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Consumer Engagement Defined

Consumer Engagement 101 Rita Zanichkowsky Director, State Health Alliances American Heart Association American Stroke Association May 8, 2008. Consumer Engagement Defined.

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Consumer Engagement Defined

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  1. Consumer Engagement101Rita ZanichkowskyDirector, State Health AlliancesAmerican Heart AssociationAmerican Stroke AssociationMay 8, 2008

  2. Consumer Engagement Defined “Consumers taking a greater role in managing their own health and their health care….seeking out information on how to handle a symptom or reading about a new prescription drug…” Source: J. Hibbard, University of Oregon

  3. Textbook Definitions Con-sum-er \ n 1 a: one that consumes: as one that consumes economic goods Pa-tient \ n 1 a: an individual awaiting or under medical care and treatment b: the recipient of any of various personal services 2: one that is acted upon Source: Merriam-Webster Collegiate Dictionary

  4. What’s In A Name? Terms respondents identify with most: • Individual 32% • Patient 31% • Person 16% • Consumer 7% • Customer 6% • Client 5% “Consumer” evokes a business model, it exemplifies everything that is wrong with healthcare. Source: Olson Zaltman Associates for RWJF

  5. What’s The Big Deal? Why Consumer Engagement matters: • Transparency is here to stay • Trend toward patient-centered measures • A new consumer generation • The system can’t improve without them • Patients are vulnerable; they suffer in the very system designed to heal

  6. Consumer Voluntary Planned/intended Willing payer Decision maker Position of strength Choice Confident Patient Involuntary Unplanned/unwanted Financially at risk Compromised Vulnerable, frightened Forced Lacks confidence Attributes

  7. Symbolic interaction Culture Life Impact Power Time limits Clinical “speak” Physician’s negative emotions Attitudes Intimidation Office setting Health literacy Normal vs. foreign Unconscious bias Active listening Barriers to EssentialDynamic

  8. Essential Barrier Patients frame healthcare in terms of a trust relationship with their provider Providers frame healthcare in terms of a system, a mechanism with many interconnected pieces Source: Olson and Zaltman Associates

  9. This Too Shall Pass…Clinician resistance • Activated consumers – we don’t have time for this • Frustration abounds • Keep the family out of here • Project of the month • This engagement thing will blow over

  10. Other Challenges • “Quality” as a competitive strategy • Provider and health plan cultures can fail to take patient needs into account • No model for sustained success in patient activation • Healthcare as a commodity

  11. Consumer Beliefs • Cost = Quality • More care = Better care • Most people still believe that the quality of care is uniformly high across providers * * Source: Robert Wood Johnson Foundation

  12. The Continuing Reality … Our Healthcare System is Still Plagued by • Overuse, Underuse, Misuse • Disparities • Wide variations in Care • Uninformed (innocent?) patients and consumers • Poor communication and self-care

  13. “Medicine is, at its core, an uncertain science…doctors desperately need patients…to help them think. Without their help, physicians are denied key clues to what is really wrong. I learned this not as a doctor, but when I was sick, when I was the patient.” Source: How Doctors Think by Jerome Groopman, M.D. A Doctor Speaks

  14. Writes down and asks questions Knows that quality varies Interviews doctors Brings an advocate Understands link between activation and preventing errors Researches their illness Tape records visits Knows what Rx is for Is confident in their ability to self-manage Uses quality data to inform decisions An Engaged Consumer….

  15. The Tipping Point Comes As Patients… • …experience small successes • …understand their health condition • …realize they can control behavioral choices • …take advantage of self-management resources • …see comparative quality information they can use

  16. The Market Push • State of Maine Employee Health Plan incentive – product design • Hannafords - nutritionists help diabetic/cardiac patients shop • Worksite wellness incentives • Employers bring self-management to the work place

  17. The Good News Activated patients are more likely to: • Be involved in managing their own condition(s) • Have better clinical outcomes • Experience fewer medical errors • Reduce costs • Check out quality information • Choose high performing providers This result in a smoother process for clinicians Everyone wins

  18. Startsmall Start with behaviors that are feasible for patients to take on. Low activated consumers have a lot of experience with failure. They feel unmotivated and disempowered.

  19. Simple Tools Work • Compare Your Care • Ask Me 3 • Videos, PSAs, Health Risk Assessments • Take-home list of key points • Advocate organizations • PAM survey instruments • Self-Management modeling

  20. Doctors Vary. So Do Patients. • Age • Gender • Socioeconomic status • Race, ethnicity, culture • Geography • Education/Health Literacy • Readiness to engage Check your own unconscious bias

  21. Trusted Messengers • Physicians, nurses, care coordinators • Faith-based organizations • Consumer Advocates • Healthcare orgs. dedicated to improving quality • Community centers

  22. A Word on…..Words Use living room language Use explicit (visual) and intuitive examples of desired behaviors: NO: “Quality care means people become better partners….” (brochure speak) YES: “Start with a 15 minute walk each day…” “Tell me your whole medical history….”

  23. What Can You Do? • Apply CE principles in your setting • Accept that this is not the “project of the month” • Consider families as allies, not visitors • Encourage questions • Consider clear communication to be a quality issue

  24. What Else Can You Do? • Change your own mind (set) • Confirm patient confidence level to adhere to a regimen • Provide existing tools and supports • Consider servant leadership principles to transform healthcare organizations • Ask, listen, seek, then guide

  25. A Few Resources • www.askme3.org • www.rwjfinfo-questionsaretheanswer.org • www.familycenteredcare.org • www.healthcaredisclosure.org • www.newhealthpartnerships.org • www.fightchronicdisease.org • www.nationalpartnership.org • www.archsurg.ama-assn.org/cgi/content/full/137/12/1419 • www.jrsm.rsmjournals.com/cgi/content/abstract/100/8/368

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