In A Consumer Driven Healthcare Environment

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Caroline Mills
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1 April 2008 In A Consumer Driven Healthcare Environment Rosemary Pope, RN, BSN, CCM Director of Operations OptumHealth Kay Sackett EdD, RN Director Nursing Research & Education Wake Forest University North Carolina Baptist Medical Center 1

OptumHealth Kay Sackett EdD, RN Director Nursing Research &

2 Introduction We Will Be Describing An E-Business Model That Uses A Data Driven Business Portal To Communicate, Collaborate, And Encourage Commerce. The Premise Is That Insurers Are The People That Have The Monetary Funding To Capitalize And Build The Infrastructure To Support Telehealth Technology. 2

The Premise Is That Insurers Are The People That Have The Monetary Funding

3 Nurses Drive Tele-Health Model Nurses Empower Members Using Critical Thinking And Evidence Based Guidelines Through A Variety Of Transparent Tele-Health Programs: Triage & Health Coaching Health Wellness & Prevention Programs Disease Management Programs Quality Initiatives: Each Of Which Focuses On Fostering Patients Proactive Involvement In Their Personal Healthcare. 3

Coaching Health Wellness & Prevention Programs Disease Management Programs Quality

4 Nurse Requirements Management Of These Types Of Programs Require That Nurses Have Specific Skill Sets And Knowledge About: Intermediate Computer Competencies Work Independently (WAH) Clinical Information Systems Databases Telephonic Triage And Healthcare Informatics Critical Thinking & Analysis Skills Understanding Of The Healthcare System. 4

Independently (WAH) Clinical Information Systems Databases Telephonic Triage And

5 What Is Tele-Health Nursing? Instant Access To A Registered Nurse Telephonic Medical Recommendations By RN s Provision Of Triage & Education How? Custom Health Coaching Empower Consumers To Become Healthier Consumer Engagement Next Steps 5

Recommendations By RN s Provision Of Triage & Education How?

6 The U.S.A. Healthcare System Is Broken Healthcare System Is Complex Consumers Don t Know Where To Turn For Help Consumers Are Challenged With Information Overload Significant Treatment And Provider Variation Exists (2) Consumers Select Their Doctor Primarily By Zip Code (1) 6

7 Treatment Choices Vary Greatly This Map Reflects The Density Of Stent Use In The Treatment Of Cardiovascular Disease. Wennberg Dartmouth Atlas of Cardiovascular Health Care 99 7

8 Guiding Consumers Access To Reliable Healthcare Information Consumers Need: - Choices That Are Right For Preferences Around Cost & Time - Facts To Choose More Reliable Care - Without Facts, Are Prone To Be Over Or Under-Treated Our Health Coaches (RN s) Know How To Navigate The Healthcare System & Can Help Consumers Find Appropriate Resources To Support Them 8

Without Facts, Are Prone To Be Over Or Under-Treated Our Health Coaches (RN s) Know How To

9 Nurses Reputation: Circa 2006 Nurses Rank #1 On Gallup Poll Results For Eight Straight Years As The Most Honest & Ethical Profession 9

10 We Are Not About Practicing Medicine We Are About Transforming Healthcare Scenario 1: Consumer Continues To Go Back To Their Zip Code Selected Doctor That Didn t Meet Their Needs The First Time Scenario 2: We Educate The Consumer On The Value Of Choosing A Quality (Premium) Physician, Motivating Them To Change. We Educate Them On Important Questions To Discuss With Their New Premium Physician So They No Longer Have Gaps In Their Care. 10

Consumer On The Value Of Choosing A Quality (Premium) Physician, Motivating Them To Change.

11 Value Basics Nurses Drive Value Right Medications Right Lifestyle Right Provider Right Care 11

12 Two Types Of Logic Deductive Logic - The Old Way Most Common Logic Used In Communication Provides Reasons Before Drawing A Conclusion(s) Disadvantageous When Presenting Your Case/Argument Outcome Is Stated LAST Think Sherlock Holmes Because Of [Fact 1], [Fact 2], [Fact 3], I Therefore Deduce That [Answer] 12

When Presenting Your Case/Argument Outcome Is Stated LAST Think Sherlock

13 Two Types Of Logic Continued Inductive Logic: The New Way Outcome Is Stated FIRST States Your Argument In Terms Your Audience Cares About, & Supports It With Facts Gets To The Point Immediately In Terms Of The Audience s Interests It Is Fact-based Gain Attention With The First Statement Take Advantage Of The Resulting Interest We Are Making A Business Choice To Compel Consumers Using Inductive Logic 13

In Terms Of The Audience s Interests It Is Fact-based Gain Attention With The First Statement Take

14 Health Coach Tech Tools Job Support Systems, References & Other Tools, Such As Web Based Application Databases The LPR Is The Link To These Databases Web Sites (Intranet and Internet) Job Aids (Policies and Procedures), Nurse Tools 14

LPR Is The Link To These Databases Web Sites (Intranet and

15 Nurse Tools

16 Epocrates : A Health Coaches Best Friend 16

17 Taber s Online : A Health Coaches Resource 17

18 Pregnancy Calculator : A Tech Tool For Consumers & Health Coaches 18

19 Treatment Decision Support (TDS) Health Coach Resource For Uterine Bleeding 19

20 Tech Tool: Health Coach Scheduling 20

21 Consumer Tech Tools - Websites Understanding Your Health Health Content Health Assessment Live Nurse Chat Personal Health Record Symptom Advisor Health Tools and Trackers Taking Healthy Action Online Health Coach Real-time Messaging Incentive Management 21

22 Consumer Tech Tools

23 Longitudinal Person Record For Improved Clinical Outcomes & A Seamless Consumer Experience LPR Longitudinal Person Record (LPR) Provides a Centralized View of the Consumer s Clinical, Service, Eligibility, and Demographic Information Across All Programs and Touch Points 23

24 Personal Health Record PHR Personal Health Record Provides Secure Access for Members and Physicians to Realtime Medical, Lab & Pharmacy Data As Well As Health Tracking, Messaging, & Reporting 24

25 Summary Consumer Outcomes: Access to Accurate, Objective, & Relevant Healthcare Information Reduction In Decisional Conflict Pertaining To Treatment Preparation & Realistic Expectations For Treatment & Hospitalization Access To The Best Healthcare Available At Appropriately Controlled Costs Avoidance Of Unnecessary/Inappropriate Treatments & Redirection To High-Quality, High-Efficiency Providers With Reduced Healthcare Deductible Costs Consumers Are Empowered To Take Charge of Their Healthcare 25

26 Summary Health Coach (RN) Outcomes: Increased Job Satisfaction Increased Marketability Enhanced Informatics/Telehealth Competencies Participate In A Virtual Workplace (Work At Home) Drivers Of Technology Change Empower Consumers To Participate In Their Personal Healthcare 26

27 Conclusion Weaver, Kennedy, Erdley, Kim, Chang, Schrader,& Maag (2007) Describe Best What Is Currently Happening In US Healthcare: Because of Advances in Technology and Telehealth Combined With the Growth of a Consumer-driven Healthcare Delivery Model, New Healthcare Delivery Venues,.. Will Be Where the New Nurse or the Clinical Knowledge Worker Will Provide Care for Patients They May Never See or Touch p

28 References 1 & 2.Wennberg Dartmouth Atlas of Cardiovascular Health Care (1999). 3.Weaver, C Kennedy, R Erdley, S Kim, J Chang, P Schrader, U & Maag, M. (2007) Healthcare In 2020 Studies In Health Technology And Informatics 128 Nursing Informatics 2020: Towards Defining Our Own Future Precedings Of NI 2006 Post Congress Conference NI2006 Seoul, Korea EDS Murray, P Park, H-A, Erdley, S Kim, J Washington, DC: IOS Press Acknowledgments: Gale Croall,MD; Mitchell Ross ; Nicholas Rao April

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