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Effective Patient Engagement: The Only Path to Achieving the Triple Aim
Ronald A. Paulus, MDPresident and CEOMission Health – Asheville, NC
Patient and Provider Priorities
Source: Forbes.com
HIGH Priority LOW Priority High Priority• Restore Health when ill
• Timeliness
• Kindness and Compassion
• Hope and Certainty
• Continuity, choice, coordination
• Trust
• Efficiency
• Aggregate-level Statistics
• Equity
• Conflicts of Interest
Patient Preferences and Priorities: Provider Priorities:
• Winning Operational Strategy
• Efficiency
• Regulatory Compliance
• Population Health
≠
Empathize with me.
Nurture me.
Meet me where I am.
Make it easy for me.
Patient’s Real Preferences Simplified
Source: Ian Worden, MMD, MHI, Better Patient Engagement
of patients have spiritual needs, but those needs are addressed only 6% of the time.
73%
Source: Astrow, A, et al. Is Failure to Meet Spiritual Needs Associated With Cancer Patients' Perceptions of Quality of Care and Their Satisfaction With Care? Journal of Clinical Oncology. December 2007
Example: Spiritual Needs
Provider Priorities
• Winning Operational Strategy• Efficiency• Regulatory Compliance• Population Health
increase in patient adherence.
Source: K. Zolnierek, M.R. DiMatteo, “Physician Communication and Patient Adherence to Treatment: A Meta-analysis.” Med Care, Aug 2009; 47(8): 826–834.
19%
When physician communication is strong, there is a
Adherence
less.
21%
Actively engaged patients cost
Source: Healthcare Informatics February 2015
Cost
less likely to delay care.
50%
Source: Stefanie Mollborn, Irena Stepanikova, and Karen S Cook, “Delayed Care and Unmet Needs among Health Care System Users: When Does Fiduciary Trust in a Physician Matter?” Health Serv Res. Dec 2005; 40(6 Pt 1): 1898–1917.
Patients who trust their physicians are
Delays in Care
Mission Health Partners
• 275+ Primary Care Physicians• 500+ Specialist Physicians• 66,500 lives under management– 45,000 Medicare ACO– 16,000 Mission employees/dependents– 5,500 Humana Medicare Advantage members
Diving Deeper…
5%
15%
10%
30%
40%EnvironmentSocial StatusHealthcare ServicesGenesBehavior
Determinants of Health Status
McGinnis, et. al. (2002)
Patients Make the “Real Decisions”
2005
2008
2011
2014
Patient Activation Level
Source: J.Hibbard, University of Oregon
12% of the population 29% of the population 37% of the population 22% of the population
“Non-Compliance”
Ann Intern Med. 2014;160(7):441-450. doi:10.7326/M13-1705
• Six of ten patients don’t take prescriptions as prescribed…
More choices for patient care
Greater patient engagement?=≠
Good Decisions: Consumers Must Have -
• Information: available, accurate, timely• Must comprehend it• And its meaning• Determine meaningful differences• Weight factors to match needs and values• Make tradeoffs (e.g., risks and benefits)• Choose
(Hibbard & Peters, 2003)
People Often Think They’re More Effective Communicators Than They Really Are…
• Communicators speak from own perspective• Example: “Angela killed the man with the gun.”– Two meanings– When asked to make the statement “very clear” and
the Speaker thought he was understood, 50% of the time Listener did not understand
(Keysar, 2007)
Comprehension Index
• Reflects number of errors made on 33 decision tasks involving interpretation of tables and graphs
• Study Sample: N=492 aged 18-98 years old
(Hibbard, Slovic, Peters, Finucane, & Tusler, 2001)
$10$15$5$10Copayment for office visit with primary care doctor
$63$48$75$50Monthly Premium
Health Plan D
Health Plan C
Health Plan B
Health Plan A
Which health plan requires the lowest copayment for a visit with a primary care doctor? (9% error rate; 35% over 80)
Decision Task Example
31
Numeracy and Number Comprehension
• About half of Americans do not have the minimal math skills needed to use numbers embedded in newspapers (Kirsch et al., 2002)
Which of the Following Numbers Represents the Biggest Risk of Getting a Disease?
1 in 100, 1 in 1000, 1 in 10 (Lipkus, Samsa, & Rimer, 2001)
Undergrads More than HS HS or less Older adults (65+)
96% 94%83%
76%% correct
Chance Of Getting A Viral Infection = 0.0005; Out Of 10,000 People How Many Are Infected?
Undergrads More than HS HS or less Older adults (65-94)
46%33%
13% 11%
% correct
Beyond That Our World Is Changing….
The Millennials
Listening to the Consumer of the Future…
Millennials. Oh, the Places They’ll Go!….
Image by artanddesigninspiration.com
In the Sky Without Feathers
Out to Dinner in Nice Weather
In the Car With Seats of Leather
And…On a Bike Without a Tether…
Millennials: 80 Million Strong
Source: handsondodge.com.
Millennials
Millennials
Baby Boomers
Millennials
They want the right information at the right time, anywhere, and on any device…
Millennials as Healthcare Consumers
Make it About Health Make it
Simple
Make it Accessible
Millennials as Healthcare Employees
• 67% said they found their current job on Facebook; and 31% on Instagram
• They are 2X as likely to leave their jobs after 3 years compared to 30 somethings
• More than 85% of them own smartphone• 51% cannot go even 3 hours without
checking their phone• 41% struggle with “information overload”
Millennials As Physicians
Source: Greymattermarketing.com
Pay-for-value attractive to younger generations who want workday flexibility
70% of millennials prefer using EMRs for charting and documentation
Millennial physicians find as much satisfaction from free time as from work.
OUT IN
Millennials will lead the way in 21st century communication tools.
When given a choice, 68% of millennial physicians picked employee status
Going Forward…
• Competing not just with other practices and health systems, but with other care models
• 10-30% of what happens in a primary care facility will take place on an iPhone in the next few years…
Empathize with me.
Nurture me.
Meet me where I am.
Make it easy for me.
Patient’s Real Preferences Simplified
Source: Ian Worden, MMD, MHI, Better Patient Engagement
