2013q3-quarterly-learning-session-final

Patient-Centered Primary Care Collaborative of Central Ohio September 6, 2013 Learning Session

Learning Topic: Improve patient engagement in the use of evidence-based health care and shared decision making

Please save the following dates for future learning sessions (8:30-10:30AM): • December 6, 2013 • April 4, 2014 • August 22, 2014 • December 5, 2014

Welcome! www.accesshealthcolumbus.org Lead Support

Major Support

Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate Donations

Building off learning from the past two sessions...

Today’s Objectives  AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement  EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams  SHARE actionable next steps for advancing provider-based patient engagement in Central Ohio using Choosing Wisely as a good place to start!  LEARN from your perspectives!

Collaborative Approach for Improving Patient-Centered Primary Care

WHY?

WHAT?

• The need to improve patient-centered primary care as the foundation of accountable health care delivery to achieve better care, better health, better value

• Improve patient-centered primary care in private practice, hospital-affiliated, and federally qualified health centers serving patients with Commercial insurance, Medicaid, Medicare, and the uninsured

Collaborative Improvement Activities Coordinated by Access HealthColumbus

Primary Care Delivery Transformation

Provider-based Quality Reporting

Improving Primary Care in Central Ohio

Sharing Learning and Results from Collective Impact

Provider-based Patient Engagement

Provider-based Patient Engagement Projects

EMERGING PROJECT: Open Clinician Notes an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians www.myopennotes.org

EMERGING PROJECT: Choosing Wisely an initiative for engaging clinicians and patients in important conversations necessary to ensure the right care is delivered at the right time www.choosingwisely.org

Source: Engaging Patients and Families in the Medical Home, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, June 2010

why?

AIM  Better health  Better care  Better value

Traditional health care based on fee-for-service

• • • • •

Primary Care Improvements

Access and continuity Continuous improvement driven by data Coordination of care across the medical neighborhood Optimal use of health information technology Planned care for chronic conditions & preventative care

• Patient and caregiver engagement

• Risk-stratified care management • Sustained by enhanced, accountable payments in a multi-payer environment

Traditional health care based on fee-for-service

AIM  Better health  Better care  Better value

why?

Source: Unlikely Partners Find Common Ground on Curbing Health Care Costs, Robert Wood Johnson Foundation, April 2013

why?

Barriers: What can hinder patient and family engagement?

AHRQ: Guide to Patient and Family Engagement: Environmental Scan Report, May 2012

PATIENTS & FAMILIES • Fear and uncertainty • Health literacy • Provider reactions

PROVIDERS • Professional norms and experiences • Fear of litigation • Perceived level of effort

Evidence is emerging on the value of patient engagement/activation

COLLABORATION BETWEEN PATIENTS , FAMILIES & PROVIDERS • Better health outcomes • Lower health costs • Improved satisfaction for providers, patients, and families Source: Health Affairs, February 2013

Is Patient Engagement the next “Blockbuster Drug�?

What could happen that would make patient engagement a standard of care in Central Ohio?

What could be different?

Patient and caregiver voices and perspectives embedded in quality improvement initiatives

Purchasers provide incentives to primary care teams to accelerate patient engagement as a standard of care

Clinicians fully utilizing their potential as the three most trusted* professions: Nurses, Pharmacists, Doctors (*Gallup poll)

More patients have improved health status and economic productivity

Patients with lower activation associated with higher costs (per capita billed costs) All patients Hyperlipidemia (n=33,163) (n=10,515)

Hypertension (n=12,175)

Asthma (n=3,347)

Diabetes (n=4,253)

Lowest Activation

$4,679

$6,089

$7,687

$6,581

$8,474

Highest Activation

$4,320

$5,454

$6,750

$5,442

$7,901

$359 x 11,000,000 people in Ohio = real value As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined populations, knowing patients’ ability and willingness to manage their health will be a relevant piece of information integral to health care providers’ ability to improve outcomes and lower costs.

Source: Health Affairs, February 2013

why?

FUTURE NORM Primary care teams and patients/parents/caregivers have the important conversations necessary to ensure the right care is delivered at the right time

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engaged in shared decision-making to improve health and lower costs

Patients/Parents/Caregivers

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Patients/Parents/Caregivers

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CURRENT NORM skepticism and distrust

Building off learning from the past two sessions...

Today’s Objectives  AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement  EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams  SHARE actionable next steps for advancing provider-based patient engagement in Central Ohio using Choosing Wisely as a good place to start!  LEARN from your perspectives!

Consumer engagement with the health care system is a work in progress

• 2012 marks the fifth year for the Deloitte Center for Health Solutions’ survey of U.S. adult health care consumers about their interest in and ability to operate in a consumer health care market.

• These annual online surveys have queried up to 4,000 adults per year in various age, health status, income, and insurance groups to identify the degree to which consumers are prepared to engage with the health care system.

Source: 2012 Survey of U.S. Health Care Consumers: Five-Year Look Back, Deloitte

Source: 2012 Survey of U.S. Health Care Consumers: Five-Year Look Back, Deloitte

Source: 2012 Survey of U.S. Health Care Consumers: Five-Year Look Back, Deloitte

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

“My health doesn’t worry me, so I’m not as engaged with the system, focused on prevention, or interested in online resources as others. I’m costconscious, think that the health care system could improve, and am generally just not interested right now.”

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

“I’m happy with my health plan, hospitals, and doctors and see no reason to compare or switch. I trust my doctors to tell me what I need to know and make good treatment decisions for me. I follow-through with what my doctors recommend and I try to take good care of myself.”

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

“I like to learn as much as I can online and am very interested in innovative health technologies. I am generally happy with the care I get from my doctor, but am also open to alternative providers and different care settings. Making smart, informed health decisions is important to me�

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

“Taking care of my health is a priority for me – I use a lot of health care services and products, try to make informed decisions in partnership with my doctor, and do my best to adhere to treatment plans. I am highly informed through using online information and tools.”

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

“I’m independent – I like to make decisions on my own, prefer doctors who use alternative approaches/natural therapies, and switch medicines more often than most. I’m not very satisfied with the doctors, hospitals, and health plan I’ve used. I’d like to customize my own plan.”

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

“In pursuit of good value – I switch health plans and doctors, use retail clinics, order medications online, and travel for care more often than most. I am cost-conscious and improving or maintaining my health is a priority. I am open to alternatives.”

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

Source: The U.S. Health Care Market: A Strategic View of Consumer Segmentation, Deloitte Center for Health Solutions, 2012

Which of the six health care consumer segments do YOU most identify with?

use attwifi if needed

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

What is Choosing Wisely®?

• Initiative of ABIM Foundation • Trusted resources—including more than 50 national medical specialty societies, 17 consumer groups, including Consumer Reports • Choosing Wisely encourages conversations between patients and physicians • www.ChoosingWisely.org

280+ physician-developed evidence-based recommendations for better health, better care, and lower cost

Specialty societies who have released recommendations • • • • • • • • • • • • • • • • • • • • • • • • • •

American Academy of Allergy, Asthma & Immunology American Academy of Family Physicians American College of Cardiology American College of Physicians American College of Radiology American Gastroenterological Association American Society of Clinical Oncology American Society of Nephrology American Society of Nuclear Cardiology American Academy of Family Physicians American Academy of Hospice and Palliative Medicine American Academy of Neurology American Academy of Ophthalmology American Academy of Otolaryngology-Head and Neck Surgery American Academy of Pediatrics American College of Obstetricians and Gynecologists American College of Rheumatology American Geriatrics Society American Society for Clinical Pathology American Society of Echocardiography American Urological Association Society of Cardiovascular Computed Tomography Society of Hospital Medicine Society of Nuclear Medicine and Molecular Imaging Society of Thoracic Surgeons Society for Vascular Medicine

Specialty societies releasing recommendations in late 2013 • • • • • • • • • • • • • • • • • • • •

American Academy of Dermatology American Academy of Family Physicians** American Academy of Orthopaedic Surgeons American Association for Pediatric Ophthalmology and Strabismus American College of Chest Physicians American College of Emergency Physicians American College of Rheumatology* American College of Surgeons American Geriatrics Society* American Headache Society AMDA – Dedicated to Long Term Care Medicine American Society of Clinical Oncology* American Society of Hematology American Society for Radiation Oncology American Thoracic Society The Endocrine Society Heart Rhythm Society North American Spine Society Society of Critical Care Medicine Society of General Internal Medicine

*Releasing a second list **Releasing a third list

The Courage of Choosing Wisely® • Change mindsets and attitudes • Legitimize a conversation with patients about mindful use of health care resources • Gives physicians and patients a common language to speak about using evidence-based medicine • This is a good place to start.

What activity is emerging in Central Ohio?

Choosing Wisely Project – Planned Approach for 2013-2014

Primary Care Teams private practices, hospital-affiliated practices, and federally qualified health centers

• Measure change in clinical variability based on a set of Choosing Wisely recommendations

Patients

• Measure change in patient awareness and readiness towards using evidence-based health selected from participating care and engaging in shared decision-making primary care practices via a simple with health care teams application process

Specialty Care Teams

• Survey on value of presentations and webinars

raise awareness on Choosing Wisely recommendations

Partners employers, health coalitions, health plans, retirement systems, public health

• Document results from organizational activities

Provider-based Patient Engagement: Choosing Wisely (CW) Project

2014 Patient Learning Collaborative Design

Purpose: to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams

Provider-based Patient Engagement: Choosing Wisely (CW) Project 2014 Patient Learning Collaborative Design Purpose: to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams Sept-Dec/2013 a) Invite primary care teams to participate in Choosing Wisely Project b) Participating primary care teams extend invitation to patients c) Patients with interest complete online application d) GOOD PLACE TO START -- Identify 4 patient groups based on application & insurance status (commercial, Medicare, Medicaid, uninsured)

Q1/2014 Pre-measure patient attitudes and awareness

Host series of patient learning workshops for each of the 4 patient groups

atie P line n O

Mid Year Host learning session with all patients and their health care teams

S & in g k r wo t e nt N

Q4/2014 Post-measure patient attitudes and awareness Host learning session with all patients and their health care teams

rt o p up

al t r Po

Questions of CLARITY for the Choosing Wisely project and Patient Learning Collaborative approach?

Provider-based Patient Engagement: Choosing Wisely (CW) Project 2014 Patient Learning Collaborative Design Purpose: to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams Sept-Dec/2013 a) Invite primary care teams to participate in Choosing Wisely Project b) Participating primary care teams extend invitation to patients c) Patients with interest complete online application d) GOOD PLACE TO START -- Identify 4 patient groups based on application & insurance status (commercial, Medicare, Medicaid, uninsured)

Q1/2014 Pre-measure patient attitudes and awareness

Host series of patient learning workshops for each of the 4 patient groups

atie P line n O

Mid Year Host learning session with all patients and their health care teams

S & in g k r wo t e nt N

Q4/2014 Post-measure patient attitudes and awareness Host learning session with all patients and their health care teams

rt o p up

al t r Po

Building off learning from the past two sessions...

Today’s Objectives  AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement  EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams  SHARE actionable next steps for advancing provider-based patient engagement in Central Ohio using Choosing Wisely as a good place to start!  LEARN from your perspectives!

To help us advance the Choosing Wisely project and Patient Learning Collaborative approach in Central Ohio….

We invite you as a healthcare consumer to participate in one of the following co-learning stations: Station Host A Gretchen Gunderson Krista Stock

Tool • Measuring change in consumer awareness and attitudes on evidence-based health care • Providing consumers with actionable tools

B

John Leite & Bruce Wilson

Patient Networking & Support Portal • Private with moderation (via login) • Public with moderated private group (Facebook) • Public (Twitter)

C

Jeff Biehl

Raising awareness on Value-based Insurance Design for consumers with commercial insurance

Building off learning from the past two sessions...

Today’s Objectives  AWARENESS of consumers’ preferences and styles that need to be taken into consideration and strategies to encourage and support patient engagement  EXPLORE best practices and tools for the emerging Patient Learning Collaborative to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams  SHARE actionable next steps for advancing provider-based patient engagement in Central Ohio using Choosing Wisely as a good place to start!  LEARN from your perspectives!

Choosing Wisely Project – Planned Approach for 2013-2014

Primary Care Teams private practices, hospital-affiliated practices, and federally qualified health centers

• Measure change in clinical variability based on a set of Choosing Wisely recommendations

Patients

• Measure change in patient awareness and readiness towards using evidence-based health selected from participating care and engaging in shared decision-making primary care practices via a simple with health care teams application process

Specialty Care Teams

• Survey on value of presentations and webinars

raise awareness on Choosing Wisely recommendations

Partners employers, health coalitions, health plans, retirement systems, public health

• Document results from organizational activities

Provider-based Patient Engagement: Choosing Wisely (CW) Project 2014 Patient Learning Collaborative Design Purpose: to improve patient awareness and readiness for using evidence-based health care while sharing decision-making with health care teams Sept-Dec/2013 a) Invite primary care teams to participate in Choosing Wisely Project b) Participating primary care teams extend invitation to patients c) Patients with interest complete online application d) GOOD PLACE TO START -- Identify 4 patient groups based on application & insurance status (commercial, Medicare, Medicaid, uninsured)

Q1/2014 Pre-measure patient attitudes and awareness

Host series of patient learning workshops for each of the 4 patient groups

atie P line n O

Mid Year Host learning session with all patients and their health care teams

S & in g k r wo t e nt N

Q4/2014 Post-measure patient attitudes and awareness Host learning session with all patients and their health care teams

rt o p up

al t r Po

From your perspective as a healthcare consumer‌.

What is the potential value of the Patient Learning Collaborative to improve patient awareness and readiness for using evidencebased health care while sharing decision-making with health care teams?

use attwifi if needed

Later today…..  Send a link to the presentations and handouts Next week….  Access HealthColumbus will apply learning from today into the design for the emerging project  Send a record of learning from today’s session

Please save the following dates for future learning sessions (8:30-10:30AM): • December 6, 2013 • April 4, 2014 • August 22, 2014 • December 5, 2014

Thank you for your time and continued support!

Lead Support

Major Support

Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate Donations