The quest for patient-centered care: Patients as partners

Patient experience is more than just a buzzword. It's become a priority for healthcare organizations throughout the country. Some are just at the beginning stages, learning how to best engage patients in care treatment decisions. Others are well on their way to creating a new culture that encourages partnerships between providers and patients.

Two examples of organizations that have successfully developed strategies to put the patient at the center of their cultures are Wellspan Medical Group's Patient Partner Program and Maine Quality Counts, a regional health improvement collaborative. Both organizations are involved in the Aligning Forces for Quality Project (AF4Q), a national program funded by the Robert Wood Johnson Foundation to help communities improve the quality of healthcare within their regions.

During exclusive interviews with FiercePracticeManagement, Karen Jones, M.D., vice president and chief medical officer of the WellSpan Medical Group, and Lisa Letourneau, M.D., executive director of Maine Quality Counts, discussed the secrets behind their success of partnering with patients to improve primary care and what's next in their efforts to improve patient engagement.

Patients as partners

For WellSpan, which includes more than 750 primary care and specialty care providers across south central Pennsylvania and northern Maryland, a patient-centered culture means actually partnering with patients, asking for their feedback and having them join their quality council meetings, says Jones, pictured right.

The organization invited patients to become part of its quality improvement team approximately three years ago after learning about another collaborative participating in a similar initiative as part of it patient-centered medical home (PCMH) program during a meeting for the AF4Q, she says.

Wellspan asked its practices to invite two patients to become members of its quality improvement teams, which include a manager, lead nurse and lead physician or clinician, and meet once a month to discuss quality, data and how to improve practices. The patients receive training in advance so they understand the terminology and goals discussed during the meetings.

"We started small with seven practices," said Jones, who also serves as the physician champion to the AF4Q project in South Central Pennsylvania. As other practices heard about the initiative, they expressed interest. "Over a three-year period, we now have 37 practices with 80 patient partners."

The Patient Partners have helped the practices develop surveys for practices that are different than the typical patient experience survey, according to Jones. The new survey asks questions about the office environment and cleanliness, but also asked whether providers had the patients explain back important information about the visit.

The biggest challenge with the program is finding the right patients to serve as patient partners. Wellspan has assigned a consumer engagement coordinator to oversee the program, and to help practices find partners the coordinator has developed a list of characteristics that the patients should possess and questions that practice managers should ask during interviews. 

The most effective partners, she said, are good listeners, look at all sides when discussing issues, represent the needs of all patients, are willing to share their experiences and opinions without bias, are dependable, manage their own or a loved one's chronic disease, and are committed to attending practice improvement meetings and learning sessions. "They see that this is bigger than themselves, they work well in teams and they are able to articulate their thoughts and concerns," Jones said.

Patients invited to join as partners are asked to make a one-year commitment. In return for their time, they receive a small stipend to cover gas, discounts to a gym and dinner during the meetings. "Many have stayed more than one year and are in their third year. They find it very rewarding," she said.

More recently, Jones said the organization has asked some patient partners to join its quality counsel for medical groups, which looks at data to determine how the organization can improve on a system-wide level. They also are part of the group's new physician-provider orientation and meet with new physicians for half a day as part of the onboarding process.

"We have expanded the collaborative and added specialists so we can focus on the medical neighborhood so we have patient partners not only in the primary care process but also in specialty practices. It will be interesting to see how it evolves," she said.

For organizations interested in forming a patient partnership program, Jones suggests they start small but invite at least two patients to join. Some practices have their partners meet quarterly, but Jones believes more frequent meetings are better so the patients and providers truly feel they are a team. She also recommends assigning someone to serve as a coordinator of all the patient partners and schedule training for them over several different sessions instead of one day.

"It's also important to ask patients for their stories," she said. "I always ask them what it was like for them when someone asked them about advance directives or they were first diagnosed with an illness or when they were confused about their medication. Their stories speak to our heart. And that's important as we have data that speaks to our heads. It's a constant reminder of why we do what we are doing."

Initiatives designed to support primary care

Letourneau, pictured right, says the regional health improvement collaborative based in Manchester, Maine, also became involved in the partnership program through its work with the AF4Q. The collaborative has asked two consumers in the region to serve on the board to help providers plan and execute major initiatives and keep the focus on patient-centered care.

"One of the expectations of practices is that they actively engage patients in their own improvement work," she says. "Our organization also raises awareness of the public and clinicians about having more productive conversations with providers. We try to get people to be engaged in decisions about making the best use of healthcare resources like tests and treatment and asking questions like, is this right for me?"

Maine Quality Counts also offers physicians educational resources and training. The collaborative is currently involved in a PCMH pilot program involving 75 primary care practices and a set of payers, which aims to change how they practice medicine and how payers pay for primary care. The collaborative has five staff members work with the practices that currently are changing their scheduling systems to get patients to see a provider  the same day they request an appointment instead of patients waiting two weeks to see someone. They are also brining in behavioral health providers into the practice.

The patient response has been positive, but to a large extent the work is not visible to patients, Letourneau explains. "They may not notice the improvements. If your doctor is spending more time with you and managing your care in a more proactive way, you may think, 'Weren't they doing that already?'"

The collaborative hasn't done a big public awareness campaign about the pilot because the PCMH program only includes some practices in the state, and Letourneau says the group doesn't want to set false expectations within the community.

"One of the biggest challenges is there is no payment change for the rest of the practices yet. It's really limited to practices in the pilot," she says, adding the collaborative is trying to work with all the payers, including Medicare, Medicaid and major commercial insurers, to make payment change more open to providers who commit to making practice changes sustainable over time.

Meanwhile, the collaborative seeks to find new ways to incentivize patients to engage in their own care. "Our work is primarily to raise awareness and engage them in conversations and encourage them to ask questions. We are trying to change the culture of the passive patient and give them equal power in the relationship," she says.