What Role Do Patient Engagement Strategies Play in Promoting Population Health?

Transcription

1 POPULATION HEALTH identifying implementation tactics What Role Do Patient Engagement Strategies Play in Promoting Population Health? July 31, 2014

2 This presentation has been provided for informational purposes only and is not intended and should not be construed to constitute legal advice. Please consult your attorneys in connection with any fact-specific situation under federal, state, and/or local laws that may impose additional obligations on you and your company. Cisco WebEx can be used to record webinars/briefings. By participating in this webinar/briefing, you agree that your communications may be monitored or recorded at any time during the webinar/briefing. Attorney Advertising

3 Webinar Presenters Linda Tiano, Member, Epstein Becker Green and EBG Advisors (moderator) Ben Gardner, Founder and President, Linkwell Health Kathleen Fraser, RN-BC, MSN, MHA, CCM, CRRN, Case Management Society of America National President,

4 Presentation Overview This session will examine different approaches that have been used to target, engage and modify individual behaviors towards a healthier lifestyle. The speakers will highlight key examples of ways to engage high-risk and chronically ill groups to achieve meaningful clinical and financial outcomes. In addition, panelists will discuss: Methods to promote better eating and exercise Avenues to promote healthy behaviors and to address chronic disease head-on Strategies to benchmark positive changes in targeted populations and provide meaningful feedback loops to patients Ways to improve medication adherence Approaches to optimize provider involvement in patient care over the continuum Consumer engagement and leveraging marketing strategies to focus on health and target populations with chronic conditions 4

5 Chronic Conditions and Financial Burdens Source: CDC Rise in Chronic Conditions 25.8 million people in the U.S. (8.3% of the population have diabetes) If current trends continue, one in three U.S. adults will have diabetes by 2050 Over one third of U.S. adults and 17% of children are obese Financial Cost The total costs (direct and indirect) of diabetes in 2008 was $174 billion In 2008, overall medical care costs related to obesity for U.S. were as high as $157 billion Obese individuals had medical costs that were $1,429 higher than the cost of people with normal body weight 5

6 Lifestyle is the #1 Risk Factor for Chronic Conditions 6

7 What Americans with Chronic Conditions are Eating Purchasing candy: Almost two times more likely to purchase Russell Stover s candy One and a half times more likely to purchase Mounds Almost one and a half times more like to purchase a York Peppermint Patty More likely to eat dessert: Almost one and a half times more like to purchase Pepperidge Farm Three Layer cake Consuming frozen food: Nearly 40% more likely to purchase frozen French fries 17% more likely to consume frozen dinners MRI 2013 doublebase, Chronic = diabetic, hypertension, and obesity, than the average US population 7

8 Consumer Packaged Goods (CPG) Marketing 1899 Today 8

9 The Power of Nudge 9

10 Impact of Calorie Reductions A permanent 100 calorie reduction in daily intake would eliminate approximately 71.2 million cases of overweight/obesity and save $58 billion annually. Category Bad For You Calories Better for You Calories Change Breakfast Eggs 70 Fat Free Egg Beaters 30 Snack Bar Snickers Candy Bar 280 Extend Bar 150 Beverage Orange Juice 150 Trop Sweetener Sugar 15 Truvia 0 Salty Snack Potato Chips 150 Baked Lays 110 Butter Butter 100 Smart Balance 45 Entrée Stouffers Chicken Alfredo 410 Lean Cuisine Chicken Fettuccine 280 Snack Mrs. Field's Cookies 370 Murrays Sugar Free Cookies 150 Total Healthcare Analytics, Thomson Reuters 10

11 Most Diets are Unsuccessful: Unrealistic Lifestyle Changes U.S. Diet/Weight Loss Industry Trend $30 billion market value in US $60.5 billion market in US U.S. Obesity Trend % % Survey: Most Americans are Weight Conscious, April

12 What do consumers understand? 12

13 What do consumers want to read? What health plans want consumers to read 13

14 Linkwell s Approach to Engagement 14

15 15

16 Overall Approach 16

17 Ongoing Message Drives Behavior Change * Percent change in healthy spend year-over-year: test vs. control 17

18 Coupons Incentivize Better Purchases * Percent change in healthy spend year-over-year: test vs. control 18

19 Content with Coupons Drive Healthy Eating * Percent change in healthy spend year-over-year: test vs. control 19

20 The Result Increase in Health Plan Perception 16% more consumers rated their health plan excellent/very good Ongoing Communication Majority of consumers want ongoing communication from their health plan Increase in consumer engagement 58% of consumers planned to take action/redeem a coupon after receiving a Linkwell mailing Increase in Communications Appeal 8 in 10 health plan members like receiving mailings 20

21 Medication Adherence Drugs don t work in patients who don t take them. - C. Everett Koop, Former United States Surgeon General 21

22 What is adherence? A cluster of behaviors Simultaneously affected by multiple factors The extent to which a person s behavior taking medication, following a diet, or making healthy lifestyle changes corresponds with agreed-upon recommendations from a health care provider Source: 22

23 Medication Adherence Medication Adherence: The patient s conformance with the provider s recommendation with respect to timing, dosage and frequency of medication-taking during the prescribed length of time Compliance: Patient s passive following of provider s orders Persistence: Duration of time patient takes medication, from initiation to discontinuation of therapy Concordance: Wider concept from prescribing communication/consultation to patient in support of medication taking. Source: 23

24 Facts One in three patients fails to fill their prescriptions Approximately three of four Americans report they do not consistently take their medications as directed Sixty percent of patients cannot correctly name their medications and up to 20% of patients take medications prescribed for others Between 30 and 70% of medication-related hospital admissions in the U.S. are due to poor adherence Approximately one-fourth of all nursing home admissions are related to improper medication self-administration Average adherence rates are between 50-65% in those with common chronic conditions such as diabetes and hypertension Source: Case Management Adherence Guide,

25 The Cost of Non-Adherence Source: 25

26 Causes of Poor Medication Adherence High out-of-pocket costs, especially for patients on multiple prescriptions for chronic conditions. Lack of care coordination, follow-up and shared decisionmaking. Complex or burdensome treatment regimens or multiple prescribed medications. Co-morbidities, such as severe and persistent mental illness. Side effects of prescribed medications, whether real or perceived. Personal factors, including lifestyle, culture and belief system Source: Adherence to Medication Lars Osterberg, M.D., and Terrence Blaschke, M.D. N Engl J Med 2005; 353: August 4, 2005DOI: /NEJMra

27 Socioeconomic Factors Low socioeconomic status - independent predictor of low adherence Low health literacy Unemployment Lack of experience with health care system Poor access to health care Competing priorities food vs. medications Reading level single strongest predictor of practical asthma knowledge Racial disparities Age Cultural beliefs vs. inequality Does not relate independently Focus should be on beliefs about their illness Source: Case Management Adherence Guide,

28 Quantifying the Cost-Effectiveness of Medication Adherence One of the most direct ways to study the cost-effectiveness of medicines is to compare total health care costs and utilization for patient populations who are using prescription drugs appropriately versus those who are not. Researchers have found relationships between taking medications as prescribed and lower health care costs, as well as the converse relationship of not taking medications as prescribed and steeper health care costs. Source: 28

29 Average Annual Spending Related to Diabetes 29

30 Health Care System Lack of provider awareness and knowledge about adherence Lack of tools to assist health care professionals in evaluating and intervening in adherence problems Lack of tools to help the patient develop adaptive health behaviors and change ineffective or harmful behaviors Gaps in the provision of care Suboptimal communication between patients and health professionals Source: Case Management Adherence Guide,

31 The Role of Health Care Providers Health care providers have a vital role in: Stressing the importance of taking medications as prescribed Monitoring and helping patients avoid or reduce unpleasant side effects that may compromise adherence Helping to keep patients more generally well-informed about their health conditions 31

32 Improving Medication Adherence Improve Care Coordination Enhance Patient Engagement and Education Utilize Case Management, Counseling and Medication Management Expand Screening and Assessment Invest in Health IT Infrastructure 32

33 Strategies to Increase Medication Adherence Clinicians should actively discuss adherence issues with patients (e.g. comprehension, adverse events, acceptance of illness) and monitor patient adherence. External reinforcements: Reminder notes Pair pill-taking with routine daily activity (e.g. eating breakfast) Engage family members/significant others to support adherence Use simple dosing regiments (e.g., agents requiring lessfrequent dosing or long-acting formulations) 33

34 Interventions Should be Patient-Tailored Behavior related: Forgetfulness of patients Daily alerts 90-day medication supplies Automatic renewals Clinical (Questions or concerns about medications): Pharmacy consultation Linguistically and culturally important Cost related: Payment assistance programs Lower cost medication alternatives Lower cost pharmacy option 34

35 Strategies to Increase Medication Adherence Impart Knowledge Involve, Advise, Inform Empowerment - Is giving the patient freedom of choice appropriate? Simplify the Regimen Match regiment to patient s activities of daily living Modify Patient Beliefs and Behavior Ensure that patients understand their risks and consequences if they don t adhere to medication regimens Address fears and concerns Provide Communication and Trust* Active listening, emotional support, use plain language Elicit patient s input in treatment decisions *Source: 35

36 Evaluating Adherence Self-report Ask about adherence behavior at every visit Periodically review patient s medication containers, noting renewal dates 36

37 Overcoming Challenges or Barriers Introduce team-based care: Collaborate with pharmacists and/or nurses Educate patients on how to take medications Monitor by pill box Improve access and communication: Offer patients the opportunity to contact the provider s office with any questions Use telemedicine, particularly in rural areas Use technologies and analytical services that facilitate measuring and improved adherence 37

38 Patient Communications Having a clear understanding of how the use of technology impacts patients is critical for care managers and other providers if they want to effectively engage their patients and improve clinical outcomes. 38

39 Source: 2012 Health IT Survey Series, Trend Report #5: Patient Engagement Strategies 39

40 Trends in Engagement Strategies Knowing the types of technology patients currently use, as well as where IT trends are headed, can help providers, care managers and other health care professionals target their outreach strategies to get and keep patients engaged. In an increasingly mobile and technology-driven society, providers and their patients now have the ability to utilize tools that were previously unavailable or underutilized in order to open a two-way line of communication with their patients, thereby creating a deeper level of engagement that allows patients to become more meaningfully involved in their own care. 40

41 Questions 41

42 POPULATION HEALTH identifying implementation tactics Linda Tiano Epstein Becker Green (202) Ben Gardner Founder and President Linkwell Health th Street, NW Washington, DC Kathleen Fraser National President ( ) Case Management Society of America

43 POPULATION HEALTH identifying implementation tactics THANK YOU