Dan Prince

National Public Radio has been running a series on obesity. I have found the segments on the radio and the related articles in their blog very interesting, particularly in light of the findings we reported in our Living in Denial white paper a few months ago.

In the NPR piece “Workplaces Feel the Impact of Obesity,” author Jennifer Ludden writes that obesity costs U.S. employers $73 billion a year. And that doesn’t cover everything. Ludden said companies are having to use pickup trucks as company ‘cars’ to accommodate plus-size drivers. They are having to replace toilets when wall-mounted ones collapse. They are having to spend big money on big office chairs. A spokesman from chair manufacturer ErgoGenesis told Ludden that sales of their ‘bariatric’ chair, for workers up to 600 pounds, are brisk.

A custom chair ErgoGenesis made for a customer too big for its <600 lb 'bariatric' office chair. The custom chair cost $1,800. The regular bariatric chair costs $1,300.

Pete Gaffney of ErgoGenesis is quoted as saying that the intended users of these chairs are sometimes offended by them. “I’ll kid around with the ladies sometimes,” he says. “They’ll say, ‘Well, that’s too big for me! It’s too wide!’ I’ll say ‘Look, when you go home everybody likes to get into a nice pair of comfortable jeans. Just consider the few extra inches as a nice comfortable pair of jeans. You’ll thank me.’ ”

They do thank him, Ludden writes.

The large ladies who look at the chair and say “That’s too big for me!” reminded me of many of the respondents in our “Fitter or Fatter” study, the substance of our Living in Denial white paper. We did an online survey of 1,500 adult Americans. With all the media and public health attention that has been paid to the obesity epidemic, we wanted to see if it was having any effect. Were people trying to get in shape? Did they think they already were?

We didn’t recruit for the study based on weight, but it turned out our respondents mirrored the general population. Based on BMI measurements, 60% of our respondents were overweight or obese.

Many of them seem to have just as faulty a self-concept as the ladies who think they’re too small for the ErgoGenesis bariatric chair.

Among the overweight or obese respondents to our survey, 11% said they were in “excellent” health; 61% said their health was “good.” Yet excess weight contributes to almost every malady that plagues us as a nation, from diabetes to heart disease. And our respondents, at least on some level, know that. When asked what America’s number one health issue is, 60% of them said, “Obesity.” (The health issue that came in number two in the voting, “Cancer,” was cited by just 16% of respondents.)

Who is going to break the news to these people, that they are part of the obesity epidemic? Employers avoid the issue. Family members do, too. And too often, so do doctors.

“A physician’s behavior is the strongest predictor of how they will counsel patients around preventive health behaviors,” according to Harvard Medical School professor Dr. David Eisenberg, quoted in a blog called Obesity Discussion. The post cited a 2003 study that found doctors who watch their own weight are more likely to advise and encourage their patients to lose weight. It cuts the other way, too. A heavy doctor was quoted as saying she felt like a hypocrite if she counseled patients to lose weight when she had her own weight problems.

I found a vintage 2004 statistic (from a study published in the Annals of Epidemiology) that 44% of male physicians were overweight and 6% were obese. (No stats were available for female physicians.) If doctors are trending like the rest of us, I would guess that half of them are overweight by now. That would suggest that very few of us with weight problems are likely to get straight talk from the professional we would trust most on the matter – our physician.

The conclusion would seem to be, ‘Doctor, heal thyself’ – so you can give the rest of us the help we need to get our weight under control.

What do you think we should be doing about obesity? Comment on this post or send me an email at dan.prince@catalysthcr.com.

Dan Prince

Health literacy is a problem that confronts nurses, doctors and hospital staff every day. It’s going to be an even bigger problem for healthcare professionals when millions of currently uninsured Americans flood into the system in 2014.

But the organizations that may feel the most pain when the floodgates open are the health plans. I’ve been reading about how they are preparing for the change, and I’m concerned that insurers may be focusing too narrowly – and cutting a few too many corners.

What is “health literacy?”

The US Department of Health and Human Services defines health literacy as “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” People with low health literacy are less likely to know what healthy behaviors are and to adopt them.

In testimony Susan Pisano of AHIP (America’s Health Insurance Plans) presented in July 2011 at the Institute of Medicine’s Health Literacy Roundtable Meeting, she said 9 in 10 Americans have “difficulty using health information to make informed decisions about their health, profoundly affecting their health and access to care.” And profoundly impacting their interactions with the companies processing payments for their care.

Health plans’ efforts to raise health literacy

Ms. Pisano’s testimony was about AHIP’s efforts to assist health plans in addressing and improving health insurance literacy.

Health insurers see more and more clearly the writing on the wall for their companies. AHIP conducts health plan surveys every two years on disparities in health, and one of the topics covered is health literacy. Their 2008 study showed 69% of plans had introduced some components of a health literacy program. Two years later, in 2010, this was up to 83%.

A big focus of AHIP’s effort is to assure that the reading level of materials is low enough and the language is plain enough. A little aside here, I have to mention as the head of a healthcare research company: Pisano said consumer testing of materials was an important priority, but that many companies were skipping it, instead testing materials on their own employees who seem similar to the target audience. As a research company, we can, of course, point out all kinds of flaws with this approach, starting with the fact that employees who work in almost any part of a health insurance company are likely to be more health and health insurance literate because of where they work. But the biggest threat to the reliability of this kind of research is the fact that these employees already have health insurance benefits and have dealt with the system as customers. They really can’t stand in for people who haven’t.

Health literacy is about more than reading

Another concern Ms. Pisano’s testimony raised for me was the almost exclusive focus on “materials.” A 2004 study by Dean Schillinger, Andrew Bindman, Frances Wang et al. on “Functional Health Literacy and the Quality of Physician-Patient Communication Among Diabetes Patients” showed that health literacy isn’t just a “reading” issue. It profoundly affects how well people understand verbal explanations and follow instructions they get in face to face or phone encounters.

Schillinger et al. were thinking about doctors’ and nurses’ encounters with patients in offices, clinics and hospitals, but health literacy colors people’s experience of every part of the healthcare system. The implications are very clear for health insurers.

Health plans need to be preparing front-line service people to ascertain the level of the customer’s health literacy and adjust their vocabulary, their pace, their tone and possibly the language they’re speaking in – to fit the need.

As millions of people open their first EOBs ever in 2014, the phone banks will be lighting up. Health plans who step up to the health literacy challenge now will be the winners – or at least the survivors.

Seize the opportunity

There’s an opportunity here as well as a threat. I hope that health insurers, along with the rest of the healthcare system, will see the opportunities in the 2014 challenge. In addition to bracing themselves for millions of customers with even less health literacy than their current customers, they should be doing what they can to increase Americans’ health literacy across the board.

What do you think? How is your company getting ready to deal with customers who have little to no experience with the healthcare system? And let me know what your company is doing to increase customers’ health literacy. Comment on this post or send me an email at dan.prince@catalysthcr.com.

Dan Prince

Pauline Chen, MD, wrote in the New York Times about the reaction she got when she described ACOs to friends who didn’t work in healthcare.

“I concluded to my friends, A.C.O.’s will be able to stem spiraling costs, increase efficiency and improve quality. Clinicians and hospitals will have a financial motive not to do more procedures and incur more visits but to keep patients healthy and out of the hospital.

“I took a deep breath then looked around. One friend had stood up and was excusing herself to go to the bathroom. The other was looking into her bag, rummaging around for her cellphone.

“’Thanks for the explanation, Pauline,’” she said. She pulled her phone out and quickly glanced at its screen. “I hate to break it to you,” she continued, ‘but whatever that care plan is called, it still sounds like an H.M.O. to me.’”

Accountable Care Organizations seem to be a good idea. Their aim is to reduce cost, enhance healthcare quality and improve the patient experience. But ACOs are a fuzzy concept to most consumers, and if, like Patricia Chen’s friends, consumers confuse them with HMOs, the ACO concept may be DOA when it gets to market.

ACOs are provider organizations – primary care physician groups at the core, with specialist physicians, nurse practitioners, physicians’ assistants and potentially a host of auxiliaries, allied with their local hospitals – formed to “support the care needs of a defined population of patients.”

But the American public doesn’t respond very well to programs that divide it arbitrarily into “defined populations.” In their research published in the New England Journal of Medicine, Anna D. Sinaiko, Ph.D., and Meredith B. Rosenthal, Ph.D., write that “in many ACO-like models . . . patients who receive the majority of their care from participating providers have been assigned to an ACO through ‘invisible enrollment,’ with no prospective notification and sometimes no awareness by the patients that they’re associated with an ACO.”

Fundamental to improving patient experience is giving people a sense of control over their healthcare destiny. Just as they balked at HMOs and were willing to pay more for the privilege of being covered under a Preferred Provider plan, healthcare customers will find ways to sabotage the ACO they’re assigned to if they don’t think it will really serve them.

The focus with ACOs so far has been on providers and payments. To be successful, ACOs are going to have to focus just as hard on a third p – patients.

I’d like to hear your thoughts on how those promoting ACOs and those working to build them can really meet the goal of improving patient experience. Comment here or write me at dan.prince@catalysthcr.com.

Dan Prince

Jacksonville Medical Center in Jacksonville, AL, wanted to tell the world about its high HCAHPS rating and top ranking in its county, so it took out ads and papered billboards with blue ribbons proclaiming ‘We’re Number 1.’

The campaign flopped, and the hospital has shifted gears. It’s going to show the community what is so great about its service and what the customer experience is really like there – on video.

The story was reported a few weeks ago in HealthLeaders Media, and I added it to my fat file of articles on video and its impact on healthcare marketing. In my opinion, if you’re marketing patient care and you want to send positive messages about customer experience, video is just about the best medium there is.

It appears that many hospital marketers agree with me. The American Medical Association’s news site, amednews.com, recently ran an article entitled Online videos may offer most bang for medical marketing buck.

The article cited a 2010 study of hospital marketers who said the emerging marketing tool they considered most effective was online video.

The genome video of Vanderbilt Medical Center in Nashville, TN, is part of an impressive, well-produced series that inspires confidence in the institution. That feeling that you’re dealing with best-of-breed is part of the patient experience. If your treatment is going to be cutting edge and experimental, you want that confidence. Video can deliver.

But in most cases, healthcare customer experience is more about feeling that real humans, with good hearts as well as good skills, are going to be taking care of you at a critical time. I like the video clips on the Lawrence & Memorial (New London, CT) website, which just went up in August, for the sense they give you of what it’s really like to be inside the hospital.

Lawrence & Memorial’s videos have lower production values – and, of course, an entirely different purpose – than Vanderbilt’s genome series. But low production values can have advantages. Cost is certainly one. Another is an unvarnished believability. A marketing sheen can create a credibility gap. Good clear images, no motion blur, clean editing, good audio – all the things you pay extra for in video production – are the clues to the viewer that reality has been, for good or ill, manipulated.

Your goal will dictate the way you approach video, but if your goal is simply to communicate to patients – to customers – that being served by you will be a good experience, videos that are less polished may get better results.

Video tips

A few more things to think about as you consider video for your hospital, practice group, clinic or other healthcare facility.

1. Put the videos on your website and on YouTube or Vimeo. These sites host your video for free, and anything on YouTube has a better chance of going viral (at least a little bit!) than video on your website. Vanderbilt Medical Center has a YouTube Channel. You can, too.

2. If your facility has a Facebook page (and it should!), your videos should be there as well.

3. Put your key people in short videos. Some hospitals and physician practice groups are starting to include them in their ‘Find a Doctor’ web pages.

4. Show staff in real-life situations, being themselves. And, with permission and in strict compliance with HIPAA, show real patients, too.

5. Many smart phones come equipped with video cameras inside. You may be surprised how effective videos shot by staffers with iPhones could be for you.

6. Keep the videos short. One minute is good. Four is usually too long.

I’d love to hear how video projects have worked for you. Comment here or contact me at dan.prince@catalysthcr.com.

Dan Prince

The New Patient Experience Imperative Report issued recently by HealthLeaders focuses on hospital leadership’s response to patient experience. I found their take on the issue interesting, since we had done a similar study six months earlier.

One chart in the HealthLeaders study was particularly striking to me. When survey participants were asked about their patient experience strategies, 56% said that making physicians, nurses and staff accountable for patient satisfaction was part of their strategy. Yet, only 17% said that tying executive compensation to patient experience measures was part of their strategy.

The initial impression is that executives perceive that improving patient experience is the job of somebody else – the clinical staff mostly.

Our research for The Beryl Institute last April provided a little more insight into who hospital leaders really hold responsible for improving patient experience.

The State of Patient Experience in American Hospitals report we prepared for The Beryl Institute showed that indeed few hospitals – only 14% of those surveyed – hold the CEO or COO responsible for improving patient experience. But they aren’t siloing it as a clinical staff issue either. For example, only 6% give the primary responsibility to the CNO. Forty-two percent of the hospitals surveyed have made a committee responsible and accountable for addressing patient experience.

From “The State of Patient Experience in American Hospitals,” April 13, 2011, The Beryl Institute. The research was conducted by Catalyst Healthcare Research.

Respondents to the Beryl survey were primarily senior leaders, clinical leaders and quality improvement leaders. The heartening findings for me were that people very clearly saw that, whether or not the CEO or COO was directly responsible for improving the patient experience, “strong, visible support from the top” was the number one driver of success, and that getting clinical managers involved and supportive of key changes was the second most important driver.

From “The State of Patient Experience in American Hospitals,” April 13, 2011, The Beryl Institute. The research was conducted by Catalyst Healthcare Research.

Given that ‘cultural resistance’ was cited in our study as the number one obstacle, getting clinical and support staff involved in improvement, with support from the top leaders, was a principle supported by both studies.

This topic and other important patient experience issues will take center stage at The Beryl Institute’s annual Patient Experience Conference. Dates for the 2012 conference have just been announced: April 25-27, 2012, in Fort Worth, Texas, and I’m honored to be speaking. My topic is “What’s Reasonable? Patient and Caregiver Perspective in Provisions of Service.” To register for the conference at Early Bird prices, click here and use promo code RETROEARLY.