Opportunities and Challenges to Improve the Patient Experience: One Group s Practice

Opportunities and Challenges to Improve the Patient Experience: One Group s Practice March 23, 2017 Presented by John F. Fitzgerald, MD, MBA President, Indiana University Health Physicians Executive Associate Dean of Clinical Affairs, Indiana University School of Medicine

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The IU Enterprise The Indiana University Health system has 14 hospitals, 350 primary care offices, and 2.6 million outpatient visits Indiana University School of Medicine is the largest allopathic medical school in the country over 1500 medical students with 1,166 residents and fellows Indiana University Health Physicians is an academic multi-specialty physician practice group, with 2000 providers, in over 250 locations, and serving over 700,000 patients. 4

IU Health s Accountable Care Organization Entered into MSSP contract in 2012 2000 Physician and 14 Hospital Participants 20% Primary Care, 80% Specialists 40,000 attributed beneficiaries in MSSP Also manages 200K lives in fully capitated Commercial, MA, and Medicaid products. 5

IUHACO Attributed Beneficiaries 40,000 attributed Beneficiaries 72% Aged 23% Disabled 4% ESRD 11% Dual Eligible Significantly more % of patients with HIV/Aids, Organ Transplant, Metastatic Cancer, Hematologic malignancies, Cirrhosis, and Dialysis than average MSSP ACO 6

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Performance Rate (percentile) IU Health s ACO Patient/Caregiver Experience Measures 100 90 80 70 60 50 40 30 20 10 0 2013 2014 2015 CAHPS Getting Timely Care, Appointments, and Information 8

Performance Rate (percentile) IU Health s ACO Patient/Caregiver Experience Measures 100 90 80 70 60 50 40 30 20 10 0 2013 2014 2015 CAHPS How Well Your Providers Communicate 9

Performance Rate (percentile) IU Health s ACO Patient/Caregiver Experience Measures 100 90 80 70 60 50 40 30 20 10 0 CAHPS Patients Rating of Provider 2013 2014 2015 10

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IUHP s Keys to Patient Experience Patient and Family Advisory Council identified 2 key factors critical to meeting and exceeding patients expectations of their experience Good Access Good provider-patient communication 12

Improving Access - IU Health Initiatives and Programs for Timely Care/Appointments Same Day Access for 100% of Primary Care Physicians, and physicians in Cardiology, CV Surgery, General Surgery, Hematology/Oncology, Otolaryngology, Orthopedics, and Vascular Surgery Zocdoc patient scheduling tool for cell phone assists in filling in last minute openings Portal Scheduling Patient self scheduling through online portal Video Visit Program in Primary Care offers visits 7-days per week, 12-hours per day Outcomes: Weekly senior management review of average median appointment lag for all specialties Same Day Access Commercial http://preview.hyc.com/iuhealth/iu H-1947-TV-IU/index.html 13

Improving Communication: Multiple Interventions One Size Doesn t Fit All 14

IU Health Physicians Initiatives and Programs to Improve Provider Communication Patient and Family Advisory Council IU Talks Training at Orientation on Provider Communications and Empathy Standards of Assurance Coaching Shadowing Patient Experience Summit 15

Patient and Family Advisory Council 16

1 7 IU Health Physicians Primary Care Patient and Family Advisory Council Meet every other month to get patient input, recommendations and perspectives on various patient experience topics such as: Self-scheduling Appointments vs. Calling the Office Patient Engagement in Quality Initiatives Patient Engagement: Communication with Provider s Office via Website Portal Use of Computers in the Exam Room How to Communicate Registration Times/Appointment Times

IU Talks Program IU Talks is an interactive, immersive communication skills course focused on difficult discussions with patient and families facilitated by trained physicians Substantial participation by group members Now offered to all new providers at their orientation Objectives: Recognize role of emotion in conversations especially regarding serious medical news Use effective empathetic response to support patients and families Diffuse conflict and align medical care to patient values and goals without acceding to demands for inappropriate therapies Increase awareness of non-verbal cues 18

IU Talks: Deliberate Empathy is Key N- Name emotion U- Understand (validate) R- Respect (Praise) S- Support E- Explore S- Silence IU Talk video.mp4 View File Courtesy: VitalTalk www.vitaltalk.org

IU Talks Participation MD Participation Over 400 MDs annual participation Participation in IU Talks qualifies MDs to earn entire patient satisfaction component of compensation plan Mandated for individuals with scores below 25 %ile 20

How valuable is IU Talks in improving your communication? 21

Orientation Training on Communication and Empathy Our data revealed newly hired MDs had significantly lower scores than established MDs Developed Provider Orientation Enhancing the Patient- Provider Relationship 3 hour workshop: Helps providers improve their communication skills and build more satisfying relationships with patients Specifically focuses on many of the questions in the Provider Communication composite Incorporates the Four Habits communication model and Motivational Interviewing 22

Orientation Training on Communication and Empathy Non-provider Team Member 3 hr Essentials of Service Excellence training focused on elevating the understanding and making practical application of the Standards of Assurance and Assuring Behaviors 23

Standards of Assurance Communication Quality Accessibility Environment We communicate clearly and with compassion. We uphold the highest standards of quality care and service. We make it easy and convenient for our customers to obtain our services. We maintain a welcoming environment. 24

Assuring Behaviors Use AIDET consistently Smile and make eye contact Anticipate needs and solicit questions Reduce hassles Keep it clean and clutter free Strive to make it right, right away 25

Shadowing and Coaching Program Providers a trained coach shadows a provider for a half day to observe at least 4-6 patient encounters and provide feedback, which incorporates the Four Habits Model and Motivtional Interviewing, both rigorously demonstrated as effective for building patient engagement, trust and motivation to change behavior Team members a trained coach embeds herself/himself into the practice to offer evidence-based insights and feedback customized to the person(s) being observed 26

Shadowing and Coaching Outcomes Year 1: 82 providers received shadowing and coaching. Average overall satisfaction score for 12 months postshadowing rose 4.87 percentage points compared to previous year. Year 2: 76 providers received shadowing and coaching. Average overall satisfaction score for 12 months postshadowing rose 4.67 percentage points compared to previous year. 27

Patient Experience Summit 2016 Annual Patient Experience Summit Celebrate patient experience accomplishments Reenergize efforts around the patient experience Recognize providers & teams Providers with 100% score for Overall Rating of Provider and Provider Communication Top service line and office score for Overall Rating of Provider Most improved service line score for Overall Rating of Provider Top Courteous & Helpful Office Staff 28

Other Interventions Challenging Encounters Workshop Provides team members the skills/confidence needed to handle stressful patient encounters in a positive, productive manner Positive Intent Versus Negative Impact Workshop Helps team members explore the impact of well-intended, words and actions can causing a negative perception. The workshop also offers the opportunity to re-think words and actions to have a positive impact Physician Compensation Plan 29

Physician Compensation and Patient Satisfaction All MDs have component of Compensation tied to personal or specialty level quality performance. Ranges from 0.5% - 25%. 50% of quality component tied to patient satisfaction results Need 50+ %ile performance to qualify for patient satisfaction component. 75%ile gets full payout Below 30%ile forfeit all quality component IU Talks participation qualifies MD for patient satisfaction component. 30

IU Health Physicians Corporate Patient Satisfaction Survey Continuous throughout year Sampling from billing data Asks about most recent visit within 2 weeks of data Minimum of 30 responses per MD per year Too long 60 questions, takes 20 minutes to complete 31

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IU Health Physicians Corporate Patient Satisfaction Survey Continuous throughout year Sampling from billing data Asks about most recent visit within 2 weeks of data Minimum of 30 responses per MD per year Too long 60 questions, takes 20 minutes to complete 33

Notable differences between ACO and Corporate Results 2015 Corporate v. ACO results 100.00% 90.00% 80.00% 80.61% 89.20% 93.00% 91.94% 85.60% 70.00% 69.90% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Getting Timely Care, Appointments, and Information How Well Your Providers Communicate Patients' Rating of Provider ACO-1 ACO-2 ACO-3 Adult IUHP ACO 34

Possible Explanations of Corporate - ACO Differences Respondent Age Socioeconomic Status race, income Methodology Timing Most recent visit Length may introduce respondent bias Specialty Mix of MDs Provider Experience 35

Conclusions Multiple interventions and programs associated with IUH ACO s high level of patient satisfaction in MSSP attributed patients. Cannot prove any causal relationship between a specific program and results Differences in characteristics of patients and providers from surveys sampling other patient populations may affect other results and limit validity of comparisons to internal and external benchmarks. 36

Questions? 37