With the development of the accountable care organization (ACO) initiative within the Affordable Care Act, a shift occurred in the relationship between providers and patients. Previously, providers had the responsibility of coordinating care and the role of the patient was essentially a passive one. With the new legislation, providers are forced to work with patients to help them be accountable for their own care. Success is no longer measured with the amount of services provided; rather, they are now measured with the indication of better health outcomes. The ACO cannot survive or succeed unless there is a working relationship between patients and providers.
This is where health coaching comes into the picture. If patients need to change behavior to be more healthy/active/adherent/involved in their care, how can they be supported in that endeavor when they have such limited time with their healthcare team? Patients spend only about five hours per year with an HCP, leaving over 5000 hours they must spend managing their condition themselves. To combat this trend, ACOs began to look into the idea of health coaching to serve as a supplemental source of information and support for patients.
Instead of serving a clinical role, health coaches help patients get to the underlying behavioral barriers to doing the recommended steps needed to improve their own health outcomes. Health coaches are led by the patient’s agenda instead of the other way around. By having an advocate who is not pushing a clinical agenda, patients can open up, overcome ambivalence, and decide on a plan of action. Then they can set goals with their coach to keep them accountable in a positive and encouraging environment. The health coach is not a personal trainer, a dietician, or a therapist. What this person does do is help the patient focus on what they want to change in the ways they have identified will work for them. After all, patients are the experts on themselves.
But has health coaching provided tangible value in the space of accountable care, especially in cases of chronic disease? Published literature says ‘yes.’ In a summary by Bennett et al from as early as 2010, they list some of the literature proving the efficacy of health coaching for chronic diseases. In a study on the impact of health coaching on a behavioral weight-loss program, participants who worked with a professional health coach or peer lost more body weight than those working with a trainer. A study by the CDC indicated that even phone-based health coaching improves patients’ wellness goals related to healthy weight, healthful eating, and physical activity.
Health coaching is also making its way into the educational setting. The Vanderbilt University School of Medicine has collaborated with other programs to sponsor a health coaching certificate program starting in the fall of 2014.
“So much of the old model has been to scare or shame people into making changes, but this program offers a different model of collaboration with individuals and helps them be successful at their health goals” indicates Dr. Manning, one of the program directors.
Health coaching. Another empirically-proven way to put the patient in the center for lasting results.(Read full post)
Pharma companies often boast a corporate vision that is broader than their products, or the conditions those products aim to treat.
“feel better”….“improving care for patients”…“a healthier world”…“extend quality of life”
Changes in the healthcare landscape have underscored the relevance of vision statements like these. But how do the day-to-day operations of companies really contribute to realizing this vision? Under the ACA, metrics like patient satisfaction are becoming more and more important; how do we know if the products pharma companies are developing and the services they are offering are really making a difference in patient’s lives? Are patients feeling better? Is care improving?
I recently heard a radio story on innovative ways to measure well-being at a societal level. The Organization for Economic Cooperation and Development (OECD) in Paris has developed a tool that asks people all over the world to prioritize the components that make up a happy life. The Better Life Index allows respondents to rate the importance of basic needs like housing, income, education, and health, but also more intangible things like life satisfaction and work-life balance. Aggregate those responses at a national level and you get a good picture of the well-being of the country as a whole. OECD hopes that the Index will be used in conjunction with traditional measures like GDP to paint a more comprehensive picture of the lives of real people around the world.
If we think of traditional efficacy and safety measures as analogous to GDP in a pharma context, what are our industry equivalents of the Better Life Index? And why are so few people talking about them?
Here at MicroMass, we strive to insert patient centricity into all of our client work. There are behavioral-based patient reported outcomes (PROs) that can be embedded into clinical trials to uncover the real impact of products in development on patients’ lives. Click here to read more about how MicroMass Medical Communications can help companies maximize the impact and relevancy of clinical data.(Read full post)
It can be really difficult for us to hear bad news, especially when the bad news is about something serious like our health.
In some of our recent research about the conversation between doctors and patients with chronic conditions, we asked patients to share how their doctor communicated the diagnosis to them, and how they as the patient felt hearing the news.
We found that, even though patients are often upset when finding out they have a condition like Multiple Sclerosis, there are things that the doctor does or doesn’t do that can positively or negatively impact the patient moving forward.
First, we found that patients want and need the whole truth about their condition. Doctors may sometimes think they’re helping by watering down the information or not talking too much about details of the condition, when in reality the patients need this information to gain clarity, familiarity, and to successfully move forward to starting treatment.
We also found that, while it’s very important for the doctors to give the patients a detailed and complete diagnosis, doctors should also make sure to leave enough time during the conversation to talk about treatment options. If the patient hears just that they’ve been diagnosed with Leukemia but doesn’t hear what treatment options are available, they could be left without much confidence or hope in being able to treat their condition.
Lastly, we found that the first few sentences of the conversation communicating bad news, like a diagnosis, matter a lot. In several instances patients described how the doctor didn’t communicate the beginning of the diagnosis well, saying things like “you have an aggressive cancer” or “I’m so sorry”. In these cases, the patient tended to not hear and really process the rest of the conversation. Things like poor word choice or the wrong demeanor can impact patients negatively in a way that lasts far beyond the diagnosis.
No patient wants to hear bad news. But when bad news needs to be communicated, it helps the patient immensely when they hear the whole truth, all about their treatment options, and are met with words and demeanor that give them as much confidence and hope as possible.(Read full post)
Imagine you’re in the shoes of Bill, a type 2 diabetes patient. You’ve just left the doctor’s office, where you’ve told your PCP that things seem to be going pretty well. You are eating better, you are starting to take some short walks, and overall you feel pretty good. Your doctor seems happy about all of this, but your A1c is higher than he’d like, he tells you. He says you should pay more attention to things like carbs, and creating a balanced plate at meals. And you should exercise more, because the walks aren’t doing the trick.
What? You just told him that you’re eating well and you’re exercising. You feel let down as you leave the appointment. On your way out, the receptionist hands you a few pamphlets that your doctor wants you to take home and read.
You scan the titles: Eating Healthy with Diabetes, The Diabetes Diet, and Type 2 Diabetes and Exercise. You toss the pamphlets in the trash on your way to your car.
What just happened here? The short version is this: Bill goes to his quarterly appointment feeling energized and proud of the work he’s done caring for his diabetes, only to be told that what he’s doing isn’t enough, and he needs to do more to get tighter control of his numbers. His doctor hasn’t truly heard him, and is treating him like a number. On top of that, his provider gives him information-heavy, generic materials covering topics Bill already thought he was managing well. Bill leaves feeling defeated and annoyed with his doctor.
These well-intentioned informational materials typically get tossed aside for these reasons and others. In the research we’ve conducted with patients with chronic diseases, they’ve told us the number one quality they value in their doctors is their ability to listen. They want a doctor to hear their view point and take their position into consideration when coming up with an action plan. Patients want a management plan that reflects both their expertise (as the patient) and the doctor’s expertise. The complete opposite happened to Bill.
There are so many ways Bill’s scenario could be improved. Key tactics that could have a big impact on Bill’s situation include:
- Point of care tools delivered to his PCP to help him work with Bill to uncover his key behavioral drivers to change
- Trainings to help his PCP communicate more effectively and utilize appointment time more efficiently
- Behaviorally-based content provided to Bill to help him set personal goals that are of interest to him and that will help him work through his unique problems and obstacles
These kinds of personalized solutions allow us to reach an audience more effectively and promote positive change. They help facilitate better in-office communication between doctors and patients, which impacts how a patient views his or her condition and ultimately how it gets managed. And these solutions serve as extensions of the appointment, helping patients manage their conditions over the 3 or 4 months they are on their own between appointments.
It’s time to rethink how we’re educating our patients and truly begin energizing them to take an active role in their care.(Read full post)
Medical innovations surround us: needle-free vaccines, personalized medicine, bionic eyes. When most people think of innovation, technological or pharmaceutical advances come to mind. But what if there were one simple aspect of medical treatment that everyone had access to, costs very little, and could profoundly change the health of every patient with a chronic health condition? Would you consider that an innovation?
The answer is simple – communication between patients and providers. Words. Tone. Advice. Instructions. Questions. Communication is more of a fundamental than an innovation. But without communication, patients would not able to receive the care that is best for them. And providers would not know the important context in which to interpret clinical values and symptoms. In fact, without communication, doctors would not know about some symptoms at all—symptoms with no objective value or name—things like “I have trouble walking to my mailbox because I am so short of breath” or “My pain gets worse when I walk upstairs.”
Trust me, I am a fan of innovation. I just wonder if the fundamentals of health care are minimized because they lack the cool factor. And focusing on the fundamentals, like effective communication, can have a tremendous impact on both quality of care and healthcare costs.
Common chronic diseases in our population today, such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, and asthma, all depend on patients self-managing and making everyday decisions, including interpreting and following medical advice, taking medication, following a diet, and deciding what information to share with their doctor. Patients largely manage their conditions on their own every day; providers get only a glimpse of what is going on. That’s why communications is so important.
What can be discussed in the average 7-minute patient-provider conversation to set patients down the right path? How should that 7 minutes be spent? What questions should the provider ask? What information should the patient share?
With many chronic diseases, prescription treatment is necessary. Indeed, patients must leave the office visit with the right medication for their needs. But I would argue that communication, not medicine, should be elevated to first-line therapy.
Providers have an opportunity to uncover what matters most to patients—and to uncover what patients are most willing to do. Discussing the clinical benefits of starting a new treatment does little to help patients who don’t see their condition as chronic. Perhaps that 7 minutes would be better spent on improving the patient’s health in another way, such as discussing goals related to diet or addressing challenges the patient is having with their medicine.
Healthcare organizations today focus mostly on clinical and technological innovations to improve both the continuity and the quality of care. Fundamentals, like communication skills, are getting lost in the mix. It’s time we think about equipping providers with the knowledge from recent advances in behavioral science by investing in skill-building programs and resources to help providers apply communication strategies such as motivational interviewing and shared decision making. These evidence-based approaches can drive the lasting changes in behavior and outcomes that are needed to meet today’s success metrics.(Read full post)
It is very hard to comprehend the depths of the tragedy that happened with the downing of Malaysia Airlines Flight 17 last Thursday. The implications of the 298 lost souls will continue to resound for decades to come.
Some of the lives lost were devoted to improving access, advocating for rights, creating innovative solutions, and sharing passion and commitment to end HIV/AIDS all over the world. Many of those individuals were on their way to the International AIDS conference in Melbourne, Australia. Dr. Joep Lange was one of the key researchers behind several HIV treatment trials and devoted his life to the development of affordable HIV treatments for use in resource-poor countries, in addition to preventing mother-to-child transmission of HIV. His death is an enormous loss to global health research.
We at MicroMass continue to turn our thoughts and prayers to the victims and families of this senseless tragedy, and salute the work that was done by the talented and visionary individuals on board Flight MH17 in the space of HIV/AIDS worldwide. May we honor Dr. Lange and those lost by continuing to contribute to their determined effort to end the spread of HIV/AIDS.
“If we can get cold Coca-Cola and beer to every remote corner of Africa, it should not be impossible to do the same with drugs.” –Dr. Joep Lange.(Read full post)
Last week our behavioral and creative teams had the privilege of receiving a 1-day health coach training from experts at the UNC-Greensboro Department of Public Health Education. This training was a unique opportunity to learn best practices when working with patients in the most intimate of settings: a health coaching session.
The dynamic day included an explanation of the 3 different styles of communication used in coaching: Directing, Guiding, and Following.
“Directing” takes place when the coach tells the patient what to do and the best way to do it. “Following”, on the other hand, has the coach openly listening with no agenda, and following along with whatever the patient wants to discuss. The “Guiding” style is when the coach affirms that the patient is capable, and works to increase the patient’s ability to change the desired behavior, guiding them through questions and conclusions rather than dictating them.
It was interesting to learn from this training that, though guiding may be favored in our changing healthcare environment, there is a time and place for each of the 3 styles of communication in talking with patients. There are times when, for the patient to understand the gravity of a diagnosis or necessity of treatment, the doctor should use the directive communication style. The patient needs to know exactly what to do and how important it is to do it. Other times following may be most appropriate, if the patient simply needs time to have their thoughts or concerns heard.
A big part of my internship with MicroMass this summer is working on a research project that looks at the trends in doctor/patient communication and how the way in which a doctor communicates with the patient may bring about different patient outcomes. We’re currently fielding the study, and are eager to learn more about the doctor/patient relationship from people living with chronic disease. Of particular interest is learning how these different coaching styles are being used in real-world situations and how they may impact both positive and negative outcomes.
The question is –which style is most beneficial when? And how can the healthcare provider figure that out in at any given moment? We are looking forward to seeing how the results of this study bring us one step closer to finding out.(Read full post)
When people find out I do pharmaceutical marketing, they act like they’ve met a Yeti. “YOU do those ads on TV with all those nutty side effects?!” And then the questions begin.
“How come those ‘sick’ people look so happy?”
“If I get that disease will I have a lake house, too?”
“What’s with all the side effects?”
“What in the heck is a ‘fatal event’ anyways?”
And my personal favorite—“Why do they always say ‘talk to your doctor’? Don’t you HAVE to talk to them to get the prescription?”
I may not have deep answers to any of their other questions, but I can answer that last one. Yes, you do have to talk to your doctor to get started. But that talk needs to be more than you going into his office to announce your interest in this shiny new drug and expecting him to just whip out his prescription pad.
Sure, you want to talk about that awesome commercial you just saw. Sure, you want to know what a “fatal event” is and if those magic new prescription-only eye drops are worth the risk. Sure, you want to know if your insurance will cover this. But even if you get beyond all that, the conversation is not over.
Now you two have to talk about your role in your treatment plan with these little droplets. This is an essential and unfortunately overlooked step that can make a huge difference. This is the part where you find out if this is a treatment plan you can actually adhere to. Perhaps you have to inject the drug into your ear 6 times a day. And then lay flat for 2 hours after each injection. If you have a job where sitting upright for long periods of time is encouraged, this drug may not be for you. But if you have an honest talk about your treatment goals and your lifestyle, you can find out what will be best for you.(Read full post)
Patient engagement is a concept that we’ve been hearing a lot about for the last couple of years and one that is critical to impacting health outcomes. As we’ve seen in our own research, oftentimes industry terms are considered buzzwords and carry different meanings to different people. While there isn’t true consensus on the exact definition, even greater uncertainty for me remains around the steps required to actually create an engaged patient.
Type “patient engagement” in Google, and you get 754,000 results. There are sites that claim they’ll help you boost patient engagement, help you create motivated and engaged patients, and even provide tools to help healthcare providers better understand why patient engagement is so important. Clearly, it’s an important topic, but who do you listen to when it comes to motivating patients? What is truly important?
I watch a lot of TED Talks, and one that sticks out in my mind was presented by e-Patient Dave. Dave was diagnosed with terminal cancer, but through networking and social media, was able to find a treatment that ultimately saved his life. He has a website that contains his own postings, guest entries, and other resources from the patient and HCP perspective.
In March, Dave shared a guest post, written by Dr. Patricia Flatley Brennan, that talked about the importance of technology in creating an engaged patient. I agree, technology allows for so many different experiences for patients and providers that were not available just a handful of years ago. But when I read the title, Patients+Providers+Technology=Engagement, the first thing I thought was, “It’s not this simple.” Questions and thoughts were popping into my head, like:
- What if patients have inaccurate perceptions about their condition?
- What if the provider uses terms that the patient doesn’t understand?
- What if the technology is just information overload?
- Technology alone isn’t the answer
Dr. Brennan makes some really good points. For example, she talks about the fact that patients are truly the experts when it comes to their own bodies. She also talks about the importance of patient-provider communication. But she goes on to state “the key to…creating successful partnerships between patients and providers is technology.” As a behavioral science expert, this made me nervous. We don’t want to be sending the message that if technology is included, patients will be more engaged. As I stated earlier, it’s just not this simple.
Take physical activity trackers, for example. Lots of people use them to track their daily activity. They may even bring their trackers to doctor’s appointments. But these trackers are nothing more than a digital way to track activity. For patients who are also struggling with things like not knowing how to exercise, not knowing what exercises to do, not knowing what equipment they need, or believing they need to lose 50 pounds for it to matter, a tracker, while digital, isn’t going to help them with these underlying issues. As a result, they are no more engaged before or after using the tracker.
I don’t dispute the value of any of the programs that are presented in the posting. In fact, many of them look really great, and deserve attention for the positive change they’ve helped create. What I am cautioning against more generally is promoting technology alone as the key ingredient. While technology is important, paying attention to the underlying drivers of behavior is equally critical in promoting change. Starting with an understanding of what drives behavior, then integrating this with technology, can yield powerful tools that will not only change patient behavior but also impact health care delivery and clinical outcomes.
I’m not in any way downplaying the role of technology here, but suggesting that taking into account the drivers of behavior can lead to even more meaningful technological developments.(Read full post)
It happens to people all over the world. A man loses his job and has no idea how he is going to pay his monthly bills. And on top of it, he has a daily medication he needs to keep up with. He goes to the doctor, but because of a myriad of factors, he doesn’t disclose the fact that he just lost his job. He’s tired. He’s embarrassed. He’s in denial.
What the doctor doesn’t know is that Tom is about to spiral into a bout of serious depression. He will become disengaged from his own care simply because he will be in “survival mode” over the next few months. Tom will stop taking his medication every day, and since the doctor won’t see Tom for another 6 months, it’s not until then that the doctor realizes that Tom’s health has declined greatly due to non-adherence.
At the other side of the country, Carla is diagnosed with HIV. Her doctor prescribes Complera, which is a drug that requires patients to consume at least 400 calories with the drug. Overwhelmed and reeling, Carla doesn’t ask questions. The problem? Carla is homeless and doesn’t consume 400 calories at any given meal. Carla takes the medication and because she does so on an empty stomach, she experiences very difficult side-effects and decides not to adhere to her medication. She sets off down a path of resistance to an entire class of HIV medications.
Where is the disconnect? Providers often do a great job developing rapport, and many patients trust and value their physicians. However, as evidenced by non-adherence trends, something isn’t clicking in those exam rooms. If Tom’s doctor had said “So, what’s going on in your life these days, Tom? Has anything happened recently that might get in the way of you taking your meds?” or if Carla’s nurse said “Walk me through a day in your life” or “What is important to you when you think about taking an HIV medication” then maybe they would have realized that Carla needed a different medication because of her circumstances.
A recent study in JAMA showed that there are difficulties teaching effective communication to providers. In the study, 472 internal medicine and nurse practitioner trainees were randomly assigned to either participate in an eight-session, simulation-based communication course, or to forgo communications training. The end results from patients indicated that there was no difference in satisfaction with the ones who had been trained. In fact, the patients who talked with providers who had the training were more likely to be depressed.
What if we focused on engaging patients instead of only thinking about the communication aspect? Providers don’t need to be trained as expert communicators, but they do need to delve deeper into the life of a patient in order to uncover key information that the patient isn’t telling them. By doing this, providers will be able to tailor the treatment regimen in a way that will ensure optimal adherence/buy-in from the patient.(Read full post)