Patient-Centered Primary Care Collaborative of Central Ohio Q2 2013 Learning Session Learning Topic: Choosing Wisely a best practice to improve provider-based patient engagement
Please save the following dates for 2013 learning sessions (8:30-10:30AM): • Friday, September 6 • Friday, December 6
Welcome! www.accesshealthcolumbus.org Lead Support
Major Support
Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate Donations
Collaborative Approach for Improving Patient-Centered Primary Care
WHY?
WHAT?
HOW?
• 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, hospitalaffiliated, and federally qualified health centers serving patients with Commercial insurance, Medicaid, Medicare, and the uninsured
• Access HealthColumbus coordinates local primary care improvement projects in collaboration with leaders from business, government, health care and the social sectors of Central Ohio
Collaborative Improvement Activities Coordinated by Access HealthColumbus
Access HealthColumbus is coordinating the following collaborative activities: A. Patient-Centered Medical Home (PCMH) Recognition Projects B. Primary Care Quality Reporting Project C. Provider-based Patient Engagement Projects D. Local Federally Qualified Health Center (FQHC) Improvement Collaborative E. Sharing our learning with others
SPREAD: Patient-Centered Medical Homes (PCMH)
In coordination with Access HealthColumbus: Coordinated by others: Recognized PCMHs
Recognized PCMHs
Emerging PCMHs
Today’s Objectives AWARENESS on value of improving Provider-based Patient-Engagement EXPLORE promising best practices from around the country Choosing Wisely - a best practice to improve provider-based patient engagement LEARN from your perspectives!
patient activation Understanding one’s role in the care process and having the knowledge, skill, and confidence to manage one’s health and health care patient engagement A broader concept that includes activation; the interventions designed to increase activation; and patient’s resulting behavior standard of care A formal diagnostic and treatment process a doctor will follow for a patient with a certain set of symptoms or a specific illness. That standard will follow guidelines and protocols that experts would agree with as most appropriate, also called "best practice. local provider-based patient engagement objective Based on best practices, partner with primary care teams to implement improvements that advance patient engagement as a standard of care in Central Ohio
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
Update on spread of Open Clinician Notes
Open Clinician Notes an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians www.myopennotes.org
Update on spread of Open Clinician Notes January: VA opened notes to 1.1 million patients , includes local VA ambulatory center May: Geisinger (PA) opened notes to over 120,000 patients in primary care & specialties May: Beth Israel Deaconess Medical Center (Boston) opened notes for all of primary care, orthopedics, and rehab in May; will include rest of ambulatory by the end of the 2013, and planning to open inpatient notes in 2014 Summer: MD Anderson (Houston) and Mayo (MN) are opening notes for primary care and specialties Summer: Cleveland Clinic are opening notes via new transparent EMR - give patients access to pathology records, X-ray reports, physician notes, and the list of their current health issues, which physicians use to briefly describe a patient’s health status, recent concerns, and known diagnoses. Patients will be able to view online nearly everything their doctor sees in their EMR, except for behavioral health information, which is prohibited from release by state law. Source: myopennotes.org
Today’s Objectives AWARENESS on value of improving Provider-based Patient-Engagement EXPLORE promising best practices from around the country Choosing Wisely - a best practice to improve provider-based patient engagement LEARN from your perspectives!
why?
Patient-Centered Health 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
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?
CENTRAL OHIO NEWS January 1, 2014
Patients, Providers, and Purchasers agree to partner on the use of evidence-based recommendations to improve health, quality and value.
CENTRAL OHIO NEWS January 1, 2015
Evidence starting to show that primary care teams and patients are having the important conversations necessary to ensure the right care is delivered at the right time as a standard of care in Central Ohio.
CENTRAL OHIO NEWS January 1, 2016
Based on important conversations taking place between primary care teams and patients, evidence is in…. • Better health outcomes • Better quality of care • Better value for patients, employers and government
why?
CURRENT NORM skepticism and distrust
evidence-based care is viewed as rationing my care
Patients/Parents/Caregivers
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
engaged in shared decision-making to improve health and lower costs
Patients/Parents/Caregivers
Small Group Discussion Question ďƒ˜ What are your reflections when considering the shift from the CURRENT to FUTURE norms?
Today’s Objectives AWARENESS on value of improving Provider-based Patient-Engagement EXPLORE promising best practices from around the country Choosing Wisely - a best practice to improve provider-based patient engagement LEARN from your perspectives!
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
More doesn’t equal better
VIDEO link: http://www.youtube.com/watch?v=J1o0rpggfIg
30% 70%
Up to 30% of health care in the U.S. is unnecessary
What is Choosing Wisely®? • Initiative of ABIM Foundation • Trusted resources—including more than 30 national medical organizations and Consumer Reports • Choosing Wisely encourages conversations between patients and physicians • www.ChoosingWisely.org
What is Choosing Wisely速?
VIDEO link: http://www.youtube.com/watch?v=yqA2L6kLLmg&list=PL71AB65CF44225B52
135+ 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
Choosing Wisely – Societies and Regional Health Collaboratives
?
Source: ABIM Foundation http://www.abimfoundation.org
Consumer Reports resources Tip sheet series
Video series
http://consumerhealthchoices.org/for-employees
Choosing Wisely速 for patients
Choosing Wisely速 for patients
Example of Evidence-Based Recommendation
Video link: http://www.youtube.com/watch?v=qcYPcB3D314&feature =c4-overview-vl&list=PL71AB65CF44225B52
Aware of rising costs, but didn’t understand why it’s happening, but were quick to suggest possibilities Rising costs affecting their daily lives and purchasing behaviors Issue is personal and they are getting angry Increasingly questioned their doctors’ recommendations Denying needed care for self/family due to cost Want to act more like consumers in health care Did not think prices tied to quality Uncertain who can best address rising costs No idea what they could do to lower the cost, aside from avoiding getting sick
Important conversations: Knowing the Costs of Health Care
Video link: http://www.youtube.com/watch?v=4t-G6AkCDu8
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 next? How could we use Choosing Wisely® to shift health care norms? What could happen in Central Ohio? – Increased focus on shared decision-making to improve health and lower costs. – Reward providers for better care – Employers engage in aligning benefits with provider-defined evidence-based medicine
Today’s Objectives AWARENESS on value of improving Provider-based Patient-Engagement EXPLORE promising best practices from around the country Choosing Wisely - a best practice to improve provider-based patient engagement LEARN from your perspectives!
CURRENT NORM skepticism and distrust Choosing Wisely as a good place to start!
evidence-based care is viewed as rationing my care
Patients/Parents/Caregivers
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
engaged in shared decision-making to improve health and lower costs
Patients/Parents/Caregivers
Choosing Wisely Project – Planned Approach for 2013-2014 Q2: Learning session to raise Awareness awareness & shape project Q3: Engage partners to raise Providers awareness of project
Patients
Purchasers Health Plans Public Health Community Partners
Q3: Engage partners to raise awareness of project
Q4: Secure participation commitment
2014: Learning and training sessions for primary care teams
Q4: Patients invited to participate
2014: Learning and training sessions for patients
Q4: Secure participation commitment
2014: Community awareness & education
Small Group Discussion Question ďƒ˜ What are the opportunities and challenges of making Choosing Wisely a standard of care in Central Ohio?
Later today….. Send a link to the presentations and videos Send a link for you to indicate your interest in participating in the emerging Choosing Wisely Project Next week…. Access HealthColumbus will apply learning from today into the design for the emerging project
Please save the following dates for 2013 learning sessions (8:30-10:30AM): • Friday, September 6 • Friday, December 6
Send a record of learning from today’s session Thank you for your time and continued support! Lead Support
Major Support
Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate Donations