Patient Engagement Campaign

1. Patient Engagement Campaign Kellie Slate Miller, MS September 27, 2012 Consumer Engagement and Shared Decision-Making: From Concept to Reality Webinar Series: Session 4

2. Engaging Patients as Active Participants in their Own Care • Opportunity to engage patients in a dialog with their own health. • Surveys continue to support the good news that most patients report a high level of trust with their health care providers. • At the same time, data suggests that patients are sometimes reluctant to engage in collaborative discussions with physicians about their choices in health care. • Why patients are often reluctant to actively engage in a collaborative discussion about their health care choices.

3. Engaging Patients as Active Participants in their Own Care Patients and the public across many diverse demographic groups have shown a desire to become more involved in their care and more informed about their health (Frosch et al., 2012)

4. 2012 Research Study Led by Dominick L. Frosch, PhD • “Communicating with Physicians About Medical Decisions: A Reluctance to Disagree” • Showed that nearly all patients could envision asking questions (93%) and discussing preferences (94%) • Few felt they would actually voice a disagreement and challenge their doctor (14%) • Those not willing to disagree, about 47% feared being labeled “difficult” and 40% worried such actions would lead to a damaged relationship • 51% thought it might compromise care • (

5. Engaging Patients as Active Participants in their Own Care • 80 % of Internet users - seek health information online, making this the third most popular Internet activity (Fox, 2011). • This growing interest in health represents an opportunity to increase patients’ involvement in their own care, in the care of their loved ones, and in the improvement of the overall system. It further highlights new roles for health professionals in partnering with patients to share reliable online sources of health information (Alston and Paget, 2012). • Moreover, the development of new models of care delivery, such as patient-centered medical homes, health homes, and accountable care organizations (ACOs), offers opportunities to incorporate patient engagement at all levels of care.

6. Patient Engagement • What We Say: • Want patients to take active role in making decisions about their health • Want patients to ask questions • Want patients to express values & preferences • What We know: • Patients – even well educated, are reluctant to ask questions • Patients fearful of challenging provider recommendations • Many patients feel physicians are authoritarian (vs. “authoritative”

7. Institute of Medicine 2012 Report – 10 Recommendations for a Better Health Care System Statistics about Health Care in the U.S.

8. 10 IOM Recommendations for a Better Health Care System • To promote the transformation to a “learning” system that continuously improves care management and patient outcomes — and that aims to reduce the estimated 30% of health spending that is wasted — the Institute of Medicine made 10 major recommendations: • Improve capacity to capture clinical, care delivery process, and financial data for better care, system improvement and generation of new knowledge. • Streamline and revise research regulations to improve care, promote capture of clinical data and generate knowledge. • Accelerate integration of the best clinical knowledge into care decisions. • Involve patients and families in decisions regarding health and health care, tailored to their preferences.

9. http://iom.edu/~/media/Files/Report%20Files/2012/Best-care/Best%20Care%20at%20Lower%20Cost_Recs.pdfhttp://iom.edu/~/media/Files/Report%20Files/2012/Best-care/Best%20Care%20at%20Lower%20Cost_Recs.pdf

10. Institute of Medicine http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America/Infographic.aspx 10

11. IOM Best Care at Lower Cost Conclusion 7-1: Improved patient engagement is associated with better patient experience, health, and quality of life and better economic outcomes, yet patient and family participation in care decisions remains limited. Related findings: • Patients often are insufficiently involved in care decisions. Fewer than half of patients receive clear information on the benefits and trade-offs of the treatments for their condition, and fewer than half are satisfied with their level of control in medical decision making (see also Chapter 2 in Full Report). • Patient-centered care has been correlated with better health care outcomes and quality of life, as well as other benefits. The use of patient-centered care in a primary care setting has been associated with reduced pain and discomfort, faster recovery in physical health, and improvements in emotional health. • If implemented properly, meaningful engagement of patients in their own care has the potential to reduce costs. For example, it has been reported that informed patients are up to 20 percent less likely than other patients to choose elective surgery. Reference: IOM Best Care Full Report 2012

12. 10 IOM Recommendations for a Better Health Care System • Promote community-clinical partnerships and services aimed at managing and improving health at the community level. • Improve coordination and communication within and across organizations. • Continuously improve health care operations to reduce waste, streamline care delivery and focus on activities that improve patient health. • Structure payment to reward continuous learning and improvement in the provision of better care at lower cost. • Increase transparency on health care system performance. • Expand commitment to the goals of a continuously learning health care system. • Source: “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” Institute of Medicine, Sept. 6 (nap.edu/catalog.php?record_id=13444

13. Patient Engagement Objectives 13 Move patients to action to become involved in helping improve Maine's health care system. To do this they need to understand: • Major problems in US in safety, quality, cost, and patient experience • Most patients are not aware of extent of problems • “Patients” are able to change the interaction in the system • Involve other “caring patients” in change efforts in a supportive environment to partner with providers to improve all aspects of health care

14. Involve Patients in All Aspects of Our Health Care System • Improve one’s own health / health of family member • Better Health. Better ME! • Wellness offerings • Healthy eating • Get information to make informed choices about care • Promote BHBM & GetBetterMaine • Help patients access information • Articles in newsletters • Provide additional information on organizational websites • Partner w/other organizations to help improve health • (i.e. BHBM Partner Organizations) needed for outreach

15. Involve Patients in All Aspects of Our Health Care System • Work directly with health care providers to help improve the delivery, quality, experience of care • Participate in provider committees (with training) • Work with stakeholders to drive system, policy, payment changes to transform care • Meetings with local providers and health systems • Community forums on quality-cost

16. QC Efforts to Engage Patients/Consumers: Partnering for Improvement • Engage consumers in QC governance - at all levels • Seek consumer input on all strategic activities • QC Consumer Advisory Council • Engage consumers in clinical redesign efforts, and support providers in their efforts - e.g. ME PCMH Pilot • Provide messages, action steps, tools, and opportunities for engagement that support consumers in becoming more active partners in their care

17. Maine Quality Counts Patient Engagement Work • January 2011 - PCMHs incorporated “Core Expectation” • April 2012 • QC Conference 2012 Occurred focusing on partnering with patients • Created the “Partnering with Patients” Video Clip – exploring what successful patient-provider partnerships look like in Maine. http://youtu.be/EpcJuYTEEb4 • QC Consumer Advisory Council First Meeting • May 2012 - Better Health. Better ME! Patient Engagement Operations Team developed

18. Patient Engagement Campaign Take Charge of your health: Step ONE: VISIT your Primary Care Provider Step TWO: ASK Questions Step THREE: KNOWand understand your health related numbers Step FOUR: FIND and use community health resources and programs

21. Better Health. Better ME!Partner Organizations: • Central Maine Healthcare Corporation • Consumers for Affordable Health Care • Eastern Maine Healthcare Systems • Get Better Maine (Maine Healthcare Management Coalition) • Maine Association of Area Agencies on Aging • MaineGeneral Health and Medical Center • MaineHealth • Maine Primary Care Association • Maine Quality Counts • Seniors Plus • Allied groups include: • Maine CDC, MaineCare, • MaineQuality Forum/Dirigo Health, Maine Medical Association, Maine Osteopathic Association

22. Next… • Support QC Consumer Advisory Council • Implement the “Better Health. Better ME!” patient engagement campaign • Identify new opportunities for true “engagement”, conversations • Opportunities for collaboration?

23. What BHBM Partner Organizations Are Doing Introducing: Maine Area Agencies on Aging Jessica L. Maurer, Esq. Executive Director

25. What BHBM Partner Organizations Are Doing • For example: • Maine Primary Care Association • Consumers for Affordable HealthCare • Eastern Maine Health Systems • MaineCare • And others efforts: • Town of China

26. Additional Information for Patients: • Materials: • QC PATHWAY Brochures (Diabetes, COPD, Healthy Lifestyle) • Getting Ready for appointments: 9 things You can Do to Get Better Care • 5 Things You Should Know when You Get a New Prescription • Websites: • Get Better Maine: www.getbettermaine.org • Choosing Wisely: www.choosingwisely.org • Consumer Reports Best Buy Drugs: www.consumerreports.org/health/best-buy-drugs/index.htm • National Patient Safety Foundation’s “Ask Me 3:” www.npsf.org/for-the-healthcare-professionals/programs/ask-me-3/ • http://familydoctor.org/familydoctor/en/healthcare-management/working-with-your-doctor/tips-for-talking-to-your-doctor.html • Institute for Patient and Family Care - http://ipfcc.org/ • Agency for Healthcare Research and Quality: http://www.ahrq.gov/questions

27. Engaging Patients – Partnering for Improvement

28. MHMC’s “GetBetterMaine” Quality Reports

31. Patient Engagement: What Physicians Can Do to Help Patients Get More Engaged • Create a Safe Space • Use Your Team • Use Patient Engagement Tools: such as, • Choosing Wisely – www.choosingwisely.org • AHRQ – www.effectivehealthcare.ahrq.gov/ehc/decisionaids/prostate-cancer • MaineHealth – www.mainehealth.org/mh_body.cfm?id=7848 • Center for Advancing Care - http://cfah.org/ • National Patient Safety Foundation’s “Ask Me 3:” www.npsf.org/for-the-healthcare-professionals/programs/ask-me-3/ • Mayo Clinic – http://shareddecisions.mayoclinic.org/decision-aids-for-diabetes • Foundation for Informed Decision Making – http://informedmedicaldecisions.org/shared-decision-making-in-practice/decision-aids

32. Action: What Can You Do? In Your Practice? • Distribute the “Better Health. Better ME!” brochure and encourage your patients to use it • Encourage your patients to access www.getbettermaine.org for quality information • Request BHBM Brochures (free) for your Practice • Encourage use of the QC Pathways Brochures & request copies for your Practice • Share the Provider Tools with your medical staff In Your Community? • Connect with the AAA 32

33. Contact Info / Questions 33 • General information • Lisa Letourneau MD, MPH: LLetourneau@mainequalitycounts.org • Patient Engagement Campaign • Kellie Slate Miller, MS: kslatemiller@mainequalitycounts.org • Maine PCMH Pilot: www.mainequalitycounts.org (See “Major Programs”  “PCMH Pilot”) • PCMH: Nancy Grenier: ngrenier@mainequalitycounts.org • CCTs: Helena Peterson: hpeterson@mainequalitycounts.org