PR and Health Reform by Chuck Alston

Editor's Notes

• #3: PRSA Health Academy webinar:Learn about the massive restructuring that is underway as health systems and insurers figure out a new world order that is blurring the lines between companies that manage risk – insurers – and those that provide care – health systems. Consider how this new landscape of health care is littered with language land mines that can damage a health system’s brand.Explore new language that communicates the benefits of these health care delivery and payment reforms.Understand the new emphasis to drive patient and consumer behavior change toward wellness, access to preventive care, and medication adherence.Recognize the growing importance of stakeholder communications both within the health care sector and between it and purchasers.Big believer in research. Many sources today – RWJF, work for commercial systems and published research A list of major sources available at end of presentation.
• #4: Most people know it as an attempt to expand access. But its quality provisions are quite far –reaching, b/c as the people on this call know, Medicare is the 800 ground gorilla of health care payment. Where it goes, the private sector won’t be far behind. DRG system in hospitals, for example.
• #5: This is a map of the world before Columbus sailed the ocean blue.Like Columbus, we are venturing off the known map
• #6: Healthcare M&A Activity Surges in Q2Margaret Dick Tocknell, for HealthLeaders Media , July 26, 2012 Healthcare services, which includes physician groups, hospitals, and managed care, M&A at $19.2 billion, which is more than double the 2011 value in second quarter. Levin Associates report.The surge in M&A activity reflects increased pressure on the healthcare industry to reduce costs and increase the quality of care. Everyone is "trying to figure out what they need to do that," Steve Monroe, a Levin Associates editor, told HealthLeaders Media.The value of physician group M&As climbed to $4.2 billion during second quarter 2012 thanks to another blockbuster, the $3.7 billion agreement between Davita, a Denver-based dialysis chain with 1,800 locations, and HealthCare Partners, which operates medical groups and physician networks with more than 2,500 employed or affiliated physicians in California, Florida, and Nevada.There were 21 physician group M&As posted for the quarter compared with 27 transactions valued at $416 million for the comparable 2011 quarter.The Davita-Healthcare Partners acquisition reflects the continuing effort by providers to position themselves to tightly control costs and to create alignments that enable the care continuum to be realized. This is happening across the healthcare industry, explains Monroe. "Everyone is trying to position themselves, and cover themselves, so they can deal in an environment that is still a bit unknown.""Integrating Coventry into Aetna will complement our strategy to expand our core insurance business, increase our presence in the fast-growing government sector and expand our relationships with providers in local geographies," Mark T. Bertolini, Aetna's chief executive, said.
• #9: They wall off health care from commercialization (we will talk about exceptions to this later)Do not want to think of cost and care in the same breath
• #11: “More for the money we spend” – what could be wrong with that; in every other sector, it’s what people wantShows how people feel about this sector
• #12: As always, as communicators we seek to meet consumers where they are –not where we wish them to be – and then craft strategies for taking them where we want to go.Reiterate These were developed as defensive messages – not to take the story to the public, but to respond if asked. We can see that in first takeaway.This is not a conversation most consumers want to engage in. The focus groups made it abundantly clear that consumers do not want to think or talk about how, when or why their healthcare providers are paid. Anger frustration fear anxiety about health care costs; blame for insurers but also hospital profits; technology; low-income help; aging population. What can they do: take better care of themselves; they go without care – ER broken arm storySome now asking for cost info but cannot get itLittle to no knowledge about how the current reimbursement process works, and linking money or payment to their health andhealth care makes them uncomfortable at best, very angry at worst.Especially in this economy, the notion that physicians should be paid differently to do high quality work or go the extra mile to give their patients the care they need is a non-starter. The messages in this report therefore, are best used reactively rather than proactively.
• #15: The goobledygook lingo of heath care reform the way it appears to consumers
• #16: To paraphrase Geena Davis to Jeff Goldblum in The FlyBe careful, be very very carefulTeamsValue etcAre laden with baggage unapparent on the surface
• #18: Let me pause here a second and let you soak some of this inOn the left, some of those terms on the previous slideOn theright, what people think ofwhen they hear those terms
• #23: New research from Blue Shield Foundation of CA into Medicaid patientsSuch is the pull of physician care that majorities of those who have an initial preference for a doctor over another care provider hold thatposition even if it means appointments are briefer (73 percent say that’s worth the tradeoff), the doctor doesn’t know them as well (60 percent),or it’s harder to get an appointment (56 percent).• While doctors are present, continuity is lacking. Two-thirds of patients say they don’t see the same care provider every time they visit their facility. Nearly six in 10 of them would prefer more regular contact with the same caregiver – a desire that helps open the door to considerationof alternatives.•For many, preference for a doctor falls short of a demand. One-third have no preference for a doctor over a nurse or physician’s assistant,and more are open to non-doctor care under specific circumstances. Among those who initially prefer a doctor, nearly four in 10 shift theirpreference to a non-physician provider if it means it’s easier to get an appointment. And just 23 percent of all low-income Californians prefera doctor across every condition tested.Openness to non-doctor alternatives rises in some groups, for example among younger patients and those in better health. And among peoplewho don’t currently see the same care provider each time, a not insubstantial four in 10 are content with that arrangement. Insight can begained from closer examination of this and other more flexible patient populations, provided in the full report that follows.
• #41: A new class of consumers – small but hitting critical massOur unpublished research demonstrates the connection; high deductible policy holders want price info but cannot get it
• #42: 40 percent in commercial plans had deductibles $2,00 or higher
• #44: Two thirds use the old staff model; community physicians with privileges; 60 percent hospitalists
• #45: Hospitalists drop to 58 percent; staff to half; but clinical integration up to 37 percent, from 20 percent on previous slideReflects ACO model
• #46: Physicians are extremely frustrated with the current health care system.Virtually every physician interviewed passionately expressed deep frustration with the health care system in general, and their concerns about the inadequate reimbursement structure in particular.They feel squeezed by today’s payment system and pressured to see more patients, frustrated that they cannot give their patients the time they need because they are not reimbursed for much of the work needed to build a better patient-provider relationship or to adequatelycoordinate their patients’ care. They are aggravated by what they see as ever growing administrative requirements, especially time spent supplying documentation for reimbursements, and payers interfering with care, e.g., insurers requiring authorizations for treatments. They raise concerns about inequities in pay compared to specialists. Many of the physicians in the one-on-one interviews expressed a strong desire to leave medicine. Only slightly morethan one in four of those surveyed said they were “very satisfied” professionally. Physicians are open to the idea payment reform.Physicians recognize that rising health care costs are unsustainable and they are open to hearing about efforts to potentially change the waypayment/reimbursement works. While the downsides of various payment reform experiments past and present still concern them – and they see the devil in the details – their level of frustration has seemingly made them more receptive to new ideas. Awareness lackingAll but a few of the physicians interviewed were unaware of various payment or delivery reform efforts. Concepts like accountable care organizations, patient-centered medical homes, bundled payments, etc., were either completely new to them, or they were familiar with the terms but did not know any specifics. Only a small percentage of those surveyed described themselves as very knowledgeable about these three payment models. Do not trust hospitals
• #47: Physicians are extremely frustrated with the current health care system.Virtually every physician interviewed passionately expressed deep frustration with the health care system in general, and their concerns about the inadequate reimbursement structure in particular.They feel squeezed by today’s payment system and pressured to see more patients, frustrated that they cannot give their patients the time they need because they are not reimbursed for much of the work needed to build a better patient-provider relationship or to adequatelycoordinate their patients’ care. They are aggravated by what they see as ever growing administrative requirements, especially time spent supplying documentation for reimbursements, and payers interfering with care, e.g., insurers requiring authorizations for treatments. They raise concerns about inequities in pay compared to specialists. Many of the physicians in the one-on-one interviews expressed a strong desire to leave medicine. Only slightly morethan one in four of those surveyed said they were “very satisfied” professionally. Physicians are open to the idea payment reform.Physicians recognize that rising health care costs are unsustainable and they are open to hearing about efforts to potentially change the waypayment/reimbursement works. While the downsides of various payment reform experiments past and present still concern them – and they see the devil in the details – their level of frustration has seemingly made them more receptive to new ideas. Awareness lackingAll but a few of the physicians interviewed were unaware of various payment or delivery reform efforts. Concepts like accountable care organizations, patient-centered medical homes, bundled payments, etc., were either completely new to them, or they were familiar with the terms but did not know any specifics. Only a small percentage of those surveyed described themselves as very knowledgeable about these three payment models. Do not trust hospitals
• #49: Employer sponsored health not going away, but it is changing; CDHC/high deductibles etcWant to control costs and will explore new payment systems;Employee toolkit from AIR
• #50: They are pushing for new payment methods – notice the mythbusting “the most expensive hospital may not be the best”Fully aware of Dartmouth research; recent United HealthCare research
• #54: Hospital CompareLeapfrogJoint CommissionUS NewsPhysician CompareAnd many individual state reportsHave been hard to use, but getting better
• #55: Also Castlight and others getting into the fray
• #59: Chronic Disease Management is highly interventional, requiring high touchPatient Activiation MeasuresKate Laurig –Chronic Disease Self Management
• #60: This places a great new premium on behavior change communications