Beyond Infographics: Contextual Factors in Healthcare … posters...Tomoaia-Cotisel et. al. Context...
Transcript of Beyond Infographics: Contextual Factors in Healthcare … posters...Tomoaia-Cotisel et. al. Context...
Beyond Infographics:
Contextual Factors in Healthcare MR
Thomas M. Richardson PhD, MBA, PA-C
Sr. Vice President Consulting, KJT Group, Inc.
Agenda
03 14 17 30Market Research
Level Set
Define Contextual
Factors
The Changing
Healthcare
Landscape
Pt Engagement-
Behavior Models
35 40 50 ##Clinical Decision
Making Models
Practice Change
Models
Summary and
Questions
Summary &
Questions
2
MARKET RESEARCH
The Goal of Marketing
• Right product
• Right message
• Right target market
4
The Goal of Market Research
• Target audience’s wants, needs,
beliefs and what they value the most
• Factors influencing the clinical decision
making process and purchasing
decisions
5
We focus on…
• Pills
• Devices
• Medical Products/Supplies
• Services
6
We conduct many different types of studies…
• Trackers (ATUs)
• Product Concept and Message Testing
• Market Landscape
• Segmentation and Positioning
• Pricing and Forecasting
• New Product Development and Product Design
• Product and Services Innovation
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Qualitative Research
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“So how does that
make you feel?”
Quantitative Research
9
10
Designing and Conducting MR is a Simple
Process
11
Infographics
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Healthcare Market Research
PROBLEM
• Market research projects
• Scope: Wider
• Timeline: Shorter
• Budget: Tighter
• Focus on “Key Takeaways” and
infographics
• INSIGHTS come from a deep
understanding of the issues at hand
SOLUTION
• Focus on your Research Design
• Consider Contextual Factors
• Leverage Existing Theoretical
Frameworks
13
T-Shaped Employees
14
Generalist/Broad Knowledge
Specia
list
Healthcare Ecosystem
Mark
et R
esearc
h
CONTEXTUAL FACTORS
What do we mean by context?
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• Context: noun. the set of circumstances or facts that surround a particular event,
situation, etc.
http://www.dictionary.com/browse/context
Why does context increasingly matter in
market research?
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• Because we are trying to understand
how to change behaviors, get people
to adopt new practices, prescribe new
drugs, perform new procedures
• Increasingly our clients are developing
and researching more complex
healthcare “solutions” to address the
needs of healthcare delivery system
• Decision making is moving from the
individual level to group, committee,
unit, practice, department, hospital,
health system levels.
• The issues of costs, reimbursement
and the interpretation of “value” varies
among the key stakeholders
http://www.dictionary.com/browse/context
THE CHANGING HEALTHCARE
LANDSCAPE
Healthcare Delivery is Dynamic and Heterogeneous
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Moving Toward Integrated Delivery Systems
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Pay for and Reimbursement for Healthcare Services
21http://www.blogarama.com/programming-blogs/274030-tech-pulse-aspnet-source-code-projects-n-blog/862588-healthcare-system-overview
The Spectrum of Value-based Reimbursement
22http://www.mckesson.com/population-health-management/resources/pay-for-performance-model/
Fee for
Service
Pay for
Coordination
Pay for
Performance
Bundled
Payment
Shared
Savings
Programs
(Upside and
Downside)
Capitation
Low Risk High Risk
Focus on Quality Reporting and Outcome Metrics
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Type Description
Outcome Evaluates patient health as a result of the
care received.
Process Determines if the services provided to
patients are consistent with routine clinical
care.
Structure Assesses the characteristics of a care
setting, including facilities, personnel,
and/or policies related to care deliver.
Patient Experience Provides feedback on patients’
experiences of care.
24Kindig, David, and Greg Stoddart. "What is population health?." American Journal of Public Health 93.3 (2003): 380-383.
What is Precision Medicine?
• According to the National Institutes of Health (NIH), precision medicine is "an
emerging approach for disease treatment and prevention that takes into account
individual variability in genes, environment, and lifestyle for each person."
25https://ghr.nlm.nih.gov/primer/precisionmedicine/definition
Personalized or Patient Centered Medicine
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Right Treatment
Right Patient
Right Time
Right Setting
Right Provider
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Drug Distribution System
28AMCP Guide to Pharmaceutical Pricing http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=16476
Health Plan/Payer
Pharmacy Benefit Manager
Drug Manufacturer
Wholesaler
Pharmacy
Provider (hospital, physician)
BeneficiaryFlow of Funds
Flow of Prescription Drugs
2 1
3
4
Payment Share of rebates
from manufacturer
Premium
ASP-AWP- or WAC-based,
negotiated payment
AWP- or WAC-based,
negotiated payment
Negotiated discount/rebate for
drugs (volume, market share)
Negotiated discount/rebate for
drugs (volume, market share,
formulary placement)
Negotiated discount/rebate for
drugs (volume, market share)
Chargeback
Drugs
Drugs
Drugs
Drugs
Drugs
WAC-based
payment subject
to prompt
pay/other terms
WAC-based
payment
WAC-based
payment
Cost sharing/
payment
Cost sharing/
payment
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Healthcare Trends
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• Pharma moving “beyond the pill”
• Medical device manufactures looking
to develop full “solutions” across the
care continuum
• Evidence-based practice and more
personalized and patient-centered care
• Monitoring and early detection
• Patient engagement, adherence
and compliance
• Patient support programs
• Care management
• Integrated technologies
PATIENT ENGAGEMENT-
BEHAVIORAL MODELS
Health Belief Model
32Janz, Nancy K.; Marshall H. Becker (1984). "The Health Belief Model: A Decade Later". Health Education & Behavior. 11 (1): 1–47.
Stages of Change Model
33Prochaska, James O., and Carlo C. DiClemente. "Toward a comprehensive model of change." Treating addictive behaviors. Springer US, 1986. 3-27.
https://www.pinterest.com/pin/134756213823204661/ http://hbftpartnership.com/documents/uploadResources/TranstheoreticalT-Prochaska1982.pdf
Maintenance: works
to sustain the behavior
change
Action: practices the desired behavior
Preparation: intends to take action
Contemplation: aware of the problem and of the desired behavior change
Precontemplation: unaware of the problem
Create awareness; change values and beliefs
Persuade and motivate
Educate
Facilitate action
Reinforce changes, reminder communications
Wagner’s Chronic Care Model
34http://www.improvingchroniccare.org/index.php?p=The_Chronic_CareModel&s=2
Anderson Behavioral Model of Health Care Utilization
35Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995 Mar;36(1):1–10.
CLINICAL DECISION MAKING
MODELS
Clinical Decision Making
37Satterfield JM1, et al.Toward a transdisciplinary model of evidence-based practice. Milbank Q. 2009 Jun;87(2):368-90.
Best available research evidence
Resources, including
practitioner expertise
Population characteristics, needs, values,
preferences
Decision-making
Environment and
organizational context
Elements of Evidence-Based Policy & Practice
38Satterfield JM1, et al.Toward a transdisciplinary model of evidence-based practice. Milbank Q. 2009 Jun;87(2):368-90.
Haynes, R.B., P. Devereaux, and G.H. Guyatt. 2002. Clinical Expertise in the Era of Evidence-Based Medicine and Patient Choice. ACP Journal Club 136:A11–A14.
Roger’s Innovation-Decision Process
39Rogers, Everett (16 August 2003). Diffusion of Innovations, 5th Edition. Simon and Schuster
Roger’s Innovation-Decision Process
40Rogers, Everett (16 August 2003). Diffusion of Innovations, 5th Edition. Simon and Schuster
MODELS EXAMINING
PRACTICE CHANGE
42Tomoaia-Cotisel et. al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.
Ann Fam Med. 2013 May-Jun;11 Suppl 1:S115-23.
Understanding an Intervention’s Context
43Tomoaia-Cotisel et. al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.
Ann Fam Med. 2013 May-Jun;11 Suppl 1:S115-23.
Level 3:
External Environment
Level 2:
Larger Organization
Level 1:
Practice
• Market Environment
• Community characteristics
• Political authority
• Grant or other external financial support
• Level of coordination/ involvement with community
• Payment model(s) available
• Competing priorities
• Degree of intervention integration
• Contractual arrangements
• Ownership
• Leadership style
• Structural capabilities
• Financial incentives
• Employee mix
• Clinician demographics, attitude and training
• Patient panel size and characteristics
• Ownership
• Leadership style
• Structural capabilities
44Hernandez SE1, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case
study application. Health Care Manage Rev, 2013, 38(2),
Patient Centered Innovation in Healthcare
Organizations
45Hernandez SE1, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case
study application. Health Care Manage Rev, 2013, 38(2),
• Clear mission
• Aligned beliefs, values, norms
• Proactively initiate change
• Willing to experiment & take risks
Organizational Mission & Culture
• Clarity of purpose
• Specific change objectives
• Coherence of strategic & operational plans
Organizational Strategy • Structure
• Design & coordination mechanisms
• Task design
• HR processes
• Size
• Technological
Organizational Capability
• Patient-Centered Innovation
Strong Motivators for Change
↑ ↓Effective Organizational Leadership
Environmental Context
46https://pcmh.ahrq.gov/sites/default/files/attachments/ContextualFactors.pdf
Contextual Factors that Influence PCMHs & Outcomes
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• National, State, local organizational
policies
• Community norms and resources
• Healthcare system organization
• Payment and incentive systems
• Practice culture, history, and staffing
• Characteristics of patient populations
and subgroups
• Historical factors and recent events
• The culture and motivations
surrounding monitoring and evaluation
• Changes in these factors over time
https://pcmh.ahrq.gov/sites/default/files/attachments/ContextualFactors.pdf
48https://aspe.hhs.gov/basic-report/evaluation-hhs-delivery-system-reform-efforts-and-affordable-care-act-provisions-consolidated-evaluation-
design-recommendations
49https://aspe.hhs.gov/basic-report/evaluation-hhs-delivery-system-reform-efforts-and-affordable-care-act-provisions-consolidated-evaluation-
design-recommendations
Health System Environment
Organization Characteristics
Outcomes
• Market size, structure, capacity
• Population characteristics
• Provider & payer concentrations
• Competitive dynamics
• State & local policy environment
• Local culture
• Leadership
• Structure & service capacity
• Financial & operating characteristics
• Data management & analytic capacity
• Performance improvement infrastructure
• Payer relationships & contracting structures
• Physician & staff engagement
• Spending
• Service use & mix
• Patient experience
• Quality
• Access
The Mathematical Model
50https://aspe.hhs.gov/basic-report/evaluation-hhs-delivery-system-reform-efforts-and-affordable-care-act-provisions-consolidated-evaluation-
design-recommendations#3
SUMMARY
52
Right Treatment
Right Patient
Right Time
Right Setting
Right Provider
Think in Terms of Linking Goals
Right Product
Right Message
Right Target Market
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Key Takeaways
Focus on research design
1 Leverage theoretical models
2 Embrace the relevant contextual factors
3
54
Thank YouThomas M. Richardson PhD, MBA, PA-C
Sr. Vice President Consulting, KJT Group, Inc.
1.585.624.8050 x344