academyhealth engagement, empowerment, enhancement: the role of consumers in health care and...

Engagement, Empowerment, Enhancement:

Graphic: Flip the Clinic

The Role of Consumers in Health Care and Advocacy

Your team for today’s discussion:

S. Whitney Bowman-Zatzkin, MPA, MSRDirector, Flip the Clinicwhitney@fliptheclinic.org | @MsWZ

Thomas Workman, Ph.D.Principal Researcher, American Institutes for Researchtworkman@air.org

Claire Brindis, Dr.P.H.Director, Philip R. Lee Institute for Health Policy StudiesProfessor, Pediatrics and health PolicyDirector, Bixby Center for Global Reproductive healthExecutive Director, Adolescent and Young Adult Health, National Resource CenterClaire.Brindis@ucsf.edu

Amanda OteroHealth Care Organizer, TakeAction Minnesotaamanda@takeactionminnesota.org

Paving the Road for Patient and Family Engagement

Thomas Workman, Ph.D.Kristin L. Carman, Ph.D.American Institutes for Research

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Kristin L. Carman, Pam Dardess, Maureen Maurer, Shoshanna Sofaer,Karen Adams, Christine Bechtel and Jennifer Sweeney (2013). Patient And Family Engagement: A Framework For Understanding The Elements And Developing Interventions And Policies. Health Affairs 32(2), 223-231

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8 change strategies

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Using the roadmap

• Catalyze efforts – 5 Simple Actions

• Organize current work, identify opportunities for pushing further

• Unify efforts and identify opportunities for partnerships

The power of [the roadmap] will only be fully realized when everyone takes action. Only then will we realize the power of shared goals and partnerships. Only then will we discover the power of the patient at the center of healthcare.”

- SUE COLLIER Clinical Content Development Lead

American Hospital Association/Health Research Educational Trust

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Community and partnership

• Download and share the roadmapwww.patientfamilyengagement.org

#PFEroadmap

• Make a commitmentwww.patientfamilyengagement.org/commitments

• Share a resourcewww.patientfamilyengagement.org/resources

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Let us know how we can help

Kristin L. Carman, PhDVice President, Health and Social Development Program

American Institutes for Research

202-403-5090, kcarman@air.org

Thomas Workman, Ph.D.Principal Researcher, American Institutes for Research

301-592-2215, tworkman@air.org

Pam Dardess, MPHPrincipal Researcher, American Institutes for Research

919-918-2311, pdardess@air.org

AIR’s Center for Patient & Consumer Engagementwww.aircpce.org

Strategies and Tactics for Achieving Meaningful Consumer Engagement in Health CareClaire D. Brindis, Dr. PH., Dana Hughes, Dr.PH, Laura Schmidt, Ph.D., Laurie Jacobs, Ph.D., Caitlin Kennedy, Ph.D.

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco

June 13, 2015

ACA & Consumer Engagement

• ACA & patient-centered care– Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS)

• ACA & consumer engagement in system redesign– CMS’ state demonstrations to integrate care for dual

eligible patients

– CMMI’s testing of new service & delivery models

• Role of advocates in consumer engagement

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CAMPAIGN FOR BETTER CARE

Community Catalyst

PICONational Partnership for Women & Families

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Atlantic Philanthropies’ Campaign for Better Care

Ultimate goal:

Better quality care, better patient experiences with care and more affordable care for low-income older adults and other vulnerable populations

Strategy 1:

• Design and test models of consumer engagement in institutional decision-making which assure the inclusion of the perspectives of vulnerable populations and their families (and result in the ultimate goal)

Strategy 2:

• Identify methods to sustain this work over time

A Multidimensional Framework for Patient and Family Engagement in Health and Health Care

Levels of Engagement

  Consultation

  Involvement

  Partnerships & Shared Leadership

Direct Care

  Patients receive information

Patients asked about treatment

preferences

Decisions based on patients’ preferences, medical evidence, &

clinical judgment

Organizations design &

governance

  Organization surveys patients about care

experiences

Hospital involves patients as advisors or advisory council

members

Patients co-lead hospital safety & quality improvement committees

Policy Making

  Policy agency’s focus groups ask patients about health care

issues

Patients’ research priorities used by public agency in funding decisions

Patients equally represented on agency committee deciding how

to allocate health program resources

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Continuum of Engagement

Carman KL, et al. S. Patient and Family Engagement: A Framework For Understanding The Elements And Developing Interventions and Policies. Health Affairs 32 (2013)

A Multidimensional Framework for Patient and Family Engagement in Health & Health Care

Levels of Engagement

  Consultation

  Involvement

  Partnerships& Shared Leadership

Direct Care

  Patients receive information

Patients asked about treatment

preferences

Decisions based on patients’ preferences, medical evidence, &

clinical judgment

Organizations design &

governance

  Organization surveys patients about care

experiences

Hospital involves patients as advisors or advisory council

members

Patients co-lead hospital safety & quality improvement committees

Policy Making

  Policy agency’s focus groups ask patients about health care

issues

Patients’ research priorities used by public agency in funding decisions

Patients equally represented on agency committee deciding how

to allocate health program resources

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Continuum of Engagement

Carman KL, et al. S. Patient and Family Engagement: A Framework For Understanding The Elements And Developing Interventions and Policies. Health Affairs 32 (2013)

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Centers for Medicare and Medicaid Services

State Demonstrations to Integrate Care for

Dual Eligible Individuals

Primary Care Transformation

Initiatives to Speed Adoption of Best

PracticesAccountable Care Health Care

Innovation Awards

Comprehensive Primary Care

Initiative

Partnerships for Patients Pioneer ACOs

Community Catalyst National Partnership for Women & Families Rutgers /PICO

Community Catalyst

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• Work to build a nationwide network of local & state health advocacy organizations & coalitions

• Share expertise via technical assistance

Organizational Focus

• Shape state policy development & implementation to incorporate consumers

• Institutionalize consumer involvement in state policy & provider/health plan activities

Primary Campaign for Better Care

Goals

• Support state advocates

• Setting: Urban & rural communities & state capitols

Campaign for Better Care Approaches

National Partnership for Women and Families

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• Advocate at the federal level for policies & laws that help women & families

• Support effective implementation at local & state levels

Organizational Focus

• Support implementation of consumer engagement provisions for hospitals, primary care practices, & ACOs

Primary Campaign for

Better Care Goals

• Provide technical assistance/consultation to CMMI & providers

• Setting: Localities where CMS demonstrations are taking place

Campaign for Better Care Approaches

PICO

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• Utilize faith-based community organizing to address problems & concerns within congregations & communities based on shared values

Organizational Focus

• Empower consumers at the local level to improve individual & community health/well- being

• Achieve Medicaid savings for high utilizers & return savings to local communities

Primary Campaign for Better Care

Goals

• Engage in community organizing among Hot Spotter patients & community members

• Direct patient support as part of care management

• Setting: Communities served by local participating PICO federations

Campaign for Better Care Approaches

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Slide Title. Arial Bold, 32ptApproaches to

Consumer Engagement

Community Catalyst

National Partnership PICO

Consumers serve on decision-making bodies

Creation of formal mechanisms for obtaining consumer feedback on health services & health service needs

Technical assistance on decision-making bodies, other engagement techniques

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Slide Title. Arial Bold, 32ptApproaches to

Consumer EngagementCommunity

CatalystNational

Partnership PICO

State-level oversight bodies that include consumers & their advocates

Standards, regulations, & monitoring approaches that best serve the interests of consumers.

Consumer use of programs that help individuals & family caregivers be more engaged in their health

Facilitate consumers and their advocates in conversations with policymakers (state & federal)

Tactics and Strategies Implemented to Increase Consumer Engagement

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Slide Title. Arial Bold, 32ptTactics Community

CatalystNational

Partnership PICO

Federal advocacy

State advocacy

Technical Assistance

Information sharing/learning networks

Community Organizing

Coalition building

Training

Strategy/Tactic #1:

Educate, Engage & Influence Federal & State Policy Makers to Incorporate Consumers’ Needs & Interests into Policy

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Strategy/Tactic #2:

Actively Engage Consumers in Decision Making & Ensure Their Perspective is Heard

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Strategy/Tactic #3:

Engage Health Plans & Providers to Genuinely Involve Consumers in Decision Making

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Strategy/Tactic #4:

Engage With Other Organizations to Act Collectively in Support of Consumer Engagement

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Lessons Learned

What matters:

• Flexibility

• Relationships

• Opportunities for collective learning

• Focus on both the system & local level

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Lessons Learned (continued)

Other Essential Ingredients:

• Provider/clinician investment and commitment

• Consumer engagement recognized as a vital component of system reforms

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Lessons Learned (continued)

Common challenges:

•Consumer health literacy

•Health care system’s complexity

•Fear of feasibility of changes

•Lack of buy-in

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Implications & Future Questions

• For advocates:– Does consumer engagement make a difference?

• For evaluators & researchers:– The need for:

• Metrics

• Sustainable & scalable models

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Leveraging Engagement:Policy Change

Amanda OteroHealth Care Organizer, TakeAction Minnesota

• Among the most comprehensive public coverage

• Among the highest insured rate (95%)

• Lowest premiums

• Highest deductibles

Minnesota

What Advocacy Made Possible: The 9 Lives of Minnesota Care

October 19, 2012, St. Paul Pioneer Press, Front Page

• You want to plan around people’s priorities, needs, preferences.

• You want to understand if/how your plan will impact people.

• You need to simplify complex information for patients or the public.

• You need policy or funding to achieve your HST goals.

You might need consumers/advocates if…

Where can I find them?

• Patients• Community organizations• Advocacy organizations• Everywhere!

Deep Dive

Graphic: Flip the Clinic

Key Points

IMAGE

• Be mindful of your gift to/for others in healthcare

• Consumers and clinicians should be flexible, creative,

and maintain a spirit of adventure

• Huge gains are possible

• Be bold

• Patients and clinicians have permission to experiment, inform, and explore healthcare together.

Graphic: Flip the Clinic

Thank you!

Graphic: Flip the Clinic

S. Whitney Bowman-Zatzkin, MPA, MSRDirector, Flip the Clinicwhitney@fliptheclinic.org | @MsWZ

Thomas Workman, Ph.D.Principal Researcher, American Institutes for Researchtworkman@air.org

Claire Brindis, Dr.P.H.Director, Philip R. Lee Institute for Health Policy StudiesProfessor, Pediatrics and health PolicyDirector, Bixby Center for Global Reproductive healthExecutive Director, Adolescent and Young Adult Health, National Resource CenterClaire.Brindis@ucsf.edu

Amanda OteroHealth Care Organizer, TakeAction Minnesotaamanda@takeactionminnesota.org