2013q2-record-of-learning

Patient-Centered Primary Care Collaborative of Central Ohio: Q2 2013 Learning Session Topic: Provider-Based Patient Engagement June 28, 2013 Record of Learning Learning Session Objectives  Provide update on Access HealthColumbus’ efforts to advance patient-centered primary care in Central Ohio  Raise awareness on Choosing Wisely, and why it will provide value to the community.  Shape Choosing Wisely project and identify additional stakeholders.

Learning Session Materials  Please click here to view the presentation slides and links to videos. (url: http://issuu.com/ahcols/docs/2013q2-quarterly-learning-session-f) Learning from Small Group Discussions Below is the learning from the 115 leaders from business, government, health care and the social sector that participated at the session. Participants working in small groups and were asked to explore the current norms of health care in Central Ohio, as well as, the opportunities and challenges the Choosing Wisely project presents.

Discussion A: Shifting from current to future norms in Central Ohio Imagine if value and care in Central Ohio were improved through a shift in culture.

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Discussion A: What are key reflections when considering the shift from the current to future norms?

Concerned that patients will not be engaged in shifting to the future norms. o Concerned about increased time needed to educate patients on what their real needs are vs. what they expect. Additional concerns include healthcare literacy amongst patients, as well as additional overhead costs to practitioners for additional staffing needs. o Emphasize health education to patients on a fifth grade level so that patients can clearly understand their health factors and expectations for impacting their own health. Empowering patients in their own health maintenance/care. o Empowerment and education needed for patients and providers regarding their roles and RESPONSIBILITIES: "what does it mean to be a GOOD patient?" o Healthcare culture change will involve and require patient engagement and accountability.

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o Lack of standard or common processes to address non-compliant/lack of engagement from patients across providers. o Need to acknowledge reasons why consumers have become ' detached' from primary care providers, and address them when building new models. o Need to get beyond fear of holding their provider accountable. o Open the pathway by educating clients and let clients be the solution.

Current payment model does not support this shift. o How long will payers sit at the table without seeing evidence based changes? o If payment is based on outcomes, how do you keep providers from avoiding the sickest patients who need them the most and may not be able to manage their own care? o Need for increased revenue to meet the increased demand for care. o Physicians and payers need to take the lead and establish uniform standards; for example what tests to pay for and when. o There has to be an alignment throughout all the different payers for a shift to occur. o Upfront transparency in cost & quality for patients to easily access in order to make decisions about their healthcare is necessary.

Shift to future norms will take a lot of time. o It's going to take time. Longer office visits leads to fewer patients in a day which leads to lower revenue unless there is reimbursement. We need more education. Providers need to acknowledge that change in lifestyle is not easy. o Providers need more TIME & resources to engage in conversation with patients face to face.

Shift will require a collaborative approach involving providers, patients, and purchasers/employers/health plans. o All 3 components need to be involved for success. o Difficulties convincing decision makers regarding front end investment necessary to make the shift.

Requires all parties to move towards each other and willing to "give a little" on their stances. o Effective communication between groups is not occurring so we are relying on who is communicating to us which is the media. o It is hopeful that there is alignment of conversations and efforts are occurring among stakeholders.

There is importance of maintaining proportionality among all so none should bear the brunt of change. o More than just a culture shift: it's moving a battleship 180 degrees. o There is need to engage more partners in care coordination. o There will need to be shared dialogue and decision making with patients and providers. o Wellness efforts moving away from onsite screenings at the employer back to the PCP.

Discussion B: Exploring Choosing Wisely as a best practices for improving providerbased patient engagement Primary care teams and patients having the important conversations necessary to ensure the right care is delivered at the right time based on physician-developed evidence-based recommendations 2

Discussion B: What are the key opportunities and challenges of making Choosing Wisely a standard of care in our community?

• Opportunity to strengthen partnerships focused on improving healthcare. o A move towards shared decision making process o All stakeholders agree on what questions to ask to cover all/unusual situations. o Opportunity for payers and providers to remove barriers o Opportunity to engage a broader range of community partners. o There needs to be a consensus among PCP, minute clinics, and ER about antibiotics so there is not "patient shopping". Public health can play a role in educating about antibiotic overuse.

Utilize patient advisory boards to engage patients.

• Opportunity to engage patients in their care, and help improve their health literacy. o Engage consumers on what they CAN do besides tests/procedures/drugs - shift the mindset of the patient o Health literacy needed to educate patients understand the materials. o It forces patients to take an active role in their healthcare and be more engaged. o Patient education versus self-diagnosing o Strengthen standard of care. Engage patient in their care. Increase in shared evidence • Opportunity to utilize a number of resources to achieve success. o Ask media to promote this concept .... Or start our own show! o Can assist with creation of wellness initiatives o Choose champions to spread these recommendations. Determine what percentage of patients are over users to target them. o Devise tools to use for education during "downtime": lobby, exam rooms.

• Opportunity to change how providers and patients interact. o Changing mindset of physicians who are being directive or directed by patients with their own agendas. o Clearer path between physician and patient to build relationship and communicate the standard of care had shifted. o Clinical guidelines provide a tool for providers to determine recommended testing. o Getting providers comfortable with change in dialogue-discussing risks and benefits.

• Challenges o Can help steer clear of fear based results. o Getting large medical organizations to allow other branded education tools/programs o It takes time..."I don't have the time..." o Physician fear of malpractice and litigation if consumer driven request from patient fails o Revenue drives business (money is earned from testing right now) o We see each other as competition rather than partners

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Small Group Polling on the Value of Choosing Wisely What is the potential value of Choosing Wisely as a standard of care in Central Ohio?

Next Steps •

What can I do to advance Choosing Wisely in Central Ohio?

Various ways to be involved  Provider: Learning and training sessions for primary care teams  Patients: Learning and training sessions for patients  Community Partners: Community awareness and education campaign To indicate your interest in participating in the Choosing Wisely project, please click here (url: http://www.surveymonkey.com/s/SQFNWLC)

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Access HealthColumbus will apply learning from the session to guide the advancement of Choosing Wisely as a best practice for improving provider-based patient engagement in Central Ohio.

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