15. Behavior Change & Policy - Dr. Jane Brock (Colorado Foundation for Medical Care) at MfC '11





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Published on Dec 1, 2011

In addressing the notion of government policy as agent of behavior change, Dr. Jane Brock of Colorado Foundation for Medical Care discussed collaborative work with the Center for Medicaid and Medicare Services (CMS) to tackle the issue of high hospital readmissions for Medicare beneficiaries. According to Brock, 20% of Medicare patients are readmitted within 30 days of discharge. "The system is just so complicated, providers are unaffiliated, there is no consistent method for transferring clinical info, no standard transition process, and we don't activate patients and caretakers to engage in self-care," Brock outlined. However, initially through a regional pilot and then through a CMS-funded multi-state project, Brock and her Quality Improvement Organization (QIO) counterparts in 14 states were able to drive dramatic decline in readmissions through health coaching. In some cases, as much as 50% decline among coached vs. uncoached patients. "Patient activation trumps everything," articulated Brock, "and patients who feel confident that they know what they're supposed to manage, or they know where to get help, goes a long way to taking care of all of the other problems."

The CMS project used the Patient Activation Measure (PAM), referenced above by presenter Rodney Hart, to create baselines, target the highest risk patients, and then measure progress. The transitions care framework incorporated medication management, patient-centered record, red flags capture and one home visit and follow up calls by a community-based organization (CBO) coach. Following on the heels of the successful project, Brock described how they were able to get a bill drafted into the Patient Protection and Affordable Care Act that allocates $500 million dollars for hospitals to partner with CBOs to provide transition coaching for Medicare beneficiaries. "This is a precedent," noted Brock, "Medicare Hospital Trust Fund dollars are now going to reimburse an organization that is not a medical service provider." Still, policy may not be the magic wand that Brock envisioned it to be. "The policy is there, people are trying to understand and learn about it, but it's clear that with a new policy, there's still the same amount of background and educational work that we [QIOs] do for any other kind of quality improvement initiative."

Brock's talk was given at Consumer-Centric Health: MODELS FOR CHANGE '11, a conference that featured more than 20 presentations on all facets of health behavior change. The presenters represented diverse fields of medicine, employer health, mobile technology, health insurance, gaming, public health, research, and anthropology. The 1½ day conference, held at Seattle University in Seattle, Washington, began with an opening keynote on Oct 12, with the main sessions on Oct 13, divided into three sections (1) WHAT'S WORKING IN BEHAVIOR CHANGE; (2) HOW TO SCALE BEHAVIOR CHANGE; and (3) WHAT ELSE IS NEEDED TO MAKE BEHAVIOR CHANGE MORE EFFECTIVE AND SUSTAINABLE.

Models for Change '11 was convened by Health Innoventions with support from Bastyr University's Center for Health Policy & Leadership and Seattle University's Organization Systems Renewal Program.

Health Innoventions (http://www.healthinnoventions.org) is a non profit that serves the public good by promoting the translation and dissemination of actionable consumer-centric information to support health-enhancing programs, technology and policy.


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