PR and Health Reform by Chuck Alston

© 2011 MSLGROUP SLIDE 1

Chuck AlstonSenior Vice President/Director of Public AffairsMSL Washington DC

The Changing Landscape of Health Care and What It Means for

Communications

Webinar for the PRSA Health Academy

PR and Health Reform


Agenda

• Restructuring in the health care sector

• The new landscape’s language land mines

• Communicating the benefits delivery, payment reforms

• Stakeholder communications

• Trends to watch


Biden Was Right: It Was a Big $#%^ing Deal

President Obama Signs the Affordable Care Act


Restructuring for the New World Order


You Want to Go Where with My Health Care?

THE JOURNEY FROM VOLUME TO VALUE


From Volume to Value

Value equals higher quality care at a lower cost – what could be wrong with that?

This mantra works for:


But Just Ask Them

They think

Valuis a four letter word


People equate value with “bargain-basement pricing” not high-quality care

What Value Looks Like


Health Care: I Don’t Want to Buy in Bulk

Tested statement:

“Here in our community, we are looking at ways to improve the health care that we all receive, so that we get more for the money we spend. That includes making sure that doctors understand that we want to pay for the right care, not tests that we do not need or other unnecessary procedures.”

Charlotte, N.C., woman:

“More for the money, I don't know, it sounds like you are buying bulk.”

Source: Focus group held in Charlotte, N.C. for the Robert Wood Johnson Foundation, 1 March 2011.


VALU = Rationing, Poor Quality

• “Eliminating waste,” “increasing efficiency” or even “saving money” sparks fear of rationing care that they want – and feel they need – but that may be expensive

• Feelings that care will be cheapened, or that time

with physician will be cut or – worst of all – that the care that they want could be curtailed is threatening. It shuts down the conversation.

• The premise of VBID programs — the use of high quality providers or evidenced-based procedures leading to lower costs — is counterintuitive to employees’ perceptions that lower cost equals lower quality

Sources: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No

authors given.)Employee Health Engagement: Identifying the Triggers and Barriers to Engaging Employees in Their Health Benefits and

Wellness Programs. Chicago, Ill: Midwest Business Group on Health, 2011.


• Consumer beliefs:

Higher priced care must be better

More care must be better

Agency theory – doctors have my interests at heart

When it comes to my health care, sky’s the limit

• Third-party payment system – patients only see their portion of the costs*

* Let’s talk more about this later!

Summary: Barriers to Communicating Value


You Mean Well, But Sound Scary

DO THEY HEAR WHAT YOU SAY?


The Way “We” Talk About Health Care


Do They Hear What You (Think You) Say?

The new landscape of delivery and payment reform is covered with language landmines


A Few Choice Words About Medical Homes

“It just sounds like a nursing home.”-- Boston focus group

participant

“First you go to a medical home, and then you go to the funeral home.”

-- Edina, MN focus group participant

“It just gives me the creeps.”-- Edina, MN focus group

participant

Source: Ross M, Igus T, Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente Journal. 2009;13(1):8-16.


Let’s Try that Again

What You Say What They Hear

Medical home Nursing home, home health, end of life

Medical decision support End-of-life decisions

Guidelines or treatment guidelines Restrictive, rigid, limited, driven by cost

Integrated health care delivery system Bureaucratic, industry language, meaning unclear

Integrated care Bureaucratic, industry language, meaning unclear

Multispecialty medical group Bureaucratic, industry language, meaning unclear, trying to do too much, low quality, limited choice of specialists to choose from

Best practices Bureaucratic, meaning unclear, insincere, cookie-cutter care, not tailored to the individual

Evidence-based medicine Impersonal, one size fits all

Accountable Something will go wrong, minimal care, buzz word

Source: Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente Journal.13(1):8-16. 2009.


Lost in Translation

“Of course the system is integrated. There are black and white patients.”

-- Participant in focus group conducted for MSL client

“I know my doctor is high-quality. He has Town & Country in the waiting room.”

-- Participant in 2007 focus group for the Robert Wood Johnson Foundation


REFORM

Reform Fatigue

• Improvements, sure

• Changes, maybe

• But please, no more reform


Red Flag on the Revolving Door

• Hospitals are on red alert to reduce readmissions to avoid Medicare penalties

• Communicators need to be on red alert to not make it sound like the hospital or health system wants to ration care

• DON’T focus keeping people out of the hospital

• DO focus on the solution --- improving care for patients when they return home -- because it will be seen as a benefit

How would you grade each of the following?

A

B

C

D

F

Don’t know/ Refused

The quality of health care in the country as a whole 11 22 38 17 11 2 The quality of health care YOU receive 31 34 19 6 7 3

Source: Robert Wood Johnson Foundation/Harvard School of Public Health poll from March 9-18, 2011.


The Team Trap

Messages about “teams” can create more concern than comfort

Sources:Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The

Permanente Journal.13(1):8–16. 2009.Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No

authors given.)Photo: The Medical Group, Beverly, MA.


Who’s in Charge?

Concerns recede when it is clear the doctor is calling the signals

Sources:Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The

Permanente Journal.13(1):8–16. 2009.Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No

authors given.)


Park Your ACO in a Medical Home Garage

Takeaways: Consumers resist being consumers when it comes to their health care

• Consumers don’t want to talk about delivery system typology, or how doctors and hospitals are paid

• They don’t know volume from value, and don’t want to

• The get mad that money influences the way care is delivered

Conclusion: Put the “We’re Your New Hometown ACO Campaign” on hold


Patient-centered Messaging

SO WHAT, WHO CARES, WHAT’S IN IT FOR ME?


The Problem with My Health Care is…

• Uneasy relationship with my doctor

• Doctor is pressed, encounter feels rushed, questions go unanswered

• Lack of clear,

trustworthy information

• Too many mistakes, too much miscommunication that can make things go wrong

Source: Talking About Health Care Payment Reform with U.S. Consumers. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)


The Conversation About Care Starts Here

The doctor-patient relationship is the foundation for messaging about quality improvement or delivery and payment reform. Start here and build out.


What Do Patients Want?

• More time with their physicians

• Better coordinated care

• To not pay more


What Do Patients Want?

Takeaway 1: They actually want an ACO wrapped around a medical home. (Just don’t use those phrases.)

Takeaway 2: They will engage in a conversation about the delivery and reimbursement system if they think it would give them more of what they want without costing them more.


The ABCs of Delivery Reform Communications

ENOUGH ABOUT WHAT NOT TO SAY


“It’s All About Me”

• Focus on the patient

• Any message about changing payment or delivery should focus on patient benefits not how health care is paid for

• Position the benefits to consumers as “improving care coordination,” “increasing preventive care,” “improving the doctor-patient relationship” and "improving communication across doctors”

• Offer “solutions” to problems they see

• If you must talk about money, talk about spending health care dollars wisely, not saving money


How to Say It

We are working to:

• Improve your health care

• Find better ways to care for you

• Make sure you get the best care possible

Source: Research conducted for the Robert Wood Johnson Foundation.


What to Say

Our goal for your care is:

• Strong relationship with your doctor

• Time with your doctor

• Addressing all your concerns

• Involving you in decisions about your care

• Making sure you understand your follow-up care

• After-hours help, alternatives to the emergency room


How to Say It

How we are improving care:

• Better communication, coordination among doctors

• Getting you all the preventive care you need

• Make sure you get rightmedications and tests

• Help you make appointments easily, fill out forms once, take tests once, so you do not have to repeat yourself over and over

• High-quality care, tailored just for you, based on best medical evidence and your doctor’s recommendation


If You Have to Talk About Reimbursement

• Finding better ways to pay for care

• Make sure the way insurance pays for health care is consistent with way you want to receive it

• Making sure every dollar is spent wisely


“Coordinated Patient Care improves the quality of care and brings down costs by encouraging primary care physicians to work closely with their patients’ other specialists when treating them. When doctors work as a team, patients receive top quality care. By using electronic records, doctors and hospitals will reduce medical errors and the duplication of tests, bringing down our costs.”

Talking About Coordination

Source: Coordinated Patient Care. Herndon Alliance, accessed 9/02/2011 at http://herndonalliance.org/resources/system-change/coordinated-patient-care.html


• Increased coordinated patient care will bring about better patient experiences and quality of care and electronic medical records will help make this possible.

• Improved coordinated patient care will lead to reduced costs and fewer medical errors.

• Coordinated care supports doctors to be the best they can be.

• Coordinated care encourages patients to be active participants in their care.

• Increased coordinated care means more face--‐time with your doctors.

Coordinated Patient Care

Source: Coordinated Patient Care. Herndon Alliance, accessed 9/02/2011 at http://herndonalliance.org/resources/system-change/coordinated-patient-care.html


FIVE TRENDS TO WATCH


1. PATIENTS BEHAVING LIKE CONSUMERS


High Deductibles Will Drive Consumerism

Health plans increasingly have high deductibles

Source: Health Savings Accounts and Account-based Health Plans: Research Highlights. Washington: America’s Health Insurance Plans’ Center for Policy and Research, 2012.


Price Seekers

Source: Spring/Summer 2012 Altarum Survey of Consumer Health Care Opinions. Ann Arbor, Mich.: Altarum Institute, 2012. (No authors given.)

• Who is most likely to ask about the price of care? Younger age, Lower income, Higher insurance deductible, Recent hospitalization, More experience using computers and smartphones, and Not being an impulse shopper in other aspects of life.

• Neither health status nor gender was predictive of asking about price.


2. PHYSICIAN ALIGNMENT, EMPLOYMENT


Physician Employment Now

Source: Zeis M. Physician Alignment: Integration over Independence. Brentwood, Tenn.: Health Leaders Media Intelligence, 2012.


Physician Employment Then

Source: Zeis M. Physician Alignment: Integration over Independence. Brentwood, Tenn.: Health Leaders Media Intelligence, 2012.


Reaching Primary Care Docs

• Primary care doctors are frustrated.

• Tell them you understand and want to lift their burdens

• The highlight of their job is working with patients. Focus on change as a way to improve their relationships with patients, to get them back to the reasons they became doctors

• Physicians are open to new arrangements, payment reform — if it offers benefits to them

• Primary concern is loss of income• No trust hospitals will cut the pie fairly

• Low understanding of different payment reform models

• You want to “improve” payment system, not reform it

Source: Talking with Physicians about Improving Payment and Reimbursement. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)


Source: Talking with Physicians about Improving Payment and Reimbursement. Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)

Communicate Alignment of Interests


3. EMPLOYER PURCHASING


“Large employers are confident they’ll offer health benefits within the next 5 years but continue to develop innovative strategies to help employees receive high quality care and to control rising health care costs. Results show major trend of offering online transparency tools so employees can find information about price and quality.”

Employers Shopping for Value


B2B Comms: Focus on Value


Range In Average Price Per Procedure Across California Hospitals For California Public Employees’ Retirement System (CalPERS) Patients

Undergoing Knee Or Hip Replacement, 2009.

Employers Are Watching Price

Source: Robinson JC and MacPherson K. “Payers Test Reference Pricing And Centers Of Excellence To Steer Patients To Low-Price And High-Quality Providers.” Health Affairs, 31(9): 2028-2036, 2012.


Range Of Prices For Colonoscopy Per Procedure Paid By Safeway In Three Markets, 2009.

Safeway Reference Pricing

Source: Robinson JC and MacPherson K. “Payers Test Reference Pricing And Centers Of Excellence To Steer Patients To Low-Price And High-Quality Providers.” Health Affairs, 31(9): 2028-2036, 2012.


4. TRANSPARENCY


Transparency: Get Your Story Ready


Price Transparency


5. HEALTH CARE + PUBLIC HEALTH


Can You Prevent the Next Case of Diabetes?


75% of our health care spending is on people with chronic conditions.

• 7 out of 10 deaths among Americans each year are from chronic diseases.

• Almost 1 out of every 2 adults—had at least one chronic illness.

The Bravest New World: Population Health

Source: The Power of Prevention: Chronic Disease …The Public Health Challenge of the 21st Century. Atlanta: National Center for Chronic Disease Prevention and Health Promotion, 2009. (No authors given.)


• Accountability for population health is the heart of being an ACO

• Behavior change communications will make health care feel even more like public health

• health promotion activities to encourage healthy living and limit the initial onset of chronic diseases

• early detection efforts, such as screening at-risk populations

• appropriate management of existing diseases and related complications

ACO Comms, Meet Public Health Comms


CDC recommendations on chronic disease prevention

• Quitting smoking

• Diet, exercise

• Healthy blood pressure and healthy blood cholesterol levels

• Instilling healthy behaviors and practices during youth

From cures, rescue care to preventive care


All Health is Local: Research Your Audience

SUMMING UP, LOOKING AHEAD


• Research. Don’t assume.

• Localize the message

• Pay attention to ecology, culture

• Physician champions and internal comms are critical for introducing new care models

All Health Care is Local


The Research Behind Today’s Presentation

RESOURCES


• Bechtel C and Ness D. “If You Build It, Will They Come? Designing Truly Patient-Centered Health Care.” Health Affairs. 29(5): 914-920. May 2010.

• Carmen K, et al. “Evidence That Consumers are Skeptical about Evidence-based Health Care.” Health Affairs. 29(7): 1400-1406. July 2010.

• Gerber A, et al. “A National Survey Reveals Public Skepticism About Research-Based Treatment Guidelines.” Health Affairs. 29(10): 1882-1884. October 2010.

• Ross M, Igus T and Gomez S. “From Our Lips to Whose Ears? Consumer Reaction to Our Current Health Care Dialect.” The Permanente Journal.13(1): 8–16. 2009.

• “Talking About Health Care Payment Reform with U.S. Consumers.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)

• “Talking with Physicians about Improving Payment and Reimbursement.” Princeton, N.J.: Robert Wood Johnson Foundation, 2011. (No authors given.)

• Anzalone Liszt Research. “Coordinated Patient Care.” Herndon Alliance, accessed 9/02/2011 at http://herndonalliance.org/resources/system-change/coordinated-patient-care.html

To Learn More


Health care communications and public affairs

We are part of the MSLGROUP Americas, the PR arm of the Publicis Groupe, one of the world’s largest communications firms. Our team offers clients the personal touch and category expertise of a boutique, with access to national and global resources should they require them.

Our health care and health care policy work is holistic: We design and execute programs that seek to change minds, policy and behavior with audiences running the gamut from the chronically ill to the chronically wonky.

We specialize in health, health care and medical issues, working on the cutting edge of patient and provider communications, quality improvement, delivery and payment reform, and public affairs and reputation management.

Whether your business is delivering care to patients or messages to Capitol Hill, find out why trade associations, non-profit foundations, health plans, hospitals and health systems have turned to us to take care of them.

Chuck Alstonsenior vice president/[email protected]

Michael Kingvice president

Aaron Cohenvice president/media

Eva Fowleraccount supervisor

Katherine Brickaccount supervisor

Emily Burtonsenior account executive

Alyssa SnowSenior account executive

Leah-Michelle Nebbiaassistant account executive

Colleen Johnsonassistant account executive


To Follow Up

Chuck [email protected]

PR and Health Reform by Chuck Alston

Health & Medicine

Transcript of PR and Health Reform by Chuck Alston