship
  • Increasing knowledge about health and treatments

Part of getting the best possible care is having a doctor who listens to you, answers your questions, and includes you in decisions about what treatments are best for you.

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

satisfaction linked to shared decisions
Satisfaction Linked to Shared Decisions

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

why certain language resonates
Why Certain Language Resonates

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

best framing language
Best Framing Language

Making sure you get the best possible care starts with you and your doctor making the best decision for you.

Your doctor can help you understand what types of care work best for your condition, based on medical evidence.

Because there are always new treatments, doctors use this evidence to keep up with which work best.

Your doctor’s experience helps him/her evaluate and apply the evidence to your situation.

The doctor also needs to listen to you so he/she understands your values, preferences and goals.

This is important because every patient is different, and when there are options, it is important for the doctor to know what is important to you.

how to describe the doctor s recommendations
How to describe the “Doctor’s Recommendations”
  • Yes
    • Medical evidence
    • Recommendation
    • Best practice
    • Guideline
    • What is proven to work best
  • Maybe
    • Medical science
    • Evidence-based medicine
    • Comparative effectiveness
  • No
    • Research – “Research changes every day”
    • Standard – “But I’m different”

Source: Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012

patients as consumers

Patients as Consumers

Spending My Money is Another Matter

high deductibles will drive consumerism
High Deductibles Will Drive Consumerism

Health plans increasingly have high deductibles

price seekers
Price Seekers

Altarum Institute Spring/Summer 2012 Altarum Survey of Consumer Health Care Opinion

  • Who is most likely to ask about the price of care?

 Younger age,

 Lower income,

 Higher insurance deductible,

 Recent hospitalization,

 More experience using computers and smartphones, and

 Not being an impulse shopper in other aspects of life.

  • Neither health status nor gender was predictive of asking about price.
resources

Resources

The Research Behind Today’s Presentation

to learn more
To Learn More
  • Alston C, et al. “Communicating with Patients on Health Care Evidence.” Washington, D.C.: Institute of Medicine. September 2012.
  • Bechtel C and Ness D. “If You Build It, Will They Come? Designing Truly Patient-Centered Health Care.” Health Affairs. 29(5): 914-920. May 2010.
  • Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-based Health Care.” Health Affairs. 29(7): 1400-1406. July 2010.
  • Carmen K, et al. “Patient And Family Engagement: A Framework For Understanding The Elements And Developing Interventions And Policies.” Health Affairs. 32(2): 223-231. February 2013.
  • Coulter A. “Patient Engagement—What Works?” Journal of Ambulatory Care Management. 35(2): 80-89. April-June 2012.
  • Delbanco T, et al. “Inviting Patients To Read Their Doctors’ Notes: A Quasi-Experimental Study And A Look Ahead.” Annals of Internal Medicine. 157(7): 461-470. October 2012.
  • Gerber A, et al. “A National Survey Reveals Public Skepticism About Research-Based Treatment Guidelines.” Health Affairs. 29(10): 1882-1884. October 2010.
  • Greene J and Hibbard J. “What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs.” Health Affairs. 32(2): 207-214. February 2013.
  • Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente Journal.13(1): 8–16. 2009.
  • “Talking About Health Care Payment Reform with U.S. Consumers.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
  • “Talking with Physicians about Improving Payment and Reimbursement.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)
slide61

Health care communications and public affairs

We are part of the MSLGROUP Americas, the PR arm of the Publicis Groupe, one of the world’s largest communications firms. Our team offers clients the personal touch and category expertise of a boutique, with access to national and global resources should they require them.

Our health care and health care policy work is holistic: We design and execute programs that seek to change minds, policy and behavior with audiences running the gamut from the chronically ill to the chronically wonky.

We specialize in health, health care and medical issues, working on the cutting edge of patient and provider communications, quality improvement, delivery and payment reform, and public affairs and reputation management.

Whether your business is delivering care to patients or messages to Capitol Hill, find out why trade associations, non-profit foundations, health plans, hospitals and health systems have turned to us to take care of them.

Chuck Alston

senior vice president/director

chuck.alston@mslgroup.com

Michael King

vice president

Aaron Cohen

vice president/media

Eva Fowler

account supervisor

Katherine Brick

account supervisor

Emily Burton

senior account executive

Alyssa Snow

senior account executive

Leah-Michelle Nebbia

account executive

Colleen Johnson

assistant account executive

to follow up
To Follow Up

Chuck Alston

chuck.alston@mslgroup.com