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.

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.

 

Consumerism: The Future of Healthcare

Patient-Focused Care is a Growing Challenge

Even before the advent of the Affordable Care Act, a primary goal for healthcare providers has been to get consumers more involved in their own healthcare decisions.

From the now-defunct federal Health Systems Agencies (the original HSAs), to Health Maintenance Organizations (HMOs), to Flexible Spending Accounts, to Health Savings Accounts (the new HSAs), to the more recent Accountable Care Entities, engaging and empowering consumers to make informed choices about their healthcare needs has been both an ongoing objective and challenge.

Healthcare communicators, who are at the heart of providers’ consumer relations and community relations efforts, need to understand what’s driving this important movement.

 

Key Drivers of Healthcare Consumerism

In a recent webinar sponsored by Thomas Jefferson University’s Jefferson College of Population Health and IBM Watson Health, Dr. David B. Nash, dean of the college, noted that the two biggest factors driving the evolution of healthcare consumerism are utilization and costs.

Dr. Nash pointed to data from 2015 showing that the total expenditure for healthcare in the U.S. topped $3.2 trillion, accounting for 17.8% of the country’s gross domestic product. Per capita national health expenditures amounted to almost $10,000. Almost 60% of those expenditures were tied to two areas of spending: Hospital Care (32.3%) and Professional Services (26.2%).

One key problem, he noted, is quality. More “socialized” national systems found in Canada and Europe provide consumers with better quality at a better price compared to the U.S. health system. At the same time, U.S. consumers are shouldering more of the total healthcare cost burden, including unanticipated costs. According to the Kaiser Family Foundation, U.S. workers’ share of health insurance premiums grew 221% since 1999, while premiums themselves increased 203%.

From a healthcare finance perspective, it’s an unsustainable situation. Empowering consumers to exercise more control over their healthcare spending is part of the solution.

 

More Education, Transparency Needed

Unfortunately, too many consumers don’t understand what they’re paying for – or how they’re paying for it. Lack of awareness about insurance terms, processes and pricing tend to inhibit patients from getting involved more directly in their healthcare decisions.

“If you can’t define what a copayment is, you won’t be an empowered consumer,” Dr. Nash explained.

Consumers want to understand what is happening, but available data can be overwhelming. Many are turning to social and public sources for information, but lack the ability to translate the data in a meaningful way that would help their decision-making.

 

Social Determinants of Health (SDOH)

Other key factors driving the evolution of healthcare consumerism are social determinants that describe conditions in which people live, learn, work and play – all of which can have significant impact on an individual’s health risks and outcomes.

Poverty, not surprisingly, is the number one social determinant of health. Those without insurance, or access to regular healthcare checkups inevitably fare worse in terms of early detection of adverse conditions and ensuing complications, chronic health issues, and life expectancy.

A recent Robert Wood Johnson Foundation survey asked American physicians what kind of prescriptions they wish they could write to assist patients with social needs. Among their top answers: Fitness Programs (75%), Nutritional Food (64%), and Transportation Assistance (47%). For doctors whose patients were predominantly urban and low-income, the responses were just as telling: Employment Assistance (52%), Adult Education (49%), and Housing Assistance (43%).

 

Engagement is Key

To help address many of these needs, many health systems are increasing their focus on community-based care, meeting patients closer to where they live and addressing their individual needs. This trend can be seen in a number of ways:

  • Increasingly, large regional health systems are affiliating with traditional community hospitals, based on level, type of condition or geography.
  • The popularity and prevalence of retail clinics continues to grow, as health systems see a means to deliver lower-cost local services beyond primary care.
  • Bedless hospitals are springing up – newer entities that are often multi-specialty and offer traditional hospital services except for inpatient care.
  • The BCBS Institute is partnering with the ridesharing company Lyft to address transportation-based SDOH. The Institute and Lyft will work together to coordinate rides in neighborhoods with limited public transit access and low rates of vehicle ownership.
  • The growing popularity of telehealth, mobile technology and digital therapeutics, that allow physicians to provide lower cost care and regularly monitor their patients’ progress almost anywhere at any time.

In addition, spending more time with patients – encouraging them to ask questions, taking time to explain procedures, treatments and options – can be a major factor in improving healthcare outcomes individually and in the community. Healthcare insurance professionals can also play an important role by working closely with consumers to make sure they understand options and nuances involved in their insurance decisions.

Healthcare communicators have a major role to play as well, by paying close attention to the evolving nature of healthcare consumerism and working with their colleagues – healthcare administrators, physicians, nurses and other medical professionals, as well as their allies throughout the community – to reach out, identify and educate consumers to ensure as many as possible get the care and support they need to live healthy, happy lives.

Letter Rip: Send That Letter to the Editor

Research, Customization will Increase Your Odds of Success

The letter to the editor, alongside its big brother, the op-ed, is a tried-and-true earned media tactic. And for good reason: letters are reader-contributed, run the gamut of topics that are news-based and “evergreen,” and are generally short, which means they get read. On top of all that, newspapers publish several every day, and as a result have a solid appetite for good ones.

Frequently appearing in hyper-local markets, letters can be a significant consumer marketing tool. They are effective for a variety of reasons:

  • Educating the public (or correcting the record) about a specific health concern, issue or controversy
  • Creating/enhancing name/brand recognition within the target area
  • Establishing the client’s reputation as an authority on the specific topic or issue
  • Reinforcing the client or organization as a caring and concerned member of its local community(s)

Establish Goals, and Don’t Self-Promote

SPRYTE has had great success with well thought-out, well-researched letter to the editor campaigns on behalf of various clients, frequently publishing the same letter in a number of newspapers across the country, under different bylines, where clients have local offices or franchises, for example.

But the letter to the editor isn’t low-hanging fruit. Success hinges on several factors, not the least of which is the skill of the writer. While the urge is to get your organization’s or client’s name out prominently and positively, editors will see right through letters that are too self-promotional. Writers need to constantly ask the question, “What will the paper’s readers get out of this?” More precisely, what public good can we provide, or what useful or compelling information can we share? What important topic or viewpoint can we open readers’ eyes to?

As with just about all earned media tactics, it’s useful to lay out your goals first, then let them inform the content of your letter. If your goal is to inform readers, make sure to include facts and/or statistics. If you want to thank or bring attention to a group, highlight the problem the group or individuals have helped to solve, and what they’ve accomplished. And if your goal is to weigh in on a subject that’s being widely covered and thus gain thought-leadership credibility, be sure to base your argument on established facts and logic.

Best Practices for Your Letter to the Editor

Here are some more tips from SPRYTE’s playbook for leveraging letter to the editor campaigns:

Avoid high-traffic times of year. Saluting mothers on Mother’s Day, or veterans on Veteran’s Day or Memorial Day will put your letter into intense competition for space. Same with the winter holidays (resist that New Year’s resolutions self-help letter). Instead, if you’d like to peg your letter to a significant or recurring event, set your sights on less prominent days, such as an obscure anniversary, a lesser-known holiday, or an organization milestone that no one else can claim. In recent years, SPRYTE has jumped on Peace Officers Memorial Day, “Juneteenth,” POW-MIA Recognition Day, and National Caregivers Day, generating dozens of published letters.

Move fast. If you want to respond to a published article, or give your take on a topic in the news, waiting even a few days can make your letter to the editor stale. Monitor media coverage that’s relevant to your organization’s expertise, and get the wheels spinning for a letter the day the story runs. Submit it the next day or within 48 hours. And don’t forget to reference the specific article in your letter.

Follow the rules. Many papers have specific guidelines for letter writers, so read them and follow them. Words might be limited to 200 or even 150, so make every word count. (In general, shorter letters or more likely to be used in any case.) Some publications require you to e-mail your letter to a specific department or editor, and others have online submission forms. Submit in the prescribed format to give your letter to the editor the best chance of being used. And some papers specifically state they don’t run general “thank you” letters, or letters that don’t respond to a specific article that was published, so make note of those restrictions too.

Customize your letter. If you’ve gone to the trouble to write a letter to the editor, take the time to adapt it for every newspaper/market you’re submitting it to. Include the local office location and healthcare professional’s name, for example, rather than the CEO of the national organization. Name the city and reference the local issue if applicable. This will greatly increase the chance of your letter getting used.

Be available. Just about every paper has a letter verification process to ensure validity, and that might include a phone call or e-mail to or from the letter writer confirming contact information, city of residence and organization. Make sure the person who signs the letter to the editor is aware they might be contacted, or might proactively have to call a number to verify.

Manage expectations. Even if you get a canned e-mail that says your letter to the editor is being considered for publication, you’re only at second base. Your letter might be pushed out due to lack of space, competing, more timely topics, or a more insightful (or entertaining) letter on the same subject. Then again, if your letter is more of an evergreen, it could run days or even weeks letter when you’re not expecting it.

Letters to the editor can be a powerful tool in the healthcare communicator’s arsenal. They can build your reputation, influence public opinion, spur changes in behavior, and, as part of a bigger campaign, possibly even influence public policy. So letter rip!

 

Social Workers Bring Help and Hope

For Them, Caring is a Calling

“Never, never, be afraid to do what’s right, especially if the well-being of a person or animal is at stake. Society’s punishments are small compared to the wounds we inflict on our soul when we look the other way.” – Martin Luther King, Jr.

What is it that makes social workers tick? With March being National Social Work Month, we at SPRYTE thought what better time to delve into some of their motivations and inclinations?

For healthcare communicators, who are often tasked with showcasing the conscience of their organization – whether through corporate social responsibility programs, employee communications, or thought leadership initiatives – understanding how and why social workers do what they do can help shine a bright light on the path ahead.

For Episcopal Community Services’ Neibert Richards, MSW, LSW, it was always about caring and people.

“I originally went to school to major in nursing, but soon after I arrived, the school decided to phase out the major,” she recalls. After that, she was undecided as a major. That’s about the time she was introduced to the opportunity presented by social work.

“The biology and all the other classes just weren’t fitting with what I wanted to do,” says Richards. But the idea of helping others was clearly a guiding force.

 

A Caring Tradition

Those roots run deep. Her father was a minister. Her mother, a teacher. There were four children in all. The family moved to the U.S. from Guyana when she was eight.

“Family was always a huge factor for me,” Richards says. “I was always longing for connections, wanting to know who my cousins are. I was the one who always had an issue when someone couldn’t come to be with the family for the holidays.”

Soon after getting her Master’s in Social Welfare, she joined Episcopal Community Services (ECS), where she signed onto the foster care program. Today, 22 years later, she is Director of Permanent Housing at ECS.

 

Changing Times

Over the years, there have been many changes in the way social workers are viewed, she says.

“I think the career path is better organized. Social workers are viewed more as true professionals.” she says.

Hopefully, that view will supplant what Jeanne Morrison, MSW, Support Services Director for Crossroads Hospice & Palliative Care in Philadelphia, says is probably the biggest misperception people have about social workers.

“Lots of times, people use the term ‘social worker’ for someone who is actually a caseworker,” explains Morrison. “Especially in child welfare situations, there is a belief that it’s the social worker who is there to take the child away.  The reality is that the social worker’s goal is to keep families together whenever possible.”

 

Looking at Strengths

Morrison notes that social workers are trained to evaluate clients from a strength standpoint – whether it’s the family, an individual, or a group dynamic. The initial goal is to identify existing strengths that can be built upon to help address certain issues that the client is facing.

She says the effort is a true collaborative partnership between the social worker and the client.

To do that effectively, it’s important “to meet people where they are,” she says. “In order to identify their hopes and plans, you need to understand things from their standpoint. You can’t expect people to come to you. If you do, you’ll get nowhere fast. But if you can understand and meet them where they are, you can start identifying their hopes and dreams from that stanpoint.”

 

Next Generation of Social Workers

Emily Blumenthal is a student at the George Warren Brown School at Washington University in St. Louis currently working toward her degree in social work.

She says the holistic perspective that social workers are trained to utilize is one of the things that led her in this direction.

“As a social worker, you’re trained to look at the environment the individual is in – you need to pay attention to who they’re surrounded by, family, friends, whatever is going on. It’s important to get the whole perspective,” she says.

Blumenthal is currently in the midst of a practicum with Perinatal Behavioral Health Service working with pregnant women with mood disorders or depression, doing screenings and providing information in a clinical setting. Following this, she will move on to another practicum (focus to be determined) that will last about a year. The experience will provide her with a broader base of training and insights that will assist in a future career decision.

She says her ultimate goal is to go into counseling, perhaps working with young adults, couples, and young famiies. But she’s confident that her background and training in social work will enable her to choose from a number of options.

 

Remembering what’s Important

For ECS’ Neibert Richards, that diversity of opportunity is one of social work’s greatest strengths.

“Social workers are a lot of people who care about helping others, giving someone a helping hand to advance to the next stage of life so they can move in a positive direction,” she says.

“They’re the ones, walking the streets, counting the homeless every year for HUD,” Richards explains. “They’re the ones who have no problem going into a home that’s drug-infested, letting someone know that we have a bed here, the kids can come. They’re trying to get them to think beyond this life that they’re in. It isn’t easy for them. Social workers do it because they care.”

For healthcare communicators, when you’re telling your story, caring and people are usually good places to begin as well.

SPRYTE’s 2018 Hospice Predictions

Consumerism Drives High Touch and Tech

The past few years have seen a number of issues and innovations gain prominence in healthcare and the hospice industry.

Individualized, patient-centered care, technological advances and a growing ability on the part of patients to actively compare healthcare providers are three of the key trends that healthcare communicators – especially those who work in the hospice industry – are likely to encounter in the months ahead.

 

Focus: Understanding the Whole Patient

Beginning January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) began paying physicians to engage in advance care planning conversations with their patients to help them understand and make decisions about their end-of-life treatment preferences.

In the first year, approximately 575,000 Medicare recipients took advantage of the new benefit, according to a Kaiser Health News survey – almost twice the number expected.  Expect that number to increase in 2018. At the same time, look for an effort to broaden the focus of the conversation.

Dr. Tim Ihrig, Chief Medical Officer for Crossroads & Palliative Care (full disclosure: a SPRYTE client), says such conversations should go beyond discussions about extreme treatment measures and do-not-resuscitate orders. Instead, they should empower patients to consider what is most important to them from physical, medical, emotional and spiritual standpoints and use that as a basis for envisioning how they want to live their final days, weeks, months or years. Helping patients understand how palliative care can enhance the quality of their lives as they reach the final stages should be part of that evolving conversation as well.

Healthcare communicators need to understand the growing importance of patient-centric, value-based care to help educate patients and their own staff about best practices and what to expect.

 

More Ability to Compare and Contrast

Over the past few years, the CMS has developed a series of websites aimed at providing consumers with information that will enable them to begin the process of comparing healthcare providers in various sectors, including Physician Compare, Hospital Compare, Nursing Home Compare, and Inpatient Rehabilitation Facility (IRF) Compare. The websites offer a way to compare providers within a geographic area (and against national averages) based on specific quality metrics.

In August, 2017, the CMS launched Hospice Compare. The goal was to allow users to sort through hospices based on quality metrics, such as the percentage of patients who were screened for pain, or difficulty breathing, or whether patients’ preferences are being met. Almost immediately, however, the site became the focus of complaints that incorrect information was being provided – incorrect addresses, phone numbers and profit statuses were among the problems identified.

CMS administrators say they are working hard to correct the bad information. At the same time, they say additional quality metrics will be added to help users make more informed choices as they compare hospice providers. Look for a more accurate and robust Hospice Compare website to appear – eventually. (No clear timeline has been established.)

In the meantime, healthcare communicators need to be alert to new developments and be ready to provide accurate information about their own organizations on a timely basis.

 

Technology’s Role Will Continue to Grow

Many people are still surprised when they learn that hospice is not a place, but rather a program designed to help patients with a terminal illness live peacefully and painlessly as they reach the end of life. The growth of telehealth will make the delivery of hospice-related services more accessible and reliable than ever. Nothing, of course, will supplant the value of in-person visits by a nurse or care provider. But the availability of round-the-clock medical monitoring and telecommunications with patients or family members will enable a higher level of quality care for those who are homebound, who lack family support, or who live in very rural or isolated locations.

Other technological advancements in the area of virtual reality are already helping to educate providers, support staff, first responders and family members about what it’s like to experience some of the conditions and challenges faced by patients who are elderly, infirm, or dealing with dementia. In fact, during 2017, two of our healthcare clients – Crossroads Hospice and Holy Redeemer Health System – staged “virtual dementia tours” for the benefit of caregivers and family members. Special programs such as this allow healthcare providers to showcase their special knowledge while providing an important educational public service – always a great opportunity for communicators.

Additional technology-driven developments are underway – programs to better track opioid use and abuse, enhanced data-driven analytics to help providers in the areas of tracking, documentation and reporting, and improved work management systems that enable providers to offer more timely, efficient care to their patients.

No doubt, 2018 will be an exciting time. As always, healthcare communicators will need to be alert and constantly aware of the fast-paced developments taking place in their industry and how they can impact their own organizations.

Published January 2, 2018 by Spryte Communications in Public Affairs

Is Your Website ADA Compliant?

Online Information Barriers Risk Litigation  

The 1990 Americans with Disabilities Act (ADA) prohibits discrimination against individuals with disabilities in every area of public life, including employment, education, transportation, telecommunications and all public and private places that are open to the general public.

As professional communicators, we work closely with our clients to help them craft messages to reach their target audiences. With the continuing evolution of web-based communications, the need to adapt the message for each target audience is a growing challenge.  For healthcare communicators, making sure important information can be accessed and understood by as many people as possible is critical.

Many of us are familiar with some of the most common changes fostered by the ADA – door ramps, public restroom accommodations, and special wheelchair lifts on public buses, to name a few. But the ADA has also played a key role in the evolution of online commerce, by trying to ensure that the disabled have equal access to goods, services and digital content on websites operated by businesses and other organizations.

 

Technology Brings Change

As part of a recent webinar sponsored by the New England Society for Healthcare Communicators (@NESHCo), presenters from @SilverTech, a digital marketing firm, noted that the federal government often serves as a catalyst for changes that are adopted throughout industries.

Several prominent legal cases have helped further the cause of greater website accessibility for the disabled.

National Federation of the Blind v. Target Corp. was a class action suit brought against the retailer because blind consumers could not navigate the Target website and make purchases as readily as a non-disabled consumer could. The result: The court found the ADA’s prohibition against discrimination in the “enjoyment of goods, services, facilities or privileges” applied to public accommodations in cyberspace as well as a physical retail store.

In National Association of the Deaf v. Netflix, Netflix was found to have violated ADA protections because it failed to provide closed captioning for its “Watch Instantly” digital content. The case confirmed that businesses that sell services exclusively through the internet were also subject to ADA provisions that protect disabled citizens against discrimination.

In 2014, an agreement negotiated between the Justice Department and Peapod, an internet grocer, further solidified the scope of the ADA’s reach, by emphasizing the importance of ensuring websites are equally accessible via mobile devices.

 

The Future: Greater Accessibility

These recent cases may be the beginning of many more website accessibility cases. That means pressure on organizations to ensure that digital content on their websites and affiliated technology are independently accessible, regardless of whether the user is working from a laptop, smartphone or other mobile device.

Healthcare organizations and financial institutions – because they tend to be highly transactional – may be particularly vulnerable to potential ADA accessibility litigation. For example, for consumers who use a hospital website to find a physician, look up services, identify locations – any such type of direct engagement – the information should be as accessible as if the consumer were entering the facility itself.

 

Enhancing Accessibility Enhances SEO

Making sure one’s website is accessible to people with disabilities not only protects against ADA-related litigation, it also enhances the search optimization of your site.

The basic idea of the internet has always been to provide information in as accessible a fashion as possible. By limiting accessibility, you run the risk of cutting off customers and potential markets. Thus, it’s important for organizations to follow best practices to ensure their websites’ accessibility is constantly maintained.

The Web Accessibility Initiative (WAI) of the World Wide Web Consortium (WC3), the primary international standards organization for the internet, has published a series of web accessibility principles to help organizations keep their websites current.

 

P.O.U.R.

The thrust of the Web Content Accessibility Guidelines 2.0 (WCAG) can be remembered by using the acronym P.O.U.R.

P is for Perceivable. All digital content and user interface components should be presented to users in different ways to account for different means of perception.  For example, digital content should provide text alternatives to non-text content. Multimedia should have captions or other alternatives to explain the action that is taking place. Assistive technologies should be integrated where possible, so that meaning isn’t lost. Also, enabling users to see and hear – rather than just read – content is a plus. Consider offering transcripts of podcasts. If your website includes video, provide visual access to audio information through in-sync captioning. Also, don’t rely on color as a navigational tool or as the only way of distinguishing items.

O is for Operable. Websites should be designed so interface components and navigation is easily operable (e.g., via keyboard or mouse), and tagged to work with voice control systems. The interface should assist users in navigating and finding digital content, and also give users enough time to read and use it. Including a skip navigation feature can make it easier for automatic screenreaders to make sense of on-screen content.

U is for Understandable. Information about the user interface and its operation should be clear and understandable. For example, error messages should provide a clear explanation of the problem (Not just say “Error” or “Invalid field”). Digital content should also appear and operate in predictable ways. (In other words, try to make it as easy as possible for the user to find what s/he’s looking for.)

R is for Robust. Content should be robust enough that it can be interpreted by a wide range of user applications, including assistive technologies. Compatibility with current and future user tools should be an ongoing goal.

 

Conclusion

The internet’s continuing evolution as a primary source of commerce, entertainment, information and services has changed the way business, government and society operate. Those with disabilities may find that some websites don’t provide the level of access they need to partake of information, products or services that are presented on their websites.

Organizations, particularly those in healthcare, need to maximize their efforts to ensure that anyone, regardless of a disability, can easily navigate their websites and access the digital content they need. Doing so will help forestall ADA-related litigation. But it will also enhance the basic navigability and SEO compatibility of the website.

How to Write an Obituary: Preparing a Lasting Tribute

A Good Obituary Remembers the Living as Well as Those Lost

At times in our professional careers – and in our personal lives – we may be called upon to craft an obituary for a professional acquaintance, colleague, friend or loved one.

As a communications consulting firm, we have worked with hospice clients in developing appropriate guidelines for such sensitive messages. In addition, we occasionally are asked to put together such tributes on behalf of a company executive, board member or respected volunteer who has passed.

It can be a daunting challenge – where to start?

Contemplating one simple question can serve as a practical starting point:  How would you like to be remembered?

At its most fundamental level, an obituary serves several functions. It’s a notification that someone has passed. It’s an account of the life they’ve lived, as well as the range of people whose lives they’ve touched – not only extended family but special friends, acquaintances and others. It also provides important news and directions for planned services or funeral arrangements. Sometimes it can contain special thanks to caregivers or friends who were there in a time of need. It might also be an opportunity to suggest where charitable donations can be given in a loved one’s memory.

Moving Beyond the Basic

Still, at its best, an obituary is a tribute to a life well-lived and a person well-loved.

Remember that you’re not just reporting information. You’re telling the story of someone’s life. Of course to do that, you’ll need to gather basic information.

By talking with loved ones you should be able to get the basics: age, occupation, education, military service, where they were born, places they lived.

Try to get an appreciation of their lives by looking through different lenses. What were their interests? What sports or hobbies did they enjoy? What about community involvement or faith-based activity?  What charity events did they promote or support? What were their most important or impressive accomplishments?

Adding Some Color

Instead of a formal interview, you may find that family members or friends will respond better in more relaxed conversations. Give them time to think and reminisce in an informal, comfortable setting. Get them to tell interesting stories about their interactions with the loved one who has passed. The goal is to give readers insights into what made that person special. Maybe it’s a special trait of character like a short fuse or a sense of humor that brings a smile to a loved ones’ face. Maybe they’ll talk about the individual’s sense of modesty, community-mindedness, generosity, love of travel and so on.

With those memories as your palette, try to paint a word picture of who this person was and what they meant to the world, their friends and their loved ones. Don’t just say that so-and-so was a good person. Show the reader by describing their interactions and the energy they put into those aspects of their lives they held most important.

As you round out the obituary, you’ll need to determine which family members to include – those who preceded them in death, as well as surviving relatives and other loved ones. How far back does the family want to go? Be extra careful about accidentally omitting people: grandparents (both sides, living as well as deceased), step-families, aunts and uncles, significant others, and of course, children, grandchildren and more, if needed.

Remember that those who are giving you information for the obituary have lots of other things on their mind. Be extra careful not to hurt anyone’s feelings with an unintended omission. Finally, find out if there is a specific charity or other cause the family wants to single out for memorial donations.

Adapting to Fit the Need

Consider creating several different versions/lengths for the obituary – a short one for a paid ad, and a longer one that could be used as a handout at the eulogy or funeral service. Check with your local newspaper for appropriate publishing lengths. With genealogy so popular, you might consider an even longer one to offer some family history, or to post on a website.

Also, make sure to proofread the finished work. Better yet, have a family member or other knowledgeable person review the finished copy for accuracy and completeness.

Dealing with Unfortunate Realities

Finally, keep in mind that, unfortunately, there are unscrupulous people in this world who look to prey on the vulnerable. Be careful about including information that might be used for identity theft, or that might make someone vulnerable for exploitation. Depending where you live, you may want to avoid identifying the address of the surviving spouse, or even the time of the funeral, as would-be burglars sometimes scan obituaries so they can target what they think will be an unwatched house.

The bottom line: be compassionate, be complete, but also be careful.

Published October 24, 2017 by Spryte Communications in Public Affairs

Telehealth: Potential & Promise

E-records and video chats are only the beginning

Given recent events, finding common ground in a discussion over healthcare policy might sound like a fool’s errand.

But there’s one area that is garnering strong support from all sides – telehealth.  And its popularity continues to grow. For example, Kaiser Permanente, which began using telehealth on a national basis in 2006, reports that 52 percent of its patients (approximately 59 million) received telehealth treatment in 2016.

Telehealth is fast becoming a priority throughout the industry. In its “2017 U.S. Telemedicine Industry Benchmark Survey,” released last month, REACH Health, an enterprise telemedicine software company, reported that 51 percent of executives and caregivers surveyed considered telehealth a high priority. Another 36 percent said it was a medium priority. Only 13 percent ranked telehealth as a low priority.

For healthcare communicators, it is important for us to have an understanding of key issues impacting our industry – and how they are likely to affect our own organizations, partners, clients, patients, and others that play a role in our business or service enterprises.

The Health Resources and Services Administration (HRSA) defines telehealth as “the use of electronic information and telecommunications technologies to support and promote clinical healthcare, patient and professional health-related education, public health and health administration.”

The Potential of Telehealth

Exponents in telehealth believe it will help point the way to achieving a number of long-sought goals, including:

  • Improving access to healthcare
  • Making healthcare delivery more efficient
  • Enhancing providers’ ability to coordinate care and securely share patient information
  • Reducing hospitalizations and in-person clinic visits by enabling patients to be monitored or receive care and counseling “distantly” without having to make a physical visit to a doctor’s office or hospital (something that is particularly important in under-served rural areas)
  • Reducing costs – because telehealth services can be delivered more efficiently

Telehealth and Telemedicine

While people may use the terms telehealth and telemedicine interchangeably, there are distinctions that can be made. Telehealth is a broad term that includes a wide range of remote healthcare services and technologies, including non-clinical services such as providing healthcare information, education and training for health professionals and health consumers. Telehealth also includes health systems management via internet and telecommunications applications.

By comparison, telemedicine is a more clinically focused subset of telehealth that primarily focuses on the use of electronic communications and software applications to provide clinical services to patients without an in-person visit.

Embracing the Future

Recently a number of healthcare providers have announced that they are actively adopting and investing in telehealth services.

Earlier this year, The Philadelphia Business Journal announced a new joint effort between Griswold Home Care, (Full disclosure: A SPRYTE client) a home care provider with over 200 office locations in 33 states, and telehealth services provider Teladoc. The aim: to give Griswold clients 24/7 access to talk to a doctor or get a diagnosis over the telephone. The Teladoc physicians can diagnose and recommend treatment for a range of medical conditions, including colds and flu, allergies, bronchitis, rashes, and respiratory or sinus ailments, as well as provide short-term prescription refills.

Earlier this month, NJBIZ reported that Vanguard Medical Group had partnered with virtual care company Zipnosis to create a new online diagnosis and treatment service that a Vanguard spokesman described as “the wave of the future.” The new program comes on the heels of recently enacted New Jersey legislation (S291) that authorizes healthcare providers to engage in telemedicine and telehealth as a type of treatment covered by insurance.

Increased Government Support

It might sound surprising given the recent volatile debate over national healthcare reform, but support for telehealth is something on which members of both parties have expressed enthusiastic support. At the end of September, Senate Republicans and Democrats unanimously passed legislation called the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care (CHRONIC) Act of 2017.

The purpose of the CHRONIC Act is to enable Medicare-accountable care organizations to expand the utilization of telehealth services, incorporate wider telehealth benefits in Medicare Advantage plans and expand the use of virtual care for stroke and dialysis patients.

Sen. Orrin Hatch (R-Utah) the prime sponsor of the bill, said the legislation would “improve disease management, lower Medicare costs and streamline care coordination services.”

Meanwhile, his counterpart, Sen. Ron Wyden, (D-Oregon), lauded the bill for placing a stronger focus on primary care by providing “more care at home and less in institutions. It will expand the use of lifesaving technology,” he said.

A Promising Future

In recent years there has been a continuing evolution of the healthcare provider model into one that is more individual patient-focused and results-oriented. Telehealth is helping to support this evolution by providing a practical means for physicians to treat and counsel patients at a distance, efficiently, economically, and in a collaborative way with fellow medical professionals.

Telehealth has been, and will continue to serve a key role in fulfilling the promise of these initiatives, particularly as healthcare providers’ interest in deinstitutionalized care models such as community-based urgent care facilities, virtual medical centers, mobile health programs and remote clinical services continues to grow.

As healthcare communicators, we’re accustomed to serving many masters – from hospital administrators to clinicians to volunteers to patients to government regulators, and more. As telehealth continues to roll forward, it will be more important and more challenging than ever to work with these often widespread and disparate groups to ensure that your messaging is clear and consistent across all communications channels, and that interested parties have access to timely and accurate information.