Maryland Hospital Waiver Consumer Perspective MHA Annual Meeting June 2, 2015

Maryland Hospital Waiver OpinionWorks Credentials Measure perceptions, behaviors Random samples, focus groups Chesapeake Bay Trust Extensive work assessing public behavior Maryland Citizens Health Initiative Research on health consumer attitudes Horizon Foundation & Partners Complex study on behavior health risk factors West Virginia Department of Health Barriers to healthy pregnancy program for Medicaid-eligible Anne Arundel County Department of Health Teen attitudes on nutrition, exercising, smoking The Baltimore Sun newspaper (2007-present)

Maryland Hospital Waiver Focus Group Method 5 Groups Columbia (October 29) Easton (October 30) Baltimore (Urban, people of color; November 5) Baltimore (Suburban, Caucasian; November 5) Bowie (November 6) 120-minute sessions, professionally facilitated Tested: Attitudes, Perceptions of Hospital Care Reaction to Waiver Concept Hopes and Worries

Maryland Hospital Waiver Research Objective Know how best to discuss the Maryland Hospital Waiver with the public, anticipating any concerns consumers may have and emphasizing the Waiver’s key advantages for consumers.

Context

Maryland Hospital Waiver Consumer Audience A Lower-income, younger Primary experience is with emergency department Financial striving/stress Significant feelings of discrimination based on ability to pay

Maryland Hospital Waiver Consumer Audience B Older and chronically ill, or caregivers Experience with inpatient hospital care and scheduled procedures Higher baseline satisfaction with hospital care Translates into concern about change

Maryland Hospital Waiver Consumer Context Urgent care facilities used heavily. Hospitals seen as a business; consumers doubt their motives. Hard to imagine hospitals playing a preventative role. No one is looking out for me!

Introducing the Waiver Concept

Maryland Hospital Waiver The Waiver Concept “Global Budget” “Lump Sum” Audience A=AOK

Maryland Hospital Waiver The Waiver Concept “Global Budget” “Lump Sum” Audience B=Concerned

Maryland Hospital Waiver The Waiver Concept Community-Based Care = Privacy Concerns

Maryland Hospital Waiver The Waiver Concept: History

Maryland Hospital Waiver The Waiver Concept Consumers Appreciate a Watchdog. Monitor budgets Watch for abuse Protect consumers Make sure hospitals have what they need.

Maryland Hospital Waiver The Waiver Concept Faith Community Trusted Caring Protect Privacy

Testing Messages

10=Very important to me. 5=50-50. 0=Not important at all. Maryland Hospital Waiver Testing Ideas How Important to Me Personally (Scale 0-10) Times in Top 3 16 10 12 6 Please rate each of these statements about the Maryland Hospital Waiver. 10=Very important to me. 5=50-50. 0=Not important at all.

“Hospitals should be doing this anyway!” Maryland Hospital Waiver Testing Ideas: Tier 1: Do No Harm “When patients are in the hospital, everyone there will do everything they can to make sure patients don’t get a new infection or disease that makes them stay in the hospital longer.” Even though: “Hospitals should be doing this anyway!”

Maryland Hospital Waiver Testing Ideas: Tier 2A: Practicalities “The hospital will make sure you have your prescriptions in hand before you leave the hospital.” “After patients leave the hospital, they will get more of the help they need to remain healthy and stay out of the hospital – like clear instructions about medicines and the name and phone number of someone to call if they need help.”

Most impactful on skeptical, worried consumers. Maryland Hospital Waiver Testing Ideas: Tier 2B: Look Out for Me “State health regulators will monitor the hospitals to make sure they are protecting consumers, and will penalize hospitals if they do anything to harm patient care.” Most impactful on skeptical, worried consumers.

10=Very important to me. 5=50-50. 0=Not important at all. Maryland Hospital Waiver Testing Ideas: Importance Please rate each of these statements about the Maryland Hospital Waiver. 10=Very important to me. 5=50-50. 0=Not important at all.

Believability scores lower across the board Maryland Hospital Waiver Testing Ideas: Believability How Believable to Me Personally (Scale 0-10) Believability scores lower across the board Please rate each of these statements about the Maryland Hospital Waiver. 10=I strongly believe this is true. 5=I have my doubts. 0=I don’t believe it at all.

Recommendations

“Proactive. Not Reactive.” Maryland Hospital Waiver Recommendations Look forward, not back. Is this old or new? But I thought it was started in the 1970s. Where’s my $45 billion?! “Proactive. Not Reactive.”

“Better outcomes for patients.” Maryland Hospital Waiver Recommendations De-emphasize the payment model. Global budget concept raises worries. Forces consumers to contemplate what hospitals are not going to do. Blocks our ability to converse with consumers. “Better outcomes for patients.”

Emphasize the practicalities. Maryland Hospital Waiver Recommendations Emphasize the practicalities. Prescription in hand. Knowing who to call. Consumers’ real world. Don’t be a wonk.

Emphasize coordination of care. Maryland Hospital Waiver Recommendations Emphasize coordination of care. Consumers like knowing hospitals will be part of a larger plan to coordinate care. It’s attractive that more care will be provided by a primary care provider. Be mindful of privacy concerns Consumers want strict limits on sharing. Want to feel like they are in control.

Partner with the Faith Community Maryland Hospital Waiver Recommendations Identify a watchdog. Pacifying effect on skeptical consumers. It may take them some time to believe it. Partner with the Faith Community Deep trust in faith leaders. Strong bonds within families of faith. Helps navigate confusing health system.

Maryland Hospital Waiver Key Concepts & Language Better outcomes for patients. Giving hospitals a stake in helping people stay healthy. Easier for consumers to navigate the health care system. Putting consumers in control. Always protecting patients’ privacy. Expanding the network of support people need to get well and stay healthy. Ensuring that hospitals have the resources to deliver the level of care patients need.