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)
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)
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)
Last week I had the privilege of spending two days with diabetes experts in Washington, DC at the American Diabetes Association’s 5th Disparities Partnership Forum.
The goal of the conference was to provide a forum for discussion around the onset of type 2 diabetes in high-risk populations. One of the many populations discussed was women. Brandy Barnes, the Founder and CEO of DiabetesSisters, and I submitted an abstract to the ADA highlighting the unique needs of women living with diabetes and it was selected as one of two Promising Practices to be presented at the conference.
I was so excited about being able to share the work of MicroMass and DiabetesSisters with an audience of experts who are all genuinely interested in understanding how to positively influence women with diabetes. Creating sustainable behavior change is critical, and I know together our organizations are already making great strides.(Read full post)
The aging workforce (the Boomers) has different values and attitudes than those exhibited by younger workers – you know the “Generation X” and “Generation Y” (Gen X & Y) folks. Much has been written about these differences and their potential effect on many industries, and healthcare is not exempt.
What is of concern is that the healthcare industry is growing, and we are facing a physician shortage. The major contributing factors to this shortage are: an aging population; rising practice expenses; and an increase in the number of physicians who want a more flexible work schedule. In addition, there are an estimated 340,000 physicians who have started retirement at the beginning of 2010.
Adding all the new technological advancements in medicine along with these demographic trends, we can begin to see the importance of successfully recruiting young physicians. In essence, recruiting young physicians will (if it has not already) become paramount to the success of many healthcare entities.
Both Gen X and Y physicians carry many of the known traits of Gen X and Gen Y workers: they are technologically savvy and expect technology to be well utilized in the workplace; they value personal fulfillment; they seek a casual work environment and an attractive work/life balance; they are interactive and prefer immediate feedback; and they seek out creative challenges and opportunities to lead. Best of all they are ambitious; however, they require good rational reasons to go the extra mile.
It is clear that the practice of medicine is in the midst of an evolution, and it appears that Gen X and Y physicians will be perfectly suited for it. In fact, one could argue they are driving it. And of course, the federal health care law is an impetus to some of these changes, as well. It is fortunate for us that Gen X and Gen Y physicians embrace technology and teamwork; they like electronic medical records and smartphone apps; and they like sharing the load with other doctors on the team. This is opportune because we need doctors who can practice medicine as well as improve medical care on the larger scale.
From the human health behavior point of view, it will be interesting to see how we, as healthcare marketers, adapt to this new kind of physician and the new patient-physician dynamic/dialogue that will occur. From my personal point of view, I cannot wait for the new ways in which these new, young physicians will make my healthcare experience better.(Read full post)
If you’re like me, you’ve heard the song hundreds or even thousands of times and never thought too deeply about the lyrics. Let’s face it; they don’t make a lot of sense on their own. Some have speculated that the song references the personalities of different members of the band (i.e. “one holy roller” for George Harrison, the “spiritual” Beatle). Or possibly, it’s just the result of some other illegal, “creative influences.”
As I’ve been researching journal articles and reading blogs and editorials on healthcare reform, I’ve been struck by the fact that so many of the proposed changes to the system are about making healthcare more collaborative. It’s about providers, patients, and other stakeholders coming together. Just take a look at three of the proposed changes—Accountable Care Organizations (ACOs), Insurance Exchanges, and Patient-Centered Medical Homes (PCMHs).
Accountable Care Organizations
ACOs are one of the most anticipated aspects outlined in healthcare reform. The idea is that all sorts of providers, including physicians, specialists, and hospitals will come together to provide care that focuses on quality rather than volume of services. Kind of sounds like an HMO, right? Well, not exactly. One of the major differences between ACOs and HMOs is that ACOs give their patients the option of going to providers outside the ACO network. ACOs would cover a minimum of 5,000 Medicare patients for at least 3 years. The goal of an ACO is for providers to work together to cut unnecessary healthcare costs while still providing quality services. If they are able to meet certain cost and performance measures, they’ll be reimbursed by Medicare according to their cost savings. To keep ACOs from dominating the marketplace, they’ll be subject to anti-trust and anti-fraud review processes. The moral of the story is that it’s advantageous to work as a team to save money and be reimbursed a chunk of the savings.
What happens to all the people who aren’t insured through their employer or are purchasing their own insurance? Prior to healthcare reform, those individuals would either end up paying higher premiums or choosing to forego insurance entirely. If the individual mandate stands, anywhere from 30-35 million people who were previously uninsured will be required to purchase insurance. With so many people buying insurance on their own, why not bring them together to leverage more affordable premiums? That’s exactly what insurance exchanges are designed to do. Exchanges will prohibit insurance discrimination against individuals with pre-existing conditions and bring together individuals and small businesses (with fewer than 100 employees) to purchase insurance. All exchanges will be required to have four different benefit categories of plans as well as a catastrophic plan. These exchanges will be run by states and are effective starting January 1, 2014. For more information on exchanges, see the Kaiser summary of healthcare reform.
Patient-Centered Medical Homes
In a similar vein to ACOs, PCMHs will bring together providers to enhance patient primary care. The difference between an ACO and a medical home is that ACOs are networks of providers, while a medical home is a team of primary care providers, usually made up of physicians, nurses, and physician assistants, who are assigned to a particular patient. The PCMH team is led by the patient’s personal clinician who works together with their team to coordinate care and promote overall patient health. This approach has been shown to be especially beneficial for patients with chronic conditions, but is also an effective approach for other groups of patients, as well. The Affordable Care Act provides an incentive for PCMHs—they can receive reimbursement for caring for patients with chronic conditions who are covered by Medicaid.
Even though the lyrics of “Come Together” may not make all that much sense, the message certainly applies to the changes we’re seeing in healthcare today. Healthcare is moving in the direction of collaboration and it’s moving quickly. Most of the changes mentioned above are already being implemented or in the final stages of planning. Only time will tell how these changes actually stand up to all the hype, but for now, it looks like the one thing is for sure–patients, providers, and others are coming together, right now, over the health concerns of you and me.(Read full post)
Affordable Care Act. Obamacare. The Donut Hole. Individual mandate. Healthcare reform.
It’s hard to escape it—discussion about the changing US healthcare system is everywhere.
As I was driving into work this earlier this week, I heard a story about the upcoming Supreme Court ruling on the constitutionality of the Affordable Care Act (ACA). You can listen to it here.
Despite the hubbub in the media around the healthcare debate, sifting through all the policy lingo and technical jargon can be overwhelming. The law itself is a lengthy 955 pages–not exactly user-friendly.
For many of us, the topic of healthcare reform is like the mystery meat casserole Great Aunt Marilyn brings to family reunions—you don’t really know what’s in it, you definitely don’t want to ask what’s in it, but you try it anyway because she tells you, “It’s good for you!”
Whether we understand what’s in it or not, the Affordable Care Act will change healthcare as we know it. In fact, it already has. Since it was enacted in 2010, the ACA has expanded health insurance coverage for young adults and individuals with pre-existing conditions, offered prescription drug discounts to seniors, provided free preventive care like mammograms and colonoscopies to the newly insured, and started to shift the healthcare system to a more patient-centered model. (Healthcare.gov, a site managed by the Department of Health and Human Services has outlined the key aspects of the law and a timeline for when they will be rolled out.)
This summer, I’ll be taking a look at ways the Affordable Care Act is changing the healthcare landscape in the US. Each week, I’ll focus on a different topic related to healthcare reform and how it impacts people in different levels of healthcare, from patients to providers to pharmaceutical companies. Check back in for more insights, ideas, and musings about all things healthcare–Great Aunt Marilyn would want you to. Just watch out for the casserole.(Read full post)
It usually goes something like this:
- Patient goes to see doctor for an ailment
- Doctor assesses patient
- Doctor writes patient a prescription
- Patient thanks doctor and leaves, prescription in hand
- Patient decides not to fill the prescription.
From then on, the doctor and patient are operating under conflicting assumptions—a great plot for a 70s sitcom, but bad news for better medical care.
Recent research looked at primary nonadherence, that is, patients failing to fill an initial prescription. Rates of nonadherence were highest in metabolic diseases such as diabetes (31%), hypertension (28.4%) and high cholesterol (28.2%).
If so many people are failing to fill their scripts, but the doctor assumes that they are taking the medication as prescribed, how can treatment progress effectively?
Doctors are only as good as the information they have.
Given the high rate of primary nonadherence, doctors should make the following direct question a standard part of follow up visits, “Did you fill the prescription for Drug X that I gave you?” People are less likely to lie in the face of a direct question.
Obviously that one question won’t solve the communication disconnects that plague doctors and patients, but it’s a start.
So don’t lie to your doctors. Trust me, they’d rather hear the ugly truth.(Read full post)
For many people living with chronic conditions, new research in medicine is opening up possibilities to advance treatment at an amazing pace. With a better understanding of the cause and contributing factors for many conditions, the idea of a “cure” is not a far-fetched possibility.
This could really change the way certain conditions are viewed. For many physicians (and patients) disease management is often focused on addressing symptoms of the condition – the downstream effects. Think about the flu – the vaccine is pretty good at preventing it, but once you have it there’s not much to be done except minimize the symptoms.
But now, there might be a way to stop the virus before it can spread in the body. Research has uncovered a “master key” of sorts that could act like a universal “off switch” for flu viruses. This approach of looking upstream and focusing on the root cause might lessen the overall burden and perceived severity of many conditions.
Marketing for many drugs has mirrored this treatment approach for years. The focus is almost always trying to affect the prescribing decision of the doctor. When you consider that this decision is the culmination of a lengthy and involved process that includes not only the time spent with a particular patient, but also the doctor’s past experience treating similar patients, the way they were trained in medical school, and even their personal beliefs and prejudices, you see that there is a lot more going on upstream that has potential to shape prescribing behavior.
These factors that guide prescribing decisions are often overlooked in pharmaceutical marketing because the drug doesn’t always have a role. But if, like in the flu example, you can effect a change early in the process, the downstream results can be favorable.(Read full post)
Recently, the FDA approved Dendreon’s Provenge, a vaccine for prostate cancer. The vaccine is a milestone for immuno-oncology, as well as for personalized medicine. It’s really interesting – each dose of the vaccine is made from a patient’s own cells so every therapy is unique to the individual.
Testing individuals to customize therapy is nothing new. It’s been done for years in oncology and infectious disease, but usually as a guide for selection of existing therapies.
The potential for further advances in personalized medicine is huge, potentially reaching many important therapeutic areas. But one key issue that I can see from this is re-training physicians to think differently about treatment than they do now.
We know that physicians often treat patients in a predictable way, usually based on their own experience, expectations, and assumptions about a condition or medication. Most of the time this is OK, especially when you consider the time constraints in most practices and the prevalence of many chronic conditions. But illness affects everyone differently, and a one-size-fits-all approach may not be ideal.
Perhaps the evolution of personalized medicine will help health care practitioners to think differently about the way they practice. By learning more about the personal characteristics, values and behaviors of patients and not just the condition they have, their approach to treatment could become more individualized. Personalized medicine already has its own advocacy group. Lets encourage more frequent use of patient insights to create a personal medicine movement.(Read full post)