PR and Health Reform by Chuck Alston
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The Affordable Care Act is best known for the health insurance provisions recently upheld by the Supreme Court. But, the law’s implications reach far beyond expanded insurance coverage. It has helped propel a wave of private sector innovations to raise the quality and lower the cost of health care – all with significant implications for public relations. New health care delivery entities that go by the name of “accountable care organizations” and “patient-centered medical homes” are springing up across the country. In this PRSA Health Academy webinar: • Learn about the massive restructuring that is underway as health systems and insurers figure out a new world order that is blurring the lines between companies that manage risk – insurers – and those that provide care – health systems. • Consider how this new landscape of health care is littered with language land mines that can damage a health system’s brand. • Explore new language that communicates the benefits of these health care delivery and payment reforms. • Understand the new emphasis to drive patient and consumer behavior change toward wellness, access to preventive care, and medication adherence. • Recognize the growing importance of stakeholder communications both within the health care sector and between it and purchasers. Chuck Alston is senior vice president at MSL Washington DC and specializes in health care communications and policy. He has conducted extensive research with patients and consumers about their perceptions of health care payment and delivery reform. His clients include the Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted solely to health and health care, as well as hospitals, health systems and insurers. He is leading an Institute of Medicine research project on communicating about medical evidence.
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PR and Health Reform by Chuck Alston
- 1. PR and Health Reform The Changing Landscape of Health Care and What It Means for Communications Webinar for the PRSA Health Academy Chuck Alston Senior Vice President/Director of Public Affairs MSL Washington DC © 2011 MSLGROUP SLIDE 1
- 2. Agenda • Restructuring in the health care sector • The new landscape’s language land mines • Communicating the benefits delivery, payment reforms • Stakeholder communications • Trends to watch © 2011 MSLGROUP SLIDE 2
- 3. Biden Was Right: It Was a Big $#%^ing Deal President Obama Signs the Affordable Care Act © 2011 MSLGROUP SLIDE 3
- 4. © 2011 MSLGROUP SLIDE 4
- 5. Restructuring for the New World Order © 2011 MSLGROUP SLIDE 5
- 6. THE JOURNEY FROM VOLUME TO VALUE You Want to Go Where with My Health Care? © 2011 MSLGROUP SLIDE 6
- 7. From Volume to Value This mantra works for: Value equals higher quality care at a lower cost – what could be wrong with that? © 2011 MSLGROUP SLIDE 7
- 8. But Just Ask Them They think Valu is a four letter word © 2011 MSLGROUP SLIDE 8
- 9. What Value Looks Like People equate value with ―bargain-basement pricing‖ not high-quality care © 2011 MSLGROUP SLIDE 9
- 10. Health Care: I Don’t Want to Buy in Bulk Tested statement: “Here in our community, we are looking at ways to improve the health care that we all receive, so that we get more for the money we spend. That includes making sure that doctors understand that we want to pay for the right care, not tests that we do not need or other unnecessary procedures.” Charlotte, N.C., woman: ―More for the money, I don't know, it sounds like you are buying bulk.‖ Source: Focus group held in Charlotte, N.C. for the Robert Wood Johnson Foundation, 1 March 2011. © 2011 MSLGROUP SLIDE 10
- 11. VALU = Rationing, Poor Quality • ―Eliminating waste,‖ ―increasing efficiency‖ or even ―saving money‖ sparks fear of rationing care that they want – and feel they need – but that may be expensive • Feelings that care will be cheapened, or that time with physician will be cut or – worst of all – that the care that they want could be curtailed is threatening. It shuts down the conversation. • The premise of VBID programs — the use of high quality providers or evidenced-based procedures leading to lower costs — is counterintuitive to employees’ perceptions that lower cost equals lower quality Sources: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) Employee Health Engagement: Identifying the Triggers and Barriers to Engaging Employees in Their Health Benefits and Wellness Programs. Chicago, Ill: Midwest Business Group on Health, 2011. © 2011 MSLGROUP SLIDE 11
- 12. Summary: Barriers to Communicating Value • Consumer beliefs: Higher priced care must be better More care must be better Agency theory – doctors have my interests at heart When it comes to my health care, sky’s the limit • Third-party payment system – patients only see their portion of the costs* * Let’s talk more about this later! © 2011 MSLGROUP SLIDE 12
- 13. DO THEY HEAR WHAT YOU SAY? You Mean Well, But Sound Scary © 2011 MSLGROUP SLIDE 13
- 14. The Way “We” Talk About Health Care © 2011 MSLGROUP SLIDE 14
- 15. Do They Hear What You (Think You) Say? The new landscape of delivery and payment reform is covered with language landmines © 2011 MSLGROUP SLIDE 15
- 16. A Few Choice Words About Medical Homes ―It just sounds like a nursing home.‖ -- Boston focus group participant ―First you go to a medical home, and then you go to the funeral home.‖ -- Edina, MN focus group participant ―It just gives me the creeps.‖ -- Edina, MN focus group participant Source: Ross M, Igus T, Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal. 2009;13(1):8-16. © 2011 MSLGROUP SLIDE 16
- 17. Let’s Try that Again What You Say What They Hear Medical home Nursing home, home health, end of life Medical decision support End-of-life decisions Guidelines or treatment guidelines Restrictive, rigid, limited, driven by cost Integrated health care delivery system Bureaucratic, industry language, meaning unclear Integrated care Bureaucratic, industry language, meaning unclear Multispecialty medical group Bureaucratic, industry language, meaning unclear, trying to do too much, low quality, limited choice of specialists to choose from Best practices Bureaucratic, meaning unclear, insincere, cookie-cutter care, not tailored to the individual Evidence-based medicine Impersonal, one size fits all Accountable Something will go wrong, minimal care, buzz word Source: Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1):8-16. 2009. © 2011 MSLGROUP SLIDE 17
- 18. Lost in Translation ―Of course the system is integrated. There are black and white patients.‖ -- Participant in focus group conducted for MSL client ―I know my doctor is high-quality. He has Town & Country in the waiting room.‖ -- Participant in 2007 focus group for the Robert Wood Johnson Foundation © 2011 MSLGROUP SLIDE 18
- 19. Reform Fatigue • Improvements, sure • Changes, maybe • But please, no more reform REFORM © 2011 MSLGROUP SLIDE 19
- 20. Red Flag on the Revolving Door • Hospitals are on red alert to reduce readmissions to avoid Medicare penalties • Communicators need to be on red alert to not make it sound like the hospital or health system wants to ration care • DON’T focus keeping people out of the hospital • DO focus on the solution --- improving care for patients when they return home -- because it will be seen as a benefit Don’t know/ How would you grade each of the following? Refused A B C D F The quality of health care in the country as a whole 11 22 38 17 11 2 The quality of health care YOU receive 31 34 19 6 7 3 Source: Robert Wood Johnson Foundation/Harvard School of Public Health poll from March 9-18, 2011. © 2011 MSLGROUP SLIDE 20
- 21. The Team Trap Messages about ―teams‖ can create more concern than comfort Sources: Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1):8–16. 2009. Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) Photo: The Medical Group, Beverly, MA. © 2011 MSLGROUP SLIDE 21
- 22. Who’s in Charge? Concerns recede when it is clear the doctor is calling the signals Sources: Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1):8–16. 2009. Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) © 2011 MSLGROUP SLIDE 22
- 23. Park Your ACO in a Medical Home Garage Takeaways: Consumers resist being consumers when it comes to their health care • Consumers don’t want to talk about delivery system typology, or how doctors and hospitals are paid • They don’t know volume from value, and don’t want to • The get mad that money influences the way care is delivered Conclusion: Put the ―We’re Your New Hometown ACO Campaign‖ on hold © 2011 MSLGROUP SLIDE 23
- 24. SO WHAT, WHO CARES, WHAT’S IN IT FOR ME? Patient-centered Messaging © 2011 MSLGROUP SLIDE 24
- 25. The Problem with My Health Care is… • Uneasy relationship with my doctor • Doctor is pressed, encounter feels rushed, questions go unanswered • Lack of clear, trustworthy information • Too many mistakes, too much miscommunication that can make things go wrong Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) © 2011 MSLGROUP SLIDE 25
- 26. The Conversation About Care Starts Here © 2011 MSLGROUP SLIDE 26
- 27. What Do Patients Want? • More time with their physicians • Better coordinated care • To not pay more © 2011 MSLGROUP SLIDE 27
- 28. What Do Patients Want? Takeaway 1: They actually want an ACO wrapped around a medical home. (Just don’t use those phrases.) Takeaway 2: They will engage in a conversation about the delivery and reimbursement system if they think it would give them more of what they want without costing them more. © 2011 MSLGROUP SLIDE 28
- 29. ENOUGH ABOUT WHAT NOT TO SAY The ABCs of Delivery Reform Communications © 2011 MSLGROUP SLIDE 29
- 30. “It’s All About Me” • Focus on the patient • Any message about changing payment or delivery should focus on patient benefits not how health care is paid for • Position the benefits to consumers as ―improving care coordination,‖ ―increasing preventive care,‖ ―improving the doctor-patient relationship‖ and "improving communication across doctors‖ • Offer ―solutions‖ to problems they see • If you must talk about money, talk about spending health care dollars wisely, not saving money © 2011 MSLGROUP SLIDE 30
- 31. How to Say It We are working to: • Improve your health care • Find better ways to care for you • Make sure you get the best care possible Source: Research conducted for the Robert Wood Johnson Foundation. © 2011 MSLGROUP SLIDE 31
- 32. What to Say Our goal for your care is: • Strong relationship with your doctor • Time with your doctor • Addressing all your concerns • Involving you in decisions about your care • Making sure you understand your follow-up care • After-hours help, alternatives to the emergency room © 2011 MSLGROUP SLIDE 32
- 33. How to Say It How we are improving care: • Better communication, coordination among doctors • Getting you all the preventive care you need • Make sure you get right medications and tests • Help you make appointments easily, fill out forms once, take tests once, so you do not have to repeat yourself over and over • High-quality care, tailored just for you, based on best medical evidence and your doctor’s recommendation © 2011 MSLGROUP SLIDE 33
- 34. If You Have to Talk About Reimbursement • Finding better ways to pay for care • Make sure the way insurance pays for health care is consistent with way you want to receive it • Making sure every dollar is spent wisely © 2011 MSLGROUP SLIDE 34
- 35. Talking About Coordination ―Coordinated Patient Care improves the quality of care and brings down costs by encouraging primary care physicians to work closely with their patients’ other specialists when treating them. When doctors work as a team, patients receive top quality care. By using electronic records, doctors and hospitals will reduce medical errors and the duplication of tests, bringing down our costs.‖ Source: Coordinated Patient Care. Herndon Alliance, accessed 9/02/2011 at http://herndonalliance.org/resources/system- change/coordinated-patient-care.html © 2011 MSLGROUP SLIDE 35
- 36. Coordinated Patient Care • Increased coordinated patient care will bring about better patient experiences and quality of care and electronic medical records will help make this possible. • Improved coordinated patient care will lead to reduced costs and fewer medical errors. • Coordinated care supports doctors to be the best they can be. • Coordinated care encourages patients to be active participants in their care. • Increased coordinated care means more face--‐time with your doctors. Source: Coordinated Patient Care. Herndon Alliance, accessed 9/02/2011 at http://herndonalliance.org/resources/system- change/coordinated-patient-care.html © 2011 MSLGROUP SLIDE 36
- 37. FIVE TRENDS TO WATCH © 2011 MSLGROUP SLIDE 37
- 38. 1. PATIENTS BEHAVING LIKE CONSUMERS © 2011 MSLGROUP SLIDE 38
- 39. © 2011 MSLGROUP SLIDE 39
- 40. High Deductibles Will Drive Consumerism Health plans increasingly have high deductibles Source: Health Savings Accounts and Account-based Health Plans: Research Highlights. Washington: America’s Health Insurance Plans’ Center for Policy and Research, 2012. © 2011 MSLGROUP SLIDE 40
- 41. Price Seekers • Who is most likely to ask about the price of care? Younger age, Lower income, Higher insurance deductible, Recent hospitalization, More experience using computers and smartphones, and Not being an impulse shopper in other aspects of life. • Neither health status nor gender was predictive of asking about price. Source: Spring/Summer 2012 Altarum Survey of Consumer Health Care Opinions. Ann Arbor, Mich.: Altarum Institute, 2012. (No authors given.) © 2011 MSLGROUP SLIDE 41
- 42. 2. PHYSICIAN ALIGNMENT, EMPLOYMENT © 2011 MSLGROUP SLIDE 42
- 43. Physician Employment Now Source: Zeis M. Physician Alignment: Integration over Independence. Brentwood, Tenn.: Health Leaders Media Intelligence, 2012. © 2011 MSLGROUP SLIDE 43
- 44. Physician Employment Then Source: Zeis M. Physician Alignment: Integration over Independence. Brentwood, Tenn.: Health Leaders Media Intelligence, 2012. © 2011 MSLGROUP SLIDE 44
- 45. Reaching Primary Care Docs • Primary care doctors are frustrated. • Tell them you understand and want to lift their burdens • The highlight of their job is working with patients. Focus on change as a way to improve their relationships with patients, to get them back to the reasons they became doctors • Physicians are open to new arrangements, payment reform — if it offers benefits to them • Primary concern is loss of income • No trust hospitals will cut the pie fairly • Low understanding of different payment reform models • You want to ―improve‖ payment system, not reform it Source: Talking with Physicians about Improving Payment and Reimbursement. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) © 2011 MSLGROUP SLIDE 45
- 46. Communicate Alignment of Interests Source: Talking with Physicians about Improving Payment and Reimbursement. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) © 2011 MSLGROUP SLIDE 46
- 47. 3. EMPLOYER PURCHASING © 2011 MSLGROUP SLIDE 47
- 48. Employers Shopping for Value ―Large employers are confident they’ll offer health benefits within the next 5 years but continue to develop innovative strategies to help employees receive high quality care and to control rising health care costs. Results show major trend of offering online transparency tools so employees can find information about price and quality.‖ © 2011 MSLGROUP SLIDE 48
- 49. B2B Comms: Focus on Value © 2011 MSLGROUP SLIDE 49
- 50. Employers Are Watching Price Range In Average Price Per Procedure Across California Hospitals For California Public Employees’ Retirement System (CalPERS) Patients Undergoing Knee Or Hip Replacement, 2009. Source: Robinson JC and MacPherson K. ―Payers Test Reference Pricing And Centers Of Excellence To Steer Patients To Low-Price And High- Quality Providers.‖ Health Affairs, 31(9): 2028-2036, 2012. © 2011 MSLGROUP SLIDE 50
- 51. Safeway Reference Pricing Range Of Prices For Colonoscopy Per Procedure Paid By Safeway In Three Markets, 2009. Source: Robinson JC and MacPherson K. ―Payers Test Reference Pricing And Centers Of Excellence To Steer Patients To Low-Price And High- Quality Providers.‖ Health Affairs, 31(9): 2028-2036, 2012. © 2011 MSLGROUP SLIDE 51
- 52. 4. TRANSPARENCY © 2011 MSLGROUP SLIDE 52
- 53. Transparency: Get Your Story Ready © 2011 MSLGROUP SLIDE 53
- 54. Price Transparency © 2011 MSLGROUP SLIDE 54
- 55. 5. HEALTH CARE + PUBLIC HEALTH © 2011 MSLGROUP SLIDE 55
- 56. Can You Prevent the Next Case of Diabetes? © 2011 MSLGROUP SLIDE 56
- 57. The Bravest New World: Population Health 75% of our health care spending is on people with chronic conditions. • 7 out of 10 deaths among Americans each year are from chronic diseases. • Almost 1 out of every 2 adults—had at least one chronic illness. Source: The Power of Prevention: Chronic Disease …The Public Health Challenge of the 21st Century. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, 2009. (No authors given.) © 2011 MSLGROUP SLIDE 57
- 58. ACO Comms, Meet Public Health Comms • Accountability for population health is the heart of being an ACO • Behavior change communications will make health care feel even more like public health • health promotion activities to encourage healthy living and limit the initial onset of chronic diseases • early detection efforts, such as screening at-risk populations • appropriate management of existing diseases and related complications © 2011 MSLGROUP SLIDE 58
- 59. From cures, rescue care to preventive care CDC recommendations on chronic disease prevention • Quitting smoking • Diet, exercise • Healthy blood pressure and healthy blood cholesterol levels • Instilling healthy behaviors and practices during youth © 2011 MSLGROUP SLIDE 59
- 60. SUMMING UP, LOOKING AHEAD All Health is Local: Research Your Audience © 2011 MSLGROUP SLIDE 60
- 61. All Health Care is Local • Research. Don’t assume. • Localize the message • Pay attention to ecology, culture • Physician champions and internal comms are critical for introducing new care models © 2011 MSLGROUP SLIDE 61
- 62. RESOURCES The Research Behind Today’s Presentation © 2011 MSLGROUP SLIDE 62
- 63. To Learn More • Bechtel C and Ness D. ―If You Build It, Will They Come? Designing Truly Patient- Centered Health Care.‖ Health Affairs. 29(5): 914-920. May 2010. • Carmen K, et al. ―Evidence That Consumers are Skeptical about Evidence-based Health Care.‖ Health Affairs. 29(7): 1400-1406. July 2010. • Gerber A, et al. ―A National Survey Reveals Public Skepticism About Research- Based Treatment Guidelines.‖ Health Affairs. 29(10): 1882-1884. October 2010. • Ross M, Igus T and Gomez S. ―From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.‖ The Permanente Journal.13(1): 8–16. 2009. • “Talking About Health Care Payment Reform with U.S. Consumers.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) • ―Talking with Physicians about Improving Payment and Reimbursement.‖ Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.) • Anzalone Liszt Research. ―Coordinated Patient Care.‖ Herndon Alliance, accessed 9/02/2011 at http://herndonalliance.org/resources/system-change/coordinated- patient-care.html © 2011 MSLGROUP SLIDE 63
- 64. Health care communications and public affairs Chuck Alston senior vice president/director chuck.alston@mslgroup.com We are part of the MSLGROUP Americas, the PR arm of the Publicis Groupe, one of the world’s largest Michael King communications firms. Our team offers clients the vice president personal touch and category expertise of a boutique, with access to national and global resources should Aaron Cohen they require them. vice president/media Our health care and health care policy work is Eva Fowler holistic: We design and execute programs that seek to account supervisor change minds, policy and behavior with audiences running the gamut from the chronically ill to the Katherine Brick chronically wonky. account supervisor Emily Burton We specialize in health, health care and medical senior account executive issues, working on the cutting edge of patient and provider communications, quality improvement, Alyssa Snow delivery and payment reform, and public affairs and Senior account executive reputation management. Leah-Michelle Nebbia Whether your business is delivering care to patients assistant account executive or messages to Capitol Hill, find out why trade associations, non-profit foundations, health plans, Colleen Johnson hospitals and health systems have turned to us to assistant account executive take care of them. © 2011 MSLGROUP SLIDE 64
- 65. To Follow Up Chuck Alston chuck.alston@mslgroup.com © 2011 MSLGROUP SLIDE 65
Hinweis der Redaktion
- PRSA Health Academy webinar:Learn about the massive restructuring that is underway as health systems and insurers figure out a new world order that is blurring the lines between companies that manage risk – insurers – and those that provide care – health systems. Consider how this new landscape of health care is littered with language land mines that can damage a health system’s brand.Explore new language that communicates the benefits of these health care delivery and payment reforms.Understand the new emphasis to drive patient and consumer behavior change toward wellness, access to preventive care, and medication adherence.Recognize the growing importance of stakeholder communications both within the health care sector and between it and purchasers.Big believer in research. Many sources today – RWJF, work for commercial systems and published research A list of major sources available at end of presentation.
- Most people know it as an attempt to expand access. But its quality provisions are quite far –reaching, b/c as the people on this call know, Medicare is the 800 ground gorilla of health care payment. Where it goes, the private sector won’t be far behind. DRG system in hospitals, for example.
- This is a map of the world before Columbus sailed the ocean blue.Like Columbus, we are venturing off the known map
- Healthcare M&A Activity Surges in Q2Margaret Dick Tocknell, for HealthLeaders Media , July 26, 2012 Healthcare services, which includes physician groups, hospitals, and managed care, M&A at $19.2 billion, which is more than double the 2011 value in second quarter. Levin Associates report.The surge in M&A activity reflects increased pressure on the healthcare industry to reduce costs and increase the quality of care. Everyone is "trying to figure out what they need to do that," Steve Monroe, a Levin Associates editor, told HealthLeaders Media.The value of physician group M&As climbed to $4.2 billion during second quarter 2012 thanks to another blockbuster, the $3.7 billion agreement between Davita, a Denver-based dialysis chain with 1,800 locations, and HealthCare Partners, which operates medical groups and physician networks with more than 2,500 employed or affiliated physicians in California, Florida, and Nevada.There were 21 physician group M&As posted for the quarter compared with 27 transactions valued at $416 million for the comparable 2011 quarter.The Davita-Healthcare Partners acquisition reflects the continuing effort by providers to position themselves to tightly control costs and to create alignments that enable the care continuum to be realized. This is happening across the healthcare industry, explains Monroe. "Everyone is trying to position themselves, and cover themselves, so they can deal in an environment that is still a bit unknown.""Integrating Coventry into Aetna will complement our strategy to expand our core insurance business, increase our presence in the fast-growing government sector and expand our relationships with providers in local geographies," Mark T. Bertolini, Aetna's chief executive, said.
- They wall off health care from commercialization (we will talk about exceptions to this later)Do not want to think of cost and care in the same breath
- “More for the money we spend” – what could be wrong with that; in every other sector, it’s what people wantShows how people feel about this sector
- As always, as communicators we seek to meet consumers where they are –not where we wish them to be – and then craft strategies for taking them where we want to go.Reiterate These were developed as defensive messages – not to take the story to the public, but to respond if asked. We can see that in first takeaway.This is not a conversation most consumers want to engage in. The focus groups made it abundantly clear that consumers do not want to think or talk about how, when or why their healthcare providers are paid. Anger frustration fear anxiety about health care costs; blame for insurers but also hospital profits; technology; low-income help; aging population. What can they do: take better care of themselves; they go without care – ER broken arm storySome now asking for cost info but cannot get itLittle to no knowledge about how the current reimbursement process works, and linking money or payment to their health andhealth care makes them uncomfortable at best, very angry at worst.Especially in this economy, the notion that physicians should be paid differently to do high quality work or go the extra mile to give their patients the care they need is a non-starter. The messages in this report therefore, are best used reactively rather than proactively.
- The goobledygook lingo of heath care reform the way it appears to consumers
- To paraphrase Geena Davis to Jeff Goldblum in The FlyBe careful, be very very carefulTeamsValue etcAre laden with baggage unapparent on the surface
- Let me pause here a second and let you soak some of this inOn the left, some of those terms on the previous slideOn theright, what people think ofwhen they hear those terms
- New research from Blue Shield Foundation of CA into Medicaid patientsSuch is the pull of physician care that majorities of those who have an initial preference for a doctor over another care provider hold thatposition even if it means appointments are briefer (73 percent say that’s worth the tradeoff), the doctor doesn’t know them as well (60 percent),or it’s harder to get an appointment (56 percent).• While doctors are present, continuity is lacking. Two-thirds of patients say they don’t see the same care provider every time they visit their facility. Nearly six in 10 of them would prefer more regular contact with the same caregiver – a desire that helps open the door to considerationof alternatives.•For many, preference for a doctor falls short of a demand. One-third have no preference for a doctor over a nurse or physician’s assistant,and more are open to non-doctor care under specific circumstances. Among those who initially prefer a doctor, nearly four in 10 shift theirpreference to a non-physician provider if it means it’s easier to get an appointment. And just 23 percent of all low-income Californians prefera doctor across every condition tested.Openness to non-doctor alternatives rises in some groups, for example among younger patients and those in better health. And among peoplewho don’t currently see the same care provider each time, a not insubstantial four in 10 are content with that arrangement. Insight can begained from closer examination of this and other more flexible patient populations, provided in the full report that follows.
- A new class of consumers – small but hitting critical massOur unpublished research demonstrates the connection; high deductible policy holders want price info but cannot get it
- 40 percent in commercial plans had deductibles $2,00 or higher
- Two thirds use the old staff model; community physicians with privileges; 60 percent hospitalists
- Hospitalists drop to 58 percent; staff to half; but clinical integration up to 37 percent, from 20 percent on previous slideReflects ACO model
- Physicians are extremely frustrated with the current health care system.Virtually every physician interviewed passionately expressed deep frustration with the health care system in general, and their concerns about the inadequate reimbursement structure in particular.They feel squeezed by today’s payment system and pressured to see more patients, frustrated that they cannot give their patients the time they need because they are not reimbursed for much of the work needed to build a better patient-provider relationship or to adequatelycoordinate their patients’ care. They are aggravated by what they see as ever growing administrative requirements, especially time spent supplying documentation for reimbursements, and payers interfering with care, e.g., insurers requiring authorizations for treatments. They raise concerns about inequities in pay compared to specialists. Many of the physicians in the one-on-one interviews expressed a strong desire to leave medicine. Only slightly morethan one in four of those surveyed said they were “very satisfied” professionally. Physicians are open to the idea payment reform.Physicians recognize that rising health care costs are unsustainable and they are open to hearing about efforts to potentially change the waypayment/reimbursement works. While the downsides of various payment reform experiments past and present still concern them – and they see the devil in the details – their level of frustration has seemingly made them more receptive to new ideas. Awareness lackingAll but a few of the physicians interviewed were unaware of various payment or delivery reform efforts. Concepts like accountable care organizations, patient-centered medical homes, bundled payments, etc., were either completely new to them, or they were familiar with the terms but did not know any specifics. Only a small percentage of those surveyed described themselves as very knowledgeable about these three payment models. Do not trust hospitals
- Physicians are extremely frustrated with the current health care system.Virtually every physician interviewed passionately expressed deep frustration with the health care system in general, and their concerns about the inadequate reimbursement structure in particular.They feel squeezed by today’s payment system and pressured to see more patients, frustrated that they cannot give their patients the time they need because they are not reimbursed for much of the work needed to build a better patient-provider relationship or to adequatelycoordinate their patients’ care. They are aggravated by what they see as ever growing administrative requirements, especially time spent supplying documentation for reimbursements, and payers interfering with care, e.g., insurers requiring authorizations for treatments. They raise concerns about inequities in pay compared to specialists. Many of the physicians in the one-on-one interviews expressed a strong desire to leave medicine. Only slightly morethan one in four of those surveyed said they were “very satisfied” professionally. Physicians are open to the idea payment reform.Physicians recognize that rising health care costs are unsustainable and they are open to hearing about efforts to potentially change the waypayment/reimbursement works. While the downsides of various payment reform experiments past and present still concern them – and they see the devil in the details – their level of frustration has seemingly made them more receptive to new ideas. Awareness lackingAll but a few of the physicians interviewed were unaware of various payment or delivery reform efforts. Concepts like accountable care organizations, patient-centered medical homes, bundled payments, etc., were either completely new to them, or they were familiar with the terms but did not know any specifics. Only a small percentage of those surveyed described themselves as very knowledgeable about these three payment models. Do not trust hospitals
- Employer sponsored health not going away, but it is changing; CDHC/high deductibles etcWant to control costs and will explore new payment systems;Employee toolkit from AIR
- They are pushing for new payment methods – notice the mythbusting “the most expensive hospital may not be the best”Fully aware of Dartmouth research; recent United HealthCare research
- Hospital CompareLeapfrogJoint CommissionUS NewsPhysician CompareAnd many individual state reportsHave been hard to use, but getting better
- Also Castlight and others getting into the fray
- Chronic Disease Management is highly interventional, requiring high touchPatient Activiation MeasuresKate Laurig –Chronic Disease Self Management
- This places a great new premium on behavior change communications