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

3. 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?

4. 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

5. 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….

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

7. 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; 12/9/2014

8. 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

9. 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.

10. 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.

11. What do patients want most. JAMA. 2011;306(22):2500-2501. doi:10
What do patients want most? JAMA. 2011;306(22): doi: /jama
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

12. 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: , March 2007; Physician Executive Council interviews and analysis.

13. 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…

14. 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

15. 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.

16. Good Luck!