Colorado PTN Learning Lab

Transcription

1 Colorado PTN Learning Lab Supporting Clinicians and practice teams to have Cost of Care conversations with patients Facilitated by: Lisa Tuttle, Maine Quality Counts Kathy Reims, University of Colorado Kellie Slate Vitcavage, Maine Quality Counts Beth Neuhalfen, Denver Health January 10,

2 How to be engaged during this Learning Lab! Click on the microphone icon in the lower left hand corner to mute or unmute yourself- Please mute when not speaking Click on the video icon in the lower left corner to turn off/on your video- Please keep your video on Click on the chat icon to send questions or comments to others- Please chat to all so everyone can see your message Please type your name and role into the chat now

3 Agenda for Today: Welcome, Objectives & Introductions Why conversations around reducing utilization and cost of care are important patient centered practice Review Assessment results to hone in on challenges and successes Discuss strategies and tools to support conversations with clinical and administrative leaders, providers, practice teams How could you start or expand the support for Cost of Care conversations with your clinicians/practices? Final Thoughts & Next Steps: preparing for onsite Learning Lab February 27 LEARNING LAB 3

4 Meet the Presenters: Lisa Tuttle, Program Director, Communities of Practice, Maine Quality Counts Kathy Reims, MD, FAAFP Faculty Lead, Department of Family Medicine, University of Colorado 4

5 Meet the Presenters: Kellie Slate Vitcavage, Project Manager, Consumer & Community Engagement Maine Quality Counts Beth Neuhalfen, BS-CHC Denver Health Hospital Authority 5 January 10, 2018

6 Today s Learning Objectives Objective: Increase the comfort and confidence of Colorado PTN Practice Facilitators in speaking with Practices and Clinicians about reducing unnecessary utilization and cost of care. Objective: Review and extend assessment results to prepare for late February on-site Learning Lab to dive deeply into tools, strategies and approaches that can support clinical workflows and practice cultures to advance conversations around reducing unnecessary utilization and cost of care. 6

7 What Language Are We Using? 7 January 10, 2018

8 8 January 10, 2018

9 Why are conversations about appropriate utilization and cost of care important?

10 Low Value Care Pervasive 42 percent of Medicare beneficiaries receive at least 1 of 26 low-value services per year Costly and wasteful percent of total health care spending Can cause harm to patients Exposing a patient to multiple, additional studies prolongs surgical delay, increases exposure to radiation, prolongs and exacerbates underlying anxiety, and increases the likelihood of additional incidentalomas. 1 Niess MA, Prochazka A. Preoperative chest x-rays: a teachable moment. JAMA Intern Med. 2014;174(1):12. Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams J. Measuring Low-Value Care in Medicare. JAMA Intern Med. 2014;174(7): doi: /jamainternmed Health Policy Brief: Reducing Waste in Health Care, Health Affairs, December 13,

11 Stopping doing something is different than doing more Inherent Challenges Clinician autonomy More than adding to standing orders Fear of litigation Revenue generation and incentives may play a role Requires organizational commitment to high value care including data support Requires Different Skills Skills to say no Skills to elicit patient preferences Skills to describe absolute risks and engage patients in meaningful shared decision making 11

12 Patient-Centered Framing Some of the motivation for this work came from patients themselves... Members are facing enormous costs, and they need to pay more out of pocket. So patients are demanding lower cost for medical care, and that is generating interest among physicians. Our doctors care about our members, and how these costs are affecting them. -- Margaret Ferguson, Kaiser Permanente Colorado We had to be conscientious about how we presented the data. We needed to present the evidence base, and we needed to show that this overuse was causing patient harm. -- Amanda Schondelmeyer, Cincinnati Children s Hospital MacColl Institute Environmental Scan 2016 personal communication 12

13 Assessment Results 13

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18 Strategies and Tools to facilitate and support practices in advancing conversations Creating executive buy-in/creating clinical buy-in: identifying a starting point, using meaningful data Creating a patient-focused culture that normalizes discussions of utilization and cost in the clinical visit Engage all members of practice team in supporting reducing utilization and cost of care discussions, sharing functions Empower clinicians to know what is available in their practice/system or broader community that will assist patients with shared decision making around utilization, financial costs and transparency 18

19 The Conversation What are your thoughts about? How have you already been thinking about? What challenges have you encountered? What support do you need to overcome? What works best for you? Links to resources Case studies Research Training opportunities Examples of using data Other? 19

20 Leadership Buy-in Sticky Messages o Executive leaders o Physician leaders o Site managers & leaders System change Support with time and data Healthy competition 20

21 Team-Based Care Team members support rationale Unified voice of high value care Team members helpful to use decision aids, elicit preferences, link to resources 21

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23 Patient-Focused Culture Do what is right for patients & honor their preferences Do no harm Care that has value Support skill development to engage patients 23

24 Clinician Support Provide reliable data Allow time for sense-making conversations Provide decision aids as available Support communication skills Identify system or community resources Conversation Guide Patient Decision Aids 24

25 Final Thoughts Are there other thoughts or concerns you d like to discuss? Priorities for Faceto-face Learning Lab? 25

26 LEAVING IN ACTION Thank you all for your participation today In-person learning lab: February 27 th, 2018 on Cost & Utilization, hosted by Colorado PTN

27 The project described was supported by Funding Opportunity Number CMS-1L from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.