Presentation Transcript

1. Michelle Barclay, MA, Vice President, Program Services Maria Clarys, BA, Physician Outreach Manager Alyssa Aguirre, LICSW, Clinical Services Manager Alzheimer’s Association Minnesota-North Dakota Chapter

   Developing effective relationships between community providers and physicians: An Alzheimer's Model

   Age Odyssey June 17, 2013
2. Learning Objectives Learn strategies and techniques to engage physicians and encourage referrals from the medical clinic to related community organizations Understand the barriers to Alzheimer's diagnosis and referral Discover communication strategies to build partnerships with medical clinics and serve more individuals with early stage Alzheimer’s disease Model Program: Direct Connect
3. Agenda Overview of Benefits / Barriers Physician Engagement Strategies The Direct Connect Program
4. Benefits of Early Diagnosis Optimize current medical management Improve clinical outcomes Relief gained from better understanding Maximize decision-making autonomy Open the door to service delivery Risk reduction Plan for the future Avoid or reduce future costs Diagnosis as a human right Alzheimer’s Disease International World Alzheimer Report 2011
5. Physician Barriers to Early Diagnosis Insufficient training, knowledge Limited knowledge of screening/diagnostic/management tools Mistaking signs of dementia for normal aging Perceived limitation of treatment options Lack of appreciation for the impact of early intervention Disclosure discomfort Fear of delivering a “death sentence” Fear of patient, family reaction Concern about making the wrong diagnosis Fear of opening Pandora’s box and managing a patient’s complex needs Potential negative implications for the provider/patient relationship
6. Assessment, Diagnosis, Treatment Cognitive Assessment Medicare Annual Wellness visit cognitive assessment not yet integrated into usual care AD Diagnosis less than 50% diagnosed in primary care less than 35% have diagnosis in medical record AD Treatment less than 50% of those diagnosed receive any drug or non-drug treatment (disease education, etc) 2 year delay from MD referral to patient action
7. ACT on Alz: Practice Parameters Providers Care Coordinators www.actonalz.org/provider-practice-tools
8. Physician Engagement The Basics Gain Attention: office staff, those in leadership roles Build Interest Answer objections or questions Set the stage for further contact
9. How to Gain Attention Work on your “Elevator Speech”…10-30 seconds Walk in to the clinic…don’t be afraid. Ask for nurse manager, nurse, clinic manager, staff of provider. Get name and number of contact person from front desk staff, and follow up.
10. Gaining Attention: Continued Make sure they know you are not a pharmaceutical rep. Wear a name tag. Always. Havebusiness cards ready; in your pocket, bag, etc. Be prepared. Try not to get frustrated. Don’t take it personally.
11. Possible Outcomes You’ll see someone…Hooray! Be prepared with extra information. Be ready for giving an intro/elevator speech; have calendars and cards ready. You will NOT see providers, perhaps staff. You may leave info and business cards Listen to clues from staff. TRY NOT TO GET FRUSTRATED. DON’T TAKE IT PERSONALLY.
12. How to Build Relationships Talk to all who will listen; you never know how your information may roll downhill. Be AUTHENTIC. Be yourself, and talk what you know. Build trust and credibility. Return calls, do what you say, and do it in a timely manner. They will remember if you don’t.
13. How to Build Interest YOUR GOAL isto make them WANT to hear more, or to contact you. This is an opportunity to ask more questions, not just “spew what you do”. Build Interest: Quick description or question. Example: “Do you currently have protocols in place for those with a new diagnosis of any dementia? What are the next steps for families or patients?” NOTE: On average, you will have much better discussions if you are able to make an appointment.
14. How to Build Interest , cont. We are always “selling”…It’s what we are trained to do! Help your audience to understand what you do, and why it is important to them. This applies to all involved; clinicians, office/nurse managers, nurses, staff, and patients/caregivers. ASK QUESTIONS to uncover their needs. REMEMBER the rule of WIFM WIFM: “What’s In It For Me?” They may be thinking, “So What?”…you can help them see why your service is important to help them.
15. What Kinds of Questions Should I Ask? The point of questions/probes is to gain a better understanding of the client’s needs. You have been trained to do this with clients. Closed questions: Yes or No answers; hard to get information “Do you have Alzheimer’s patients?” Open ended: Those that require a more detailed response; much easier to build a discussion around these. “What is your current protocol for screening/diagnosis/treatment of Alzheimer’s Disease?” “How do you help families find the right resources after a diagnosis?”
16. Understanding Clinicians’ Motivators Find out what is causing them PAIN/distress/sleepless nights regarding their dementia patients. They will not listen…REALLY listen…until you have uncovered or acknowledged the challenges that are causing them distress. (Much like families in distress.) Most common challenges for providers: Time constraints from patients’ higher-level needs Lack of knowledge of support or resources to address patient challenges Lack of financial compensation to address these challenges
17. How Can I Impact Providers? They are HARD to see. Why? Number 1: Super busy. Patient load and reimbursement are the biggest challenges they face. Anything outside of this realm is seen as a distraction. Most are motivated by things/people who: Save them time and money Reduce their stress Increase their recognition and appreciation WE HELP TO EASE THESE CHALLENGES
18. Answering Objections Whatever business or non-profit you represent, you will get objections. You are asking for change. Most will resist. (This is a common challenge in patient care as well.) If you are asked a tough question, you can always say “I’m not sure about that answer; may I find out and email/call you with an answer when I have it?” Sometimes, objections are red herrings to help distract you…then they don’t have to consider you any more.
19. Answering Objections, cont. Try to formulate answers to objections as you go along. Answer questions, and give the rationale behind it. Stay calm. Don’t let them rattle you. REMEMBER: physicians/providers can be challenging. It is their nature.
20. Real World: Objection examples Most objections revolve around these issues: Price: (Q): “My patients can’t afford your fee for time with a consultant.” (A): Our fees are minimal compared to private organizations; we also have sliding fee scales based on the income of the patient. Many/most fees are extremely minimal. Does this address your concern?” Fear of Change: (Q): “I’ve been using this screening tool for years, and I know it like the back of my hand” or, “I don’t have time for new screens and processes.” (A): I can understand your concern. I can assure you, this excellent tool will not take any more of your time, and will give better results. I can help you get acclimated to the screen and you will be comfortable in no time. Would this be of value to you?
21. More Real World Objections: Complacency: (Q): “There aren’t any really good medications; why should I diagnose?” and, “You can’t diagnose dementias properly with just these screens.” “What is the point of Dx? There is little that can be done.” (A): I can understand your thoughts. In fact, many of the new screens make it easier to give a more accurate picture of staging of dementia, as well as possible types. I think you might agree that, to help prevent crisis, an earlier diagnosis is key. There is much evidence to support that early intervention can help both the patient and the carepartner to alleviate much of the stress that can be a part of Alzheimer’s disease and related dementias.
22. Objections, cont. Timing: (Q): “We are going through a big change (EMR, management) here right now; I don’t have time to make more changes.” (A): I can certainly understand what a challenge that must be. I am happy to come back in a month or two. What might work best for you, 4 weeks or 8? External input: “I need to talk to the clinic manager/my colleagues/nurse before I can decide to proceed.”
23. And even more Objections: Personal/Office politics: “We have our own way of doing things with dementia patients: you will need to talk to our clinic manager.” Trust: “I like what you say you do, but this will make more work for me.” and, “If my clinic gives you all of our patients, how can you keep up?” Many others: most fall into these categories.
24. Closing/Next Step HARD close: think high-pressure sales: “How many patients can you send to us in the next month?” SOFT close: “So, does our service sound like something that will be helpful? Where do you see this fitting in to your practice?” Try to give them ACTION…that will help them close themselves. (“Please read this literature/visit our website, send me an email” etc.) MAKE A FOLLOW UP APPOINTMENT
25. Getting Clinicians to ACT Take the opportunity to give the provider or staff member an action step. Set the stage for a future visit. “NEXT STEP”…this phrase can help you stay focused. “What is MY next step to move this person/clinician/clinic forward?” What is a next step that I can assign to this person, that would help them remember us/me at the most important time? Visit website, read literature, etc.
26. In Closing, Guidelines to Remember Don’t forget to go back. One visit will RARELY change anything. Remember, they are very interested in what you do; they just don’t all know it yet. Remember, Don’t take it personally.
27. Thank You… On to our Care Consultation Model…
28. Usual Care
29. Systematic Connections Model Direct Connect
30. Direct Connect Goals Strengthen physician relationships Encourage earlier diagnosis Increase physician referrals to the Alzheimer’s Association Reduce the time between diagnosis & non-drug treatment from 2 years to 2 weeks Support families through education, planning assistance, and connection to programs & services that improve quality of life
31. Community Care Consultant Ideally a social worker, psychologist, care coordinator, or RN with experience in dementia and trained in facilitating family meetings Meets with families and individuals with dementia Communicates back to the physician
32. Topics Covered in Family meetings
33. Impact
34. Direct Connect Program Video
35. Challenges Families are sometimes resistant to meeting with a social worker Scheduling MD’s communication with patients about the service Direct Connect is only maintained if feedback loop with care consultant is in place
36. What type of referrals do we get? MD Outreach Manager Hired
37. Clients referred by their physician
38. Further Questions for study What is the “magic number” of contacts to get physicians to use direct connect or refer early stage patients? What “type” of contacts are the most impactful? ie. face to face, e-mail, phone calls, etc. Embedding a care consultant in a clinic system
39. Discussion How are you engaging physicians currently? How will you engage physicians differently after learning new information? Others?
40. Contact Information Michelle Barclay mbarclay@alz.org 952-857-0524 Maria Clarys mclarys@alz.org Alyssa Aguirre aaguirre@alz.org 952-857-0535