Juneteenth – America’s Other Independence Day

Patient Experience Relies on Understanding Diverse Perspectives

Americans love their Fourth of July holiday. After all, it’s America’s birthday – the day we traditionally set aside to celebrate the signing of the Declaration of Independence and the establishment of a free nation where “all men are created equal.”

But for many, those hallowed words proved hollow. Hundreds of thousands of slaves throughout the young United States – especially in the South – would need to wait almost another century before their rights to equality were officially recognized.

Another View of History

On July 5, 1852, famed African American abolitionist Frederick Douglass, himself a former slave, delivered an impassioned speech spelling out the irony inherent in the July 4th celebration:

“This Fourth of July is yours, not mine. You may rejoice, I must mourn,” Douglass said. “What, to the American slave, is your Fourth of July? I answer: a day that reveals to him, more than all other days in the year, the gross injustice and cruelty to which he is the constant victim…”

It would take another 13 years, hundreds of thousands of lives, and a Civil War that tore apart the fabric of the American nation before four million African-American slaves would get their own taste of freedom.

Juneteenth – Freedom Reborn

On June 19, 1865, Union General Gordon Granger, military commander of the defeated Confederate state of Texas, read aloud General Order No. 3, telling the populace of Galveston that: “The people of Texas are informed that, in accordance with a proclamation of the United States, all slaves are free.”

Spontaneous celebrations among the newly freed African American population quickly erupted across the South as Juneteenth was born. African-American communities across the U.S. soon adopted Juneteenth as their own holiday, using it as an occasion for celebrating freedom with public events, picnics and church gatherings.

Understanding Leads to Compassion

Once we understand the history of Juneteenth and how it came into being, it’s easier to appreciate why many African Americans consider Juneteenth to be a day to celebrate not only the vision of freedom President Lincoln described in his 1863 Emancipation Proclamation but also the original promise of the Declaration of Independence.

Since our childhood, we’ve been told that America is a melting pot, comprised of people from all over the world, representing a multitude of religious backgrounds, races, cultures, customs, languages and lifestyles.

Healthcare providers face the everyday challenge of understanding how these differentiating factors may affect individuals’ or families’ attitudes toward illness, pain, coping and death. It is important to appreciate why these attitudes are held, because they can significantly influence their willingness to explore various treatment options. Hospice, in particular, can be an especially touchy discussion topic.

For example, according to statistics, African-Americans comprise approximately 12% of the U.S. population, but they make up only 7.6% of hospice patients. Ironically, African-Americans have a disproportionately higher rate of cancer and heart disease, which are among the top hospice diagnoses.

Researchers point out several reasons for this incongruity. As a rule, African-American families tend to be less trustful of the American healthcare system. In addition, because medical decisions tend to be made within the family, there may be a reluctance to consult with a new, unknown healthcare professional or someone outside the home. Finally, statistically speaking, African Americans tend to be especially reluctant to cease life-prolonging procedures such as tube feeding, organ donation, and palliative care in the hospice setting – because extending life is generally seen as something to be preferred.

Honoring Differences

Healthcare communicators need to recognize that their messages may be perceived very differently by diverse audiences and adjust accordingly to ensure positive patient experience.

As the U.S. healthcare system continues to evolve to one that is more population health-oriented and patient-centered, there is a growing need for healthcare providers to educate patients, families and the general public about what they can do to stay healthier, as well as the nature of specific healthcare challenges and treatment options.

Understanding their emotions, how they think, and the reasons behind these different perspectives is vital to helping patients and families make treatment decisions that are most appropriate for their individual situations.

It’s not unlike coming to appreciate the Juneteenth holiday. The better we understand the history and background of our patients, the better we can understand and honor the views and emotions that influence their decisions and actions.

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.

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