Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare &amp; Medicaid Services’ Health Care Innovation Awards Program

Skillman, Megan; Cross‐Barnet, Caitlin; Singer, Rachel; Ruiz, Sarah; Rotondo, Christina; Ahn, Roy; Snyder, Lynne Page; Colligan, Erin Murphy; Giuriceo, Katherine; Moiduddin, Adil

doi:10.1111/1475-6773.12622

Cited by 36 publications

(33 citation statements)

References 29 publications

(58 reference statements)

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“…19 Previous research has documented difficulty in engaging physicians in innovations, such as new programs or models of care, when they are experiencing burnout. 14,18 One potential strategy identified in this study and previous research to alleviate some burden on PCPs may be incorporation of APPs in primary care. 9,14 This may be a possible solution for some practices but not suitable for all and could even create additional strain especially for solo practices to employ new personnel.…”

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confidence: 99%

“…14,18 One potential strategy identified in this study and previous research to alleviate some burden on PCPs may be incorporation of APPs in primary care. 9,14 This may be a possible solution for some practices but not suitable for all and could even create additional strain especially for solo practices to employ new personnel. Another strategy could be referring patients with complex care and social support needs to programs such as HBPC when possible and available.…”

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confidence: 99%

“…5,11 In addition, other recommended strategies for engaging physicians in quality improvement, also applicable to palliative care, are engaging leadership, utilizing a physician champion, conducting physician outreach, providing physician education, tailoring program to match style/preference of physician, and ensuring innovations-values fit with the program and physicians. 7,14 Several of these strategies were already implemented in the palliative care program in this study and others such as refining the educational, marketing, and outreach materials and language used among the PCPs could be tried and evaluated in a subsequent study They may also suggest key actions that brand new HBPC programs can take in an effort to engage PCPs more fully and other clinicians who may refer patients to the service. Further research is warranted.…”

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confidence: 99%

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Engaging Primary Care Physicians to Refer Patients to Home-Based Palliative Is Challenging and Complicated

Kogan

Sadamitsu

Gaddini³

et al. 2020

Palliative Medicine Reports

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Background: Before the Affordable Care Act (ACA), the financing landscape for fee-for-service health care lacked broad structure and incentives to provide palliative care outside hospitals. Since the ACA, several payers have taken the opportunity to offer home-based palliative care (HBPC) to their members. Objective: To evaluate the impact of outreach efforts by a physician champion among a cohort of primary care physicians (PCPs) to introduce a new HBPC program and benefit, obtain buy-in, and motivate referrals for Blue Shield patients. Design: Secondary qualitative analysis of detailed field notes from a HBPC physician champion from in-person meetings with a cohort of PCPs and their office staff. Subjects: PCPs were from a physicians group in northern California that met with the physician champion during a 12-month study period. Results: During the 12-month study period, the physician champion met with clinicians at 27 distinct primary care offices. Qualitative analyses revealed three independent themes relating to receptivity and perception of the new HBPC program: (1) physician-level factors (overburdened, lack of palliative care knowledge, misconceptions around palliative care, and patient control), (2) practice-level factors (practice structure and role/integration of advance practice providers), and (3) first impression of the HBPC program (receptivity, ''dirty data,'' and communication). Conclusion: Results hold important implications for practice and new approaches to engaging PCPs in HBPC, obtaining buy-in, and generating patient referrals. PCPs need better support in caring for patients with serious illness and HBPC can likely fill that role if PCPs are willing to refer and HBPC programs adapt.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Engaging Primary Care Physicians to Refer Patients to Home-Based Palliative Is Challenging and Complicated

Kogan

Sadamitsu

Gaddini³

et al. 2020

Palliative Medicine Reports

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“…Finally, the external generalizability of our findings may be limited. The models we studied applied for a Health Care Innovation Award, which suggests that compared to typical providers, they may be particularly motivated to improve care and reduce cost ( Skillman et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Innovative Models for High-Risk Patients Use Care Coordination and Palliative Supports to Reduce End-of-life Utilization and Spending

Ruiz

Snyder

Giuriceo

et al. 2017

Innovation in Aging

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Background and ObjectivesCare coordination and palliative care supports are associated with reduced anxiety, fewer hospital admissions, and improved quality of life for patients and their families. Early palliative care can result in savings in the end-of-life period, but there is limited evidence that larger-scale models can improve both utilization and the cost of care. Three models that received Health Care Innovation Awards from the Centers for Medicare & Medicaid Services aimed to improve quality of care and reduce cost through the use of innovative care coordination models. This study explores the total cost of care and selected utilization outcomes at the end-of-life for these innovative models, each of which enrolled adults with multiple chronic conditions and featured care coordination with advance care planning as a component of palliative care. These included a comprehensive at-home supportive care model for persons predicted to die within a year and two models offering advance care planning in nursing facilities and during care transitions.Research Design and MethodsWe used regression models to assess model impacts on costs and utilization for high-risk Medicare beneficiaries participating in the comprehensive supportive care model (N = 3,339) and the two care transition models (N = 587 and N = 277) who died during the study period (2013–2016), relative to a set of matched comparison patients.ResultsComparing participants in each model who died during the study period to matched comparators, two of the three models were associated with significantly lower costs in the last 90 days of life ($2,122 and $4,606 per person), and the third model showed nonsignificant differences. Two of the three models encouraged early hospice entry in the last 30 days of life. For the comprehensive at-home supportive care model, we observed aggregate savings of nearly $19 million over the study period. One care transition model showed aggregate savings of over $500,000 during the same period. Potential drivers of these cost savings include improved patient safety, timeliness of care, and caregiver support.Discussion and ImplicationsTwo of the three models achieved significant lower Medicare costs than a comparison group and the same two models also sustained their models beyond the Centers for Medicare & Medicaid Services award period. These findings show promise for achieving palliative care goals as part of care coordination innovation.

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“…Communication that helps physicians to see the benefits of EHRs and changes to the EHR could facilitate physician adaptation. For example, working with physician champions within a department who can model a positive attitude may help address specialty-specific concerns may facilitate adaptation among colleauges, a strategy that has been successful in facilitating interventions across various domains of health care [31,32]. However, while physican champions may be effective for encouraging a positive attitude toward changes, they alone may not be sufficient.…”

Section: Positive Attitudementioning

confidence: 99%

A qualitative study of physician perspectives on adaptation to electronic health records

Sieck

Pearl

Bright

et al. 2020

BMC Med Inform Decis Mak

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Background: Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation. Methods: We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis. Results: We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation.

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Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services’ Health Care Innovation Awards Program

Cited by 36 publications

References 29 publications

Engaging Primary Care Physicians to Refer Patients to Home-Based Palliative Is Challenging and Complicated

Engaging Primary Care Physicians to Refer Patients to Home-Based Palliative Is Challenging and Complicated

Innovative Models for High-Risk Patients Use Care Coordination and Palliative Supports to Reduce End-of-life Utilization and Spending

A qualitative study of physician perspectives on adaptation to electronic health records

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