Presentation at the Institute of Medicine, Dec. 6, 2013

1. building better healthcare
for low-income Californians:
results on shared decision making
blueshieldcafoundation.org
blueshieldcafoundation.org
Institute of Medicine
Dec. 6, 2013
Presenter:
Gary Langer
Langer Research Associates
langerresearch.com
@LangerResearch

2. blueshieldcafoundation.org
a model of patient engagement
feel informed about your health
comfortable asking
provider questions
provider usually explains things in
a way you understand
confident you can make healthcare
decisions
page 2
connectedness
continuity
engagement
empowerment:

3. blueshieldcafoundation.org
information is essential
page 3

4. desire for clear, accessible information
have all you need would like more
page 4 blueshieldcafoundation.org
44%
28%
55%
71%
overall if information were clear and
easily accessible

5. healthcare decision making
% who want an equal say in care decisions
% who prefer to leave decisions to their care provider
page 5 blueshieldcafoundation.org
59%
81%
39%
17%
initially if clear information about
treatment options is provided

6. preference for an equal say
information attenuates group differences
initially when clear info is provided
page 6 blueshieldcafoundation.org
47%
72% 75%
49%
43%
72%
76%
83%
90%
77%
72%
90%
<HS college whites latinos non-english english

7. patient-provider relationships
• while information is a necessary component of shared decision
making, communication between patients and providers is critical
• virtually every key outcome is predicted by the quality of patient-provider
relationships: satisfaction with care, trust in medical
professionals, confidence, empowerment and engagement
• top predictors of positive patient-provider relationships:
• feeling informed about one’s health
• having care providers who encourage an active role
• having as much of a say in health decisions as desired
• connectedness
• using alternative care strategies and tools
blueshieldcafoundation.org
page 7

8. features of patient-provider relationships
weak strong
blueshieldcafoundation.org
30%
35%
47%
54%
62%
73%
have all the info you
need to make
informed decisions
have desired amount
of say
very confident in
decision-making ability
page 8
patient-provider relationship:

9. forthcoming: addressing the income gap
feel you have a great deal of say in decisions about
your care:
low-income Californians: 37%
higher income Californians: 50%
however: the gap among income groups in patients’
perceptions of the amount of say they have in their
care is highly attenuated by positive patient-provider
relationships
blueshieldcafoundation.org
page 9

10. forthcoming: major decision making
among low-income Californians who’ve made a major
medical decision in the past year, 75% say they wanted to be
“very involved” in the decision
• 57% percent say they were
of 9 basic decision-support activities tested, low-income
Californians who’ve made a major medical decision say their
caregivers initiated an average of 4.9
these supports powerfully impact engagement & satisfaction
decision supports: <5 5+
very involved in the decision 38% 75%
very satisfied with the process 41% 76%
blueshieldcafoundation.org
page 10

11. blueshieldcafoundation.org
conclusions
• expressed desire for concierge care signifies patients’ deeper
need for connectedness and continuity
• these plus information and communication are key components
of patient empowerment and engagement
• positive patient-provider relationships are the mechanism through
which the critical outcomes of patient centeredness are achieved
• strong patient-provider relationships can be achieved outside the
traditional model, via:
• alternative approaches such as team-based care and healthcare
navigators
• use of health information and communication technology – patient
portals, internet resources, e-mail and text communications
• accessible, understandable information and communication from
trusted sources
• encouragement of patient engagement and self-efficacy
page 11

12. blueshieldcafoundation.org
blueshieldcafoundation.org
Institute of Medicine
Dec. 6, 2013
Thank you!
Presenter:
Gary Langer
Langer Research Associates
langerresearch.com
@LangerResearch