Beyond Infographics: Contextual Factors in Healthcare MR. Thomas M. Richardson PhD, MBA, PA-C Sr. Vice President Consulting, KJT Group, Inc.

Transcription

1 Beyond Infographics: Contextual Factors in Healthcare MR Thomas M. Richardson PhD, MBA, PA-C Sr. Vice President Consulting, KJT Group, Inc.

2 Agenda Market Research Level Set Define Contextual Factors The Changing Healthcare Landscape Pt Engagement- Behavior Models ## Clinical Decision Making Models Practice Change Models Summary and Questions Summary & Questions 2

3 MARKET RESEARCH

4 The Goal of Marketing Right product Right message Right target market 4

5 The Goal of Market Research Target audience s wants, needs, beliefs and what they value the most Factors influencing the clinical decision making process and purchasing decisions 5

6 We focus on Pills Devices Medical Products/Supplies Services 6

7 We conduct many different types of studies Trackers (ATUs) Product Concept and Message Testing Market Landscape Segmentation and Positioning Pricing and Forecasting New Product Development and Product Design Product and Services Innovation 7

8 Qualitative Research So how does that make you feel? 8

9 Quantitative Research 9

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11 Designing and Conducting MR is a Simple Process 11

12 Infographics 12

13 Healthcare Market Research PROBLEM Market research projects Scope: Wider Timeline: Shorter Budget: Tighter SOLUTION Focus on your Research Design Consider Contextual Factors Leverage Existing Theoretical Frameworks Focus on Key Takeaways and infographics INSIGHTS come from a deep understanding of the issues at hand 13

14 T-Shaped Employees Generalist/Broad Knowledge Healthcare Ecosystem Market Research Specialist 14

15 CONTEXTUAL FACTORS

16 What do we mean by context? Context: noun. the set of circumstances or facts that surround a particular event, situation, etc. 16

17 Why does context increasingly matter in market research? Because we are trying to understand how to change behaviors, get people to adopt new practices, prescribe new drugs, perform new procedures Increasingly our clients are developing and researching more complex healthcare solutions to address the needs of healthcare delivery system Decision making is moving from the individual level to group, committee, unit, practice, department, hospital, health system levels. The issues of costs, reimbursement and the interpretation of value varies among the key stakeholders 17

18 THE CHANGING HEALTHCARE LANDSCAPE

19 Healthcare Delivery is Dynamic and Heterogeneous 19

20 Moving Toward Integrated Delivery Systems 20

21 Pay for and Reimbursement for Healthcare Services 21

22 The Spectrum of Value-based Reimbursement Fee for Service Pay for Coordination Pay for Performance Bundled Payment Shared Savings Programs (Upside and Downside) Capitation Low Risk High Risk 22

23 Focus on Quality Reporting and Outcome Metrics Type Outcome Process Structure Patient Experience Description Evaluates patient health as a result of the care received. Determines if the services provided to patients are consistent with routine clinical care. Assesses the characteristics of a care setting, including facilities, personnel, and/or policies related to care deliver. Provides feedback on patients experiences of care. 23

24 Kindig, David, and Greg Stoddart. "What is population health?." American Journal of Public Health 93.3 (2003):

25 What is Precision Medicine? According to the National Institutes of Health (NIH), precision medicine is "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person." 25

26 Personalized or Patient Centered Medicine Right Treatment Right Patient Right Time Right Setting Right Provider 26

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28 Drug Distribution System Pharmacy Benefit Manager Payment Health Plan/Payer Flow of Funds Flow of Prescription Drugs Negotiated discount/rebate for drugs (volume, market share, formulary placement) Share of rebates from manufacturer Drug Manufacturer Negotiated discount/rebate for 2 1 drugs (volume, market share) AWP- or WAC-based, negotiated payment 3 ASP-AWP- or WAC-based, negotiated payment Premium Pharmacy Drugs Drugs Negotiated discount/rebate for drugs (volume, market share) Cost sharing/ payment Drugs WAC-based payment Wholesaler Provider (hospital, physician) 4 Drugs Beneficiary Drugs Chargeback WAC-based payment subject to prompt pay/other terms WAC-based payment Cost sharing/ payment AMCP Guide to Pharmaceutical Pricing 28

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30 Healthcare Trends Pharma moving beyond the pill Medical device manufactures looking to develop full solutions across the care continuum Evidence-based practice and more personalized and patient-centered care Monitoring and early detection Patient engagement, adherence and compliance Patient support programs Care management Integrated technologies 30

31 PATIENT ENGAGEMENT- BEHAVIORAL MODELS

32 Health Belief Model Janz, Nancy K.; Marshall H. Becker (1984). "The Health Belief Model: A Decade Later". Health Education & Behavior. 11 (1):

33 Stages of Change Model Facilitate action Reinforce changes, reminder communications Persuade and motivate Educate Maintenance: works to sustain the behavior change Action: practices the desired behavior Create awareness; change values and beliefs Preparation: intends to take action Contemplation: aware of the problem and of the desired behavior change Precontemplation: unaware of the problem Prochaska, James O., and Carlo C. DiClemente. "Toward a comprehensive model of change." Treating addictive behaviors. Springer US,

34 Wagner s Chronic Care Model 34

35 Anderson Behavioral Model of Health Care Utilization Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav Mar;36(1):

36 CLINICAL DECISION MAKING MODELS

37 Clinical Decision Making Best available research evidence Environment and organizational context Decision-making Population characteristics, needs, values, preferences Resources, including practitioner expertise Satterfield JM1, et al.toward a transdisciplinary model of evidence-based practice. Milbank Q Jun;87(2):

38 Elements of Evidence-Based Policy & Practice Satterfield JM1, et al.toward a transdisciplinary model of evidence-based practice. Milbank Q Jun;87(2): Haynes, R.B., P. Devereaux, and G.H. Guyatt Clinical Expertise in the Era of Evidence-Based Medicine and Patient Choice. ACP Journal Club 136:A11 A14. 38

39 Roger s Innovation-Decision Process Rogers, Everett (16 August 2003). Diffusion of Innovations, 5th Edition. Simon and Schuster 39

40 Roger s Innovation-Decision Process Rogers, Everett (16 August 2003). Diffusion of Innovations, 5th Edition. Simon and Schuster 40

41 MODELS EXAMINING PRACTICE CHANGE

42 Tomoaia-Cotisel et. al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Ann Fam Med May-Jun;11 Suppl 1:S

43 Understanding an Intervention s Context Level 3: External Environment Level 2: Larger Organization Level 1: Practice Market Environment Community characteristics Political authority Grant or other external financial support Level of coordination/ involvement with community Payment model(s) available Competing priorities Degree of intervention integration Contractual arrangements Ownership Leadership style Structural capabilities Financial incentives Employee mix Clinician demographics, attitude and training Patient panel size and characteristics Ownership Leadership style Structural capabilities Tomoaia-Cotisel et. al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Ann Fam Med May-Jun;11 Suppl 1:S

44 Hernandez SE1, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case study application. Health Care Manage Rev, 2013, 38(2), 44

45 Patient Centered Innovation in Healthcare Organizations Environmental Context Strong Motivators for Change Effective Organizational Leadership Clear mission Aligned beliefs, values, norms Proactively initiate change Willing to experiment & take risks Organizational Strategy Clarity of purpose Specific change objectives Coherence of strategic & operational plans Structure Design & coordination mechanisms Task design HR processes Size Technological Patient-Centered Innovation Organizational Mission & Culture Organizational Capability Hernandez SE1, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case study application. Health Care Manage Rev, 2013, 38(2), 45

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47 Contextual Factors that Influence PCMHs & Outcomes National, State, local organizational policies Community norms and resources Healthcare system organization Payment and incentive systems Practice culture, history, and staffing Characteristics of patient populations and subgroups Historical factors and recent events The culture and motivations surrounding monitoring and evaluation Changes in these factors over time 47

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49 Health System Environment Organization Characteristics Outcomes Market size, structure, capacity Population characteristics Provider & payer concentrations Competitive dynamics State & local policy environment Local culture Leadership Structure & service capacity Financial & operating characteristics Data management & analytic capacity Performance improvement infrastructure Payer relationships & contracting structures Physician & staff engagement Spending Service use & mix Patient experience Quality Access 49

50 The Mathematical Model 50

51 SUMMARY

52 Think in Terms of Linking Goals Right Treatment Right Patient Right Time Right Setting Right Provider Right Product Right Message Right Target Market 52

53 Key Takeaways Embrace the Focus on Leverage relevant research theoretical contextual design models factors 53

54 Thank You Thomas M. Richardson PhD, MBA, PA-C Sr. Vice President Consulting, KJT Group, Inc x344 54