Transcript Slide 1

American Institutes for Research
Communicating With Workers
About Evidence-Based Health Care
Kristin L. Carman, Ph.D.
American Institutes for Research
June 10, 2009
Content
• Current context for communicating with employees
about evidence-based health care
• Development of a Communication Toolkit and lessons
learned about challenges communicating with
employees
• Supporting more effective communication
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Current Context for Communicating
with Employees About
Evidence-Based Health Care
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Employees Must Be Part of Any
Health Care Solutions
• Current policy directions place high expectations on
employees
– Belief that changing employees behaviors and choices
are essential for controlling costs and for improving
quality.
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Expectations for Employee Behaviors
• Choose high quality / cost-effective health plans,
providers and hospitals
• Choose evidence-based treatments
• Engage as a partner in care with providers
• Self-manage chronic illness
• Maintain healthy behaviors
• Seek preventive care
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4 Trends Affecting Employees
• Growing costs with employees paying greater out of
pocket expenses
• A proliferation of information and information sources
• More responsibility for making choices
• Increased complexity of:
– Health care options
– Tasks involved in managing personal health
– Health care navigation
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The Stakes Have Been Raised for Employees
• Individuals are being asked to assume more
responsibility for choices
• The impact of choices have become more
consequential – for personal finances, for health, and
for the kind of care they get
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Finding Ways to Engage Employees
Has Become a High Priority
• Being an activated consumer is not just about
knowledge, must also have skill, and the confidence
to take action
– Problem solving
– Literacy skills
– Numeracy skills
– Decision-making skills
– A variety of skills to adopt healthy behaviors
– Confidence to be a prepared and assertive patient
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Development of a Communication
Toolkit & Lessons Learned
About Communication Challenges
The Role of Evidence in the
21st Century Health Care System
Evidence based health care
embodies these values:
•Decisions are based on
medical evidence and quality
standards
•Reduction in the under-,
mis-, and overuse of
treatments and health care
resources
•Patients having more active
engagement in and
ownership of their health care
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Roles in Evidence-Based Health Care
Purchasers/
Employers
• Select insurers
that offer high
quality and
efficient networks
• Provide patients
with evidencebased information
and decision
support
Employees
• Seek evidence
when making
decisions
• Use evidence to
make informed
decisions about
plan, provider, and
treatment
• Discuss evidence
with providers
• Learn about cost
and quality issues
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Plans
• Reward providers
based on meeting
evidence
standards
• Provide quality
improvement
efforts and
decision support
technologies
• Provide patients
with evidencebased information
and decision
support
Clinicians
• Seek evidence
when making
decisions
• Use evidence to
make informed
decisions about
treatment and
provider referrals
• Discuss evidence
with patients
Purpose of the Toolkit
• Take positive aspects of making health care decisions
based on evidence and translate them into language
and concepts that employees can understand and
embrace
• Help employers, unions, and others frame messages
to employees about evidence-based health care
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What We Did
Assess and understand
• What are employers and unions doing to communicate about this topic?
• What are desired components of the Toolkit?
• What are consumers’ understanding, attitudes, and beliefs about this topic?
Methodology
• Environmental scan
– Literature review
– Review of websites
– Phone interviews with experts
• 4 focus groups with union and non-union employees (59%)
• 5 rounds of interviews to test materials with union and non-union employees
(25%)
• Survey of employee attitudes about evidence-based concepts and
experiences (NBGH Survey on Employees and Healthcare Decision Making)
– 20% union members
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Lessons learned:
There are stumbling blocks to understanding
and acting on key concepts underlying
evidence-based health care
These stumbling blocks mean that existing
information and supports for employees may
not be as effective as they could be
Three Core Challenges to
Communicating with Employees
1. Fundamental disconnect between the tenets of
evidence-based medicine and the knowledge,
values, and beliefs held by many employees
2. Employees have limited experience with
becoming more actively involved and find it hard to
engage
3. Employees don’t necessarily trust important existing
communication channels
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Challenge #1:
Fundamental disconnect between the
tenets of evidence-based medicine
and the knowledge, values, and beliefs
held by many employees
Employees Are Unfamiliar with Key Tenets of
Evidence-Based Health Care
• Unfamiliar with the
terms “medical
evidence,” “quality
guidelines,” and “quality
standards”
• Only 49% surveyed
said they had heard
about medical research
• Only 34% surveyed
had ever had a
physician discuss the
topic with them
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“Of course my doctor uses
evidence-based medicine.
He makes decisions based
on the available evidence—
things like my test results
and medical history.”
Employees Have Negative Beliefs About Using
Guidelines and Standards to Make Decisions
“Using medical guidelines
sounds like...your doctor
can’t give you other
treatment without approval.
It’s taking your choice away
and putting the decision in
somebody else’s hands.”
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Many believe that
guidelines and
standards
•restrict choice
•inhibit innovation
•are inflexible
•are biased
•represent low
standards
Employees Have Beliefs That Challenge Key Goals
of Evidence-based Health Care
Employees believe:
•More care is better
•Newer care is better
•More costly care is better
“I don’t see how extra
care can be harmful to
your health. Care would
only benefit you.”
•Their physicians know best
•Treatment decisions and
health care quality should
not be discussed in terms
of costs
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“Because if you’re going
to have a doctor that’s
better, he’ll charge
more.”
Challenge #2:
Employees have limited
experience with
becoming more actively involved
and find it hard to engage
Employees Have Limited Experience
in Engaging Physicians
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Employees Are Inundated with Information
• Competing demands
for their time,
attention, and action
• Inundated with
information
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“Sometimes you get so
much information that you
just don’t know what to do
with it anymore. I sit down
to read something, and the
more I read, the less I
know.”
Challenge #3:
Employees don’t necessarily trust
important existing
communication channels
Employers and Health Plans Are Not Considered
Trustworthy Sources of Health Information
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Information May Not be Personally
Relevant to Employees
• Not sure how all this
information is
personally relevant
and what they can or
should do
• This is especially
problematic because
workers find it difficult
to know who and
what to trust
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“I think they’re just trying to
cut costs—I don’t think
employers are looking at
our health at all. They’re
looking at what will cost
them the least. I don’t think
that employers would even
give us benefits if they
didn’t have to.”
Policy Implications
• Comparative effectiveness research
– Employees may be leery of payor motivation in conducting
and implementing this research
• Evidence-based benefits design/value-based insurance
– While logical to payors and policy-makers, it may not
resonate with employees
• Transparency and cost information
– Employees views may threaten the basic premise of
reporting efforts
What to do? Continue to translate evidence-based health
care into concepts and concrete, manageable activities to
support and motivate employees
Supporting More
Effective Communication
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Communication Toolkit Key Features
• Explain unfamiliar concepts in ways that are easy for
employees to understand
• Reinforce key messages and include vignette
examples
• Approachable and easy to skim
• Action oriented -- tell employees what specific things
they can do, what the benefits will be, and where they
can learn more
• Insert text that tells what the company or union is
doing to support evidence-based care
Contact Information
Kristin L. Carman, Ph.D.
Managing Director
American Institutes for Research
1000 Thomas Jefferson Street, NW
Washington, DC 20007-3835
(202) 403-5090
[email protected]
www.air.org
Visit the Communications Toolkit at
http://www.businessgrouphealth.org/usinginformation
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