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The Patient's Power in Improving Health and Care

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Around the globe, we are facing a trifecta of healthcare challenges: financial constraints, an aging population, and an increased burden of chronic disease. We need to turn healthcare upside down, empowering our patients to take action for their health and helping physicians, nurses, and healthcare professionals move from being sages to guides.

Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you”?

Through her work at the Institute for Healthcare Improvement (IHI), Maureen Bisognano has worked diligently to support the IHI Triple Aim: improving the experience of patient care, improving the health of populations, and lowering costs. In this webinar she will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

In this webinar you will learn:

- Lessons from the “flipped school” in the education system and how they can be successfully applied in healthcare to improve patient behavior.

- How increased patient engagement can help to improve healthcare outcomes and deliver a better care experience while reducing costs.

- Ways that technology can effectively improve data capture, patient accountability, and decision-making.

- The impactful stories of four patients who became innovators in their own care.
improve data capture, patient accountability, and decision-making.

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The Patient's Power in Improving Health and Care

  1. 1. The Patient’s Power in Improving Health and Care Maureen Bisognano - President Emerita and Senior Fellow, IHI
  2. 2. © 2018 Health Catalyst • Across the world, we’re facing significant financial constraints, the aging of the population, and the increasing burden of chronic disease. • We’ll need to move to the Triple Aim of improving the experience of care, improving the health of the population, and lowering per capita costs. • “More and faster” won’t get us there…we need new ways to think about care. • Many answers here in this room…“all teach, all learn”. “Our” Shared Challenge 2
  3. 3. 3
  4. 4. © 2018 Health Catalyst • The students’ results flipped in every grade • In every class, failure rates dropped • Graduation rate rose to over 90% • College attendance rates rose from 63% to 80% • Most important, the “flipped classroom” closed the gap between the students from socio-economically challenged families and their peers • It helped teachers identify the “silent failers” (the students most in need) and then work with them in the classroom Flipping the Classroom 4
  5. 5. “Sage on the stage” to 5 “Guide on the side” From
  6. 6. © 2018 Health Catalyst IHI Triple Aim 6 Experience of Care Per Capita Cost Population Health
  7. 7. What’s the matter? 7 What matters to you? Source: Barry MJ, Edgman-Levitan S. ”Shared Decision Making – The Pinnacle of Patient-Centered Care.” N Engl J Med. 366;9. pp 780-782
  8. 8. dis-ease to 8 health-ease Move from
  9. 9. © 2018 Health Catalyst The Next “Blockbuster Drug” 9
  10. 10. © 2018 Health Catalyst • Patients in a coordinated care setting (focused on engagement) have 88% reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack compared to those not in a program • Clinical care teams reduced overall mortality by 76% and cardiac mortality by 73% • “Imagine what the headlines would be if a new cardiac drug showed this kind of effectiveness? It would be malpractice not to use it!” Patient Engagement 10 Source: Leonard Kish. HL7 Standards Blog. 8/28/12. available at:
  11. 11. © 2018 Health Catalyst Trevor 11 Link
  12. 12. © 2018 Health Catalyst • “Energy to do all I need” • “College life is hectic, the schedule is unpredictable, so being able to predict and control my health and energy…I can thrive” Trevor’s Definition of Health 12
  13. 13. © 2018 Health Catalyst • No surprises • Straight answers • Advice • Easy Access • He’d love to be able to email in questions, but when I asked about texting, he said he thought he could, “cut the old people some slack.” • He thinks they might need more time before technology is fully optimized in daily care. What Trevor Needs from Health Care 13
  14. 14. © 2018 Health Catalyst • A strong bond with doctor and care team • Ability to express a concern or ask a question and get straight answers and advice • Would love to “FaceTime” visits — sees the future as human connections and continuous communication • All without going to the office Trevor’s Dream 14
  15. 15. © 2018 Health Catalyst What percent of your young patients are like Trevor (prefer to manage their own health and care)? 1. 0% - 25% — 19% of respondents 2. 26% - 50% — 26% of respondents 3. 51% - 75% — 36% of respondents 4. 76% - 100% — 19% of respondents Poll Question 15
  16. 16. 5000 Hours 16
  17. 17. © 2018 Health Catalyst • Complications are costly • …in human terms • …in disability terms • …in dollar terms • …and in terms of hospital utilization The Cost of Diabetes 17
  18. 18. © 2018 Health Catalyst The Old Way • Ryhov Hospital in Jönköping had a traditional hemodialysis and peritoneal dialysis center • But in 2005, a patient, Christian, asked about doing it himself Change the Balance of Power 18
  19. 19. © 2018 Health Catalyst Christian taught a 73-yr-old woman how to do it… The New Way 19 …and they started to teach others how to do it.
  20. 20. © 2018 Health Catalyst • Now, they aim to have 75% of patients to be on self-dialysis • They currently have 60% of patients The New Way 20
  21. 21. © 2018 Health Catalyst • From Anette (nurse leader): • Surprised at design differences between patients, family, and staff • Managing at 1/2 - 1/3 less cost per patient • Evidence of better outcomes, lower costs, far fewer complications and infections • “We brought in the country’s employment, helped the patients make or update the CVs, and trained them for a new career.” Lessons to Date 21
  22. 22. © 2018 Health Catalyst 22
  23. 23. © 2018 Health Catalyst • Now calculated costs at 50% of costs in other hemodialysis units • Complications dramatically reduced and subsequent expensive care avoided • Measuring success by “number of patients working” Update 23
  24. 24. © 2018 Health Catalyst 24
  25. 25. © 2018 Health Catalyst Successful Spread – Waco, Texas 25
  26. 26. © 2018 Health Catalyst Comparison of In-Center Self-Care Hemodialysis to Non-Self Care 26 Employment rate: 26% vs 7% in a facility within the same building Source: Edward R Jones, MD, MBA, Medical Director, Self-care FMC Mt Airy Phila.
  27. 27. © 2018 Health Catalyst 27
  28. 28. © 2018 Health Catalyst • The patient starts by selecting a few values that matter most to them when choosing a treatment plan • Then detailed information is provided to help the patient rate treatment options according to how well they match each chosen value My Dialysis, My Choice 28 Source:
  29. 29. © 2018 Health Catalyst • Based on the patient’s rankings on each value, the results are compiled to help them decide which dialysis treatment option is best for their lives and health My Dialysis, My Choice 29 Source:
  30. 30. © 2018 Health Catalyst • If we can flip care to coordinate all aspects of care — physical, social, functional, emotional, and safety — we can prevent hospitalizations, improve the quality of life for millions, and save millions. All Aspects of Care 30
  31. 31. © 2018 Health Catalyst Centering Pregnancy 31 Source: Boston Medical Center
  32. 32. © 2018 Health Catalyst 32
  33. 33. © 2018 Health Catalyst • Young woman from Boston – 24 weeks pregnant with her first child • Her husband is still back in Nigeria and she’s hoping he’ll be here for the birth Norah 33
  34. 34. © 2018 Health Catalyst • Norah, like all the young women who participate in the group visit, takes her own vital signs, weighs herself, and enters all the info into her record. • She shares the record with the physician and midwife – it’s flipped! – and then moves to the back of the room to be examined before the group portion of the visit begins. • While the exams are conducted, there is a lot of chatter, a lot of questions asked and advice given, and a lot of relationship-building. Centering Model 34
  35. 35. © 2018 Health Catalyst “I’m very afraid of labor. I’m terrible with pain. I’m scared. I don’t think I’ll be able to do it.” The midwife said, “those of you who have had babies before, what advice do you have for Norah?” • Relaxed • Ice cubes • Confidence What Matters to Norah 35
  36. 36. © 2018 Health Catalyst • Reduced the risk of preterm birth by 33%1 • Reduced racial disparities for preterm births • Hispanic women in Centering demonstrated lower preterm birth rates than those in traditional care models (5% vs. 13%)2 • Reduced the odds of preterm births by 41% in African American women3 • Nearly twice the number of Centering Healthcare participants breastfed (46%) than those in a comparison study (28%)4 Centering Results 36 1Ickovics, et al. Obstetrics and Gynecology, 2007 2Tandon, et al. J. Midwifery & Women’s Health, 2012 3Ickovics, et al. 2007 4J of Midwifery & Women’s Health, 2004
  37. 37. © 2018 Health Catalyst What If We Flipped the Patient Discharge Process? 37 Link
  38. 38. © 2018 Health Catalyst • Interprofessional team who are the first to meet with new patients in need of home-based care • Occupational therapists • Physiotherapists • Nurses • Social workers • Work towards independence and mastery of everyday life, transitioning patients to either: • Discharge without need of further healthcare, or • Home-based care with the best possible function Reablement – Oslo Kommune 38 Source: Thomas Lystad
  39. 39. © 2018 Health Catalyst • Assess the needs of the patient: • Interests • Resources • Limitations • Current function • Goal • Plan • Assessment of the care and adaptation of the plan is ongoing • Goal: Transfer or discharge the patient when we have achieved best possible function and a stable need for healthcare Reablement – Oslo Kommune 39 Source: Thomas Lystad
  40. 40. © 2018 Health Catalyst • History • 70 year old man with COPD, type 2 diabetes, and two previous heart attacks • Suffered a major stroke, and spent a month in the hospital • Left side paralysis, poor cognitive and physical function Jarle 40 Source: Thomas Lystad • Began prescribed reablement program, which was continuously reassessed; made good progress and entered health rehab • Came back to reablement after challenges; they helped him find a new, more accessible apartment • Now largely independent, and needs a wheelchair only for long distances
  41. 41. © 2018 Health Catalyst Flo 41 Link
  42. 42. © 2018 Health Catalyst • Flip the balance of care – from the hospital to the community • Flip the balance of delivery – from individual providers to care teams • Flip the balance of power – from the provider to the patient and family • Flip the balance of costs – from treatment to prevention and co-production • Flip the balance of emphasis from volume to value; and from health care to health Flipping Health Care 42
  43. 43. © 2018 Health Catalyst What impedes you at the organizational level from more fully including patient input into the care you provide? 1. Leadership — 18% 2. Daily, immediate operational challenges — 32% 3. Resources (labor, money) — 15% 4. IT documenting/workflow systems — 14% 5. Performance measures focused elsewhere — 20% Poll Question 43
  44. 44. © 2018 Health Catalyst • IQ — Intelligence Quotient • Processing complex data sets and having the mental capacity to problem solve at speed • EQ — Emotional Quotient • The ability to perceive, control and explain emotions; risk-taking, creating resilience and empathy • CQ — Curiosity Quotient • Inquisitive, open to new experiences, finding novelty exciting The Importance of Curiosity 44 Source: Chamorro-Premuzic T. “Curiosity Is as Important as Intelligence.” Harvard Business Review. Aug 27, 2014.
  45. 45. © 2018 Health Catalyst Innovation • Where are care models and processes broken? • Where do we need new thinking? • Innovation labs, design processes • Harvesting Spread • Where do we see variation in performance? • How can we reliably spread to ensure that we can provide the best care to every patient, where they are? • Transparent data • Curiosity • Spread model Exnovation • How do we stop what doesn’t work anymore? • How will we eliminate wasteful practices and processes?  It takes courage! Innovation-Spread-Exnovation 45
  46. 46. © 2018 Health Catalyst Do you have a CEO – “Chief Exnovation Officer”? 1. Yes — 8% 2. No — 92% Poll Question 46
  47. 47. © 2018 Health Catalyst Maureen Bisognano President Emerita and Senior Fellow Institute for Healthcare Improvement 53 State Street, 19th Floor Boston, MA 02109 47
  48. 48. © 2018 Health Catalyst Healthcare Analytics Summit 18 Sept. 11-13, Salt Lake, Grand America Hotel TOBY COSGROVE, MD former CEO and President of Cleveland Clinic (2004-2017), who as a cardiac surgeon performed more than 22,000 operations and holds 30 patents for medical innovations KIM GOODSELL the actualized ‘genomified,’ quantified, digitalized “patient of the future," her debut at the 2014 Future of Genomic Medicine conference made headline news announcing— “The patient from the future, here today” DANIEL KRAFT, MD a Stanford and Harvard trained physician- scientist, inventor, entrepreneur, and innovator, Kraft is the Founder and Chair of Exponential Medicine, a program that explores convergent, rapidly developing technologies and their potential in biomedicine and healthcare BRENT JAMES, MD former Chief Quality Officer at Intermountain Healthcare - known internationally for his work in clinical quality improvement, patient safety, and the infrastructure that underlies successful improvement efforts PENNY WHEELER, MD President and Chief Executive Officer of Allina Health, returns a second time as one of the most popular HAS speakers ever MARC RANDOLF Co-founder of Netflix, Marc will share the Netflixed story: how a scrappy Silicon Valley startup brought down Blockbuster and the lessons that could be applicable to healthcare JILL HOGGARD GREEN PhD, RN, Chief Operating Officer – Mission Health and President – Mission Hospital, and recently named to the 2017 Becker’s Healthcare list of the country’s top Women Hospital and Health System Leaders to Know ROBERT WACHTER, MD global leader in healthcare safety, quality, policy, IT; Chair of the Department of Medicine, University of California, San Francisco; best-selling author, “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age” More highlights 4 Digital Innovators (Keynotes) AI Showcase (10 walkabout case studies) Digitizing the Patient Showcase (10-12 stations) 28 Educational, Case Study, and Technical Breakouts 24 Analytics Walkabout Projects More Networking (Introducing “Brain Date”) CME Accreditation For Clinicians 5-Star Grand America Hotel Experience 96 Total Presentations National keynotes Employer Innovation Scott Schreeve MD, CEO, Crossover Health Payer Innovation Kevin Sears Executive Director of Marketing and Network Services, Cleveland Clinic Biosensor Innovation John Rogers PhD, Founding Director, Center Bio-Integrated Electronics, Northwestern University Pricing Innovation Gene Thompson Project Director, Health City Cayman Islands
  49. 49. Q&A
  50. 50. Thank You!