Leadership

“The Brave New World of Patient-Centered Care”

– Dr. Susan Frampton’s Address to the Idaho Healthcare Summit

Dr. Susan Frampton opened her keynote address at this year’s Idaho Healthcare Summit with a tale of her bout with Lyme disease and how she was able to leverage technology on a Friday night to work with her primary care practitioner. She’d had the disease before, knew its symptoms, and wanted to start the prescription she knew she needed that weekend. Using the technology on her smartphone and a call with her physician’s nurse, she ultimately got the prescription called in within 12 hours of initiating the first contact. It was a story of patient-centered care.

This set the stage for the rest of her talk about keeping the patient at the center of care as the healthcare landscape changes. Her keynote address, “Brave New World of Patient-Centered Care: Trends in Policy, Practice, and Payment,” framed areas of opportunity in patient-centered care – where it’s going and what patients are asking to be delivered. She spoke at the fourth annual Idaho Healthcare Summit in Boise on May 17, 2018.

Healthcare Consumerism

 Dr. Frampton’s discussion focused on the rise in “consumerism” in healthcare: regulatory trends like direct access lab testing and direct to consumer advertising and genetic testing; patients turning to consumer-based rating services like Yelp to find doctors and hospitals; and Uber partnering with physician offices to transport patients. She said that virtual health (telemed services, texting, email) is becoming the 20th century house call and that payers are beginning to cover these services. She emphasized that meeting patients where they are is essential for the healthcare system to remain effective.

All these consumerism trends point to patients becoming more engaged in their own healthcare and seeking care at lower costs; which lead to better quality outcomes. A 2017 National Academy of Medicine publication on evidence connected better quality outcomes to engaged patients/consumers; she said it hasn’t yet led to lower costs but she sees that on the horizon.

But with the landscape changing so dramatically – financially and technologically – with programs like Doctor on Demand, do-it-yourself disease management phone apps, artificial intelligence, and personal wearable technology, she said, it’s important to keep healthcare where it needs to be – centered on the patient. It must be accountable to engaged patients, families, and consumers.

Policy Changes

And the landscape is also changing with respect to policy. In 2017, the National Academy of Medicine revised its definition of patient-centered care to read:

“care designed with patient involvement, to ensure timely, convenient, well-coordinated engagement of a person’s health and healthcare needs, preferences, and values: it includes explicit and partnered determination of patient goals and care options; and it requires ongoing assessment of the care match with patient goals…”

In addition, the CMS payment reform initiative on Alternative Payment Models (APM) now includes patient engagement criteria; shared decision-making is a ‘must pass’ criteria for PCMH certification; congress has taken steps to aid family caregivers; a public-private partnership funded by HHS to the tune of $1billion, Partnership for Patients (PfP), is working to improve the quality, safety, and affordability of health care for all Americans; and CMS is awarding funding to continue Hospital Improvement Innovation Networks (HIINs).

Idaho is participating in PfP with 29 hospitals (61%-80% of hospitals) enrolled for the state. The PfP vision for hospitals and other health care providers is to achieve quality and safety goals by:

  • fully engaging patients and their families,
  • determining what matters most to them in every situation,
  • and partnering with them to make improvements to all aspects of care.

Despite these trends, Dr. Frampton asked whether consumer-centric approaches to health care are a capability in the U.S. healthcare system? Her answer was no, not yet. In a recent study, 66% said consumerism is a priority but not a capability (16%). She said resistance to change, lack of urgency, competing priorities, and lack of clear evidence seem to be barriers to action.

Still, consumers want it quick and easy – this is what is means to be an engaged patient – and, she said, you lose business when you don’t deliver. So, the Centers for Medicare and Medicaid Services (CMS) has listed as its strategic goals:

  1. Empowering patients and doctors to make decisions about their health care.
  2. Ushering in a new era of state flexibility and local leadership.
  3. Supporting innovative approaches to improve quality, accessibility, and affordability.
  4. Improving the CMS customer experience.

All of which lead to what Dr. Frampton spoke directly to as the theme of this year’s summit, “Healthcare Solutions the Idaho Way.” Her address focused on policies and practices that align with Idaho’s efforts to transform healthcare and initiatives taking place around the state to keep the patient at the center of care. Her closing urged the audience to ‘Think Globally, and Act Locally,” and suggested:

  • Using technology more effectively to engage patients, families, and consumers.
  • Tying healthcare service quality improvements to consumer preferences and related emerging ‘personalized’ technologies.
  • Striving to meet and exceed patient and consumer expectations around cost, convenience, access, and quality.
  • Supporting patients and their families to play larger roles as members and captains of their own healthcare teams.

…it’s all about continuing the story of patient-centered care in Idaho.

________

Dr. Frampton is the president of Planetree International, a non-profit advocacy organization that works with a growing network of healthcare provider organizations across the continuum to implement comprehensive person-centered models of care. Dr. Frampton, a medical anthropologist, has authored numerous publications, including the three editions of Putting Patients First (Jossey-Bass 2004, 2008, 2013) and served as lead author on the National Academy of Medicine’s Harnessing Evidence and Experience to Change Culture, released in early 2017. In addition to speaking internationally on culture change, quality, safety, and the patient experience, she was honored in 2009, when she was named one of “20 People Who Make Healthcare Better,” by Health Leaders Magazine.

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