A Bed's Eye View of Health Reform by MSL Global

A BED'S EYE VIEW OF HEALTH REFORM What Patients See When They Look at the New Landscape of Health Care Delivery Presentation to VHQC April 9, 2013

Chuck Alston Senior Vice President/Director of Public Affairs MSL Washington DC

ÂŠ 2011 MSLGROUP

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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

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WE MEAN WELL, BUT SOUND SCARY Take Care With How You Talk About Health Care

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The Way “We” Talk About Health Care

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Do They Hear What You (Think You) Say?

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

ÂŠ 2011 MSLGROUP

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Come Again? What You Say

What They Hear

Medical home

Nursing home, home health, end of life

Medical decision support

End-of-life decisions

Guidelines or treatment guidelines

Restrictive, rigid, limited, driven by cost

Integrated health care delivery system

Bureaucratic, industry language, meaning unclear

Integrated care

Bureaucratic, industry language, meaning unclear

Multispecialty medical group

Bureaucratic, industry language, meaning unclear, trying to do too much, low quality, limited choice of specialists to choose from

Best practices

Bureaucratic, meaning unclear, insincere, cookie-cutter care, not tailored to the individual

Evidence-based medicine

Impersonal, one size fits all

Accountable

Something will go wrong, minimal care, buzz word

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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

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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

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

REFORM

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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.” 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.) Photo: The Medical Group, Beverly, MA. © 2011 MSLGROUP

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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.” 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.) © 2011 MSLGROUP

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THE JOURNEY FROM VOLUME TO VALUE You Want to Go Where with My Health Care?

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From Volume to Value This mantra works for:

What could be wrong with that? ÂŠ 2011 MSLGROUP

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Just Ask Them

They think

Valu ÂŠ 2011 MSLGROUP

is a four letter word

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What Value Looks Like

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

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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. © 2011 MSLGROUP

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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. © 2011 MSLGROUP

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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!

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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

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SO WHAT, WHO CARES, WHAT’S IN IT FOR ME? The Path to Patient-centered Messaging

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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

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The Conversation About Care Starts Here

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What Do Patients Want?

• More time with their physicians • Better coordinated care

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What Do Patients Want?

• More time with their physicians

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What Do Patients Want?

• More time with their physicians • Better coordinated care • To not pay more

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What Do Patients Want?

An ACO wrapped around a medical home. (Just don’t call it that.)

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ENOUGH ABOUT WHAT NOT TO SAY The ABCs of Delivery Reform Communications

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“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

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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 • DO focus messaging on the solution—improving care for patients when they return home—because it will be seen as a benefit

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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. © 2011 MSLGROUP

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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

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If You Have to Talk About Reimbursement Don’t Talk about…

Instead…

How doctors are paid

How insurance companies pay for care

MDs giving too many tests because of system incentives

Right now, insurance companies pay doctors based on how many patients they can squeeze in a day or how many different procedures they do

“Reward” or “incentivize”

Make sure the way insurance pays for health care is consistent with way you want to receive it; High-quality care, tailored for you

Getting the “wrong” tests

Getting the right tests

Getting “unnecessary” tests

Getting same test “twice” or tests you don’t need

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PATIENT ENGAGEMENT The Blockbuster Drug of the Century

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Framing question

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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 © 2011 MSLGROUP

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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

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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 © 2011 MSLGROUP

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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 © 2011 MSLGROUP

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COMMUNICATING ABOUT MEDICAL EVIDENCE Put Evidence in the Context of Shared Decision-making

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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.

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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

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The Care They Want v. The Care They Get

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Put Evidence Under an Umbrella Concept

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

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Elements of an Informed Medical Decision

Medical Evidence

Informed Medical Decision

Clinician Expertise

Patient Goals & Concerns

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People Value All 3 Elements Strongly

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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

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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

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Satisfaction Linked to Shared Decisions

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Finding Language that Resonates

ÂŠ 2011 MSLGROUP

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Why Certain Language Resonates “meaning one of the discs…”

Participants appreciate the explanation of what is wrong—describing what a herniated disc means.

“number of options”

Participants like options, particularly when it comes to surgery. If there are options for treatment, they want to hear about them. A few crossed out “a number of” because only two options were presented.

“scientific evidence”

Many like that the physician reports on the scientific evidence—they want to know what evidence exists. “Medical evidence” tends to work better than “scientific evidence”, however. Also, adding “recent” or “up-to-date” modifiers may help for some who wonder how recent the evidence is.

“carries risk”

Risks are a key component of treatment options that consumers want to hear.

“no guarantees”

Knowing that there is “no guarantee” is a key factor that would weigh in the decision process. Additionally, the phrase resonates with participants who appreciate the honesty in a discussion.

“outcomes…will be better if you lose a bit of weight”

Some participants like this because it is truthful, while others like it because they prefer to take steps on their own prior to medical intervention.

“my opinion is…”

The doctor’s recommendation is key, although a few do not like the word “opinion”, which feels uncertain. “My experience’ or “my recommendation” may be a better word choice.

“the decision needs to be yours”

Again, participants want to be integrally involved in making decisions, so many like hearing this from their doctor

“is there information I can give you”

Participants like this gesture, and feel it is an opening to ask questions. An improvement might be asking directly: “Do you have any questions right now that I can help answer?” “How do you feel about all of this?” “What are your thoughts and concerns?”

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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 doctorâ&#x20AC;&#x2122;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.

ÂŠ 2011 MSLGROUP

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PATIENTS AS CONSUMERS Spending My Money is Another Matter

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High Deductibles Will Drive Consumerism

Health plans increasingly have high deductibles

ÂŠ 2011 MSLGROUP

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Price Seekers

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

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Growing Demand for Price Transparency

ÂŠ 2011 MSLGROUP

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Get Your Story Ready about Quality

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RESOURCES The Research Behind Today’s Presentation

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To Learn More •

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

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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.

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Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-based Health Care.” Health Affairs. 29(7): 1400-1406. July 2010.

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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.

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Coulter A. “Patient Engagement—What Works?” Journal of Ambulatory Care Management. 35(2): 80-89. April-June 2012.

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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.

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Gerber A, et al. “A National Survey Reveals Public Skepticism About Research-Based Treatment Guidelines.” Health Affairs. 29(10): 1882-1884. October 2010.

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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.)

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Health care communications and public affairs We are part of the MSLGROUP Americas, the PR arm of the Publicis Groupe, one of the worldâ&#x20AC;&#x2122;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.

Chuck Alston senior vice president/director chuck.alston@mslgroup.com

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.

ÂŠ 2011 MSLGROUP

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To Follow Up

Chuck Alston chuck.alston@mslgroup.com

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