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Slide Notes

Presentation for the HRE Health & Benefits Leadership Conference 2016 -- The Empowered Patient: Developing a Healthcare-Savvy Workforce

See more at: http://www.benefitsconf.com/sessions.html#sthash.RdF4eXMZ.dpuf

The Empowered Patient

Published on Jan 25, 2016

Unfortunately, few people have the knowledge necessary to successfully navigate the healthcare system and get themselves and their loved ones quality care when they need it. In most organizations, healthcare is the second-largest expense — second only to salaries — yet most employers don’t teach people how to get the most out of their investment. Employers implement consumer-driven health plans to encourage employees to behave as consumers, but until now no one has defined the behaviors an engaged healthcare consumer demonstrates, so employees don’t understand what they’re being asked to do. I've been on a journey to educate people to be more healthcare savvy and I hope to inspire other employers to do the same.


The Empowered Patient

Teaching Health Care Savvy
Presentation for the HRE Health & Benefits Leadership Conference 2016 -- The Empowered Patient: Developing a Healthcare-Savvy Workforce

See more at: http://www.benefitsconf.com/sessions.html#sthash.RdF4eXMZ.dpuf

In most organizations, healthcare is the second largest expense -- second only to salaries -- yet most employers don’t teach people how to get the most out of their investment.

Photo by nathanmac87

86% of people cannot correctly define the terms deductible, copay, coinsurance & maximum out-of-pocket

Source: Consumers Misunderstanding of Health Insurance, Journal of Health Economics, February 9, 2013


People don’t have the knowledge necessary to successfully navigate the healthcare system and get themselves and their loved ones quality care.

I've been working very deliberately on this since January 2014 and still 55% of the ASHA staff agree or strongly agree with the statement, "I feel that I have gaps in my knowledge about how health insurance works."


One of the tools I use to share information is Airbo. Airbo is an employee communication platform that is like You can check out my public Airbo board.



  • Complexity of the system
  • Lack of care coordination
  • Inadequate decision making tools
  • Afraid to speak up at the doctor’s office
Source: Authoritarian Physicians And Patients’ Fear Of Being Labeled ‘Difficult’ Among Key Obstacles To Shared Decision Making, 2012 NYT article


Quality = Convenience

There were a number of interesting tidbits from the Patients Take the Wheel study shared during a presentation at the World Health Care Congress last year. In the same way people don't trust congress, but like their representative consumers lack confidence in the healthcare system, but trust their doctors.

Millennials in particular are willing to change behavior to get affordable care. 54% of millennials will delay or avoid getting care because of the cost. Young consumers want convenience. They will travel an extra 30 minutes to receive care where the lab, x-ray and provider are all in one place. Millennials are embracing retail access to care -- 34% of millennials visited a retail clinic last year.

Many patients feel their doctors spend too much time looking at a computer and entering data during their visits. Few people are presently negotiating what they pay for care, but it's expected to become a trend.

Source: Will Patients Take the Wheel white paper from PNC Healthcare.


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Consumers define quality as convenience. I know our staff will drive further for dinner than they will for chemotherapy treatments. That's pretty scary when you think about safety.

Even when someone attempt to do some research, it's more difficult to find a good doctor than a good restaurant. It's confusing to see hospitals at the top of one list and the bottom of another. Quality data needs to be harnessed and coalesce around certain measures to be useful to consumers. I personally like what Leapfrog is doing in that respect.


Define Quality Care

  • Safe
  • Effective
  • Person-centered
  • Timely
  • Efficient
  • Equitable
People respond well to messages focused on safety. This is the definition I use for quality care:

i. Safe – avoid harm

ii. Effective – evidence based

iii. Person-centered – respectful and responsive to individuals needs and values

iv. Timely – when it’s needed

v. Efficient – avoids waste

vi. Equitable – does not vary in quality because of an individual’s characteristics (e.g., race, gender, employment status)

Beyond the obvious reasons to care about patient safety, the avoidance of complications has much more impact than price on the overall cost of care.

When costs are high, some will avoid care

"People who were privately insured who had deductibles that were 5 percent or more of their income delayed or avoided getting needed health care at much higher rates than people whose deductibles were less than 5 percent of their income,” says Sara Collins, vice president of health care coverage and access at The Commonwealth Fund."

All our efforts to educate folks can be negated by bad plan design.

Our highest deductible as a % percent of the lowest person's salary is 4.4% and we actually give staff half the deductible, so it's really 2.2%.

Source: How Can Insured Americans Lack Medical Care?, US News, March 17, 2015

Photo by danisabella

Consumer Driven Health Plans Turn Up the Pressure

According to the Patients Take the Wheel Study,
when asked what the number–one issue was regarding healthcare, consumers overwhelmingly mentioned costs:

•79% felt that medical care is too expensive.

• 77% agreed that health care costs are unpredictable.

• More millennials and gen-Xers (50% and 56%) said it is difficult to budget for healthcare costs — compared to 47% of boomers and 32% of seniors.

Significantly, 54% of millennials and 53% of gen-Xers said they would delay or avoid getting treatment because of cost, compared to 37% of boomers and 18% of seniors.

10 Behaviors of an Engaged Healthcare Consumer

My passion project -- I really started down this path to help my friends. Two years ago we were sitting around Carol's dining room table drinking wine and my friends started telling stories about the bills they incurred because they didn't fully understand how their health insurance worked. It made me angry and I offered to teach them the basics.

Some of my friends work for small not-for-profits and others large for-profits, one has coverage through the federal government. Across the board, these employers had done a poor job of teaching people about their benefits. I started wondering how good of a job I was doing for the ASHA staff.

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This led me to wondering what we are really asking people to do when we talk about engaging health care consumers. After looking for this information for about a year to no avail, I finally decided to crowd source a definition. I’m grateful to all the smart people who contributed. I compiled all their feedback into ten behaviors and just worked with a designer to summarize that information into an infographic. Longer descriptions with links to good sources are posted on my blog on the "healthcare savvy" tab along with this infographic. You're welcome to use the information.

Source: Inside Workplace Wellness


Let's talk about each behavior and I'l share what I've done to educate our staff about it. I'm hoping you'll each share anything you've done to support each outcome and we will walk out of here with a long list of actionable items that will really have an impact.

1. Has a primary care physician who is a partner in managing his or her health—with scheduled visits as recommended, whether for regular follow-ups for existing conditions or according to the age-related recommendations for prevention by sources such as NIH.

Think about the messenger.

Dr. Michelle Gourdine has met with our staff twice so far. She's delivered two presentations (1) How to Be the CEO of Your Health: Resources for Empowered Patients and (2) From Passive Patient to Savvy Healthcare Consumer: How to Seek and Find the Best Care.

Dr. Gourdine is a physician and CEO of Michelle Gourdine and Associates. She is a Clinical Assistant Professor in the Departments of Epidemiology and Preventive Medicine and Pediatrics at the University of Maryland School of Medicine, and a Senior Associate in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. She served as Deputy Secretary for Public Health Services for the Maryland Department of Health and Mental Hygiene (DHMH) from 2005 - 2008. So, she knows both the medical and policy sides of health care. She is a nationally-sought-after speaker and author of the book, Reclaiming Our Health: A Guide to African American Wellness.


2. Asks the 5 questions recommended in the Choosing Wisely campaign before getting any test, treatment, or procedure & carefully considers all options before deciding among them.

I learned about the Choosing Wisely Campaign at this conference a couple of years ago. It's a great resource.

Choosing Wisely is sponsored by the ABIM foundation in partnership with Consumer Reports. It aims to promote conversations between clinicians and patients by helping patients choose care that is:

- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary


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I really like their 5 Questions...

3. Reviews hospital safety data—from sources such as Hospital Compare - Leapfrog, Hospital Quality Ratings - CareChex, and Surgeon Scorecard—before deciding where to seek care.

Medical mistakes are the third-leading cause of death in this country, surpassing the number of deaths caused by car accidents, breast cancer and HIV/AIDS.

According to the LeapFrog Group:

- As many as 440,000 people die every year from hospital errors, injuries, accidents, and infections

- Every year, 1 out of every 25 patients develops an infection while in the hospital—an infection that didn’t have to happen.

- Today alone, more than 1000 people will die because of a preventable hospital error

Leapfrog Rating for Hospitals ASHA Used

To illustrate the importance of this point, I pulled a report of all the hospitals our staff and their families used over a 12 month time period. Then, I used Leapfrog's Hospital Safety Score to see how each of the hospitals we used are graded. I presented this information in an all staff meeting and urged folks to look at the scores before going to a hospital.


4. Actively monitors and tracks personal health indicators like weight, as well as any indicators related to existing conditions such as high blood pressure or diabetes.

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This is an easy item to act on, we have nurses come in to check blood pressure, weight, body fat, waist circumference and offer a bit of coaching to our staff each month. This was our first wellness initiative. We started in 1994 -- 22 years ago.

5. Maintains a list of medications taken and shows it to medical providers when seeking care, and keeps the list up to date in electronic medical records.

Patient injuries resulting from drug therapy are among the most common types of adverse events that occur in hospitals.

According to and article in the National Library of Medicine.

Drug-related adverse events, including adverse drug reactions (ADRs), have been reported to be among leading causes of morbidity and mortality [1], [2]. ADRs occur in both outpatients and inpatients [2]-[7]. In a meta-analysis in 2002, 4.9% of hospital admissions were associated with ADRs, ranging between 0.2 and 41.3% in individual studies [4]. Further, 28.9% of the ADR-related hospitalisations were considered preventable. Of inpatients, 10.9% is estimated to experience an ADR during hospitalisation [2]. According to the World Health Organization (WHO), costs of ADRs, including hospitalisations, surgery and lost productivity, exceed the cost of medicines in some countries [8]. As drug-related adverse events are estimated to cost USD 422–7062 per drug-related admission and USD 2284–5640 per inpatient with drug-related adverse events (2000 values) [9], significant costs may be saved if drug-related adverse events, including ADRs, were prevented.


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The challenge is having this information in people's hands when they need it.

On a related note, if you haven't seen this John Oliver video about Marketing to Doctors, watch it. I promise you'll be entertained and probably horrified.


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We're evaluating apps where we can feed our health plan data to people's smart phones.

6. Makes day-to-day decisions that support good health and takes any medications as prescribed and instructed.

This is another item that's in our wellness wheel house.

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Our most successful campaign about health eating was a 30 day Mediterranean Diet Challenge. We continue to build on it and have plans to offer a knife skills class and some cooking classes this summer. Through the challenge we learned one of the biggest barriers to people eating healthy is cooking. We also support a local farm. Staff purchase CSA shares each season.

Read more about our Mediterranean Diet Challenge here -- http://www.insideworkplacewellness.com/p/30-day-challenge.html

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We offer three fitness classes a day in our office.

7. Develops a personal/family budget to manage healthcare expenses.

Photo by Tax Credits

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We offer a series of educational sessions to our staff each year during open enrollment and then try to build on what we present there throughout the year. Sessions typically include:

- Securing Your Financial Future with an HSA
- Caring for Your Children
- Planning for Medical Expenses in Your Retirement
- Receiving Care from Providers Outside the Network
- Protecting Your Income When You Can't Work

During the year, we offer "how to" sessions for people interested in an HSA and even have a Yammer group to chat about how it works.

8. Uses available tools to make cost-conscious decisions.

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GoodRX is another tool I learned about at an HRE conference. I love what they're doing and we switched PBMs this year to Magellan RX because they have a partnership. Combined the tools are glitchy, but we're working through it.

Once we're confident we're getting consistent results, we will roll out the formal training we have planned for staff.

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Our big challenge now is to find a platform that integrates access to all our carriers with single sign on and creates a good user experience. We're looking for solutions.

In the meantime, we're directing everyone to Health Advocate. We have a contract with them for their empowered health services which is sort of a concierge service. They don't have real time access to our network or prescription pricing tools though, so it's not perfect.

9. Has an income-protection plan (e.g., short-term and long-term disability coverage) to rely on in case of an injury or illness that makes working impossible or limited.

We've been trying to separate out our open enrollment with UNUM for IDI and supplemental life and LTC from our health insurance enrollment so that people can focus just on protecting their income at one point during the year.

The Council for Disability Awareness had great resources and I'm sure some of you know Carol Harnett, their President. Carol writes the Benefits column for HR Executive.


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It should be obvious that wage earners want to protect what is most important to them. But for some reason, most people don’t see things that way when it comes to income. The ability to earn a paycheck doesn’t enter into many people’s thinking as something crucial to protect.
What can we do to make it more top-of-mind?

2014 Study from the Council for Disability Awareness shared this chart and these statements.

“My income is critical, but I’m not protecting it.”
Among a provided list of items adults commonly think of as important, 67% cited income among their top three choices, but only 28% believe it’s crucial to have insurance to protect it.

“I’ll take my chances.”
More than 20% of workers under 40 say they are more likely to win the big lottery jackpot than become unable to work due to illness or injury. The real odds: 1 in 259 million vs. 1 in 4.

“To know someone who becomes disabled is to feel their pain.”
People who know someone who’s unable to work for more than three months because of disability are 22% more likely to get income protection through disability insurance.
Whatever the reason, wage earners are leaving their financial well-being — and that of their families — at risk. the survey results indicate a need for relevant consumer education about the impact of losing one’s income, and what that means to them
and others around them. We need to dial up the call-to-action!

“Knowledge is Power.”
one-third of working adults would be more likely
to consider obtaining income protection if they knew more about it; that number rises to 40 percent for millennials.

“Why don't I have disability insurance? Lack of knowledge, lack of funds?”
the two most often cited reasons for not having disability insurance? younger workers say they really haven’t thought about it or just don’t know enough. older workers believe it costs too much.

“Money doesn’t grow on trees.”
Half of those surveyed said they’d tap savings or investments to pay their bills if they couldn’t work. However, 57% said they only had enough money to pay for 6 months or less of bills.


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Last year we analyzed:
· Who takes supplemental LTD?
· Who takes supplemental life?
· Who takes LTC?
· Who takes the network only plan?
· Who takes choice plus plan?
· Who takes the high deducible plan with HSA?
· Who uses the FSA?
· Who contributes the HSA max?

Conclusion: “The demographics we usually pay attention to don’t matter when it comes to benefits.”

The CDA study showed that nearly 90% of wage earners trust their employer for financial and insurance information.

A few other thoughts:

Have people write down 60% of income and ask them if they can live on it. (The employer provided LTD in our case.)

I heard that people are more likely to purchase coverage if you get them to think about who will walk their dogs if they can't.

Look at personalizing the risk -- the Personal Disability Quotient, available at www.whatsmypdq.org

10. Has an advanced healthcare directive that has been discussed with family members.

Have to admit that I haven't even started on this item yet, but I do believe it's important to have a living will and a medical power of attorney.

A living will allows you to document your wishes concerning medical treatments at the end of life.

A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf.

The National Hospice and Palliative Care Organization has great information and downloadable forms on their website.

I plan to contact them to see if someone from there can come in a speak with our staff.


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Where will you start?
Photo by marksweb

Close the gap with education and communication

Janet McNichol

This full presentation is on Haiku Deck. There is a link to the presentation with my notes on my blog in the post with the Infographic.