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

2. 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)

3. 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

4. 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.

5. Context

6. 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

7. 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

8. 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!

9. Introducing the Waiver Concept

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

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

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

13. Maryland Hospital Waiver The Waiver Concept: History

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

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

17. Testing Messages

18. 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 = =Not important at all.

19. “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!”

20. 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.”

21. 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.

22. 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 = =Not important at all.

23. 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 =I have my doubts =I don’t believe it at all.

24. Recommendations

25. “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.”

26. “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.”

27. 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.

28. 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.

29. 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.

30. 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.