1 patient engagement and the bottom line njmgmaoctober, 2015
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PATIENT ENGAGEMENT AND THE BOTTOM LINE
NJMGMAOctober, 2015
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OBJECTIVES
Understand the Business Case for Patient Engagement and Your Role
Define What Patient Engagement Is and Is Not
Identify Successful Patient Engagement Strategies (Clinical, Operational, Revenue Cycle):1. People2. Processes3. Technology
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BUSINESS CASE
Federal Quality Reporting Programs Federal Quality Reporting Programs MU, PQRS, VBPMMU, PQRS, VBPM CG CAHPSCG CAHPS Physician ComparePhysician Compare
New Payment/Delivery Models – Shift New Payment/Delivery Models – Shift from Volume to Valuefrom Volume to Value ACOs, Shared SavingsACOs, Shared Savings PCMH, PCSPPCMH, PCSP MACRA - MIPS, APMsMACRA - MIPS, APMs Triple Aim – Improved Outcomes Triple Aim – Improved Outcomes
(population), Decreased Cost (per capita), (population), Decreased Cost (per capita), Improved Patient ExperienceImproved Patient Experience
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FACTS
Engaged PatientsEngaged Patients Overall medical costs decreased by 5.3%Overall medical costs decreased by 5.3%
12.5 fewer hospital admissions12.5 fewer hospital admissions11
Activated PatientsActivated Patients Lower Activation Scores Lower Activation Scores 21% higher costs 21% higher costs22
1.1. Veroff, David, et al., “Enhanced Support for Shared Decision making Reduced Costs of Care for Veroff, David, et al., “Enhanced Support for Shared Decision making Reduced Costs of Care for Patients with Preference-Sensitive Conditions,” Health Affairs 32, No. 2 (2013): 285-83Patients with Preference-Sensitive Conditions,” Health Affairs 32, No. 2 (2013): 285-83
2.2. Hibbard, Judith H, et al, “What Evidence Show about Patient Activation: Better Health Hibbard, Judith H, et al, “What Evidence Show about Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data on Costs, “ Health affiars 32, No. 2 (2013): 207 - Outcomes and Care Experiences; Fewer Data on Costs, “ Health affiars 32, No. 2 (2013): 207 - 1414
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PATIENT PATIENT ENGAGEMENT:ENGAGEMENT:
““THE BLOCKBUSTER THE BLOCKBUSTER DRUG OF THE DRUG OF THE
CENTURYCENTURY””
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WHAT’S IN A NAME?WHAT’S IN A NAME?
WHAT’S THE DIFFERENCE WHAT’S THE DIFFERENCE ANYWAY?ANYWAY?
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PATIENT ENGAGEMENT
WHAT IS PATIENT ENGAGEMENT?WHAT IS PATIENT ENGAGEMENT?
PATIENT ENGAGEMENT ≠ PATIENT PORTAL
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DEFINITIONS
Patient Experience Patient Experience The sum of all interactions, shaped by an The sum of all interactions, shaped by an
organization’s culture, that influences organization’s culture, that influences patient perceptions, across the continuum patient perceptions, across the continuum of careof care
Patient SatisfactionPatient Satisfaction Patient’s opinion of carePatient’s opinion of care
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DEFINITIONS
Patient CompliancePatient Compliance The provider assumes a paternal role in The provider assumes a paternal role in
healthcare decisions and the patient follows healthcare decisions and the patient follows the providers instructionsthe providers instructions
Influenced by culture, age, Influenced by culture, age, sociodemographicssociodemographics
Patient AdherencePatient Adherence The extent to which a patient’s behavior The extent to which a patient’s behavior
corresponds with corresponds with agreed upon agreed upon recommendations from the providerrecommendations from the provider
Shared Decision MakingShared Decision Making
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PATIENT COMPLIANCE ≠ PATIENT PATIENT COMPLIANCE ≠ PATIENT ADHERENCEADHERENCE
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DEFINITIONS
Patient ActivationPatient Activation Patient’s knowledge, skills, ability, and Patient’s knowledge, skills, ability, and
willingness to manage his/her own healthcare.willingness to manage his/her own healthcare. PAM Score (Patient Activation Measure)PAM Score (Patient Activation Measure)
Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Behaviours, Behaviours,
Health Serv Res 2007; 42(4):1443-1463. Health Serv Res 2007; 42(4):1443-1463.
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DEFINITIONS
• Patient EngagementPatient Engagement A patient is involved in the process of their care – A patient is involved in the process of their care –
actively processing information, deciding how best actively processing information, deciding how best to fit care into their lives, and acting on their to fit care into their lives, and acting on their decisionsdecisions
Behavior-orientedBehavior-oriented Provider: gain patient’s attention and actively Provider: gain patient’s attention and actively
motivate to participatemotivate to participate
Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Behaviours, Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Behaviours, Health Serv Res 2007; 42(4):1443-1463. Health Serv Res 2007; 42(4):1443-1463.
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DEFINITIONS
Care Direction Care Direction – Atul Gawande, MD, MGMA - – Atul Gawande, MD, MGMA - 20152015 Care aligned with the patient’s priorities and Care aligned with the patient’s priorities and
goals.goals. Not just what the patient wants, but the goal of Not just what the patient wants, but the goal of
where the patient wants to bewhere the patient wants to be Shared Decision Making ≠ Provider CapitulationShared Decision Making ≠ Provider Capitulation
GoalGoal::
Align Patient Engagement with Care Align Patient Engagement with Care DirectionDirection
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PATIENT EMPOWERMENT
PATIENT EMPOWERMENT:PATIENT EMPOWERMENT:
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YOUR OFFICE’S GOALS
AreasAreas::
1.1. PeoplePeople
2.2. ProcessesProcesses
3.3. TechnologyTechnology
Question: What are Your Office’s Goals for Patient Engagement?
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PEOPLEPEOPLE
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PRACTICE ADMININSTRATOR
Answer: LEADERSHIP!Answer: LEADERSHIP!1.1. PeoplePeople
2.2. ProcessesProcesses
3.3. TechnologyTechnology
Question: What is Your Role in Patient Engagement?
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LEADERSHIP
7 Habits of Highly Effective Leaders7 Habits of Highly Effective Leaders1.1. Inspire Action/VisionInspire Action/Vision
2.2. Be OptimisticBe Optimistic
3.3. Have IntegrityHave Integrity Role ModelRole Model
4.4. Facilitate TeamworkFacilitate Teamwork Cowboys v. Pit CrewCowboys v. Pit Crew
5.5. Have ConfidenceHave Confidence
6.6. CommunicateCommunicate
7.7. Be DecisiveBe Decisive
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LEADERSHIP
Responsibilities of an Effective LeaderResponsibilities of an Effective Leader Organizational CultureOrganizational Culture
1.1. AccountabilityAccountability• ““What You Permit you PromoteWhat You Permit you Promote””
Clear ExpectationsClear Expectations
1.1. Have you told your staff whatHave you told your staff what’’s expected?s expected?
2.2. Have you defined expectations & Have you defined expectations & standards?standards?• Example: RespectExample: Respect
3.3. WhatWhat’’s your onboarding and continuing s your onboarding and continuing education process?education process?
4.4. Have you developed quality measures Have you developed quality measures and monitor expectations/standards?and monitor expectations/standards?
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LEADERSHIP
Results of Effective Leadership – Results of Effective Leadership – TransformationTransformation Staff Activation & EngagementStaff Activation & Engagement TeamworkTeamwork Office Efficiency & EffectivenessOffice Efficiency & Effectiveness
1.1. Does office efficiency = Patient Does office efficiency = Patient Satisfaction?Satisfaction?
Provider & Staff Job SatisfactionProvider & Staff Job Satisfaction Patient Satisfaction & EngagementPatient Satisfaction & Engagement Loyal PatientsLoyal Patients Healthy Bottom LineHealthy Bottom Line
1.1. ProfitabilityProfitability
2.2. Volume Volume Value Value
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LEADERSHIP
BarriersBarriers OperationalOperational
1.1. Time constraintsTime constraints
2.2. Provider/staff Provider/staff resistanceresistance
3.3. Lack of technologyLack of technology
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LEADERSHIP
BarriersBarriers PerceptionsPerceptions
1.1. ““My physicians don’t want to do it.My physicians don’t want to do it.””2.2. ““It’s not up to me.It’s not up to me.””3.3. ““These are clinical issues, so I can’t do These are clinical issues, so I can’t do
anything.anything.””4.4. ““I don’t have enough staff.I don’t have enough staff.””5.5. ““I don’t have the budget to do it.I don’t have the budget to do it.””6.6. ““Our patients aren’t capable of it.”Our patients aren’t capable of it.”
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YOUR ROLE
People – Set the Tone!!People – Set the Tone!! TrainingTraining AccountabilityAccountability Results - Monitoring/Measuring Results - Monitoring/Measuring
ProcessesProcesses Workflow – Patient, Operational, Workflow – Patient, Operational,
Revenue CycleRevenue Cycleo AMA Steps Forward –How To Guides; AMA Steps Forward –How To Guides;
Calculates ROI, Calculates ROI, www.stepsforward.org
Pre-Visit PlanningPre-Visit Planning Huddles - TeamSTEPPSHuddles - TeamSTEPPS
o www.teamsteppsportal.org/teamstepps-materials
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YOUR ROLE
TechnologyTechnology Questions in EHRQuestions in EHR Patient Portal Patient Portal
ImplementationImplementation Patient Satisfaction Patient Satisfaction
SurveySurvey Social MediaSocial Media mAppsmApps
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PHYSICIAN ENGAGEMENT
What Do Physicians What Do Physicians Want?Want? Business Case - ProfitabilityBusiness Case - Profitability Quality of LifeQuality of Life Efficiencies – Minimal Extra Efficiencies – Minimal Extra
WorkWork Caring for People ClinicallyCaring for People Clinically
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STAFF ENGAGEMENT
Incentives & AccountabilityIncentives & Accountability Rewards?Rewards? Part of Performance AppraisalPart of Performance Appraisal Redefining Staff Roles – MA, Licensed Redefining Staff Roles – MA, Licensed
Professionals, Care Coordinators/Coaches.Professionals, Care Coordinators/Coaches.
Job SatisfactionJob Satisfaction TeamworkTeamwork Less Rework & DuplicationLess Rework & Duplication Happier PatientsHappier Patients
TrainingTraining Communication SkillsCommunication Skills
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COMMUNICATION SKILLS
Acknowledge By name, friendly smile, By name, friendly smile, eye contact, non-verbal eye contact, non-verbal cuescues
Introduce By name, position/roleBy name, position/role
Duration Estimate of timeframe for Estimate of timeframe for task, procedure, wait-task, procedure, wait-timetime
Explanation About what you’re doing About what you’re doing for the patientfor the patient
Thank you Do you have any Do you have any questions? Is there questions? Is there anything else I can do for anything else I can do for you (Timing is important)you (Timing is important)
AIDET AIDET
AND MANAGE UP – Speak about staff/providers positively
Resources: AIDET Tools, www.studergroup.com
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COMMUNICATION SKILLS
AIDETAIDET
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COMMUNICATION SKILLS
The C.L.E.A.R. Service ModelThe C.L.E.A.R. Service Model
Connect Acknowledge, eye contact, Acknowledge, eye contact, smile, introduce what you do, smile, introduce what you do, use patient name, friendlyuse patient name, friendly
Listen Use nods, let patient finish, Use nods, let patient finish, repeat info for accuracy, repeat info for accuracy, empathy statementempathy statement
Explain Layperson language, Layperson language, timeframes, what you’re timeframes, what you’re doing/going to happendoing/going to happen
Ask Check for understanding, be Check for understanding, be helpful, meet patient needshelpful, meet patient needs
Re-Connect Check roomed patient every Check roomed patient every ““xx ”” min, friendly goodbye, what’s min, friendly goodbye, what’s next/follow-upnext/follow-up
Resource: SullivanLuallin Group, Star-Studded Service – 6 Steps to Winning Patient Satisfaction
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PUTTING IT INTO ACTION
AIDET EXERCISEAIDET EXERCISE
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COMMUNICATION SKILLS
Acknowledge By name, friendly smile, By name, friendly smile, eye contact, non-verbal eye contact, non-verbal cuescues
Introduce By name, position/roleBy name, position/role
Duration Estimate of timeframe for Estimate of timeframe for task, procedure, wait-task, procedure, wait-timetime
Explanation About what you’re doing About what you’re doing for the patientfor the patient
Thank you Do you have any Do you have any questions? Is there questions? Is there anything else I can do for anything else I can do for you (Timing is important)you (Timing is important)
AIDET AIDET
AND MANAGE UP – Speak about staff/providers positively
Resources: AIDET Tools, www.studergroup.com
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PATIENT ENGAGEMENT
What Do Patients Really Want?What Do Patients Really Want? AccessAccess Efficiency – short wait timesEfficiency – short wait times Friendliness & HelpfulnessFriendliness & Helpfulness CommunicationCommunication InformationInformation Follow ThroughFollow Through
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PATIENT ENGAGEMENT
What Do Patients Really Need?What Do Patients Really Need? Meet Health/Life GoalsMeet Health/Life Goals Medication AdherenceMedication Adherence Understanding/Instructions – written Understanding/Instructions – written
1.1. Laymen’s terminology Laymen’s terminology
2.2. Healthcare LiteracyHealthcare Literacy Self Care at Home – lifestyle, nutrition, Self Care at Home – lifestyle, nutrition,
etc.etc. Follow UpFollow Up Appointment RemindersAppointment Reminders
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PATIENT ENGAGEMENT
Know Your Patient PopulationKnow Your Patient Population > 65> 65 Baby BoomersBaby Boomers Gen XGen X Gen Y/MillennialsGen Y/Millennials
Cultural Diversity/SensitivityCultural Diversity/Sensitivity NJ’s Camden Project, Dr. Jeffrey BrennerNJ’s Camden Project, Dr. Jeffrey Brenner
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PATIENT ENGAGEMENT
Patient Satisfaction SurveysPatient Satisfaction Surveys Frequency?Frequency? Validity?Validity? Relevancy?Relevancy? Results?Results?
Types:Types: CG CAHPSCG CAHPS Press GaneyPress Ganey Specialty SpecificSpecialty Specific
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PROCESSESPROCESSES
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REVENUE CYCLE
Patient Engagement in Getting Paid – Patient Engagement in Getting Paid – The Time is NOW:The Time is NOW: High Deductible PlansHigh Deductible Plans Co-PaysCo-Pays Health Insurance ExchangesHealth Insurance Exchanges
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REVENUE CYCLE
Front End BillingFront End Billing Pre-VisitPre-Visit At Visit (Check-in & Check-out)At Visit (Check-in & Check-out) Payment ScriptsPayment Scripts
• Back End BillingBack End Billing After the VisitAfter the Visit Coordination Between Front & Back Office!Coordination Between Front & Back Office!
Resource: Keegan, Deborah Walker & Elizabeth Woodcock, The Physician Billing Resource: Keegan, Deborah Walker & Elizabeth Woodcock, The Physician Billing Process – Navigating Potholes on the Road to Getting Paid, MGMA, 2016 Process – Navigating Potholes on the Road to Getting Paid, MGMA, 2016
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REVENUE CYCLE
PAYMENT AT TIME OF SERVICE!PAYMENT AT TIME OF SERVICE!1.1. Balances are a MustBalances are a Must
2.2. Coinsurance CalculationCoinsurance Calculation
3.3. Automate the ProcessAutomate the Process
4.4. Unmet Deductibles Trump CoinsuranceUnmet Deductibles Trump Coinsurance
5.5. Financial Clearance a MustFinancial Clearance a Must
6.6. Expect More RefundsExpect More Refunds
7.7. Present the Contractual Adjustment as a Present the Contractual Adjustment as a DiscountDiscount
8.8. Collect in Advance for SurgeriesCollect in Advance for Surgeries
9.9. Don’t Leave the Uninsured Out of the Don’t Leave the Uninsured Out of the ProcessProcess
Resource: Woodcock, Elizabeth W, “Collections,” Conventus White Paper, 2015Resource: Woodcock, Elizabeth W, “Collections,” Conventus White Paper, 2015
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TECHNOLOGY
Patient PortalPatient Portal
Benefits:Benefits: Increased AccessIncreased Access Patient/Staff SatisfactionPatient/Staff Satisfaction Workflow EfficiencyWorkflow Efficiency Planned ProcessesPlanned Processes Decreased Phone CallsDecreased Phone Calls Decreased OvertimeDecreased Overtime Reduction in ExpensesReduction in Expenses Meet MU RequirementsMeet MU Requirements
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TECHNOLOGY
Develop Implementation StrategyDevelop Implementation Strategy PostersPosters FlyersFlyers All Staff Communicate to PatientsAll Staff Communicate to Patients User a “Staffer” to Enroll On-Site with User a “Staffer” to Enroll On-Site with
“Quick Tour”“Quick Tour” Create a “Quick Reference” Card for Create a “Quick Reference” Card for
Staff/PatientsStaff/Patients Set Enrollment GoalsSet Enrollment Goals Send “Welcome” MessageSend “Welcome” Message Staff Response Times to MessagesStaff Response Times to Messages
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TECHNOLOGY
Other TechnologiesOther Technologies
Secure MessagingSecure Messaging
Social MediaSocial Media
m-Appsm-Apps
TelemedicineTelemedicine Need license in Need license in eacheach state state Guidelines – AMA, FSMB, ATAGuidelines – AMA, FSMB, ATA
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QUESTIONS?QUESTIONS?
Susan Lieberman, MBA, BSNSusan Lieberman, MBA, BSNVice President, Practice ResourcesVice President, Practice ResourcesConventus Inter-Insurance ExchangeConventus Inter-Insurance Exchangewww.conventusnj.comwww.conventusnj.comslieberman@[email protected], x7466877-444-0484, x7466