Healthcare’s Future Lies in Transformation

Dr. Ezekiel Emanuel Offers a Compelling Argument

What will the future of healthcare look like? It’s an issue that public affairs commentators and policymakers across the political spectrum continue to debate.

In 1994, the late Dr. William Kissick, a professor emeritus at Wharton and the University of Pennsylvania Schools of Medicine and Nursing, identified three competing issues that the healthcare industry has struggled to address effectively. These issues – access, quality and cost containment – what Dr. Kissick called the “Iron Triangle of Healthcare,” continue to perplex policymakers and healthcare decision-makers to this day.

Recently one of the nation’s leading healthcare policy experts, Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global Initiatives and Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, offered some important insights into where the national healthcare system is heading, and what it might mean for the Philadelphia region. In part he rejected the conventional notion that it is possible for health care systems to only achieve two of the three parts of the Iron Triangle.  He argued all three had to be achieved together. It was all part of a symposium on “Shaping Health Care” sponsored by the Chamber of Commerce for Greater Philadelphia and The Wistar Institute.

Lowering Costs

Finding a way to provide high-value care for all Americans – namely care marked by high quality and low costs with universal coverage – is a goal shared by providers and policymakers alike. According to Dr. Emanuel, “the only way to lower healthcare costs is to change the delivery system to ensure high quality care.”

Traditionally, one of the most significant contributors to the high cost of healthcare has been the combination of providing unnecessary services and inefficiency in how necessary healthcare services are delivered.   One example is standardization of practices so everyone – from physician to nurse to medical assistant – handles the same complaint according to agreed-upon guidelines. For instance, physicians in one local oncology practice were treating mouth sores after chemotherapy in different ways.  The practice standardized to one optimal practice that everyone followed.

Another common example is the fact that some health care groups allow their physicians to control their schedules, leading to double-booking, limited hours, and an inability to work around no-shows or walk-ins.

Creating Efficiencies

Dr. Emanuel identified 12 transformational practices that he says can help physician practices and healthcare organizations improve the quality and cost of care they provide to their patients:

  1. Scheduling
  2. Registration & rooming
  3. Shared decision-making
  4. Performance measurement
  5. Standardization
  6. Chronic Care management
  7. Site of service
  8. De-institutionalization
  9. Behavioral health management
  10. Hospice
  11. Community interventions
  12. Lifestyle interventions

Many of these practices will improve  efficiencies – lowering per unit costs by finding ways to improve a healthcare process or system, or working in collaboration with partners in a way that benefits all involved parties. Others will eliminate unnecessary and undesired services – lowering total costs.

Even seemingly minor changes can show major results. For example, streamlining scheduling practices can offer several benefits: 1) It allows practices to accommodate walk-ins without long wait times instead of sending them to the more expensive emergency room; 2) it increases provider efficiency, as physicians no longer double book or adjust schedules; and 3) it decreases the amount of time wasted due to missed appointments.

Similarly, Dr. Emanuel noted that transformational organizations are providing more services, such as palliative care, in the home. This care is initiated well before a patient becomes terminally ill and is ready for hospice. This approach elicits patients’ preferences for life-sustaining treatments, such as respirators, ICU admission, or dialysis, and tries to keep them at home for the last year of life. It also makes transitioning to hospice in the last weeks of life less abrupt. All these changes lead to care that is both less costly and more in accord with patients’ wishes.

Performance Measures

The pathway for healthcare providers to truly transform also involves the use of real-time performance measures, Dr. Emanuel said. Standardizing clinical practices and treatment procedures based on measurable qualitative data is vital to reducing costs and improving outcomes.

While some physicians may insist that “their” way is the best, organizations need to convince them to adhere to guideline-driven standards. Paradoxically, one effective way to persuade doctors to adapt to standardized measures is to task them with developing the standardized practices and encourage adherence through financial incentives.

At the same time, organizations need to improve their risk adjustment skills in order to continue to improve their healthcare management practices. Risk adjustment is defined as “a statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their healthcare outcomes or healthcare costs.”  This ensures physicians who see sicker patients are not penalized.

The ultimate goal is to transform the U.S. healthcare structure into a truly patient-centered, efficient and cost-effective system.  Dr. Emanuel notes that the Philadelphia region is a leading example of how organizations are learning to work together to achieve those goals. He said he is confident that by 2030, the entire world will be looking at the United States to understand how healthcare transformation is accomplished.

Palliative Care Comes of Age

Once Seen as an End-of-Life Specialty, Palliative Care has Moved into the Mainstream

“It is not death that a man should fear, but he should fear never beginning to live.”

– Marcus Aurelius

For David R. Barile, MD, a geriatric medicine specialist based in Plainsboro, NJ, it was the steady calm of one of his patients – a grandmother and a woman diagnosed with a terminal illness that reinforced his vision of the promise of palliative care.

Faced with a life-threatening illness, she most likely was looking at weeks of chemo and radiation therapy that may or may not cure her. But either way, the treatments would sap her strength and make it extremely difficult to carry on with everyday activities she enjoyed.

But there was one more thing. No matter what, she did not want to do anything that would cause her to miss her grandson’s bar mitzvah. The best approach for helping her achieve her goal of living life the way she wanted? Palliatve care, which focuses on providing relief from the symptoms and stress of a serious illness.

A Question of Choice

For many doctors, the idea that a patient would choose to exert such a strong influence on her course of treatment might sound unusual. But to Dr. Barile, that kind of insight is something that has been lacking for too long.

Dr. Barile is also the founder and Chief Medical Officer for Goals of Care Coalition of New Jersey, an interdisciplinary partnership of leaders representing healthcare providers and systems, government agencies, and community organizations whose mission is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness and to document their preferences in a care plan. Increasing awareness about benefits of palliative care is a key part of the effort. Recently, Dr. Barile discussed the topic of palliative care as a featured speaker at a Health Issues Committee Forum sponsored by the Chamber of Commerce Southern New Jersey. (Note: SPRYTE Communications’ CEO Lisa Simon is a member of the chamber’s board of directors.)

“The Coalition’s fundamental purpose is to organize medical care to help patients achieve their life goals,” explained Dr. Barile. The approach consists of four basic steps:

  • Diagnosis
  • Prognosis
  • Identifying patient goals
  • Aligning treatment to achieve those goals

Setting Goals

It sounds simple. But as Dr. Barile notes, it’s also somewhat uncommon. More common is the  approach of “diagnose then treat.” That works well in most health situations, but falls short in end-of-life care, Dr. Barile says. And for many patients it creates a very stressful and unwanted burden.

What is often lacking is patient input, he says. What are their personal goals? And what kind of treatment plan can be developed that will enable them to meet those goals?

Another advocate for increasing awareness about palliative care is Dr. Timothy Ihrig, Chief Medical Officer for Crossroads Hospice & Palliative Care (full disclosure: a SPRYTE client).

Dr. Timothy Ihrig

Dr. Ihrig is an internationally recognized expert on hospice and palliative care and a longstanding advocate for treating patients with life-limiting illnesses according to their individual priorities and life goals – incorporating full transparency and quality of life as key values in their care programs.

 

His TED Talk, “What We Can Do to Die Well,” urges doctors to focus not so heavily on clinical interventions at the expense of overlooking patients’ overall quality of life and helping them navigate serious illnesses from diagnosis to death with dignity and compassion.

According to Ihrig, at its best, palliative care is meant to be an empowering force for patients, taking into account each patient’s perception of what it means to live with a severe, chronic, potentially fatal condition and helping them live their lives with the highest quality possible.

Improving Education

Both Drs. Barile and Ihrig believe more needs to be done to incorporate end-of-life issues into medical training, so healthcare professionals can better recognize what is happening to their patients. Better training will also enable them to communicate more effectively with their patients, help them achieve informed consent in their decisions, and mutually agree on a treatment program that will meet patients’ personal goals while providing a better quality of life.

“We need to work on the language for end-of-life care,” Dr. Barile says, noting that news stories about former First Lady Barbara Bush reported that she had “stopped treatment.”

“Palliative care is a treatment. But the range of treatment options available to patients needs to be better explained,” he says.

More Cost Effective

There’s an added benefit. According to a study publishd in April by the journal JAMA Internal Medicine, patients with serious or life-threatening illnesses who have palliative care discussions with their doctors at the beginning of treatment focusing on improved quality of life, managing pain and defining goals often experience shorter hospital stays and lower costs.

The JAMA study found that overall, for patients who received palliative care, hospitals saved an average of $3,237 per patient over the course of a hospital stay compared to patients who did not. Hospitals saved an average of $4,251 per stay for cancer patients, compared to an average of $2,105 per stay for non-cancer patients.

Their conclusion: “Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.”

Higher quality care with lower costs. Perhaps an idea worth looking into.

Managing Reputation with Bylines

Tap into Doctors’ Expertise to Build Thought Leadership Creds

When SPRYTE learned that a pediatrician at Holy Redeemer Hospital was seeing a spate of concussions relating to youth sports, we sprang into action to warn parents on signs they need to look for. The resulting article under Dr. Avi Gurwitz’s byline ran in the Philadelphia Inquirer “Expert Advice” column in the Sunday Health section, which is seen by 194,000 readers (not counting online). The twist? Concussions aren’t limited to football, but can be sustained in many spring sports too.

The first-person, “bylined” article by a healthcare professional can be a boon to your organization’s reputation. Whether it appears in a local newspaper or regional lifestyle magazine, getting your physicians’ skills and knowledge out to current and prospective patients should be a goal of any healthcare communicator, and creating thought-leadership articles is a great way to do it. The “third-party endorsement” you gain upon publication is invaluable, as it tells readers that your doctor truly is an expert, and what he or she has to say merits editorial space.

Where are Your Patients Coming From?

Start by determining where your organization’s or practice’s patients come from, and targeting the publications that reach them. Research them, and if you’re already reading them pay attention for opportunities that may be a good fit for your physicians. Daily and weekly newspapers, for example, might run regular health columns called “Expert Advice,” “The Doctor is In,” or “Things To Know,” sometimes in the Sunday health section or a recurring healthcare supplement. Notice whether they use doctor-contributed content, and in what format.

Finding topics is the easy part. Just about every physician has a few hot-button subjects they’re passionate about, or vital information they want patients to know, and are usually happy to share them if you ask. Some might be “evergreen,” but as a communications pro, you might also think seasonally, and offer ideas well ahead of time that fit in with subjects editors and readers will be thinking about. Sparing your back when doing spring gardening or landscaping can be an attractive topic in the first quarter, while minimizing risk of heart attack when shoveling snow is a natural for the winter months.

Once you’ve settled on an idea, you’ll need to flesh it out into an article query. Most editors won’t commit to running your doctor’s article until they actually see it, so you might be writing on-spec, but if you learn the publication’s editorial guidelines and adhere to them, particularly word count, you’ll increase your chances of publication.

Writing for Reputation

Schedule an interview with the doctor, so you can gather and assimilate their knowledge on the subject, determine the key points to make, and even get a sense of their “voice.” Additional background research might be required to write a fully formed article.

Once you’ve written the draft, you’ll have to send it back to the doctor for their review, along with any other internal eyes that might need to see it. But because the article is appearing under their name, the physician should have final say on the content. Be sure to add a one- or two-sentence biography of the author at the end, and offer a high-resolution head shot to the editor in case they run them.

Bylined articles can be a powerful form of reputation marketing, and as such an effective way to influence patients and prospective patients. And, like the Dr. Gurwitz column, they can deliver valuable information on any number of health topics, letting consumers know you’re a community-minded organization.

Philadelphia Opioid Crisis: An Approach to Save Lives

 

All Hands on Deck Against the Opioid Threat

One of the most serious public health issues facing us today is the opioid crisis. As the crisis has continued to grow over the course of the past decade, its impact is far-reaching in terms of financial losses as well as human costs.

As medical professionals and public policy officials strive to find answers to this continually growing problem, it is incumbent on healthcare communicators to be ready to work with their respective partners to develop strategies to reach out and bring together those impacted by this dreadful epidemic – not only abusers, but loved ones, family members, healthcare professionals, community leaders, elected officials and more.

Opioid Crisis by the Numbers

In November, a report from the Council of Economic Advisers estimated that in 2015, the economic cost of the opioid crisis was $504 billion, or 2.8% of the nation’s Gross Domestic Product that year. That number was more than six times larger than the previous estimated cost of the epidemic.

Prescription opioids are a particular problem. According to the Centers for Disease Control and Prevention (CDC), prescription opioids are a key contributor to the opioid epidemic in the United States, accounting for more than 40% of all U.S. opioid overdose deaths in 2016, with more than 46 people dying every day from overdoses involving prescription opioids. 

In Philadelphia, the impact of the opoioid epidemic has been devastating. According to the city’s Department of Health, fatal drug overdoses from 2013-2015 increased by more than 50%, from 459 deaths to 702. During 2015, Philadelphia experienced more than twice as many deaths from drug overdose than from homicide. Eighty percent (80%) of these involved opioids.

What’s to be Done?

Recently, the Healthcare Leadership Network of the Delaware Valley convened a CEO Roundtable, hosted by Cooper University Health System, on what can be done to deal with the many challenges posed by the opioid epidemic. The panel discussion sought to offer perspectives from clinical, public health, governmental policy, health system and evidence-based treatment points of view. The general consensus – there were many contributing factors to the problem and it will take a dedicated commitment of coordinated effort to bring about an effective solution.

Dr. Susan Freeman, President & CEO of Temple University’s Center for Population Health, described her organization’s approach as an “all hands on deck” effort to address many of the multi-faceted issues exacerbated by opioid abuse. Temple’s Substance Abuse Task Force Action Plan, for example, focuses on six primary areas:

  • Building trust with patients/substance abusers
  • Ceasing addiction
  • Proactively identifying patients at risk
  • Reviewing physician prescription practices
  • Education and research
  • Partnerships with entities such as the Philadelphia Department of Health and other like-minded organizations.

Focus on Families

Similarly, Douglas Tieman, president & CEO of Caron Treatment Centers, noted it’s important to remember that substance abuse is a chronic disease that doesn’t end after a 28-day rehab visit. The most effective treatments are multi-disciplinary, including medication-assisted therapy, bio-psycho-social treatment, evidence-based treatment programs such as motivational interviewing, 12-step integration, trauma and family counseling, and a continuing care plan to lessen the chances of recidivism.

Such integrated approaches can have long-term positive effects. If behavioral health, substance abuse and mental health issues are treated in time, “the costs of other health-related issues go way down as well,” he said.

Even so, getting patients and families to participate in long-term programs can be a challenge in itself.

“We live in a microwave society that wants everything immediately,” noted Alan Oberman, CEO of John Brooks Recovery Center. “Most families, unfortunately are dealing with a ‘crisis of now’ and aren’t willing to listen to discussions of long-term chronic issues.”

A Center for Healing

Adrienne Kirby, PhD and chairman and CEO of Cooper University Health Care, said her long-term goal was to create at Cooper a “center for healing” that would address many of the related factors that contribute to problems faced by substance abusers. She said Cooper has been on the front lines, working with Camden County Police, to identify and reach out to patients in need. She said intervention needs to be combined with treatment, as well as other support services, such as housing.

Another key aspect of Cooper Health’s approach is to upgrade the curriculum so that students, residents, as well as faculty, are trained to recognize and treat substance abuse patients effectively.

Information is Key

A key challenge to implementing a coordinated strategy is the sharing of information. In addition to HIPAA regulations, the infrastructure simply doesn’t exist yet to allow the exchange of bio-social information among health care entities and community-based support organizations.

“We don’t have the infrastructure for mental health that we have in physical health,” said Dr. Kirby. “The law doesn’t allow us to be there yet.”

Nevertheless, such an information-sharing capability could help ensure that substance abuse patients receive the continuing care and social support they need. For example, with patients’ permission, telemedicine apps could combine with GPS to manage patients’ long-term illnesses, monitor their activities and ensure they are complying with what is needed to maintain a healthy recovery.

Information can be even more important in terms of prevention – stopping substance abusers before they get started. Caron, for example, works with 600 grade schools and high schools to educate students about the dangers of substance abuse. According to Caron’s Tieman, if students can be persuaded to postpone their introduction to alcohol, marijuana and other substances, it can significantly delay the onset of substance abuse.

There is no panacea. The opioid epidemic has been years in the making and will no doubt take years to overcome. In the meantime, healthcare communicators who work with organizations involved in the issue need to keep abreast of news and developments so they can provide their respective audiences with timely information and advice.

 

Make Your Event Photo Count

Landing Earned Media’s a Snap with Great Images

The media won’t always be able to cover your organization’s event or happening. Sometimes they might lack the staff, have competing priorities that day, or in the case of some hyper-local newspapers, simply don’t generate their own content, relying instead on submitted material like yours.

Whatever the reason, your photo and messages can still find placement if you can provide a great photo after the fact. Unfortunately, many clients and organizations don’t plan for this, and as a result, the photography comes up well short of what newspapers are looking for.

 

Best Practice Makes Perfect

The are plenty of resources and tips for great photography just a click or two away, so we’re not going to get into the basics of great image-making here, but there are some things your front-line event people, social media staff, public relations personnel and franchise offices or ambulatory care centers should keep in mind to elevate their results, and increase the chances of landing a photo in the local paper.

High-Resolution Rules. Print publications need images to be 200 x 200 ppi at the bare minimum in order to reproduce sharply, but higher is preferable. High-resolution is a minimum of 600 x 600 dpi. Make sure whoever is shooting photos has their camera set to the highest resolution setting. This can’t be overstated.

Make Sure Your Camera’s Up to It. It used to be a hard-and-fast rule to avoid taking photos for press purposes with a cell phone, because the quality was usually poor. That’s changed with newer, more photo-friendly phones, so if you’ve got the goods, flaunt them. Of course, a digital SLR remains a great choice. Either one, in reasonably skilled hands, will get what you need. And be sure to send or upload the image at the highest resolution.

Go for an Interesting Element or Angle. Try to capture people doing something active or expressing emotion whenever possible. But even cliché photos such as check or award presentations can be made more compelling with a great background, an end-user beneficiary, or when shot from an unusual angle, or with a wide-angle lens. Look for color, such as flowers or shrubs or artwork, to add life to your photos too.

Focus on the Subject. Frame your photos to get in tight on the subject – whether it’s a physician or inanimate object such as a new medical imaging machine. The fewer walls, ceiling tiles or electrical outlets in the photo, the better.

Identify. A great photo is virtually useless to a newspaper if you don’t have the names and affiliations of every person prominently featured. This isn’t necessary for everyone in a candid group shot, but those whose faces are easily identifiable should be identified. And get their home towns too, particularly if you’ll be submitting the photo to hyper-local publications.

Remember HIPAA. You’ll need to get a signed photo release from each person in the picture, possibly even staff, and be cautious to not include any sensitive medical information in the image or caption if a patient doesn’t provide consent. A patient undergoing a specific procedure, for example, or being treated by a particular doctor or even in a specific room could provide health information they’d prefer to keep private.

Strike Fast. Newspapers want news, so send your photos as soon as possible. This might mean while the event is unfolding, but certainly the same day or within 24 hours. Weekly papers generally have more flexibility, but check their deadlines so you can get them photos for the next edition when possible.

Avoid Large Attachments. You’ve got a great picture, in high-resolution, but many journalists are wary of opening attachments, or have servers that will slow them down or reject them entirely. Unless you’ve made prior arrangements to send a large file, upload your images to Dropbox or a similar site, or a proprietary file-sharing platform if you have one (SPRYTE’s is called Docco), and provide a link to download instead. As a bonus, you’ll often be able to see whether said file has been downloaded, and possibly by whom.

Not every photo you send to newspapers will be used in print or online, but you can stack the deck in your favor by giving editors what they need, in the form they want, in a timely manner.