Communicating With Workers About Evidence-Based Health Care American Institutes for Research Kristin L. Carman, Ph.D. American Institutes for Research June 10, 2009

Content Current context for communicating with employees about evidence-based health care Development of a Communication Toolkit and lessons learned about challenges communicating with employees Supporting more effective communication 2

Current Context for Communicating with Employees About Evidence-Based Health Care 3

Employees Must Be Part of Any Health Care Solutions Current policy directions place high expectations on employees – Belief that changing employees behaviors and choices are essential for controlling costs and for improving quality. 4

Expectations for Employee Behaviors Choose high quality / cost-effective health plans, providers and hospitals Choose evidence-based treatments Engage as a partner in care with providers Self-manage chronic illness Maintain healthy behaviors Seek preventive care 5

4 Trends Affecting Employees Growing costs with employees paying greater out of pocket expenses A proliferation of information and information sources More responsibility for making choices Increased complexity of: – Health care options – Tasks involved in managing personal health – Health care navigation 6

The Stakes Have Been Raised for Employees Individuals are being asked to assume more responsibility for choices The impact of choices have become more consequential – for personal finances, for health, and for the kind of care they get 7

Finding Ways to Engage Employees Has Become a High Priority Being an activated consumer is not just about knowledge, must also have skill, and the confidence to take action – Problem solving – Literacy skills – Numeracy skills – Decision-making skills – A variety of skills to adopt healthy behaviors – Confidence to be a prepared and assertive patient 8

Development of a Communication Toolkit & Lessons Learned About Communication Challenges

The Role of Evidence in the 21st Century Health Care System 10 Evidence based health care embodies these values: Decisions are based on medical evidence and quality standards Reduction in the under-, mis-, and overuse of treatments and health care resources Patients having more active engagement in and ownership of their health care

Roles in Evidence-Based Health Care Purchasers/ Employers EmployeesPlansClinicians Select insurers that offer high quality and efficient networks Provide patients with evidence- based information and decision support Seek evidence when making decisions Use evidence to make informed decisions about plan, provider, and treatment Discuss evidence with providers Learn about cost and quality issues Reward providers based on meeting evidence standards Provide quality improvement efforts and decision support technologies Provide patients with evidence- based information and decision support Seek evidence when making decisions Use evidence to make informed decisions about treatment and provider referrals Discuss evidence with patients 11

Purpose of the Toolkit Take positive aspects of making health care decisions based on evidence and translate them into language and concepts that employees can understand and embrace Help employers, unions, and others frame messages to employees about evidence-based health care 13

14 What We Did Assess and understand What are employers and unions doing to communicate about this topic? What are desired components of the Toolkit? What are consumers’ understanding, attitudes, and beliefs about this topic? Methodology Environmental scan – Literature review – Review of websites – Phone interviews with experts 4 focus groups with union and non-union employees (59%) 5 rounds of interviews to test materials with union and non-union employees (25%) Survey of employee attitudes about evidence-based concepts and experiences (NBGH Survey on Employees and Healthcare Decision Making) – 20% union members

Lessons learned: There are stumbling blocks to understanding and acting on key concepts underlying evidence-based health care These stumbling blocks mean that existing information and supports for employees may not be as effective as they could be

Three Core Challenges to Communicating with Employees 1.Fundamental disconnect between the tenets of evidence-based medicine and the knowledge, values, and beliefs held by many employees 2.Employees have limited experience with becoming more actively involved and find it hard to engage 3.Employees don’t necessarily trust important existing communication channels 16

Challenge #1: Fundamental disconnect between the tenets of evidence-based medicine and the knowledge, values, and beliefs held by many employees

Unfamiliar with the terms “medical evidence,” “quality guidelines,” and “quality standards” Only 49% surveyed said they had heard about medical research Only 34% surveyed had ever had a physician discuss the topic with them Employees Are Unfamiliar with Key Tenets of Evidence-Based Health Care 18 “Of course my doctor uses evidence-based medicine. He makes decisions based on the available evidence— things like my test results and medical history.”

Employees Have Negative Beliefs About Using Guidelines and Standards to Make Decisions Many believe that guidelines and standards restrict choice inhibit innovation are inflexible are biased represent low standards 19 “Using medical guidelines sounds like...your doctor can’t give you other treatment without approval. It’s taking your choice away and putting the decision in somebody else’s hands.”

Employees Have Beliefs That Challenge Key Goals of Evidence-based Health Care 20 Employees believe: More care is better Newer care is better More costly care is better Their physicians know best Treatment decisions and health care quality should not be discussed in terms of costs “I don’t see how extra care can be harmful to your health. Care would only benefit you.” “Because if you’re going to have a doctor that’s better, he’ll charge more.”

Challenge #2: Employees have limited experience with becoming more actively involved and find it hard to engage

Employees Have Limited Experience in Engaging Physicians 22

Competing demands for their time, attention, and action Inundated with information Employees Are Inundated with Information 23 “Sometimes you get so much information that you just don’t know what to do with it anymore. I sit down to read something, and the more I read, the less I know.”

Challenge #3: Employees don’t necessarily trust important existing communication channels

Employers and Health Plans Are Not Considered Trustworthy Sources of Health Information 25

Not sure how all this information is personally relevant and what they can or should do This is especially problematic because workers find it difficult to know who and what to trust Information May Not be Personally Relevant to Employees 26 “I think they’re just trying to cut costs—I don’t think employers are looking at our health at all. They’re looking at what will cost them the least. I don’t think that employers would even give us benefits if they didn’t have to.”

Policy Implications Comparative effectiveness research – Employees may be leery of payor motivation in conducting and implementing this research Evidence-based benefits design/value-based insurance – While logical to payors and policy-makers, it may not resonate with employees Transparency and cost information – Employees views may threaten the basic premise of reporting efforts What to do? Continue to translate evidence-based health care into concepts and concrete, manageable activities to support and motivate employees

Supporting More Effective Communication 28

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Communication Toolkit Key Features Explain unfamiliar concepts in ways that are easy for employees to understand Reinforce key messages and include vignette examples Approachable and easy to skim Action oriented -- tell employees what specific things they can do, what the benefits will be, and where they can learn more Insert text that tells what the company or union is doing to support evidence-based care

Contact Information 31 Kristin L. Carman, Ph.D. Managing Director American Institutes for Research 1000 Thomas Jefferson Street, NW Washington, DC (202) Visit the Communications Toolkit at

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