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Juliana Preston, MPA is the Utah Executive Director at HealthInsight. Ms. Preston's responsibilities include all Utah governance, operations, staffing, customer and community relations, and development. Ms. Preston graduated from Oregon State University in 1998 with a Bachelor's of Science degree with an emphasis in Long Term Care and minor in Business Administration. In 2003, she obtained her Master's degree in Public Administration from the University of Utah with an emphasis in Health Policy.

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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Civilizing Medicine

Nurse and patient holding hands

When I first started working in nursing homes, I was struck by the sheer volume of rules and regulations governing the care of residents. Unfortunately, those rules often inhibited patient-centered care rather than offering protection. The result was an institutional approach to care with strict rules based on the diagnoses of the resident. For some residents, food was one of life's simple pleasures they could still enjoy. Despite this reality, most residents were placed on a special diet, based on their medical condition, instead of one based on their individual goals. Many residents would awaken to the smell of bacon cooking in the morning only to be told that they were not allowed to have it because of their low sodium diet. Of course, medical conditions must be taken into account, but the goals of each person must be considered—first and foremost.

This is also true outside of nursing home walls. All too often, care is overwhelmingly curative and narrowly disease-specific instead of goal-focused. My father, who had heart failure and Type 2 diabetes, had his diabetes strictly managed until the end of his life, despite the fact his life expectancy was far less than likely to benefit from strict blood sugar control. If his diabetes would have been managed according to his goals of care, instead of by the results of his hemoglobin A1c, his quality of life would have significantly increased. In fact, the results of strict management interfered with the goals of care as it caused several hospitalizations from hypoglycemia. According to an editorial in British Medical Journal (BMJ), "People with disabling, progressive illnesses expect active care, but they also seek comfort, control, and dignity."

Palliative care offers a potential patient-centered solution for the aging population facing the burden of chronic illnesses. Palliative care is specialized medical care for people with serious illness that focuses on improving the quality of life for both the patient and the family. It employs a multi-disciplinary approach consisting of specially trained doctors, nurses, social workers and other specialists who work alongside patients' doctors to provide an extra layer of support. Unlike hospice care, palliative care does not require a terminal diagnosis and includes curative/life-prolonging treatment. It is also associated with higher quality outcomes at lower costs.

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Providing Practice Transformation in Nevada and Utah

Doctor and Nurse Charting

The future of independent practices remains uncertain, except for one truth—change. Across the nation, some practices have been bought by integrated systems and many others have signed up with Accountable Care Organizations (ACO), all of which offer a wide array of services. HealthInsight continues to educate providers in our community about their options, as alternative payment models through the Centers for Medicare & Medicaid Services (CMS) emerge. We are committed that they make the best decisions for their practices and their patients.

As opportunities arise, HealthInsight will facilitate introductions with ACOs and/or Practice Transformation Networks. ACOs may utilize some of HealthInsight's experienced staff to supply onsite technical assistance as practices prepare to start Medicare Shared Savings Programs in 2017. (See recent blog by Sharon Donnelly)

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Co-pays, and Discounts, and Cash Prices, Oh My!

Tablets

At HealthInsight we have an initiative, funded by Cambia Foundation, to develop a curriculum to equip newly-insured people with tools to assist them as they navigate the health care system. As someone who has received formal health care system and policy education, and one who has worked in the system for nearly 20 years, I was confident that I was an expert on utilizing and maximizing the system for my family and me. My confidence was crushed the moment I needed to fill my son's acne prescriptions.

I am on a high-deductible health plan, which is complimented by a health savings account (contributed to by both me and my employer). At the first doctor's appointment, I was more than $1,000 away from my deductible--when in-network care and prescriptions would be covered at 100 percent. My son's pediatrician was aware that I would be paying out of pocket, so he wrote prescriptions for what he thought would be the most inexpensive. When I went to pick them up from the pharmacy, the total was $312.73 for a topical antibiotic and a tube of generic Retin-A. I was shocked, but the pharmacist reassured me that I could probably stretch them out beyond a month. I caved and bought the medication.

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Patients are People Too

Gardener with plants

In the emerging field of patient engagement there is considerable debate about what exactly to call it: patient engagement, consumer engagement, person-centered care, the list goes on. Regardless of the name, the key is to first and foremost recognize that a patient's health care isn't at the center of their universe. And if it is, then we have failed; we have taken the care out of health care.

When I was in college, I worked as a nursing assistant at the nursing home close to campus. During my training I was told to think of the residents as though they were family members. How would I want my grandmother or mother to be treated? I was assigned to work in the Special Care Unit, which is where the residents with dementia or Alzheimer's disease lived. I was nervous at first but quickly fell in love with all of them. I learned that in order to provide the best care possible I had to meet them where they were. For one lady, that meant waiting at the bus stop (a chair just outside the nurse's station) for Alice so they could go to the movie. For another, it was asking him where he put the library book that he was so desperate to return. Reorienting them to person, place and time was not helpful—it only caused more distress. In many cases, I became a long-lost daughter or childhood friend and that was OK. It was more than OK; it made them calmer, more relaxed. Outside of each room was a memory box filled with mementos and photographs from their past. The purpose was to help the residents find their rooms, but they served another purpose for me. Every time I entered the room I would pause, just for a few seconds, to look at their pictures. The pictures told so many stories of families, of professions, of sacrifices, of love. I could recall similar pictures of my grandparents and parents. The task of treating them like family was easy; in a short time, they were my family.

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When Self Care is Better Care

Doctor With Patient

"I can do it by myself!" is a frequent claim made by my 8-year-old daughter. As her mother, it is my job to decide if and when she has the skills and resources to do things on her own, like walk across the street for a playdate or cook her own scrambled eggs. My initial reaction is to tell her that no, she cannot do it by herself. I am her mother; I know best. But alas, my role as mother involves me teaching her how to do it on her own, providing her with tools and then allowing her to accomplish her goal independently.

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Lively Dinner Conversations (About Death)

Family Dinner

Over the past five years, I have said goodbye to my grandmother, my father and most recently my mother. In each case, I either played a major role in end-of-life health care decisions or was the responsible party to carry out my loved one's wishes after they passed away. Each one brought its own set of unique circumstances and each one has provided me with an important lesson—one of the best gifts you can give your family is a clear understanding of your wishes. The period of uncertainty and scrambling through the stages of grief is only compounded when decisions are made on someone's behalf without knowing what their loved one really wanted. All too often, family members are forced to make the decision based on emotion and the influence of other family members. Unfortunately, this leads to uncertainty, guilt and potential rifts in the family that can take years to mend.

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Who’s the Boss?

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Hint: It isn’t Bruce Springsteen or Tony Danza

When it comes to redesigning health care, it is easy to get trapped thinking that what we are doing is always in the best interest of patients and their families. After all, isn’t this the reason we are in health care in the first place? To heal people? To make them better? Unfortunately, all too often health care hurts. We have all heard the horror stories. In many cases, we have our own horror story to share, and we share it a lot. We need to find avenues to turn these stories into influencers for change. These stories and experiences need to drive the future delivery of health care.
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Patient Portals: a Gateway to Greater Patient Engagement

iStock 000006340105MediumThe integration of patient portal applications with electronic health records (EHRs) has made health information interactive, allowing patients to access and respond to their medical information online, from their own homes.

HealthInsight supports the adoption of patient portals as a way to improve caregiver/patient communication and increase patients’ engagement with their care.

Jordan Landing Family Medicine in West Jordan, Utah, is one example of the benefits a well-implemented patient portal provides. Jordan Landing Family Medicine is a family practice and medical spa that specializes in pediatrics, women’s health, geriatrics and dermatology.
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Beacon Beginnings

iStock 000007927672Medium croppedHealthInsight's cooperative agreement with the Office of the National Coordinator (ONC) officially ended September 30, 2013. "Improving Care through Connectivity and Collaboration," or the IC3 Beacon Community began in 2010, led by HealthInsight Utah with contributions from our major partners: University of Utah Department of Family and Preventive Medicine, Intermountain Healthcare, Utah Health Information Network, and Utah Department of Health. The goal of the efforts was to improve diabetes care through use of information exchange, using the Clinical Health Information Exchange, and assisting providers in connecting to the exchange, promoting Meaningful Use, and improving technology options around population health and advance care planning.

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