Who’s Driving Care Coordination?

Close coordination among healthcare professionals is widely seen as an avenue to improved patient outcomes and lower costs. Better care coordination is a national healthcare priority; the Affordable Care Act includes incentives to encourage it and healthcare providers are forming new alliances to deliver it.

At the center of these efforts, of course, is the patient. So are patients experiencing better care coordination?

Recently I got a firsthand look at this question when my daughter suffered what appeared to be an allergic reaction. The emergency department doctor was baffled, but ordered a variety of tests, told us to call the next day for results, and handed us a prescription. The next day, we were told it would take at least a week to get the results and that someone from the hospital would contact us. The doctor we visited a few days later told us we would never hear from the hospital, re-ran the tests, gave us a tentative diagnosis, and wrote a different prescription. After about a week when we hadn’t heard anything, we called the doctor’s office and were told the test results were normal.

Yet, my daughter was still experiencing troubling symptoms and the new medication wasn’t helping. So we scheduled an appointment with a specialist. We picked up a copy of the medical records from the first doctor and found that several abnormal test results were circled, but were never explained to us.

The specialist confirmed the diagnosis and prescribed yet another medication. When we got home from the pharmacy we found that we had been given the wrong drug. In fact, it was another patient’s prescription.

My family is not alone. Ask around and you’re likely to hear a similar story. In a Kaiser Family Foundation survey, two-thirds of consumers said that coordination among the different healthcare professionals they see is a problem; for many, it’s a major problem.

You could point a finger at healthcare professionals who are not doing all they should, but when you consider the volume of patients seen, tests ordered, procedures performed, prescriptions written, and insurance claims processed in a typical practice, the challenge is understandable.

In any scenario, patients need to play a more central role in coordinating their own care.

Many of the respondents in the Kaiser Family Foundation survey said they had taken steps to improve the coordination of their care. Here are some of the actions they reported:

  • Checked that a drug they picked up at a pharmacy matched their doctor’s prescription
  • Followed up on test results
  • Brought a list of all their medications to a doctor’s appointment
  • Brought a friend or relative to a doctor’s appointment to help ask questions and understand what the doctor said
  • Told a healthcare professional about any drug allergies—even when they weren’t asked
  • Created their own set of medical records to ensure that their healthcare professionals have all of their medical information

A good start, but these steps still represent an episodic approach to managing one’s health care. The Institute of Medicine notes that patients need to obtain and understand information about their condition and about relevant healthcare services in order to make appropriate health decisions. Seem obvious? Maybe so, but multiple studies have found that patients often do not understand their treatment plan and the role of each healthcare professional involved.

Healthcare professionals benefit from the use of “maps”: diagnostic and treatment algorithms, clinical practice guidelines, and care pathways. It’s true that much of this information is accessible to patients on the Internet—but only with a lot of digging and the ability to decipher medical jargon.

With the national spotlight on care coordination, the time seems right to find new ways to engage patients in driving their own care and providing them with more sophisticated tools to do so. As healthcare marketers, we do a good job of informing patients about specific medications and medical devices. We have the skills and technology to do more.

How about a patient Global Positioning System—or GPS?  Let’s help patients see a full picture of their condition and the options available for managing it. Let’s provide them with resources to navigate the decisions they will face. Each step of the journey should be clear. Each transition between care settings made with confidence.

Healthcare payers, in particular, are well placed to support patients in this way because they have a consistent presence in patients’ care. But, just as doctors, hospitals, skilled nursing facilities and other providers are teaming up to deliver better coordinated care, other participants in the healthcare market can and should team up to put the patient in the driver’s seat.

Chronic conditions, such as diabetes and cardiovascular disease, which entail multiple healthcare professionals and settings of care and, often, the involvement of family caregivers, are a clear priority. At Ogilvy CommonHealth Worldwide we are working with pharmaceutical industry clients in cooperation with payers, healthcare providers, advocacy organizations, and others to equip patients with chronic conditions to better manage their own healthcare journeys and, ultimately, arrive at more satisfactory outcomes.

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Let’s Be Advocates for the Advocates

One of the foundations of effective public relations is establishing strong relationships with potential advocates for a cause, brand or company.  In the pharma industry, one of the most critical allies is the patient advocacy group (PAG) sector.  Whether it’s securing optimal market access, or gaining access to funding for outreach and awareness activities, the industry and PAGs need each other’s support like never before.

The good news is that a recent survey by PatientView of 850 international, national or large regional patients’ groups found that about half of the groups have current or past relationships with pharma companies.  Of those, about 85% say their relationship is good.

But there may be some suspicion lurking beneath the surface—another survey by the same organization reported that only 37% of PAGs considered pharma companies trustworthy.

So how can we as consultancies help foster mutually beneficial relationships based on a foundation of trust?

One way is to ensure that we start with solid knowledge of how advocacy groups are formed and operate, which in turn helps us understand their drivers and motivations.

A patient group’s evolution broadly follows some key stages:

  1. An individual (usually someone personally affected by a specific disease) recognizes the need to do something to improve the situation and starts to act.
  2. Like-minded individuals come together to collectively share expertise and deliver more.
  3. Raising a group’s profile and securing more funds to support its work.
  4. Greater professionalism and a more businesslike approach to operations, such as forming a board of directors.
  5. Registering as a charity.
  6. Geographical expansion and service diversification.
  7. Mergers and growth.
  8. Establishing international networks and influence.

Pharma companies are likely to form alliances with PAGs in the later stages of their evolution, but it is important to remember that they have usually grown out of one individual’s vision and mission.

Building trust is critical—and that means being transparent and reliable. There are plenty of regulations governing financial transparency surrounding pharma/PAG relationships, but it is just as important to be transparent about our aims and objectives when partnering on a campaign or other project. PAG partners also value stability in a relationship—no one likes to be dropped after a project is completed or have their key contacts constantly changing.

Finally, we need to remember that the value exchange in the relationship doesn’t always need to be financially based. Pharma companies, and their consultancies, hold a wealth of knowledge, expertise and services that PAGs may not be able to access otherwise. Providing help with business planning, market research, public relations, insight into health service reforms, organization and operational development, and process and systems analytics may provide value far beyond that of a non-restricted educational grant.

As a consultancy, it is often our job to help form and manage these critical relationships, and we can best do this by being the advocates for the advocates.



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