thought leaders in POPULATION HEALTH identifying ... · Kathleen Fraser, RN-BC, MSN, MHA, CCM,...

POPULATION HEALTH

thought leaders in

identifying

implementation tactics

What Role Do Patient Engagement Strategies

Play in Promoting Population Health? July 31, 2014

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POPULATION HEALTH thought leaders in

Identifying implementation tactics

Webinar Presenters

3

Linda Tiano, Member, Epstein Becker Green and EBG Advisors (moderator)

Ben Gardner, Founder and President, Linkwell Health

Kathleen Fraser, RN-BC, MSN, MHA, CCM, CRRN, Case Management Society of America National President, 2014-2016



This session will examine different approaches that have been used to target, engage and modify individual behaviors towards a healthier lifestyle. The speakers will highlight key examples of ways to engage high-risk and chronically ill groups to achieve meaningful clinical and financial outcomes. In addition, panelists will discuss:

Methods to promote better eating and exercise

Avenues to promote healthy behaviors and to address chronic disease head-on

Strategies to benchmark positive changes in targeted populations and provide meaningful feedback loops to patients

Ways to improve medication adherence

Approaches to optimize provider involvement in patient care over the continuum

Consumer engagement and leveraging marketing strategies to focus on health and target populations with chronic conditions

Presentation Overview

4



Rise in Chronic Conditions

– 25.8 million people in the U.S. (8.3% of the population have diabetes)

– If current trends continue, one in three U.S. adults will have diabetes by 2050

– Over one third of U.S. adults and 17% of children are obese

Financial Cost

– The total costs (direct and indirect) of diabetes in 2008 was $174 billion

– In 2008, overall medical care costs related to obesity for U.S. were as high as $157 billion

– Obese individuals had medical costs that were $1,429 higher than the cost of people with normal body weight

Chronic Conditions and Financial Burdens

5

Source: CDC



Lifestyle is the #1 Risk Factor for Chronic

Conditions

6



Purchasing candy: – Almost two times more likely to purchase

Russell Stover’s candy

– One and a half times more likely to purchase Mounds

– Almost one and a half times more like to purchase a York Peppermint Patty

More likely to eat dessert: – Almost one and a half times more like to purchase Pepperidge Farm

Three Layer cake

Consuming frozen food: – Nearly 40% more likely to purchase frozen French fries

– 17% more likely to consume frozen dinners

What Americans with Chronic Conditions are Eating

7

MRI 2013 doublebase, Chronic = diabetic, hypertension, and obesity, than the average US population



Consumer Packaged Goods (CPG)

Marketing

8

1899 Today



The Power of Nudge

9



A permanent 100 calorie reduction in daily intake would eliminate approximately 71.2 million cases of overweight/obesity and save $58 billion annually.

Impact of Calorie Reductions

10

Category Bad For You Calories Better for You Calories Change

Breakfast Eggs 70 Fat Free Egg Beaters 30

Snack Bar Snickers Candy Bar 280 Extend Bar 150

Beverage Orange Juice 150 Trop 50 50

Sweetener Sugar 15 Truvia 0

Salty Snack Potato Chips 150 Baked Lays 110

Butter Butter 100 Smart Balance 45

Entrée Stouffers Chicken Alfredo 410 Lean Cuisine Chicken Fettuccine 280

Snack Mrs. Field's Cookies 370 Murrays Sugar Free Cookies 150

Total 1545 815 -730

Healthcare Analytics, Thomson Reuters



U.S. Diet/Weight Loss Industry Trend

1990 - $30 billion market value in US

2010 -$60.5 billion market in US

U.S. Obesity Trend

1990 – 22%

2010 – 36%

Most Diets are Unsuccessful: Unrealistic Lifestyle Changes

11

Survey: Most Americans are Weight Conscious, April 2011



What do consumers understand?

12



What do consumers want to read?

13

What health plans want consumers to read…



Linkwell’s Approach to Engagement

14


Identifying implementation tactics 15



Overall Approach

16



Ongoing Message Drives Behavior Change

* Percent change in healthy spend year-over-year: test vs. control

17



Coupons Incentivize Better Purchases


18



Content with Coupons Drive Healthy Eating


19



Increase in Health Plan Perception – 16% more consumers rated their health plan excellent/very good

Ongoing Communication – Majority of consumers want ongoing communication from their

health plan

Increase in consumer engagement – 58% of consumers planned to take action/redeem a coupon after

receiving a Linkwell mailing

Increase in Communications Appeal – 8 in 10 health plan members like receiving mailings

The Result

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Medication Adherence

“Drugs don’t work in patients who don’t take them.” - C. Everett Koop, Former United States Surgeon General

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A cluster of behaviors

Simultaneously affected by multiple factors

The extent to which a person’s behavior—taking medication, following a diet, or making healthy lifestyle changes—corresponds with agreed-upon recommendations from a health care provider

What is adherence?

22

Source: http://apps.who.int/iris/bitstream/10665/42682/1/9241545992.pdf



Medication Adherence: The patient’s conformance with the provider’s recommendation with respect to timing, dosage and frequency of medication-taking during the prescribed length of time

Compliance: Patient’s passive following of provider’s orders

Persistence: Duration of time patient takes medication, from initiation to discontinuation of therapy

Concordance: Wider concept from prescribing communication/consultation to patient in support of medication taking.

Medication Adherence

23

Source: http://www.effectivehealthcare.ahrq.gov/ehc/products/296/1248/EvidenceReport208_CQGMedAdherence_FinalReport_20120905.pdf



One in three patients fails to fill their prescriptions

Approximately three of four Americans report they do not

consistently take their medications as directed

Sixty percent of patients cannot correctly name their medications

and up to 20% of patients take medications prescribed for others

Between 30 and 70% of medication-related hospital admissions in

the U.S. are due to poor adherence

Approximately one-fourth of all nursing home admissions are related

to improper medication self-administration

Average adherence rates are between 50-65% in those with common

chronic conditions such as diabetes and hypertension

Facts

24

Source: Case Management Adherence Guide, 2012



The Cost of Non-Adherence

Source: http://pharmacy.ucsd.edu/pmt/mtm/benefits.shtml

25



High out-of-pocket costs, especially for patients on multiple prescriptions for chronic conditions.

Lack of care coordination, follow-up and shared decision-making.

Complex or burdensome treatment regimens or multiple prescribed medications.

Co-morbidities, such as severe and persistent mental illness.

Side effects of prescribed medications, whether real or perceived.

Personal factors, including lifestyle, culture and belief system

Causes of Poor Medication Adherence

26

Source: Adherence to Medication Lars Osterberg, M.D., and Terrence Blaschke, M.D. N Engl J Med 2005; 353:487-497August 4, 2005DOI: 10.1056/NEJMra050100

http://www.nejm.org/toc/nejm/353/5/



Low socioeconomic status - independent predictor of low adherence

– Low health literacy

– Unemployment

– Lack of experience with health care system

– Poor access to health care

– Competing priorities – food vs. medications

Reading level single strongest predictor of practical asthma knowledge

Racial disparities

– Cultural beliefs vs. inequality

Age

– Does not relate independently

– Focus should be on beliefs about their illness

Socioeconomic Factors

27




One of the most direct ways to study the cost-effectiveness of medicines is to compare total health care costs and utilization for patient populations who are using prescription drugs appropriately versus those who are not. Researchers have found relationships between taking medications as prescribed and lower health care costs, as well as the converse relationship of not taking medications as prescribed and steeper health care costs.

Quantifying the Cost-Effectiveness

of Medication Adherence

28

Source: http://spacinternational.com/pdf/adher.pdf



Average Annual Spending Related to Diabetes

29



Lack of provider awareness and knowledge about adherence

Lack of tools to assist health care professionals in evaluating and intervening in adherence problems

Lack of tools to help the patient develop adaptive health behaviors and change ineffective or harmful behaviors

Gaps in the provision of care

Suboptimal communication between patients and health professionals

Health Care System

30




Health care providers have a vital role in:

Stressing the importance of taking medications as prescribed

Monitoring and helping patients avoid or reduce unpleasant side effects that may compromise adherence

Helping to keep patients more generally well-informed about their health conditions

The Role of Health Care Providers

31



Improve Care Coordination

Enhance Patient Engagement and Education

Utilize Case Management, Counseling and Medication Management

Expand Screening and Assessment

Invest in Health IT Infrastructure

Improving Medication Adherence

32



Clinicians should actively discuss adherence issues with patients (e.g. comprehension, adverse events, acceptance of illness) and monitor patient adherence.

External reinforcements:

– Reminder notes

– Pair pill-taking with routine daily activity (e.g. eating breakfast)

– Engage family members/significant others to support adherence

Use simple dosing regiments (e.g., agents requiring less-frequent dosing or long-acting formulations)

Strategies to Increase Medication

Adherence

33



Behavior related:

– Forgetfulness of patients

• Daily alerts

• 90-day medication supplies

• Automatic renewals

Clinical (Questions or concerns about medications):

– Pharmacy consultation

– Linguistically and culturally important

Cost related:

– Payment assistance programs

– Lower cost medication alternatives

– Lower cost pharmacy option

Interventions Should be

Patient-Tailored

34



Impart Knowledge – Involve, Advise, Inform

Empowerment - Is giving the patient freedom of choice appropriate?

Simplify the Regimen – Match regiment to patient’s activities of daily living

Modify Patient Beliefs and Behavior – Ensure that patients understand their risks and consequences if

they don’t adhere to medication regimens

– Address fears and concerns

Provide Communication and Trust* – Active listening, emotional support, use plain language

– Elicit patient’s input in treatment decisions

Strategies to Increase Medication

Adherence

35

*Source: http://www.acpm.org/?MedAdherTT_ClinRef



Self-report

Ask about adherence behavior at every visit

Periodically review patient’s medication containers, noting renewal dates

Evaluating Adherence

36



Introduce team-based care: – Collaborate with pharmacists and/or nurses

– Educate patients on how to take medications

– Monitor by pill box

Improve access and communication: – Offer patients the opportunity to contact the provider’s office with

any questions

– Use telemedicine, particularly in rural areas

Use technologies and analytical services that facilitate measuring and improved adherence

Overcoming Challenges or Barriers

37



Having a clear understanding of how the use of technology impacts patients is critical for care managers and other providers if they want to effectively engage their patients and improve clinical outcomes.

Patient Communications

38



Source: 2012 Health IT Survey Series, Trend Report #5: Patient Engagement Strategies

39



Knowing the types of technology patients currently use, as well as where IT trends are headed, can help providers, care managers and other health care professionals target their outreach strategies to get and keep patients engaged.

In an increasingly mobile and technology-driven society, providers and their patients now have the ability to utilize tools that were previously unavailable or underutilized in order to open a two-way line of communication with their patients, thereby creating a deeper level of engagement that allows patients to become more meaningfully involved in their own care.

Trends in Engagement Strategies

40



Questions

41

POPULATION HEALTH

thought leaders in

identifying


Linda Tiano

Epstein Becker Green

[email protected]

(202) 861-0900

Ben Gardner

Founder and President

Linkwell Health

[email protected]

1227 25th Street, NW

Washington, DC 20037

www.ebglaw.com

Kathleen Fraser

National President (2014-2016)

Case Management Society of America

[email protected]

POPULATION HEALTH

thought leaders in

identifying


THANK YOU

www.ebglaw.com

www.ebgadvisors.com

thought leaders in POPULATION HEALTH identifying ... · Kathleen Fraser, RN-BC, MSN, MHA, CCM,...

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