March 26, 2018
Central Massachusetts Health

Data propels better experiences in Mass. primary care

Dr. Ana Sujata Madariya, of Worcester-based Reliant Medical Group, discusses patients care. Reliant and other local providers are exceeding statewide average patient experience scores in certain areas of care, and scores across the state have trended upward in the last several years.

How should a primary care office measure its success in treating patients? Increasingly, providers are going right to the source and asking patients, and it's starting to pay off.

"Over time, the bar has continued to be raised," said Barbra Rabson, president and CEO of Massachusetts Health Quality Partners (MHQP), an organization that collects and shares information about health care quality. "There's an expectation and an awareness that patients are the best reporters."

MHQP has been collecting data on patients' experience since 2005. Its most recent report, released in January, shows that both adult and pediatric primary care offices have improved substantially over the years.

Quality breeds quality

Rabson said that the increasing focus on quality measurements in general, and patient experience data in particular, have helped drive improvements. Part of that is thanks to insurers' reimbursement plans that increasingly base some payments on quality measures. But much of it is simply about the availability of data to the public and to providers themselves.

"When they get feedback that shows that this are not going as well as they anticipated, they want to fix it," Rabson said.

Dr. Thomas Scornavacca, senior medical director at UMass Memorial Health Care's Office of Clinical Integration and Population Health, said data-driven changes are a top priority for the UMass system's primary care offices.

"Population health, or value-based care, or the transition from volume to value—however you phrase it—is kind of where we've been living over the past six years or so," he said.

Scornavacca, who also serves on MHQP's Board of Trustees, said it can be tricky to make data-based changes at physician practices, given how many factors contribute to individuals' health and their experiences with the medical system.

Payment systems influence how much time a doctor can spend with each patient, while issues like parking affect patients' experiences going to an appointment. More broadly, things like poverty, hunger, and inadequate social services for people with disabilities or chronic conditions have a huge influence on health.

"The complexity of the system is where patients and the community struggle, and providers struggle as well," Scornavacca said. "As a provider, you're trying to give your best effort one-on-one with a patient."

To begin addressing some of the broader issues, he said, UMass Memorial has been working with groups like the YMCA, food banks, and elder service providers.

Meanwhile, on the individual practice level, Scornavacca and his colleagues try to provide data that is meaningful to doctors and other practice staff. Specialists take the information and use it to build "action plans" to improve patients' experiences in specific offices. One thing they've found particularly helpful is presenting representative comments from patients along with the numbers.

"We have found that simply sharing the comments that come in in these surveys carry exponentially more weight to providers and staff members," Scornavacca said.

One resource UMass Memorial offers its provider offices is a class called Crucial Conversations that supports listening skills and relationship-building. Some simple changes in how medical professionals interact with patients can have snowball effects on their health.

"Even a staff member can really sway the influence of how that patient not only experiences health care but also seeks out health care," he said. "If you have a bad experience and you have a chronic disease that really needs to be addressed, it's not uncommon for people to just stay home. Then it's much more difficult to help them when they're three steps down the path."

Quality incentives

Linda Coccola, who oversees the Patient Experience department at Worcester-based Reliant Medical Group, said the organization uses patient experience data, largely from its own surveys, to influence decisions at all levels. Reports on the topic go to the whole leadership team every quarter, and the data is part of every employee's annual evaluation. Employees who do a particularly good job of providing a good patient experience may receive awards and public acknowledgement. For physicians, it also affects their compensation, and the group makes data for each provider available to the public on its website.

"Every new employee, at whatever level they come into our organization, gets an intensive training on the Reliant experience," Coccola said.

The focus on patient experience even extends to the physical design of new offices. Reliant uses patient feedback to work with architects. Coccola said the changes can be as simple as setting up exam rooms with mirrors and having patients be weighed in the rooms instead of in the hall.

When providers or staff need help, Reliant provides peer coaches and training. It uses videos on empathy in health care created by an outside organization, followed by workshops where providers can talk about real-life experiences.

"We have to help providers and staff have the difficult conversations," she said.

Given the limited time primary care doctors often have to talk with patients, Reliant also offers them a communications framework to help them make the most of each visit, including clearly introducing themselves and their role, and making sure to explain the timeline for getting test results back and moving forward on treatment.

"We, just by definition, are going to have a limited time with patients," Coccola said. "How can we manage that time using effective communication? That's the challenge."

A higher standard

Since MHQP started collecting and sharing patient experience data, Rabson said, there have been big changes in health care.

"I think we're always raising the bar on what we expect from our primary care physicians, which has its costs in terms of burnout and other issues that are happening," she said. "But, on the other hand, the care has improved drastically."

Rabson acknowledges that doctor's offices face some serious barriers to providing consistently good patient experiences. Some work with a large number of patients who need help in languages other than English, or who have difficulty with transportation to their appointments, for example.

Providers also face the continuing challenge of patients who want a particular treatment—perhaps something they've seen advertised on television—that isn't necessarily appropriate for their situation. But Rabson said the solution isn't to either provide an inappropriate treatment or to leave the patient feeling like their voice wasn't heard. Instead, she said, doctors need to continue getting better at communicating clearly.

"There's ways to say 'No, this is not the appropriate care for you,' and be empathetic," she said. "Patients want what's right for them. They don't want what's unnecessary."


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