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Focus on the fundamentals

Kids playing basketball

Round the back, under the legs, and...It's a miss!

Don't you love March Madness? Go Cougars, Ducks, Beavers, Lobos, Bruins, Trojans, Rebels and Utes (if your team is missing, please add them somewhere in between the Cougars and the Utes).

I love to play and watch basketball. From ages 13-15, I would get up at 6 a.m. nearly every day to practice the fundamentals of shooting foul shots and layups at the hoop outside my home. With the ultimate goals of scoring and winning the game, the fundamentals are the best way to ensure that the ball will go in the hoop.

I love quality improvement too. You set your aim and goal; create your plan; use outcome, process and balance measures to guide the effort; put it in practice; and study the outcomes. When it works, you save people from mistakes, help them realize how to manage their care better and catch people before they fall through the cracks.

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Who knows us best?

Providers and Patients

Why concerned family members matter.

We talk a lot about patient and family engagement at HealthInsight. I'm sure it is on the mind of most health care professionals at some level. But building this into our day-to-day muscle memory of how we respond in situations is still pretty rare. I would like to tell a story of a dear friend of mine who recently dealt with the lack of patient and family engagement and all it is intended to prevent.

This is a 75-year-old man, overweight, not in horrible shape but who has long suffered from breathing problems (frequent bronchitis, sleep apnea, etc.). He has desperately needed a knee replacement for as long as I've known him but was very reluctant to take such a drastic step. Finally, he knew he didn't have any choice and made the decision to proceed. He researched local surgeons and settled on one with full confidence that he had picked the best in the area.

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Are We Providing Patient-Centered Care?

Providers and Patients

There are many definitions of "patient-centered care" or "shared decision making" floating around. But most agree that it ideally includes certain aspects such as:

  • Consideration of the patient's preferences and needs
  • Integration of care through the teamwork of all providers involved
  • Respect for the non-medical needs of the patient and family
  • The patient's physical comfort
  • Free flow of communication among the patient, family members and medical team members

When I first heard of patient-centered care, I was somewhat perplexed. It reminded me of my own situation when I was 12 years old and had just been found to have a chronic medical condition. Our family internist sat down with me and my parents and explained that this was a problem that I would have for the rest of my life. He told us that there would be ups and downs, but that it was manageable. He went over the treatment options and asked what we thought would work for us. I have always considered that situation to be an example of patient-centered care.

Since then, there have been two big changes. The first change is the formation of care teams working together for the benefit of the patient and family. This has been a great help, but at times someone tries to force members of the care team on the patient. When that happens, we start to negate the positive effect of the team. The patient's perspective always needs to be considered. The second change is the free flow of information found online. Half of patients, both old and young, have already looked up their provider's credentials on the Internet before their first visit. Sometimes the patient will get false or dangerous information about either their provider or their ailment. This information must not be brushed aside, rather explained why it is not correct or appropriate for their condition. Then the patient should be directed to good, evidence-based care websites for more information. The Internet can be an ally in the patient care, almost like a team member when used correctly.

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Patient Engagement: A Passing Fad or Revolution?

Family

At the end of February, I had the privilege of attending the 2017 Patient & Family Centered Care Conference, presented by PFCCpartners. Immediately, I was struck by the growth in attendance and the depth of the presentations highlighting best practices and innovations in patient engagement. I first attended this conference as the sole representative from HealthInsight in 2012, wanting to start the journey of Patient and Family Advisory Councils for HealthInsight Utah. This year, HealthInsight was represented by eight staff and six patient and family advisors from Nevada, Oregon and Utah-it is safe to say that patient engagement is here to stay.

Wendy Nickel, MPH, from the American College of Physician's Center for Quality and Patient Partnership in Healthcare, kicked off the conference by providing an overview of four key principles of patient engagement:

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A Rallying Call for Value-Based Health Care

stethoscope with money

As a part of my professional development, I was certified by the National Committee for Quality Assurance (NCQA) as a Healthcare Effectiveness Data and Information Set (HEDIS) auditor in 2001. I have kept this certification while expanding my skills to include data validation and Pay for Performance Value-Based Program (P4PVBP) certification as I began to recognize the changing environment and the potential shift to VBP.

With today's uncertainties in health care, the NCQA has joined several health care organizations in a call for a new model of care. In a letter to Congress and the administration, these groups have endorsed a shift from the fee-for-service health care system to value-based care. NCQA and its allies (doctors and specialty societies that represent physicians, health plans and payers) have developed a set of recommendations on how to move our health care system toward innovative, patient-centered care. These recommendations include:

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Patient Portals Wish List

Senior Couple Using Computer

Recently, when I arrived at my new dermatologist's office, I noticed an iPad was sitting on the counter instead of a clipboard, and a patient was working his way through the sign-in process. The receptionist handed me a clipboard with several sheets of paper, instructing me to fill them out. She explained that, by later that afternoon, all of my information would be in a patient portal, a secure website that gives patients 24-hour access to personal health information, and I would be able to update it, if needed.

As promised that afternoon, I received an email with a note telling me how to log in. After clicking the link and following some simple instructions, I arrived at a dashboard that prominently showed my next appointment and links to other areas of my record. The information from the forms I had filled out was there along with the notes from the visit. Two weeks later, I wanted to access the portal to see if my lab results were in. I couldn't remember the link to the site or locate the email, so I went to the clinic's website and found a link to the patient portal. The portal was easy to use, and I had all of my information right at my fingertips.

I am somewhat familiar with patient portals because I have used them before. Another portal I occasionally access, while offering secure emailing, summaries of visits, prescriptions and labs, is a bit "clunky" to use. It provides the basics; it's just not as easy to use.

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Changing the Conversation from Health Care to Health

Senior man sitting with his daughter and grandson

I was excited to hear Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC), speak at this year's Centers for Medicare & Medicaid Services (CMS) Quality Conference about the importance of moving "upstream" and strengthening the relationship between community-based prevention services and health care. This is a topic near and dear to my heart, as I started my career working in public health to help communities improve the systems that support community health and prevention. Now that I work in health care quality improvement, I see daily the health care community's challenges and opportunities in not only providing good health care, but helping people achieve health.

Most of us who work in health have learned that there are significant limitations to what the health care system can achieve alone. Our systems of care must change to meet the growing burden of chronic disease.

Cardiovascular diseases, pre-diabetes and diabetes are at a record high. According to the CDC, cardiovascular diseases are the leading cause of death in the United States. Nearly one in 10 Americans has diabetes, and without intervention, this number will likely continue to grow. More than one-third of American adults have pre-diabetes, an estimated nine out of 10 of don't know they have it. The good news is many risk factors for these conditions can be prevented or managed with lifestyle changes between visits to the doctor. Success, in many cases, depends as much on lifestyle as it does on quality care.

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The Power of Love

young hands holding older hand

Last month we lost two classics from the silver screen – Ms. Debbie Reynolds and her daughter Carrie Fischer. Their deaths came just one day apart when Ms. Reynolds died from what many have declared as broken heart syndrome, after suddenly losing her daughter the day before. Ms. Fischer, profoundly known as Princess Leia from the epic Star Wars film series, followed in her mothers' footsteps most of her life and just like her mother, she landed in the movie business before the age of 20. Both of these women left behind tremendous legacies and have amazing personal stories filled with both joy and triumph. As the world learned about Carrie's untimely death, just hours later came the news of her mothers' collapse. Carrie Fischer and Debbie Reynolds will always be remembered for their talent and iconic roles in some of Hollywood's finest movies, and their deaths will forever remain synonymous.

Wait a minute, let's back this up. Dying of broken heart syndrome? Is that a real thing? Is it truly possible for somebody to die from a broken heart? As is turns out, yes, there is real evidence that you can die from a broken heart, and in fact, it makes perfect sense. Grief is similar to other powerful emotions such as anger, anxiety or loneliness, which are all just different forms of stress. Stress has a powerful impact on our health, especially the health of our heart. According to the American Psychological Association, stress is a complicated condition that has a huge negative effect on our bodies and almost always manifests itself in physical symptoms. Additionally, and not surprisingly, we understand anger has a direct connection with increased risk of cardiovascular problems. When we see somebody expressing and venting a lot of anger we might think, "Man, this guy's going to have a heart attack!" Grief is really no different. The Mayo Clinic describes broken heart syndrome as a "temporary disruption of your heart's normal pumping function in one area of the heart ... which may be caused by the heart's reaction to a surge of stress hormones."

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Uncertainty in Health Care: A Snapshot as of January 2017

Nurse with questions

With as much focus on effort and resources that have been spent in working to transform health care over the past decade, there has never been as much uncertainty about the direction that health care should go as there is right now: January 2017!

Tremendous strides have been made over the past decade with improved technology – adoption of electronic health records, creation of health information exchanges, implementation of all payer claims databases, widespread use of video visits, expansion of telehealth use, and development of new drugs that provide definitive relief for some diseases if not cures. In addition, health care coverage is more accessible than ever for those who have been uninsured – particularly those with pre-existing conditions.

Yet, we find that many health care professionals are very anxious right now. Hospitals are restructuring to provide less inpatient care while remaining a viable part of the delivery system. Ambulatory care providers are dealing with staffing shortages while working to provide care to more people, developing team-centered care, and adapting to new payment systems. Public health is struggling to find its path in the midst of all the change and contending with, in most states, reduced funding. These are only a few examples of the complexity of transforming the health care system. The implementation of electronic health records across delivery systems has supported and encouraged more comprehensive and coordinated care; however, this hasn't been the panacea that everyone thought it would be. Even with the implementation of the technology, we have not seen widespread improvements in the quality of health outcomes, although this is moving in the right direction. We have spoken about transparency regarding quality and cost, yet we are only just beginning that journey in most markets to achieve the Triple Aim of improved care in a more efficient manner, with better outcomes and lower costs.

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Positively Impacting the Health of a Community

Mother with Sons

As a community physician and a staff member at HealthInsight, I believe I am uniquely positioned to positively impact the health of my community. On a daily basis I am working with improvement teams to advance data transparency, community and consumer engagement, and quality processes that lead to best outcomes for patients.

Over the last 18 months, I have been honored to participate in the Institute for Healthcare improvement (IHI) 100 Million Lives initiative. This initiative is an unprecedented collaboration of change agents across sectors who are pursuing an unrivaled result toward better health. In my role, I represent the Network for Regional Healthcare Improvement (NRHI), and the Collaborative Health Network in coaching a vanguard of teams bringing the 100 Million Lives initiative to their communities.

Our mission is to see 100 million people living healthier lives by 2020 and to measure health through what matters to people. The 100 Million Lives initiative asks "Whose life is getting better because we are here?" and looks at physical health, mental health, social well-being, spiritual well-being, life expectancy, and health equity. The initiative promotes sustainable change by asking us to develop financing and workforces that allow for long-term impact. As part of this effort, the initiative has intentionally crafted a survey of health and well-being that is being considered by organizations as large as the Veterans Healthcare System, as a metric for success in improving the entirety of a person's health. The survey's seven questions can provide real-time data about a program's impact. For details about the survey, contact IHI at 100MLives@ihi.org.

What have I seen in my participation to date? Here are two examples: Henry Ford Allegiance Health in Jackson, Michigan is developing a sustainable financing model that will integrate the resources needed to care for at-risk youth such as health care services, behavioral health care and educational investment. This pool of resources can serve the youth and their families in the most appropriate and efficient ways possible. Henry Ford Allegiance Health is developing a system to coordinate a network of care around families of youth and will reinvest any savings into wellness and prevention services and maintain those resources in the community for families right in Jackson.

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