Getting Engaged in the Massachusetts Health Confidence Campaign. John Wasson MD Margo Michaels MPH, HCFA

Transcription

1 Getting Engaged in the Massachusetts Health Confidence Campaign John Wasson MD Margo Michaels MPH, HCFA

2 Agenda Patient Health Confidence: What it is, why it is important, and our vision to use it to mobilize communities Ideas for local PFACs to Build Community Engagement Around Health Confidence Small group discussions and report out Joining HCFA Campaign Planning Group

3 WHAT IS PATIENT HEALTH CONFIDENCE And why is it important?

4 The Case of Mrs. M After being hospitalized for new onset congestive heart failure, Mrs. M, a 90 year-old widow, was discharged to her apartment.

5 The Case of Mrs. M Using the 10-point thermometers, she rated: Her understanding of heart failure a 1. Her confidence with self management a 4. She was prescribed VNA and Telehealth.

6 The Case of Mrs. M During the first six months after discharge she had: 4 ER visits 7 office visits 2 additional hospitalizations Her PCP received 21 telephone office contacts.

7 Who Needs Health Confidence? 50-75% Identify a Risk to Health1 Majority NOT confident about reducing that risk 25-50% Burdened by Illness1,2 Less than half are confident about managing their illness 5-10% Have to SelfManage a Health Problem Daily Data from HowsYourHealth.org: Exercise > Weight > Smoke/Drink > Other Data from HowsYourHealth.org: Burdened by Functional Limit or Chronic Illness J Am Board Fam Med 2011;24:

8 The Value of Health Confidence Health confidence is a useful, single item substitute for the evidence-based concepts of Patient Engagement, Activation, and Self-Management. Active patient engagement has been shown to: improve health outcomes improve health care experiences lower health care costs Practices (and communities) can increase engagement, activation and confidence levels.

9 QUESTIONS ABOUT THE CONCEPT?

10 HOW WE'VE USED HEALTH CONFIDENCE IN THE CLINIC SETTING

11 Measuring Health Confidence Whenever You Think Or Talk About Your Health Or Health Care Mark a 10 if you are very confident you can control and manage most of your health problems. 10 WHAT DO YOU DO NOW? Mark a 0 if you are not very confident. Copyright 2012 Trustees of Dartmouth College and FNX Corp. 5 0 Best Health Confidence I CAN MANAGE AND CONTROL MOST HEALTH PROBLEMS

12 Responding to the Measurement 1. What makes you say 4? 2. Why 4 and not zero? What would it take to make it to a 6? WHAT DO YOU DO NOW? 5 0 Copyright 2012 Trustees of Dartmouth College and FNX Corp. Best Health Confidence I CAN MANAGE AND CONTROL MOST HEALTH PROBLEMS

13 What Works 1. Segmentation of patients into meaningful categories with actions prescribed. 2. Problem-solving and action planning to identify concerns and simple, feasible strategies. 3. Brief, repetitive intervention rather than overwhelming, one-time exhortation. 4. Confidence-building so that patients become comfortable and adept at selfmanagement. Wasson JH, Baker NJ. Balanced Measures for Patient-Centered Care. J Amb Care Mngmnt. 2009;32:

14 Change in Health Confidence with HowsYourHealth.org Technology Practice A % of Patients Reporting they are Very Health Confident Practice B Practice C National Average Practice D In this analysis, adult patients from 15 primary care practices and a national sample report on changes in health confidence over time. Described in the report Better than average Less than national average Baseline 15 months Lynn Ho, MD; John Watt Haresch, MD; Mark Nunlist, MD; Adam Schwarz, MD; John H. Wasson, MD. Improvement of Patients Health Confidence: A Comparison of 15 Primary Care Practices and a National Sample J Ambulatory Care Manage. Vol. 36, No. 3, pp

15 OBSTACLES & OPPORTUNITIES Experience in the Field

16 Opportunities for Health Confidence & Motivational Interview/Problem Solving Logical, simple, actionable in multiple settings/cultures No or nominal cost in multiple media Effective in improving personal health and well being Likely to reduce undesirable consequences of health care Improves measures for desirable healthcare consequences

17 Obstacles for Health Confidence & Motivational Interview/Problem Solving Status quo and change Parochial/guild view of health care and wellbeing Measurement bias framing effect Payment bias gaming of health confidence measure

18 Health Confidence Creators & Destroyers Useful Tools Helpful Friends and Professionals Useful Information Desire to Change Finances Social Connections The Number of Health Problems or Risky Habits

19 % of Patients Reporting Very Health Confident Impact of Illness and Poverty on Health Confidence Illness Burden and Poor Illness Burden or Poor No Illness Burden and Not Poor This data from Medicare Wellness visits (n = 6800) shows the adverse impact of illness and poverty on Health Confidence status. Telephone Interview in One State Self Report in Other States Self Report in Same State Also apparent is likely positive bias by interviewer versus webbased, self-report.

20 Had Enough Confusion? Do This, Not That! You Matter, Not Now! Live Longer, Maybe If! We re Here, Please Hold! Go to: HowsYourHealth.org or HealthConfidence.org

21 Resource for Practices (Forthcoming for all family practitioners in the US)

22 Resource for Practices (Forthcoming for all family practitioners in the US)

23 Accessible Anywhere on the Internet

24 THE MASSACHUSETTS HEALTH CONFIDENCE CAMPAIGN HCFAs Vision for Community Mobilization

25 I am confident that I can manage and control most of my health problems Less than half of Massachusetts residents say they can agree with this statement, and only about 25% of people with low incomes*. How about people in your community? And, what can your organization do about it? *HYH data, 2014 out of 1700 respondents

26 I receive exactly the care I want and need exactly when and how I want and need it. Only about 30% of Massachusetts residents say they can agree with this statement*. How about people in your community? And, what can your organization do about it? *HYH data, 2014 out of 1700 respondents

27 How's Your Health Massachusetts HowsYourHealth.org

28 How's Your Health Massachusetts A family of assessment and reporting tools that enable practices and communities to efficiently utilize patient-reported information and collaborate with them on improving their Health Confidence and much more. HowsYourHealth.org

29 Campaign Goal To improve the health of Massachusetts residents by engaging community-based organizations to utilize the How s Your Health Tool

30 General Messages Is your Massachusetts community-based organization interested in Improving delivery of health services in your community in general? Better understanding the health concerns of particular groups in your community? Assessing the health education needs of your community? Finding an easy way to distribute local educational materials? Monitoring how well local health systems and practices are communicating with patients about their health care?

31 PFAC Messages What do you think.?

32 3 Months of Campaign Activities - HCFA Help connect local community based organizations and PFACs to build Health Confidence coalition Provide training on helping your community members become more Health Confident Provide technical assistance on to use and customize How's Your Health Provide Printed Materials to promote How's Your Health Help develop Action Plan

33 3 Months of Campaign Activities - PFACs or CBOs Join with other groups in your community to form a local Health Confidence coalition Meet at least 6 times over a 3 month period for training and strategy development Customize How's Your Health Massachusetts with local resources Promote use of How's Your Health within your community with a palm card Implement Action Plan to address what we find out about Community Health Confidence

34 SMALL GROUP DISCUSSIONS

35 Questions 1. How could PFACs lead or build a local health confidence campaign? 2. How could the results of Community Health Confidence serve as a galvanizing force to organize for community change?

36 NEXT STEPS

37 Community Ratings for Health Confidence $ NOT OK or Illness Burden $ NOT OK AND Illness Burden $ OK; No Illness

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40 Confidence For Reducing a Health Risk Web-site Respondents Choice for Risk Reduction Over the Next Two Months* Commitment by those Eligible Confident of Success if the Only Risk Confident of Success if 2 Risks Obese Choosing Weight Loss 68% 47% 21% Non-Exercising Choosing Exercise 54% 30% 23% Smoker Choosing Reduction 36%** 25% 19% Drinker Choosing Reduction 19% 47% 20% *A sample of 5500 adults aged of whom 30% had none of the four listed risks, 38% had only one of the four and the remainder had two or more risks. ** 45% of the smokers initially reporting that they were ready to quit and 18% of those who reported they were not ready to quit.

41 Visit-Based Example Using Information That Matters and Confidence MARKERS FOR PRODUCTIVE INTERACTION Wasson JH, Anders GS, Moore LG, Ho L, Nelson EC, Godfrey MM, Batalden PB. Clinical Microsystems, Part 2. Learning from Micro Practices about Providing Patients the Care They Want and Need. Joint Commission Journal of Quality and Patient Safety 2008;34:

42 ASSESSMENT ACTION RESULT Information Communication Confident Behavior Preferences and Values Getting a mammogram Managing CHF w/ routine exercise (From Keller and White, 1997; Rollnick, Mason and Butler, 1999)