Worth Repeating

Dr. Harlan Levine, chief medical officer of OptumHealth Care Solutions, describes how a treatment decision support program is empowering healthcare consumers, reducing discretionary evaluations and procedures and getting high satisfaction ratings from patients. The program is a finalist in the URAC Best Practice for Consumer Empowerment and Protection Awards.

The treatment decision support is designed to educate, empower and activate the consumer to engage. Treatment decision support provides enhanced one-to-one coaching for the individuals facing specific procedures or challenging treatment decisions, where the evidence has shown inconsistent patient outcomes. By combining access to accurate information and managing accurate expectations for treatment and hospitalization, the treatment decision support program can and has demonstrated a decrease in discretionary surgical rates, an increase in referrals to high quality and efficient physicians, and an increase in workplace savings. Given the nature of these types of decisions, we've designed this program to be very high touch and high tech so that we can deliver personalized information in a consumer-friendly format. As a result, we educate consumers with information specific to their condition, their treatment options, their cost, and their possible outcomes.

When you hear reports that up to 30 percent of healthcare may be unnecessary, it makes you truly understand the value of a program such as this. As an example, even though 90 percent of acute back pain resolves in the first six weeks, some in this group will get invasive procedures or treatments during this time period, and many more will get expensive evaluations. This is a great opportunity to impact consumer care. The goal of our program is to drive better outcomes, both for our consumers and for our clients. Our specially trained registered nurses are focused on increasing individuals' participation in their own care. They apply principles that go beyond traditional nursing skills, and they motivate consumers to become empowered and activated in making their own healthcare decisions. By engaging individuals in the right time in their decision-making, it increases the likelihood that positive behaviors can and will occur. By providing easy to understand treatment options, we're able to drive optimal outcomes via appropriate care. By engaging the individual's current understanding of their condition and determining their urgency in advancing their care decision process, we're able to motivate individuals to own their own healthcare decisions.

We educate the consumer on their condition, provide treatment alternatives for consumers to consider, help the consumer develop a list of questions they can take back to ask their doctors, help consumers find the best physician and facilities based on their personal preferences and unique clinical needs, and help prepare them for hospitalization when surgery is necessary or decided to be the best course of action for an individual. In addition to the clinical depth of our programs, in “consumerizing” for people the information that we communicate, we see that there are several differentiators of this program. First is the capability to direct consumers to the best physicians based on quality data – that can either come from us, from independent sources or from our customer. Secondly, the ability to prepare patients for procedures and their transition back home so they can perform daily living activities as quickly as possible. Moreover, we've gone to great lengths to identify key learnings that are relevant to the decision, be it data from literature or outcomes, or to help the consumer better understand the recovery process in terms of impairment of daily activities, work restriction, or just general activity limitation. These are important considerations that are rarely considered by a consumer prior to a procedure. We present them in a consumer-friendly manner in consumer friendly language. In so doing, we give the consumer a much more comprehensive perspective from which to make a final decision about their course of action.

Our performance metrics have validated that we've been able to change people's behavior 15 percent of the time so that they choose to treat their condition with a less invasive treatment option than they had previously considered. We have found out that we've been able to shift even 5 percent of the consumers who had already scheduled surgery to non-surgical alternatives after they spoke to one of our treatment support nurses. But what has really impressed us — and we take tremendous pride in — is the fact that 98 percent of our consumers who are enrolled in our program were satisfied with our program.

Source: Case Studies in Best Practices in Healthcare Consumer Empowerment, March 13, 2008

Case Studies in Best Practices in Healthcare Consumer Empowerment

During this 60-minute webinar, available on CD-ROM or as an on-demand presentation, an expert panel of speakers described how their respective organizations are empowering consumers, ranging from treatment decision support to increasing the use of evidence-based services.

Case Studies in Best Practices in Healthcare Consumer Empowerment is available from the Healthcare Intelligence Network for $177 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.