Beyond Infographics:

Contextual Factors in Healthcare MR

Thomas M. Richardson PhD, MBA, PA-C

Sr. Vice President Consulting, KJT Group, Inc.

Agenda

03 14 17 30Market Research

Level Set

Define Contextual

Factors

The Changing

Healthcare

Landscape

Pt Engagement-

Behavior Models

35 40 50 ##Clinical Decision

Making Models

Practice Change

Models

Summary and

Questions

Summary &

Questions

2

MARKET RESEARCH

The Goal of Marketing

• Right product

• Right message

• Right target market

4

The Goal of Market Research

• Target audience’s wants, needs,

beliefs and what they value the most

• Factors influencing the clinical decision

making process and purchasing

decisions

5

We focus on…

• Pills

• Devices

• Medical Products/Supplies

• Services

6

We conduct many different types of studies…

• Trackers (ATUs)

• Product Concept and Message Testing

• Market Landscape

• Segmentation and Positioning

• Pricing and Forecasting

• New Product Development and Product Design

• Product and Services Innovation

7

Qualitative Research

8

“So how does that

make you feel?”

Quantitative Research

9

10

Designing and Conducting MR is a Simple

Process

11

Infographics

12

Healthcare Market Research

PROBLEM

• Market research projects

• Scope: Wider

• Timeline: Shorter

• Budget: Tighter

• Focus on “Key Takeaways” and

infographics

• INSIGHTS come from a deep

understanding of the issues at hand

SOLUTION

• Focus on your Research Design

• Consider Contextual Factors

• Leverage Existing Theoretical

Frameworks

13

T-Shaped Employees

14

Generalist/Broad Knowledge

Specia

list

Healthcare Ecosystem

Mark

et R

esearc

h

CONTEXTUAL FACTORS

What do we mean by context?

16

• Context: noun. the set of circumstances or facts that surround a particular event,

situation, etc.

http://www.dictionary.com/browse/context

Why does context increasingly matter in

market research?

17

• Because we are trying to understand

how to change behaviors, get people

to adopt new practices, prescribe new

drugs, perform new procedures

• Increasingly our clients are developing

and researching more complex

healthcare “solutions” to address the

needs of healthcare delivery system

• Decision making is moving from the

individual level to group, committee,

unit, practice, department, hospital,

health system levels.

• The issues of costs, reimbursement

and the interpretation of “value” varies

among the key stakeholders

http://www.dictionary.com/browse/context

THE CHANGING HEALTHCARE

LANDSCAPE

Healthcare Delivery is Dynamic and Heterogeneous

19

Moving Toward Integrated Delivery Systems

20

Pay for and Reimbursement for Healthcare Services

21http://www.blogarama.com/programming-blogs/274030-tech-pulse-aspnet-source-code-projects-n-blog/862588-healthcare-system-overview

The Spectrum of Value-based Reimbursement

22http://www.mckesson.com/population-health-management/resources/pay-for-performance-model/

Fee for

Service

Pay for

Coordination

Pay for

Performance

Bundled

Payment

Shared

Savings

Programs

(Upside and

Downside)

Capitation

Low Risk High Risk

Focus on Quality Reporting and Outcome Metrics

23

Type Description

Outcome Evaluates patient health as a result of the

care received.

Process Determines if the services provided to

patients are consistent with routine clinical

care.

Structure Assesses the characteristics of a care

setting, including facilities, personnel,

and/or policies related to care deliver.

Patient Experience Provides feedback on patients’

experiences of care.

24Kindig, David, and Greg Stoddart. "What is population health?." American Journal of Public Health 93.3 (2003): 380-383.

What is Precision Medicine?

• According to the National Institutes of Health (NIH), precision medicine is "an

emerging approach for disease treatment and prevention that takes into account

individual variability in genes, environment, and lifestyle for each person."

25https://ghr.nlm.nih.gov/primer/precisionmedicine/definition

Personalized or Patient Centered Medicine

26

Right Treatment

Right Patient

Right Time

Right Setting

Right Provider

27

Drug Distribution System

28AMCP Guide to Pharmaceutical Pricing http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=16476

Health Plan/Payer

Pharmacy Benefit Manager

Drug Manufacturer

Wholesaler

Pharmacy

Provider (hospital, physician)

BeneficiaryFlow of Funds

Flow of Prescription Drugs

2 1

3

4

Payment Share of rebates

from manufacturer

Premium

ASP-AWP- or WAC-based,

negotiated payment

AWP- or WAC-based,

negotiated payment

Negotiated discount/rebate for

drugs (volume, market share)

Negotiated discount/rebate for

drugs (volume, market share,

formulary placement)

Negotiated discount/rebate for

drugs (volume, market share)

Chargeback

Drugs

Drugs

Drugs

Drugs

Drugs

WAC-based

payment subject

to prompt

pay/other terms

WAC-based

payment

WAC-based

payment

Cost sharing/

payment

Cost sharing/

payment

29

Healthcare Trends

30

• Pharma moving “beyond the pill”

• Medical device manufactures looking

to develop full “solutions” across the

care continuum

• Evidence-based practice and more

personalized and patient-centered care

• Monitoring and early detection

• Patient engagement, adherence

and compliance

• Patient support programs

• Care management

• Integrated technologies

PATIENT ENGAGEMENT-

BEHAVIORAL MODELS

Health Belief Model

32Janz, Nancy K.; Marshall H. Becker (1984). "The Health Belief Model: A Decade Later". Health Education & Behavior. 11 (1): 1–47.

Stages of Change Model

33Prochaska, James O., and Carlo C. DiClemente. "Toward a comprehensive model of change." Treating addictive behaviors. Springer US, 1986. 3-27.

https://www.pinterest.com/pin/134756213823204661/ http://hbftpartnership.com/documents/uploadResources/TranstheoreticalT-Prochaska1982.pdf

Maintenance: works

to sustain the behavior

change

Action: practices the desired behavior

Preparation: intends to take action

Contemplation: aware of the problem and of the desired behavior change

Precontemplation: unaware of the problem

Create awareness; change values and beliefs

Persuade and motivate

Educate

Facilitate action

Reinforce changes, reminder communications

Wagner’s Chronic Care Model

34http://www.improvingchroniccare.org/index.php?p=The_Chronic_CareModel&s=2

Anderson Behavioral Model of Health Care Utilization

35Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995 Mar;36(1):1–10.

CLINICAL DECISION MAKING

MODELS

Clinical Decision Making

37Satterfield JM1, et al.Toward a transdisciplinary model of evidence-based practice. Milbank Q. 2009 Jun;87(2):368-90.

Best available research evidence

Resources, including

practitioner expertise

Population characteristics, needs, values,

preferences

Decision-making

Environment and

organizational context

Elements of Evidence-Based Policy & Practice

38Satterfield JM1, et al.Toward a transdisciplinary model of evidence-based practice. Milbank Q. 2009 Jun;87(2):368-90.

Haynes, R.B., P. Devereaux, and G.H. Guyatt. 2002. Clinical Expertise in the Era of Evidence-Based Medicine and Patient Choice. ACP Journal Club 136:A11–A14.

Roger’s Innovation-Decision Process

39Rogers, Everett (16 August 2003). Diffusion of Innovations, 5th Edition. Simon and Schuster

Roger’s Innovation-Decision Process

40Rogers, Everett (16 August 2003). Diffusion of Innovations, 5th Edition. Simon and Schuster

MODELS EXAMINING

PRACTICE CHANGE

42Tomoaia-Cotisel et. al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.

Ann Fam Med. 2013 May-Jun;11 Suppl 1:S115-23.

Understanding an Intervention’s Context

43Tomoaia-Cotisel et. al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change.

Ann Fam Med. 2013 May-Jun;11 Suppl 1:S115-23.

Level 3:

External Environment

Level 2:

Larger Organization

Level 1:

Practice

• Market Environment

• Community characteristics

• Political authority

• Grant or other external financial support

• Level of coordination/ involvement with community

• Payment model(s) available

• Competing priorities

• Degree of intervention integration

• Contractual arrangements

• Ownership

• Leadership style

• Structural capabilities

• Financial incentives

• Employee mix

• Clinician demographics, attitude and training

• Patient panel size and characteristics

• Ownership

• Leadership style

• Structural capabilities

44Hernandez SE1, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case

study application. Health Care Manage Rev, 2013, 38(2),

Patient Centered Innovation in Healthcare

Organizations

45Hernandez SE1, Conrad DA, Marcus-Smith MS, Reed P, Watts C. Patient-centered innovation in health care organizations: a conceptual framework and case

study application. Health Care Manage Rev, 2013, 38(2),

• Clear mission

• Aligned beliefs, values, norms

• Proactively initiate change

• Willing to experiment & take risks

Organizational Mission & Culture

• Clarity of purpose

• Specific change objectives

• Coherence of strategic & operational plans

Organizational Strategy • Structure

• Design & coordination mechanisms

• Task design

• HR processes

• Size

• Technological

Organizational Capability

• Patient-Centered Innovation

Strong Motivators for Change

↑ ↓Effective Organizational Leadership

Environmental Context

46https://pcmh.ahrq.gov/sites/default/files/attachments/ContextualFactors.pdf

Contextual Factors that Influence PCMHs & Outcomes

47

• National, State, local organizational

policies

• Community norms and resources

• Healthcare system organization

• Payment and incentive systems

• Practice culture, history, and staffing

• Characteristics of patient populations

and subgroups

• Historical factors and recent events

• The culture and motivations

surrounding monitoring and evaluation

• Changes in these factors over time

https://pcmh.ahrq.gov/sites/default/files/attachments/ContextualFactors.pdf

48https://aspe.hhs.gov/basic-report/evaluation-hhs-delivery-system-reform-efforts-and-affordable-care-act-provisions-consolidated-evaluation-

design-recommendations

49https://aspe.hhs.gov/basic-report/evaluation-hhs-delivery-system-reform-efforts-and-affordable-care-act-provisions-consolidated-evaluation-

design-recommendations

Health System Environment

Organization Characteristics

Outcomes

• Market size, structure, capacity

• Population characteristics

• Provider & payer concentrations

• Competitive dynamics

• State & local policy environment

• Local culture

• Leadership

• Structure & service capacity

• Financial & operating characteristics

• Data management & analytic capacity

• Performance improvement infrastructure

• Payer relationships & contracting structures

• Physician & staff engagement

• Spending

• Service use & mix

• Patient experience

• Quality

• Access

The Mathematical Model

50https://aspe.hhs.gov/basic-report/evaluation-hhs-delivery-system-reform-efforts-and-affordable-care-act-provisions-consolidated-evaluation-

design-recommendations#3

SUMMARY

52

Right Treatment

Right Patient

Right Time

Right Setting

Right Provider

Think in Terms of Linking Goals

Right Product

Right Message

Right Target Market

53

Key Takeaways

Focus on research design

1 Leverage theoretical models

2 Embrace the relevant contextual factors

3

54

Thank YouThomas M. Richardson PhD, MBA, PA-C

Sr. Vice President Consulting, KJT Group, Inc.

tomr@kjtgroup.com

1.585.624.8050 x344