GIVEAWAY: Enter to win a FREE copy of our upcoming Social Determinants of Health report

August 15th, 2017 by Melanie Matthews

For a chance to win 1 of 3 PDF copies of Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services, a $95 value, visit our Facebook page and answer the question on the following post: Which social determinant of health has the greatest impact on health outcomes in the population you serve?

For an additional entry, SHARE our Facebook post. Giveaway ends at midnight ET August 23.

The winner will be announced here and on Facebook on August 24.

Enter today at: https://goo.gl/G2EK6P.

5 Practitioner Tactics for Tackling the Opioid Epidemic

August 15th, 2017 by Susan Butterworth, PhD, and Amanda Sharp, MPH, Q-Consult LLC
opioids

There is promising evidence that motivational interviewing can successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids.

Despite evidence and guidelines to the contrary, including significant risk of addiction, there remains a widespread belief among many clinicians and patients alike that opioid medication is a viable and effective first option for multiple chronic pain conditions. Practitioners feel pressure to provide opioids upon patient request, yet many have neither the resources nor the skill set to manage the physiological and psychological complications that can arise when treating a patient with opioids long-term.

As one qualitative study found, it can be awkward at best, and confrontational at worst, when refusing a patient’s request for opioids. Thus, clinicians are faced with the challenging balancing act of providing pain relief for their patients while simultaneously managing the potential for addiction and misuse – with most clinicians ill-equipped for the herculean task.

“Not providing the [opioid] prescription is very hard. It takes time to do the research on the patient. Confronting the patient with a problem is emotionally draining. Doing it 5-10 times in one shift is not only a reality, it is downright crippling. It sucks out [sic] last bit of energy out of your soul. Rather than confronting patients and arguing, it’s far easier to write a prescription for narcotics and move on to the next patient. This is the mindset of thousands of physicians.”
Anonymous Physician, April 25, 2013

Along with knowledge about alternative treatments, a valuable skill set for clinicians in this situation is an effective communication approach to address the possible scenarios that emerge:

  • Engaging patients in discussions about the risks of opioids;
  • Validating the frustration of chronic pain;
  • Evoking commitment to try alternative modalities;
  • Eliciting honesty about unhealthy/drug-seeking behaviors; and

Sharing concerns and resources for opioid addiction.

Motivational Interviewing (MI) is an evidence-based communication approach that has been adapted for the brief healthcare setting to address many lifestyle management issues, including chronic pain. There is one promising clinical trial that used a single MI session in an emergency department to successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids as compared to a control group. Even beginning proficiency in MI equips practitioners with the confidence and skills needed to engage patients in conversations that generally lead to outcomes of being able to maintain rapport and successfully incorporate best practice guidelines for chronic pain treatment.

Consider the following two scenarios:

Scenario 1: Your patient has recently hurt their back and has requested strong pain medication.

Scenario 2: You suspect your patient may have an addiction to opioids.

In both cases, a practitioner, competent in the MI approach, would be able to use the following strategies to successfully navigate these challenging waters. These principles and strategies are based on Miller and Rollnick’s description of MI practice.

Engage and Partner

Taking a minute or two to build rapport with the patient may be counter-intuitive to a busy clinician. However, consider the time that is spent in unproductive arguments and power struggles. Research has shown that taking a more patient-centered approach is more time-efficient in the long run. Although the clinician is an expert in clinical aspects, the patient is the expert of their life, and the only one with the ability to commit to the suggested treatment plan. By stepping out of the authoritarian role, ideally, the clinician can partner with the patient in a collaborative way to problem-solve together. When a person helps to identify the best treatment course for themselves, they feel more ownership and are more committed; thus, are more likely to follow through.

Express Empathy

A core component of engaging is being able to express empathy, or the ability to convey accurate understanding through the eyes of the patient. This takes compassion, effort, genuine interest, and reflective listening. The clinician does not need to become a counselor to provide a meaningful statement that lets the patient know that the practitioner “gets it”. When the patient feels understood and accepted, they are more receptive to the clinician’s advice and guidance.

Share Concerns while Supporting Autonomy

In MI, the clinician is not simply following the patient but is a full partner. After establishing rapport and trust, it is not amiss to share any concerns that the provider has, if patient autonomy is concretely verbalized. The patient can always go to another doctor to get what they want; by acknowledging that it is the patient’s choice to pursue what they feel is best for them, the patient relaxes. This allows the clinician to share their concern in a way that does not elicit defensiveness.

Manage Expectations

It is important to manage the expectations of the patient. By clearly and transparently stating up front what the clinician feels is best practice and ethically viable, the patient is not disappointed later. Openly share that alternative treatment options may not address the pain as completely as opioids might initially, or, in the case of addiction, that there may be withdrawal symptoms when discontinuing the medication. Honesty preserves trust and conveys the clinician’s desire to support the patient as fully as possible, while still maintaining his integrity of practice.

Provide Decision Support with Menu of Options

Now the patient is ready for a menu of options with the pros and cons succinctly laid out. These include therapies such as non-opioid meds, stretching, and alternative treatments. Some of these options may be those that the clinician is not prepared to provide; e.g., if the patient is still favoring the option of more opioids. The clinician has been transparent about which options he feels are best and is willing to provide; however, the patient is in the driver’s seat to choose the best treatment course for himself. In most cases, the clinician can positively influence the patient’s decision. If not, the discussion remains professional, rapport is not lost, and the patient will feel comfortable returning to this provider. This keeps the door open to further dialogue about the situation.

There are many resources available for those who are interested in getting trained in MI, and the approach can be used for any lifestyle management or treatment adherent situation. However, a fair warning that MI is a complex skill set and cannot be learned in a one-and-done workshop. Just like learning to speak a foreign language or play a musical instrument, it takes practice and feedback from an expert over time to develop a meaningful proficiency. As many clinicians can attest though, this is one hard-earned competency that is more than worth it — for the practitioner, the patient and society!

Susan Butterworth, PhD

Amanda Sharp, MPH

About the Authors: Susan Butterworth, PhD, is principal and Amanda Sharp, MPH is program manager for Q-Consult LLC. Both are both members of the Motivational Interviewing Network of Trainers. Please visit Q-Consult, LLC their blog and find out more about patient-centered initiatives that increase patient engagement and improve clinical outcomes.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: How Engaged Healthcare Employees Cultivate a Positive Patient Experience

August 14th, 2017 by Melanie Matthews

Excellent clinical care is only one part of a great patient experience, especially considering the limited amount of time doctors spend with patients. All staff members with whom patients come into contact must be aligned in their commitment to patients’ comfort, care, and peace of mind. By establishing core values and standards of behavior and recognizing those who embody them, hospital administrators can positively affect all patient touchpoints within their facility, according to a new infographic by WorkStride.

The infographic examines the characteristics of an engaged healthcare employee and what healthcare organizations can do to increase patient satisfaction within their organization.

UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: Reducing Clinical Variation Through Analytics

August 11th, 2017 by Melanie Matthews

Some 42 percent of wasteful healthcare spending in the United States is attributed to clinical variation, according to a new infographic by Qlik.

The infographic looks at the financial and social cost of clinical variation and how to advance positive outcomes using analytics.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results Between Medicare’s aggressive migration to value-based payment models and MACRA’s 2017 Quality Payment Program rollout, healthcare providers must accept the inevitability of participation in fee-for-quality reimbursement design—as well as cultivating a grounding in health data analytics to enhance success.

As an early adopter of the Medicare Shared Savings Program (MSSP) and the largest sponsor of MSSP accountable care organizations (ACOs), Collaborative Health Systems (CHS) is uniquely positioned to advise providers on the benefits of data analytics and technology, which CHS views as a major driver in its achievements in the MSSP arena. In performance year 2014, nine of CHS’s 24 MSSP ACOs generated savings and received payments of almost $27 million.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results examines program goals, platforms, components, development strategies, target populations and health conditions, patient engagement metrics, results and challenges reported by more than 100 healthcare organizations responding to the February 2016 Digital Health survey by the Healthcare Intelligence Network.

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Infographic: How Will Aging Baby Boomers Challenge Healthcare?

August 9th, 2017 by Melanie Matthews

By 2029, the last of the Baby Boom generation will reach retirement age. As this population gets older, they present increasing challenges but also opportunities for the U.S. healthcare system, according to a new infographic by Adventist University’s Masters in Health Administration program.

The infographic examines Baby Boomers and their health; health spending on Baby Boomers; the challenges Baby Boomers bring to the healthcare system; and strategies to address the healthcare needs of Baby Boomers.

From home sensors that track daily motion and sleep abnormalities to video visits via teleconferencing, Humana’s nine pilots of remote patient monitoring test technologies to keep the frail elderly at home as long as possible. When integrated with telephonic care management, remote monitoring has helped to avert medical emergencies and preventable hospitalizations among individuals with serious medical and functional challenges.

In Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population, Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge, reviews Humana’s expanded continuum of care aimed at improving health outcomes, increasing satisfaction and reducing overall healthcare costs with a more holistic approach.

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Service Action Teams Turn Front-Line Staff into Patient Experience Ambassadors

August 8th, 2017 by Patricia Donovan
Patient Experience

Increasingly, patient satisfaction scores figure into payors’ healthcare reimbursement formulas.

UnityPoint Health is so invested in the concept of patient experience that it charges each member of its organization, whether healthcare provider or not, with a set of basic behaviors designed to improve it.

These four foundational behaviors, rooted in courtesy and common sense, drive the manner in which patients, families and visitors are greeted and assisted at all times.

“We know there are dozens of initiatives and tactics that can be used to help improve patient experience,” said Paige Moore, director of patient experience at UnityPoint Health-Des Moines, “But the four we chose were driven by patient and visitor comments and feedback.”

Ms. Moore shared these behaviors, as well as an inside look at her organization’s patient experience improvement plan, during Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a July 2017 webinar now available in on-demand and training formats.

Having established this system-wide coda for all employees, UnityPoint Health next looked at further enlisting its frontline staff in efforts to improve the patient experience. To do so, it created a set of seven service action teams, with two more in the works.

Each service action team is composed of at least 50 percent of that department’s frontline staff, rounded out by an executive sponsor and team lead.

“We want all of our team members to be actively engaged in the projects, to take responsibility for them, to be ambassadors and patient experience champions throughout the organization,” explained Ms. Moore.

Each team reviews results from HCAHPS® and Press Ganey® patient experience surveys to identify department priorities, such as nurses’ narration of care, physicians’ use of clear language, or discharge or transfer processes.

UnityPoint Health launched its first service action team in 2014 for outpatient services. “This was our largest volume for surveys and it also had some of our lowest patient experience performance. We really wanted to get in and see what could we do to make the biggest impact on the highest number of our patients.”

Once that team developed some tactics to improve patient privacy concerns, wait times and registration processes, it saw improvements in those areas.

During the program, Ms. Moore outlined priorities and shared results from each service action team.

Importantly, there are two support service action teams: a measurements team to educate employees on the relevance of patient experience scores and their role in them, and a communications team to convey information on patient experience activities throughout UnityPoint Health. The health system also recently launched an “Excellence in Patient Experience” awards program.

And rounding out the program is the placement of patient experience directors like Ms. Moore throughout the organization, each supported by a physician champion.

Physician education in patient experience is ongoing, she added, whether during rounds or mandatory one-on-one shadowing and coaching for patient experience for all new hires.

Listen to an interview with Paige Moore on UnityPointHealth’s four foundational behaviors.

Infographic: What Is the ROI of RTLS in Healthcare?

August 7th, 2017 by Melanie Matthews

The demand for improved healthcare efficiency continues to grow as the healthcare industry moves toward value-based payment models, according to a new infographic by Locatible.

The infographic examines how real time location systems (RTLS) can improve healthcare facility efficiency.

UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: Is Your Healthcare Network Security on Life Support?

August 4th, 2017 by Melanie Matthews

With the growth of the Internet of Things (IoT), connected biomedical technology has provided a rich opportunity for healthcare to improve lives and patient outcomes. However, it has also increased fears among IT leaders in hospitals and healthcare facilities that with the proliferation of these IoT medical devices comes some very real threats to protected health information and to financial and patient safety risks, according to a new infographic by Comport Technology Solutions.

The infographic examines how why cyber criminals target healthcare organizations, the most likely types of cyberattack events targeting healthcare and how healthcare IT is focusing security efforts on IoT to mitigate threats.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry Not in recent history has the outcome of a U.S. presidential election portended so much for the healthcare industry. Will the Trump administration repeal or replace the Affordable Care Act (ACA)? What will be the fate of MACRA? Will Medicare and Medicaid survive?

These and other uncertainties compound an already daunting landscape that is steering healthcare organizations toward value-based care and alternative payment models and challenging them to up their quality game.

Healthcare Trends & Forecasts in 2017: Performance Expectations for the Healthcare Industry, HIN’s 13th annual business forecast, is designed to support healthcare C-suite planning during this historic transition as leaders prepare for both a new year and new presidential leadership.

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Montefiore SDOH Screenings Leverage Learnings from Existing Pilots

August 3rd, 2017 by Patricia Donovan

Montefiore Health Systems screens patients for social determinants of health, which drive 85 percent of a person’s well-being.

Montefiore Health System’s two-tiered assessment screening program to measure social determinants of health (SDOH) positivity in its predominantly high-risk, government-insured population is inspired by existing initiatives within its own organization. Here, Amanda Parsons, MD, MBA, vice president of community and population health at Montefiore Health System, describes the planning that preceded Montefiore’s SDOH screening rollout.

I’d like to explain how we came to implement the social determinants of health screening. Many of us in New York State participate in the delivery system or full-on incentive program. It is that program that has enabled us to step back and think about using Medicaid waiver dollars to invest in the things that make a difference.

I need not tell anybody in this industry: many studies have looked at what contributes to health. We know that clinical health in and of itself contributes somewhere between 10 to 15 percent of a person’s well-being; however, so much more of their health and well-being is driven by other factors, like their environment and patient behaviors. And yet, we had not had a chance in the healthcare system to really think about what we wanted to do about that. It was really the Delivery System Reform Incentive Payment (DSRIP) program that has allowed us to start exploring these new areas and think about how we want to collectively address them in our practices.

The way we structured our program was quite simple. We said, “If we’re going to do something about social determinants of health, let’s recognize that they are important and must be addressed, and that we have many different community-based organizations that surround or are embedded in our community that stand poised and ready to help our patients. We’re just not doing a very good job of connecting them to those organizations, so let’s backtrack and say, ‘First, we have to screen our patients using a validated survey instrument.’”

There were different sites at Montefiore that had already launched various pilots. We said, “Let’s make sure we leverage the experience and the learnings from these pilots. Then let’s think about who’s going to deal with those patients, which means we have to triage them.” For example, if somebody screens positive for domestic violence that is occurring in their home right now in the presence of children, that might require a different response from us than someone who says, “I have some difficulty paying my utilities.”

Source: Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services

sdoh high risk patients

Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services outlines Montefiore’s approach to identifying SDOH markers such as housing, finances, healthcare access and violence that drive 85 percent of patients’ well-being, and then connecting high-need individuals to community-based services.

Infographic: A 10-Point Checklist for Centralized Patient Access Success

August 2nd, 2017 by Melanie Matthews

One way hospitals can gain a competitive advantage and attract more patients in today’s competitive healthcare industry is through centralized patient access, according to a new infographic by SCI Solutions, Inc.

The infographic provides a 10-point checklist for centralized patient access success.

UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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