View from CMS: How Patient Engagement will Transform Healthcare Jean Moody-Williams, RN, MPP Deputy Director, Center for Clinical Standards and Quality, CMS
CMS Quality Strategy Better Care Healthier People Smarter Spending Foundational Principles Enable Innovation Foster learning organizations Eliminate disparities Strengthen infrastructure and data systems Goals Make care safer Strengthen person and family centered care Promote effective communications and care coordination Promote effective prevention and treatment Promote best practices for healthy living Make care affordable 2
CMS Framework for Patient and Family Engagement Goal 2: Strengthen person and family engagement as partners in their care Strategic Result: Patients and families are engaged as informed, empowered partners in their care.
CMS Framework for Patient and Family Engagement CMS aims to strengthen person and family engagement in healthcare by promoting patientcentered care delivery with a focus on improved experience, patient self-management, and enhanced shared decision-making. A shift towards patient-centered care will mean defining success not just by the resolution of clinical conditions, but also by whether patients achieve their desired health outcomes.
Foundational Principles Eliminate disparities Ensure the use of culturally, linguistically, and ability-appropriate patient and family educational materials Tailor patient self-management education and support programs to minority and underserved populations Enhance infrastructure and data systems Use health information technology (IT) to ensure communication and collaboration between providers and patients, and families and caregivers Promote and support providers in creating health IT-enabled environments for their patients that are driven by data
A picture of a community ED visit 45% higher than the overall state 70% readmission rate Life expectancy 20 years less than areas just two miles away Food desserts that exacerbated the overall status of chronic diseases Predominately African American
Foundational Principles Enable local innovations Encourage providers to develop innovative interventions to improve communication with patients and caregivers Reward health plans and providers that deploy effective patient-centric tools and resources Foster learning organizations Improve quality measurement of patient and caregiver engagement and promote transparency in access to quality data Educate providers about self-management best practices and how to teach these best practices to patients
Interventions in One Community Community organizing as the theory of change Stakeholder partner cohesiveness measurement Community review of data and prioritization of needs Mapping the network partners Facilitating development of One Stop Service Centers for Seniors Electronic Tracking of Community Service Utilization methodology Medicare Annual Wellness Visit as a means of access to healthcare
Patients Engaged in Program Development Dialysis Facility Compare Overall Distance Shift In-Center Peritoneal Home Rating Starting hemodialysis/ Dialysis Dialysis after # of 5p.m. stations Patient in multiple CMS Open Door Forum on development of Dialysis Facility Compare Patient Focus Groups to evaluate understanding of Star ratings Patient Focus Group on revised language used on the Quality Incentive Program (QIP) performance certificate and difference between QIP and Star Ratings Patients to serve as SME in DFC Star Rating TEP to identify patient centered measures and develop educational framework to aid patient understanding
Goal 2: Strengthen person and family engagement as partners in their care Objective: Ensure all care delivery incorporates patient and caregiver preferences Desired Outcomes Patients are partners at all levels of care Care and treatment reflect the patient s personal values and goals Coordination and communication occurs within and across care teams, including patients, families, and caregivers Patient and family preferences are central in decision processes and implementation Joint development of treatment goals and longitudinal plans of care Information is updated and available for use by patients Achievement of patient-centered goals that focus on prevention Improved coordination and communication within and across organizations Disparities in care are eliminated
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Goal 2: Strengthen person and family engagement as partners in their care Objective: Improve experience of care for patients, caregivers, and families Desired Outcomes Improved support for integrated care models Expanded use of evidence-based services and primary care Increased access to understandable health information Improved promotion of community-clinical partnerships and services aimed at managing and improving care at the community level
Innovation in Payment Models Goal: Our first goal is for 30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide and to do it by 2016. Our goal would then be to get to 50% by 2018. Promote models that put patients first, through Accountable Care Organizations, Patient Centered Medical Home model, and other models that discourage clinician working separately in siloes. Working to ensure that patients are more likely to get the right tests and medications rather than duplicative tests, procedures, etc. These medical homes typically offer patients access to a doctor or other clinician 7 days a week, 24 hours a day, including through extended office hours on evenings and weekends.
Goal 2: Strengthen person and family engagement as partners in their care Objective: Promote patient self-management Desired Outcomes Improved application of self-management practices in our programs Improved visibility of self-management Improved support for integrated care models Increased access to understandable health information Updated and available information for use by patients Improved patient confidence in managing chronic conditions A respectful, trustworthy, transparent healthcare culture
Million Hearts Innovation Video
CMS At Work Engaging Patients and Families Policy, Programs and Quality Improvement Benefit Design, Value and Incentives Engagement in Decisionmaking, Care Coordination, Prevention and Treatment Family and Caregiver Support and Engagement Focused Groups/Patients in the Room for Program Development Incorporating Public Comments Learning and Action Networks with Patients Measures Development and Patient Reported Outcomes Patient s Experience of Care Data Partnership for Patients QIOs/ESRD Networks Improvement Activities and Technical Assistance Weighting of Patient Experience and Patient Reported outcomes in VBP Programs Innovations Models (e.g. Medicare Care Choice Models for Palliative Care; Premium design and co-pay innovations) Money Follows the Person Promoting Patient Adherence From Coverage to Care Activities CMS Compare Sites Early Elective Delivery Reduction Initiative Every person with Diabetes Counts Transforming Clinical Practice Initiative Use of Decisions Support Tools in HIT MU requirements for providing info to patients Advanced Directives Promoting respect for Patient Values, Cultures and Traditions Families in the Room opportunities Learning and Action Network Participation Respite Programs Medicaid Family Counseling Programs Caregiver resources on Medicare.gov 16
QIO Patient and Family Engagement Campaign Goals To increase patient and family involvement in decisions regarding health and health care To promote patient and family empowerment to take action for their own health care and in an effort to improve quality of life The QIOs developed the PFEC based upon: Concepts that encompass multiple dimensions including: Respect for patients values Preferences and needs Coordination and integration of care Information, communication, and education Physical comfort and emotional support Involvement of family and friends 17
Patient and Family Engagement Projects Statistics 12% of SIPs addressed health disparities 12% targeted falls, 12% targeted dementia, 28% targeted readmissions, and 32% targeted cardiac readmissions preventions 80% of SIPs centered around the Beneficiary, 56% on the Family/Caregiver, 40% on the Provider, and 27% on the community 40% of the SIPS targeted at least 3 stakeholders 18
PFEC Landscape 25 States AZ, NE, ND, CA, KY, MI, MO, NY, CT, IL, NV, NM, UT, NJ, OK, FL, MA, MN, NC, SC, VA, IN, RI, DE, KS Beneficiary and Family Centered Care National Coordinating Center (BFCC NCC) QIO Patient & Family Engagement Affinity Groups (PFEs) 19
Highlights California Assisting Caregivers with Dementia Care (ACDC) Aim: The ACDC SIP aimed to improve the care that Medicare beneficiaries with dementia receive, through the educational enhancement of their caregivers. Through increased quality of life and care, the SIP had the potential to extend the Medicare beneficiaries ability to live safely and independently. 20
Highlights California Assisting Caregivers with Dementia Care (ACDC) Implementation: HSAG of California developed an online resource center (ORC) which included educational materials, resources, and contacts regarding dementia caregiving from reputable and trusted sources. This was complemented by original in-house video podcasts on caregiving and dementiarelated topics designed to enhance caregiver learning. They also provided a web discussion board for participating caregivers to connect with each other and share their insights. 21
Highlights California ACDC SIP Goals Metric October 2013 Baseline ACDC SIP Goals June 2014 Goal % Improvement/ Baseline Recruit 25 Caregivers 25 75 25 Pre- vs Post- test scores 74.35% 72.63% 30% # information requests 0 30 25% # of podcast views 4 44 25% 22
Illinois Highlights Reducing Hospital Readmission Rates through Patient Engagement Aim: Telligen aimed to work collaboratively with Medicare beneficiaries to provide information on the preventative services and programs provided by Medicare. Furthermore, beneficiaries were encouraged to become more proactive in their own health to reduce avoidable hospital admissions and readmissions. The project also aimed to help the beneficiaries overcome the barriers they face in obtaining their health care services. 23
Highlights Illinois Reducing Hospital Readmission Rates Implementation: Identified four communities that are low income and high crime areas with a majority of the population being African- American or Hispanic. The communities also have high rates of Medicare readmission and dual eligible. Informational brochures were developed based upon the feedback received on barriers and misinterpretation of covered services. Also, presentations were made during influential faith based conferences and during popular radio programs. 24
Highlights Illinois Readmission SIP Goals 80.00 75.00 70.00 65.00 60.00 55.00 50.00 Baseline Period 7/1/2012-12/31/2012 45.00 40.00 35.00 Measurement Period 7/1/2013-12/31/2013 30.00 25.00 Englewood Washington Lawndale Little Village State (IL) Heights **The following chart shows the readmissions per 1,000 beneficiaries for each of the four SIP communities and the state of Illinois from 2012 and 2013 as reported by the ICPC Semi-Annual Readmission Rates Report. 25
Overall Learnings from SIPs Challenges Beneficiary s knowledge gap, fear of the unknown, lack of informed understanding and informed choices Beneficiary resistance to public acknowledgement of diagnosis Beneficiary s limited ability to access resources and QIO staffers frequency of site visits Beneficiary s fear of scams, unwanted solicitations and fraudulent activity Beneficiary s concern for physical safety and being a victim of crime Organizations current inability to bill/reimburse easily under major payers Organization personnel s perception of increased workload 26
Overall Learnings Lessons Learned Development Stage Investigate target audience s preferred communication channels and vehicles Provide educational videos in various language and incorporate culturally competent and sensitive material in the language of your target population Apply principles of adult learning with limiting presentations to no more than 20-30 minutes Foster trust when working with a senior population and establish a relationship with an already trusted member or leader of the community is important Work with partners who know the community and who understand the participation patterns of the target population 27
Overall Learnings Lessons Learned Implementation Stage Engage beneficiaries through adult interactive games, build trust and knowledge about online content, and improve computer literacy including Bingo, Jeopardy, and Family Feud Include participating caregivers preference for offline communications and outreach tactics including activities during nights and weekends, and provide caregiver assessments to help determine program content Organize smaller groups of about 25 to 35 persons to promote more engagement and willingness to share stories Consider orchestrating lunchtime workshops that facilitates continued learning 28
Overall Learnings Lessons Learned Sustainability Stage Recruitment of patients, caregivers, and providers for ongoing feedback is helpful to implement and sustain a successful project and for effective material development Programs should be developed with enough flexibility to permit ongoing change/improvements based on feedback from partners and participants Self management education is not billable and consequently lessens the enthusiasm for collaboration among potential stakeholders Provide computer skills education and assistance to help seniors access the internet Identify community partners that senior centers and members can turn to for tools and resources 29
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10 th to 11 th SoW Transition Map Region QIO COR GTL 1 LIVANTA TREVOR STONE ANGEL DAVIS 2 KEPRO DAVID RUSSO ANGEL DAVIS 3 KEPRO CHERYL LEHANE ANGEL DAVIS 4 KEPRO CHERYL LEHANE ANGEL DAVIS 5 LIVANTA MALINI KRISHNAN ANGEL DAVIS 31
Beneficiary and Family Centered Care-QIOs Quality of Care Reviews Beneficiary complaints Immediate advocacy General quality of care Referrals (e.g., Suspicion of delay or denial of care due to discrimination on basis of race, color, national origin, age, disability, religion, or sex Emergency Medical Treatment and Labor Act (EMTALA) Reviews Focused Reviews CMS may direct the QIO to perform any of the reviews in the SOW as part of a focused review Some examples, In response to concerns identified in beneficiary appeal review In response to a trend identified in case review 32
Partnership for Patients Patient and Family Engagement (PFE) The Evolving Role of PFE
PfP s Aims Guide Our Work
Partnership for Patients is Committed to Patient & Family Engagement Involving patients and families in their care is the right thing to do Increasing patient and family engagement helps to drive improvement in hospitals
Partnership for Patients Strategy to Support Patient & Family Engagement 1. Authentically engage patients in the work and model best practices 2. Identify organizations that reflect best practices i. Vidant Health-NC ii. RARE Campaign-MN iii. Wexner Medical Center-OH iv. Many others 3. Replicate and spread effective practices 4. Track progress on PFE across 3700+ hospitals and increase transparency 5. Team with and support others involved in leading this work i. National Partnership for Women and Families, Institute for Patient and Family Centered Care, Institute of Medicine, Gordon & Betty Moore Foundation, many others ii. Support 236 patient advocates who are working with 27 HENs and 3714 iii. hospitals throughout the United States AHRQ s 7 Pillars Initiative, QIOs and other Federal Partners
Mobilizing a Diverse Network on PFE Healthcare Providers Practice evidence-based medicine and rely on data in making patient decisions Patients and Families Play the most vital role in Patient and Family Engagement, creating a path to better care and conversation HENs and Hospitals Are on the front lines of patient care and patient engagement Non-profit and Advocacy Organizations Provide ongoing support for key programs, activities for patients and families Quality Leaders Set the standard for how patients and families receive care C-suite Leadership Leaders in adoption of best practices at HENs and hospitals Federal Government and Agencies Have the power to influence large audiences and extend reach and frequency of messages
PFE Metrics: Measuring Hospital Successes Planning Checklist Point of Care Governance Patient and Family Advisor on Board Shift Change Huddles/ Bedside Reporting PFAC or Representative on Quality Improvement Team PFE Leader or Functional Area Policy and Protocol
Progress Toward Campaign Goals Percentage of Hospitals Meeting Each PFE Metric, July 2013 and September 2014
PfP-PFE Accomplishments Development and widespread HEN adoption of the first ever PFE Metrics Creation and expansion of the PFE Network Recruitment of patient advocates for dozens of campaign events Development and execution of 15 well-attended PFE Affinity Group Master Classes Development of more than 50 success stories, case studies and one-pagers covering a range of topics to assist HENs and hospitals in the how-to of this important work Collaboration with the Institute of Medicine (IOM) and other external stake holders
Families of patients who have been harmed are making major contributions to change and improvement results. Helen s son Louis Blackman was 15 years old when he was admitted to the hospital for an elective medical procedure to correct a common congenital defect of the chest. Louis died of a severe adverse drug event caused by the improper administration and monitoring of medication. This medical error could have been prevented. Helen has since dedicated her life to patient and family advocacy, in hopes that other patients and families may avoid the same fate. Helen and 400+ other patient and family advocates have teamed up with CMS to help hospital teams break through barriers in their work and rapidly implement best practices that save lives. 41
Sustainability in 2015 and Beyond High performing hospitals Entire systems of hospitals And Hospital Engagement Networks Have seen improvement on Patient and Family Engagement. We will always be committed to a culture of Patient and Family Engagement.
Patient deaths like Rory Staunton s can be prevented. Rory Staunton died of sepsis at the age of 12, following a scrape he received during gym class at school. Rory developed an infection, and became septic. Early recognition of sepsis would have saved Rory s life. At the Center for Medicare and Medicaid Services QualityNet conference in December 2014, Rory s Parents and Rory Staunton Foundation founders Ciaran and Orlaith Staunton made a keynote presentation urging that sepsis be made a high priority for policymakers and clinicians. 43
Meaningfully Using HIT for Patient Engagement Using secure electronic messaging to communicate with patients on relevant health information Providing patients the ability to view online, download and transmit their health information Exploring Innovations in HIT for portals allowing for one door to relevant patient information Improving Blue Button
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How Do We Improve What are your best thoughts on how CMS can collaborate with you to improve upon these efforts? How can we use HIT to better support patient and family engagement?
Contact Information Jean Moody-Williams, RN, MPP Jean.moodywilliams@cms.hhs.gov