Q1 2013 Learning Session Presentation Slides

Lead Support Major Support Additional Support

100% Access HealthColumbus

Board & Staff

Individual & Corporate Donations

Patient-Centered Primary Care Collaborative of Central Ohio

Q1 2013 Learning Session

TOPIC: Provider-based Patient Engagement

Learning Session Sponsored by Nationwide

Please save the following dates for 2013 learning sessions (7:30-10:30AM): • Friday, May 31 • Friday, September 27 • Friday, December 6

www.accesshealthcolumbus.org

2013-2014 Primary Care Improvement

Projects

Patient-Centered Medical Homes (PCMH)

Primary Care Quality

Reporting

Provider-based Patient-

Engagement

Value-based Purchasing

In coordination with Access HealthColumbus: Recognized PCMHs Emerging PCMHs Coordinated by others: Recognized PCMHs

SPREAD: Patient-Centered Medical Homes (PCMH)

250

200

1,205

0

200

400

600

800

1000

1200

RecognizedPCMH

Practitioners*

Total PrimaryCare

Practitioners(PCPs)**

Total PCPs

EmergingPCMHsRecognizedPCMHs

SPREAD: Patient-Centered Medical Homes (PCMH)

Sources * National Committee for Quality Assurance (NCQA) ** Practicing PCPs in Franklin County provided by Columbus Medical Association

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

Estimated Patients Served byPCMHs

Recognized PCMHs

Emerging PCMHs

1. Expand the capacity and availability of qualified medical homes to most Ohioans across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe

2. Define and administer episode-based payments for a majority of acute medical events across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe

Ohio’s State Innovation Model Proposal

SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.

Feb 21, 2013 Ohio Receives Federal Grant to Advance Health Care Payment Innovation

One of 16 states to receive design grant


Projects



Reporting


Engagement


Primary Care Quality Reporting

For Diabetes management outcomes (test results), blood sugar levels and cholesterol have a mix of positive and negative change values. Blood pressure levels, however, show improvement in six of the seven practices reporting in the December 2012 reports. Graphed below are the aggregated results for the three practices that participated in all three Improvement Dashboard submissions.

Measures & Values – Diabetes management outcomes

Measures & Values – Utilization from health plan data

Emergency Department utilization rates show favorable change patterns in six of eight practices, and are favorable in aggregate. Hospitalization rates show favorable change patterns in four of eight practices and are less consistent than emergency rates. They are favorable in aggregate.

Primary Care Quality Reporting


Projects



Reporting


Engagement


Value-based Purchaser Collaborative of Central Ohio 2013-2014 Value-based Benefit Design Project

Model actionable benefit strategies and designs that reallocate scarce resources from

lower-value to higher-value health services based on evidence compiled by others

WHAT: Higher-value

health services 1. 2. 3. 4. 5.

WHAT: Lower-value

health services 1. 2. 3. 4. 5.

Collaborative Approach

HOW: Incentive-based best practices

HOW: Disincentive-based best practices

DELIVERABLES: (participating purchasers utilize learning

in alignment with their organizational cultures and priorities)

A. Inventory of actionable value-based designs for:

• Benefit Programs • Payment and Contracting

B. Inventory of actionable best

practice strategies and tools to support the engagement of business leaders, health care providers, health plans and beneficiaries/patients

HOW: Health plan/TPA administration


Projects



Reporting

Provider-based Patient

Engagement


Today’s Objectives

As a patient/parent/caregiver…. AWARENESS on value of improving Provider-based Patient-Engagement

EXPLORE promising best practices from around the country -- a good place

to start! IDENTIFY commitments to advance patient engagement as a standard of

care in Central Ohio

Today’s Objectives As a patient/parent/caregiver…. AWARENESS on value of improving Provider-based Patient-Engagement




SPREAD PROVIDER-BASED PATIENT ENGAGEMENT: New project starting 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

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

Purchasers provide incentives to primary care teams to

accelerate patient engagement as a standard of care

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

Feb 2013

Better Care for Individuals Better Health for Populations

Lower Per Capita Costs

PATIENTS & FAMILIES • Fear and uncertainty • Health literacy

• Provider reactions

Barriers: What can hinder patient and family engagement?

PROVIDERS • Professional norms and

experiences

• Fear of litigation

• Perceived level of effort

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

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)

Source: Health Affairs, February 2013

All patients (n=33,163)

Hyperlipidemia (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

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.

$359 x 1,000,000 people in Central Ohio = real value

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

What might happen if patient engagement became a standard of care?

Patients and families engaged in their own care Communication and Information Sharing • Get help with organizing and coordinating care Self-care • Work with team to set self-care goals • Get help with managing chronic illness • Participate in activities to reduce health risks • Participate in peer support groups Decision-making • Use evidence-based decision aids • Discuss risks and benefits of different options • Decide jointly with the health care provider on a treatment Safety • Review medical information and treatment results with the clinician or practice team • Share information about medications and treatments received in other settings • Report on adverse events and potential safety problems


Insights from the OpenNotes

Please click on links below to view OPENNOTES videos:

OPENNOTES Video #1

OPENNOTES Video #2

http://www.youtube.com/watch?v=RatcgrW2uF4&list=PLYl_BWIZmQfVwtMByqyRJYo4sPfgV9Y-N



http://www.youtube.com/watch?v=a19_6qQoA8s&list=PLYl_BWIZmQfVwtMByqyRJYo4sPfgV9Y-N

About the OpenNotes study

• 12-month demonstration project, quasi-experimental design Summer 2010 – Summer 2011 (and still ongoing)

• Patients invited to view their PCPs’ signed notes via secure portals (only notes signed during the project – not retroactive)

• Each patient notified automatically via secure e-mail message when note was signed, and reminded to review it before next scheduled visit

3 Questions

• Does OpenNotes help patients become more engaged in their care?

• Is OpenNotes the straw that breaks the doctor’s back?

• After 1 year, will patients and doctors want to continue?

Participants 108 volunteer PCPs and almost 20,000 of their patients who use portals participated for 12 months

• Beth Israel Deaconess Medical Center, Boston

• 39 PCPs • 10,300 patients

• Geisinger Health System, Pennsylvania

• 24 PCPs • 8,700 patients

• Harborview Medical Center, Seattle

• 45 PCPs • 270 patients

PCPs’ Experience

PCPs’ Main Concerns OpenNotes impact on workflow

Pre-intervention %

BIDMC / GHS / HMC Visits significantly longer 23 / 32 / 21

More time addressing patient questions outside of visits

49 / 45 / 34

More time writing/editing/ dictating notes

46 / 36 / 34

…and the volume of electronic messages from patients did not change

Post-intervention %

BIDMC / GHS / HMC 3 / 5 / 0

8 / 0 / 0

21 / 14 / 0

PCPs’ Main Concerns OpenNotes impact on documentation

Pre-intervention % BIDMC / GHS / HMC

Post-intervention % BIDMC / GHS / HMC

Changed the way they addressed:

Cancer/possibility of cancer

33 / 18 / 26 26 / 18 / 3

Mental health issues 44 / 27 / 53 36 / 27 / 11 Substance abuse 38 / 32 / 42 28 / 23 / 8 Overweight/obesity 18 / 18 / 21 33 / 5 / 5

PCPs’ Main Concerns OpenNotes impact on patients

Pre -intervention % BIDMC / GHS / HMC

Post-intervention % BIDMC / GHS / HMC

PCPs think patients who read their notes will:

Find notes more confusing than helpful

48 / 54 / 43 13 /21 / 12

Worry more 50 / 58 / 45 15/42 / 12

Feel offended 33 / 8 / 29 18 / 8 / 2

Patients’ Experience

• 84% of BIDMC patients opened at least one of their notes

• 82% of GHS patients opened at least one of their notes

• 47% of HMC patients opened some or all (new portal users)

• 20-42% of patients reported sharing notes with others

Among Patients with Notes (visits)

Reports from Patients Post Intervention

• 70 - 72% of patients across the 3 sites reported taking better care of

themselves

• 77-85% reported better understanding of their health and medical conditions

• 76-84% reported remembering the plan for their care better

• 69-80% felt better prepared for visits

• 77- 87% felt more in control of their care

• AND, among those taking medications, 60-78% reported “doing better with taking my medications as prescribed.”

Reports from Patients Post intervention

• 1-8% of patients across the 3 sites reported that the notes

caused confusion, worry, or offense

• 26-36% had privacy concerns

Comments

and

The Bottom Line

I had to have better documentation, which is a good thing.

My fears: Longer notes, more questions, and messages from patients. In reality, it was not a big deal.

For me the most difficult thing was having to be careful about tone and phrasing of the notes knowing the patient would be reading them.

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.

Patients should not have access to their notes. The note already serves far too many purposes such as billing, research, etc, and adding one more is not a good idea. They are not intended as a vehicle for patient communication.

Doctor Comments

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).

In his notes, the doctor called me "mildly obese." This prompted immediate enrollment in Weight Watchers and daily exercise. I didn't think I had gained that much weight. I’m determined to reverse that comment by my next check-up.

If this had been available years ago I would have had my breast cancer diagnosed earlier. A previous doctor wrote in my chart and marked the exact area but never informed me. This potentially could save lives.

It really is much easier to show my family who are also my caregivers the information in the notes than to try and explain myself. I find the notes more accurate than my recollections, and they allow my family to understand what is actually going on with my health, not just what my memory decides to store.

Patient Comments

After a year of experience with OpenNotes, PCPs were asked: Taking all considerations into account, I would like my patients to continue to be able to see my visit notes online.

Some said no: 26% of BIDMC PCPs 17% of GHS PCPs 19% of HMC PCPs

On the other hand, when offered the option of turning off open notes at the end of the year-long intervention, not one doctor asked to do so.

The Bottom Line for PCPs

The Bottom Line for Patients After one year, 99% of BIDMC patients 99% of GHS patients 99% of HMC patients wanted to continue to be able to see their visit notes online.

When given a choice of doctors or health plans in the future, 86% of BIDMC patients 85% of GHS patients 89% of HMC patients said availability of open notes would have an important effect on their decisions.

Some Implications

• Trust

• Safety

• Better use of resources

• Should all patients really see everything?

• 20-42% of patients shared notes

The Inexorable Rise of Online Access and Transparency

Retailing

Consumer finance and banking

Providers: lab results, open disclosure, patient portals, VA Blue Button, MD Anderson

Consumers: • “I don’t know if I want to read my entire medical record,

but I want to have it.” • ONC direct-to-consumer promotion of HIT • Give Me My DaM Data • Consumer pressure will only intensify!

Want to learn more?

www.myopennotes.org

OPENNOTES: Exploring best practices in small groups Imagine using OPENNOTES as a patient/parent/caregiver in partnership with your primary care team. SUGGESTED DISCUSSION SCENARIOS PATIENT: reviewing information about me and my health from a recent primary care

appointment PARENT: sharing information with partner from a recent pediatric visit with child CAREGIVER: helping aging parent make sense of health information and follow-up

items

What are the opportunities and challenges of making OPENNOTES a standard of care in our community?

OPPORTUNITIES:

CHALLENGES:

OPENNOTES: Exploring best practices in small groups

TABLE POLLING As a patient/parent/caregiver…. What is the potential value of OPENNOTES as a standard of care in our

community?

What is a key reflection from your small group discussions on OPENNOTES?

pollev.com/pcmh

What might happen if patient engagement became a standard of care?

Patients and families engaged in practice improvement • Participate in quality improvement activities • Participate in patient/family advisory councils or other regular meetings • Provide feedback through surveys • Help in development of patient materials • Participate in focus groups • Do “walk-through” to give staff a patient perspective of practice workflow


Share learning from…

The Impact Health Improvement Action

Society of British Columbia (ImpactBC)

Share learning from…

Aligning Forces for Quality in South Central

Pennsylvania

Patient Partners Initiative

Start-up Recruit Patient Partners • 1-2 patient partners per practice

Patient and Provider Orientation • educate participants • clarity on expectations & roles

Monthly Patient Partners part of Primary Care Team • patients are meaningfully engaged in

quality improvement projects • measure project results

Twice a year

Collaborative Learning • patent partners, providers, and staff from

all practices • learning about quality improvement • learning about working together

Please click on links below to view IMPACTBC videos:

IMPACT BC Video #1

IMPACTBC Video #2

http://www.youtube.com/watch?v=QiHFLKGHL9w





http://www.youtube.com/watch?v=uxTNnkWlqys



PATIENT PARTNERS INITIATIVE

ACTIVELY INVOLVING PATIENTS AS PARTNERS

IN PRACTICE DESIGN AND REDESIGN

BENEFITS Increased level of empowerment for

patient partners. Process improvements New ways to deliver patient education Improved patient experience Community benefit-patient partners

volunteering to help with other patient education programs.

PRACTICES’ BENEFITS

The voice of the patient is included in practices process improvement efforts.

Improves practices understanding about health literature and how to improve comprehension with diverse group of patients.

A perspective on what is considered important to a patient as a patient.

CHALLENGES/SOLUTIONS Challenge

Keeping teams engaged in improvement efforts.

Practices & patients at different stages of development.

Measuring outcomes – changes in patient engagement level.

Solution Enduring Learning

Forum Mentor program for

both patient partners & practices.

Patient Activation Measure.

LESSONS LEARNED

Recruiting patient partners can be challenging. Provide as much support as possible to practices during this phase.

Keeping teams motivated to continue seeking improvement is an ongoing process. Ask for feedback.

Leverage successes and proactively plan the next steps.

PATIENT PARTNERS INITIATIVE: Exploring best practices in small groups Imagine participating in a PATIENT PARTNERS INITIATIVE as a patient/parent/caregiver with your primary care team. SUGGESTED DISCUSSION SCENARIOS Based on your experiences and observations, what could be better at your primary care practice/doctor’s office? Potential improvements before the primary care visit Potential improvements during the primary care visit Potential improvements after the primary care

What are the opportunities and challenges of making PATIENT PARTNERS INITIATIVE a standard of care in our community?

OPPORTUNITIES:

CHALLENGES:

PATIENT PARTNER INITATIVE: Exploring best practices in small groups

TABLE POLLING

As a patient/parent/caregiver…. What is the potential value of a Patient Partner Initiative as a standard of

care in our community?

What is a key reflection from your small group discussions on the Patient Partner Initiative?

pollev.com/pcmh

WHAT CAN I DO TO ADVANCE THESE BEST PRACTICES?

Access HealthColumbus intends to invite primary care practices to participate to pilot provider-based patient engagement (best practices) over the next two years.

We would like to include the names of patients/parents/caregivers on the invitation that is used to engage leadership from local primary care organizations. As a patient/parent/caregiver, can we include your name (not organizations) on the invitation used to engage primary care?

Your Name:

OPENNOTES YES, Access HealthColumbus can include my name on an invitation to secure commitments of participation to pilot OPENNOTES as a standard of care in Central Ohio?

PATIENT PARTNERS INITIATIVE

YES, Access HealthColumbus can include my name on an invitation to secure commitments of participation to pilot PATIENT PARTNERS INITIATIVE as a standard of care in Central Ohio?

Next Steps

Access HealthColumbus will apply learning today into the design for collaborative improvement project(s)

We will send you a link to the presentations and videos

We will send you a record of learning from today’s session

Thank you for your time and participation!

Thank Nationwide for sponsoring today’s learning session and our other public-private funding partners!

Lead Support Major Support Additional Support

100% Access HealthColumbus

Board & Staff

Individual & Corporate Donations

Patient-Centered Primary Care Collaborative of Central Ohio

Q1 2013 Learning Session

TOPIC: Provider-based Patient Engagement

Learning Session Sponsored by Nationwide

Please save the following dates for 2013 learning sessions (7:30-10:30AM): • Friday, May 31 • Friday, September 27 • Friday, December 6

www.accesshealthcolumbus.org

Q1 2013 Learning Session Presentation Slides

Documents

Transcript of Q1 2013 Learning Session Presentation Slides