Solomon McCown &

We have all sat in a medical office at some point listening to our doctor give us a diagnosis and then telling us how to proceed.  Because doctors dedicate such a large portion of their adult life to their medical education, we often blindly follow their advice without discussing the options. But that is all changing as the realities of an unsustainable health care system set in and monumental changes abound.

This month's cover story in Hospitals & Health Networks is about why shared decision making is a model to help the health care industry transition into a system that rewards value and quality of care.  While the article focuses on involving the patient in decision making about their medical treatment, the underlying theme of both shared decision making and value based care is consumer education.  How can a patient appropriately and accurately participate in a conversation with their doctor about their care options without truly understanding the system? And how can physicians who have dedicated their lives to medicine trust a patient to make an informed medical decision?

It all comes back to education - teaching patients how health care works, what it costs, what questions to ask their doctors and giving them the confidence to be a part of the decision making process.  And teaching providers to listen to their patients, identify their health goals, and move beyond the clinical diagnosis is key to truly making the patient part of the experience. To make value based care work, physicians and patients need to change the way they interact. There is more to this transition than new models of care. To make value based care work, we need to make cultural changes so that patients are encouraged to be part of their care.

The Informed Medical Decisions Foundation encourages the use of "decision aids" which help patients learn about their diagnosis and the possible treatments. The National Institute of Health has joined the movement by empowering patients to speak up in the doctor's office and provides tips about how to talk to your doctor.

While the industry understands the need to involve consumers in health care and educate them to make more informed decisions, it is not happening in reality.  A recent Kaiser Health News tracking poll found that 42 percent of Americans are unsure if Obamacare is even still a law and who can blame them with the House of Representatives voting for the 37th time to repeal it. But for a value based system to work, consumers have to be engaged.  And for consumer to be engaged, they have to understand how health care works.

by Alicia Bandy, SM& Senior Account Executive

State House News recently covered our client, the Massachusetts Developmental Disabilities Council, and its 35^th annual legislative reception, "Our Voice: Now More Than Ever." The article discussed Governor Deval Patrick's speech, during which he urged citizens to talk to their legislators and addressed his legislative priorities for those living with developmental disabilities. The article mentions the moving stories legislators and MDDC council members shared during the event.

Where is the consumer when it comes to health care and health care costs?  That's an important question and one that needs to be factored into any effort to change how we get and pay for health care in the future if the changes have any chance of succeeding.

Recent results from a series of eight focus groups conducted by the Robert Wood Johnson Foundation (RWJF), give us a little window into that question.  The focus groups took place in Philadelphia, Charlotte, Chicago and Denver and involved people who got their insurance from their employers and from the private market with deductibles of $500 or more, Medicare recipients and one group who were uninsured.

Here's what they found:  When it comes to cost, people think of what they have to pay for health care.  They really have no broader understanding of "how insurance works and/or how doctors are paid."

While participants knew very well that the cost of health care was going up, they really don't know why but they do know "practically to the penny" what their out-of-pocket costs are, something RWJF said was a new development.

For most of the participants, saving money on health care was a personal issue that related to having more money for other areas of their lives rather than because it was good for the country.

But there's some good news here as well as health care tries to control and reign in costs and that is many participants in the survey didn't necessarily think paying more for health care was related to better quality of care.  That surprised RWJF and frankly goes against what is usually referred to as the "Neiman Marcus" effect - the idea that if it costs more it's better.

The conclusion - the consumer wants more information and there is room to engage them in what is changing and why.

By Michal Regunberg, SM& Senior Vice President

In light of the unusually early & serve flu season this year, Dr. Ben Kruskal, Chief of Infectious Disease at Harvard Vanguard Medical Associates, was featured on ABC World News with Diane Sawyer on January 3. Dr. Kruskal discussed the increased number of patients with flu symptoms, noting Harvard Vanguard has seen over 600 cases per week on average.

DentaQuest Foundation Director of Policy and Programs Mike Monopoli speaks about the Oral Health Safety Net Initiative in RE: Philanthropy blog. The Initiative is part of a collective effort to change the conversation about oral health access.

The Boston Globe reported on the expanding role of physician assistants in Massachusetts in a September 17 article. The article highlighted the personal story of Martha Tuff, a stay at home mom who recently began a year of clinical rotations at Harvard Vanguard Medical Associates, an SM& client, to learn primary care.

Click here to read.

PHOTO BY ESSDRAS M SUAREZ/GLOBE STAFF

The Supreme Court ruling affirming the Affordable Care Act has set in motion an evolution destined to fundamentally change the way patients, physicians, hospitals, insurers, employers, regulators and other stakeholders access and interact with the health care system in the years ahead.

The federal government, by its own admission, did a weak job communicating around all aspects of healthcare reform. Now, with the constitutional issues resolved, the next daunting strategic communications challenge will play out on a state-by-state basis - just as it did in Massachusetts five years ago.

How state governments - and all the private and mission-driven players within each state - plan, manage and communicate both the bureaucracy and the benefits of health care reform will be critical.

By 2018, the industry that drives 17 percent of the U.S. economy is on track to be transformed into a model designed to promote access, prevention, quality, technology and efficiency.

• States will be ground zero for patient access through the creation of exchanges that bring uninsured and under-insured consumers into the system. The states also will become the new battleground for cost containment as providers and insurers jockey for advantage in the new business model.
• Patients' perceptions will largely depend on how reform impacts their access, care, their doctor and their paycheck. Deciphering and demystifying the changes will be an ongoing challenge.
• Physicians and nurses remain trusted advocates and guides for anxious consumers. Physician practices will become sought-after by providers seeking to guarantee patient flow.
• Stakeholder education, audience re-assurance, labor relations competitive marketing will be priorities for hospitals struggling to cope with the operational consequences of reform.
• Employers, large and small, not only need to understand the law and comply with new reporting requirements, but they will need to communicate new coverage options to their employees.
• Insurers have a critical opportunity to strengthen their brands and build customer loyalty, but they also will face intense scrutiny over premium requests, rate hikes and transparency.

Communicating the business of health care also will become a priority as providers turn to mergers and acquisitions to win their share of the 30 million new paying patients expected to enter the reformed system.

Health care reform isn't a single change but a series of changes phased over seven years. Fifty-two ACA provisions are already in effect, but four dozen of the most critical are scheduled for implementation in the next four years, with the majority occurring between now and 2015.

So much is at stake for so many. It's hard to think of another national episode in recent history in which smart, experienced communications and marketing strategies are more important to a smooth transition.

Our client, DentaQuest Foundation, was featured in Dr. Bicuspid on August 29 for funding the next round of state-based initiatives to reverse oral health disparities across the nation as part of its Oral Health 2014 Initiative.

Click here to read more.

Dr. Jim Glauber, Senior Medical Director of Neighborhood Health Plan, discusses the 34.1 million Americans who suffer from asthma in a May 20 op-ed on TuBoston.com. Glauber, who is a pediatric asthma specialist, discusses NHP's comprehensive asthma management programs available to both primary care physicians and patients which are intended to make treating and living with asthma easier.

To read the full article, click here.

Dr. Ruth Fretts, an OB/GYN with Harvard Vanguard Medical Associates & SM& client, was featured on the WBUR CommonHealth blog discussing a series of papers she co-authored on stillbirths. In the post, Dr. Fretts stresses the importance for more education, effort, and research around stillbirths.

Click here to read the full post.