Risk Management in the Age of the Empowered Patient Jan Ferguson, JD Risk Manager The University of Vermont Medical Center

Stories – Mine and what others have told me… You are wasting my time. Is this how you wear this? Don’t bother the doctor or I’ll send you home. I’ve got this article I’d like you to read. Young women in labor Cost conscious when unconscious What is that supposed to mean?

Drivers creating the Empowered Patient. Generational Baby Boomers Millennials Focus on “Quality” What does “quality” mean to the patient? How can you influence your patient’s experience of “quality”? Health Care Market Consumer-directed health plans High deductible health plans Health Savings Accounts

Who is the “empowered patient”? Baby Boomers Patients born between 1946 and 1964 75,000,000 Millennials Patients born between 1981 and 1997 That is a lot of patients….

Continuum Millennials Baby Boomers  I don’t want to know you… I want to have a relationship with you.

Baby Boomers As Boomers confront medical issues that come with aging, they want to know more about their providers and have more direct input into decisions about their care.¹ Boomers expect more out of their health care experience than their parents did. Physicians’ place in the hearts and minds of the Greatest Generation Health care as a relationship versus a consumable Younger Boomers are interested in technology and new forms of data collection and analysis (i.e. remote monitoring and wearables). ¹Paul Barr; www.hhnmag.com, 12/9/2014

Millennials A 26 year-old restaurant manager was asked what would happen if a restaurant was run like the United States’ healthcare system. “Oh God, it would fall apart,” Martinez said. “It would be like, ‘You want pasta? Too bad, I don’t care what food you want, all I care about is making you not hungry’.” ¹ “Honestly, if I walk down the street and met my doctor, I wouldn’t recognize him at all,” Martinez said. Millennials have different expectations and skill sets than previous generations. Millennials are on track to be the most educated generation to date. ¹Jason Hidalgo,;Reno (Nev.) Gazette-Journal; 2/7/2016

What is “Quality” mean to the patient? The Institute of Medicine IOM defined quality as the “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality as Patient Safety: From: death, disease, disability, discomfort, and dissatisfaction To: safe, effective, patient centered, timely, efficient, and equitable.

World Health Organization A health system should seek to make improvements in six areas or dimensions of quality: Effective, delivering health care that is adherent to an evidence base and results in improved health outcomes for individuals and communities, based on need; Efficient, delivering health care in a manner which maximizes resource use and avoids waste; Accessible, delivering health care that is timely, geographically reasonable, and provided in a setting where skills and resources are appropriate to medical need; Acceptable/patient-centred, delivering health care which takes into account the preferences and aspirations of individual service users and the cultures of their communities; Equitable, delivering health care which does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location, or socioeconomic status; Safe, delivering health care which minimizes risks and harm to service users.

What do patients want most. JAMA. 2011;306(22):2500-2501. doi:10 What do patients want most? JAMA. 2011;306(22):2500-2501. doi:10.1001/jama.2011.1819. Restoring Health When Ill Timeliness Kindness Hope and Certainty Continuity, Choice, and Coordination Private Room No Out-of-pocket Costs The Best Medicine Medications and Surgery

Source: Altarum Institute, “Altarum Institute Survey of Consumer Health Care Opinions,” Fall 2012; NRC Market Insights Survey, 2010; Source: Hoangmai, P, et al., “Care Patterns in Medicare and Their Implications for Pay for Performance,” The New England Journal of Medicine, 356:1130-1139, March 2007; Physician Executive Council interviews and analysis.

Customer Service: It’s like Disney and it isn’t. My motto: “Happy patients don’t sue” Adages that don’t really apply to health care: The customer is always right. I’m prepared to do whatever it takes to make you happy. Adages that can: I will do what is right for you. I will do what I can to make your experience less scary, less painful…

Money talks…in health care. High Deductible Plans and Health Savings Accounts Communication Navigating the policy – what care is subject to the deductible, what is not. Setting expectations Failure to clearly understand costs may result in dissatisfaction with care delivered. Impact on patients’ health Delay in or foregoing cancer screenings, immunizations and monitoring chronic conditions Complaints Blending money and quality

Now what… Recognize the challenge. Embrace the opportunity to meet the expectations of your “empowered patient” population. Create the culture you want in your practice by bringing the entire team on board. Select an appropriate “customer service rep” (aka your risk manager) to be the go-to person for managing your patient relations.

Good Luck!