PATIENT ENGAGEMENT AND THE BOTTOM LINE

1. PATIENT ENGAGEMENT AND THE BOTTOM LINE NJMGMA October, 2015

2. OBJECTIVES • Understand the Business Case for Patient Engagement and Your Role • Define What Patient Engagement Is and Is Not • Identify Successful Patient Engagement Strategies (Clinical, Operational, Revenue Cycle): • People • Processes • Technology

3. BUSINESS CASE • Federal Quality Reporting Programs • MU, PQRS, VBPM • CG CAHPS • Physician Compare • New Payment/Delivery Models – Shift from Volume to Value • ACOs, Shared Savings • PCMH, PCSP • MACRA - MIPS, APMs • Triple Aim – Improved Outcomes (population), Decreased Cost (per capita), Improved Patient Experience

4. FACTS • Engaged Patients • Overall medical costs decreased by 5.3% • 12.5 fewer hospital admissions1 • Activated Patients • Lower Activation Scores  21% higher costs2 • Veroff, David, et al., “Enhanced Support for Shared Decision making Reduced Costs of Care for Patients with Preference-Sensitive Conditions,” Health Affairs 32, No. 2 (2013): 285-83 • Hibbard, Judith H, et al, “What Evidence Show about Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data on Costs, “ Health affiars 32, No. 2 (2013): 207 - 14

5. PATIENT ENGAGEMENT: “THE BLOCKBUSTER DRUG OF THE CENTURY”

6. WHAT’S IN A NAME? WHAT’S THE DIFFERENCE ANYWAY?

7. PATIENT ENGAGEMENT WHAT IS PATIENT ENGAGEMENT? PATIENT ENGAGEMENT ≠ PATIENT PORTAL

8. DEFINITIONS • Patient Experience • The sum of all interactions, shaped by an organization’s culture, that influences patient perceptions, across the continuum of care • Patient Satisfaction • Patient’s opinion of care

9. DEFINITIONS • Patient Compliance • The provider assumes a paternal role in healthcare decisions and the patient follows the providers instructions • Influenced by culture, age, sociodemographics • Patient Adherence • The extent to which a patient’s behavior corresponds with agreed upon recommendations from the provider • Shared Decision Making

10. PATIENT COMPLIANCE ≠ PATIENT ADHERENCE

11. DEFINITIONS • Patient Activation • Patient’s knowledge, skills, ability, and willingness to manage his/her own healthcare. • PAM Score (Patient Activation Measure) Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Behaviours, Health Serv Res 2007; 42(4):1443-1463.

12. DEFINITIONS • Patient Engagement • A patient is involved in the process of their care – actively processing information, deciding how best to fit care into their lives, and acting on their decisions • Behavior-oriented • Provider: gain patient’s attention and actively motivate to participate Hibbard JH, Mahoney ER, Stock R, Tusler M. Do Increases in Patient Activation Result in Improved Self-Management Behaviours, Health Serv Res 2007; 42(4):1443-1463.

13. DEFINITIONS • Care Direction – AtulGawande, MD, MGMA - 2015 • Care aligned with the patient’s priorities and goals. • Not just what the patient wants, but the goal of where the patient wants to be • Shared Decision Making ≠ Provider Capitulation Goal: Align Patient Engagement with Care Direction

14. PATIENT EMPOWERMENT PATIENT EMPOWERMENT:

15. YOUR OFFICE’S GOALS Areas: • People • Processes • Technology Question: What are Your Office’s Goals for Patient Engagement?

16. PEOPLE

17. PRACTICE ADMININSTRATOR Answer: LEADERSHIP! • People • Processes • Technology Question: What is Your Role in Patient Engagement?

18. LEADERSHIP • 7 Habits of Highly Effective Leaders • Inspire Action/Vision • Be Optimistic • Have Integrity • Role Model • Facilitate Teamwork • Cowboys v. Pit Crew • Have Confidence • Communicate • Be Decisive

19. LEADERSHIP • Responsibilities of an Effective Leader • Organizational Culture • Accountability • “What You Permit you Promote” • Clear Expectations • Have you told your staff what’s expected? • Have you defined expectations & standards? • Example: Respect • What’s your onboarding and continuing education process? • Have you developed quality measures and monitor expectations/standards?

20. LEADERSHIP • Results of Effective Leadership – Transformation • Staff Activation & Engagement • Teamwork • Office Efficiency & Effectiveness • Does office efficiency = Patient Satisfaction? • Provider & Staff Job Satisfaction • Patient Satisfaction & Engagement • Loyal Patients • Healthy Bottom Line • Profitability • Volume  Value

21. LEADERSHIP • Barriers • Operational • Time constraints • Provider/staff resistance • Lack of technology

22. LEADERSHIP • Barriers • Perceptions • “My physicians don’t want to do it.” • “It’s not up to me.” • “These are clinical issues, so I can’t do anything.” • “I don’t have enough staff.” • “I don’t have the budget to do it.” • “Our patients aren’t capable of it.”

23. YOUR ROLE • People – Set the Tone!! • Training • Accountability • Results - Monitoring/Measuring • Processes • Workflow – Patient, Operational, Revenue Cycle • AMA Steps Forward –How To Guides; Calculates ROI, www.stepsforward.org • Pre-Visit Planning • Huddles - TeamSTEPPS • www.teamsteppsportal.org/teamstepps-materials

24. YOUR ROLE • Technology • Questions in EHR • Patient Portal Implementation • Patient Satisfaction Survey • Social Media • mApps

25. PHYSICIAN ENGAGEMENT • What Do Physicians Want? • Business Case - Profitability • Quality of Life • Efficiencies – Minimal Extra Work • Caring for People Clinically

26. STAFF ENGAGEMENT • Incentives & Accountability • Rewards? • Part of Performance Appraisal • Redefining Staff Roles – MA, Licensed Professionals, Care Coordinators/Coaches. • Job Satisfaction • Teamwork • Less Rework & Duplication • Happier Patients • Training • Communication Skills

27. COMMUNICATION SKILLS AIDET AND MANAGE UP – Speak about staff/providers positively Resources: AIDET Tools, www.studergroup.com

28. COMMUNICATION SKILLS AIDET

29. COMMUNICATION SKILLS The C.L.E.A.R. Service Model Resource: SullivanLuallin Group, Star-Studded Service – 6 Steps to Winning Patient Satisfaction

31. PUTTING IT INTO ACTION AIDET EXERCISE

32. COMMUNICATION SKILLS AIDET AND MANAGE UP – Speak about staff/providers positively Resources: AIDET Tools, www.studergroup.com

33. PATIENT ENGAGEMENT • What Do Patients Really Want? • Access • Efficiency – short wait times • Friendliness & Helpfulness • Communication • Information • Follow Through

34. PATIENT ENGAGEMENT • What Do Patients Really Need? • Meet Health/Life Goals • Medication Adherence • Understanding/Instructions – written • Laymen’s terminology • Healthcare Literacy • Self Care at Home – lifestyle, nutrition, etc. • Follow Up • Appointment Reminders

35. PATIENT ENGAGEMENT • Know Your Patient Population • > 65 • Baby Boomers • Gen X • Gen Y/Millennials • Cultural Diversity/Sensitivity • NJ’s Camden Project, Dr. Jeffrey Brenner

36. PATIENT ENGAGEMENT • Patient Satisfaction Surveys • Frequency? • Validity? • Relevancy? • Results? • Types: • CG CAHPS • Press Ganey • Specialty Specific

37. PROCESSES

38. REVENUE CYCLE • Patient Engagement in Getting Paid – The Time is NOW: • High Deductible Plans • Co-Pays • Health Insurance Exchanges

39. REVENUE CYCLE • Front End Billing • Pre-Visit • At Visit (Check-in & Check-out) • Payment Scripts • Back End Billing • After the Visit • Coordination Between Front & Back Office! Resource: Keegan, Deborah Walker & Elizabeth Woodcock, The Physician Billing Process – Navigating Potholes on the Road to Getting Paid, MGMA, 2016

40. REVENUE CYCLE • PAYMENT AT TIME OF SERVICE! • Balances are a Must • Coinsurance Calculation • Automate the Process • Unmet Deductibles Trump Coinsurance • Financial Clearance a Must • Expect More Refunds • Present the Contractual Adjustment as a Discount • Collect in Advance for Surgeries • Don’t Leave the Uninsured Out of the Process Resource: Woodcock, Elizabeth W, “Collections,” Conventus White Paper, 2015

41. TECHNOLOGY Patient Portal • Benefits: • Increased Access • Patient/Staff Satisfaction • Workflow Efficiency • Planned Processes • Decreased Phone Calls • Decreased Overtime • Reduction in Expenses • Meet MU Requirements

42. TECHNOLOGY • Develop Implementation Strategy • Posters • Flyers • All Staff Communicate to Patients • User a “Staffer” to Enroll On-Site with “Quick Tour” • Create a “Quick Reference” Card for Staff/Patients • Set Enrollment Goals • Send “Welcome” Message • Staff Response Times to Messages

43. TECHNOLOGY Other Technologies • Secure Messaging • Social Media • m-Apps • Telemedicine • Need license in each state • Guidelines – AMA, FSMB, ATA

44. QUESTIONS? Susan Lieberman, MBA, BSN Vice President, Practice Resources Conventus Inter-Insurance Exchange www.conventusnj.com slieberman@nipgroup.com 877-444-0484, x7466