Learning about Person and Family Engagement

SUMMARY
As a contractor for Medicare, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Kepro provides BFCC-QIO services in 29 states, the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare. 

This episode is a conversation with our guest from Kepro. Dr. Jessica Whitley is the Chief Medical Officer for Kepro and works on the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) contract.

For more information about Kepro BFCC-QIO, please visit www.keproqio.com.

KEY TOPICS
00:29: Introduction of host and information about Kepro
01:05: Introduction of guest, Dr. Jessica Whitley
04:05: Explanation of person and family engagement
08:30: Ways people can engage in their health care
18:45: How health literacy impacts health outcomes

SUBSCRIBE
Subscribe to our newsletters, Case Review Connections, On the Healthcare Front: https://keproqio.com/newsletters.aspx

RESOURCES

Information for stakeholders: https://keproqio.com/partners/

Information for people who have Medicare: https://keproqio.com/bene/

Music: Motivational Upbeat Corporate by RinkevichMusic
https://soundcloud.com/rinkevichmusic
Video Link: 

Transcript

Welcome to Aging Health Matters, a podcast from Kepro, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today’s show may help you or someone you know in their healthcare journey.  Thanks for joining us. Now let’s get started.

Scott Fortin
Hello everyone and welcome to yet another edition of Kepro’s podcast, Aging Health Matters.

My name is Scott Fortin. I am the Senior Director of Communications here for Kepro. Just a reminder of who we are; Kepro is the Beneficiary and Family Centered Care Quality Improvement Organization for 29 states, and we offer three key services for people who have Medicare: discharge appeals, quality of care complaints, and Immediate Advocacy services.

More information on these topics is available on our website at www.keproqio.com, or you can also check the show notes at the end of this show. Today's podcast is in relation to PFE or patient and family engagement, and it includes Dr. Jessica Whitley, who is the chief medical officer for Kepro’s QIO contract and a returning guest for this podcast. So with no further ado, I will introduce my guest, Dr. Whitley, how are you today?

Jessica Whitley
I'm doing very well, Scott, thank you for asking.

Scott Fortin
Great. Jessica, is there anything you'd like to remind the audience of about yourself, your background, your passions?

Jessica Whitley
Well, you know, just in case you didn't hear the previous podcast. My name is Jessica Whitley. I am a board-certified physician in Internal Medicine, even though my full-time job is as the Chief Medical Officer for the Beneficiary Family Centered Care Quality Improvement Organization contract with Medicare; that's a lot to say. But basically, it means beneficiaries, we are here to help you.

That is my full-time job. I do still practice medicine on a very part time basis, and I specialize in the care of the hospitalized patient. Patient care is a passion of mine. It is definitely a passion of mine that we provide quality patient care.

This is actually a topic that's near and dear to my heart because I believe that educating our beneficiaries, their families, even other patients that may be listening, that may not be Medicare patients. But this will also apply to you. It is to help patients to know how to engage with their own health care.

The healthcare system, definitely the COVID pandemic, created a lot of stress on the healthcare system. The healthcare system is stretched. There are sometimes not enough providers, and the providers that are there are often seeing quite a few patients, so that we can try to make sure all patients are seen and cared for. So in this type of environment, it is so, so important that patients don't just see themselves as I'm showing up to the doctor, and the doctor is going to know everything to do. And the doctor's going to be able to fix me. It's really, really important for quality of care, and I think it's a necessary aspect of quality of care that patients and their families, caregivers, friends are actively involved in that care. 

You are a partner with your doctor, and you are the most important partner as the patient or the beneficiary because it's your body and it's your life and it's your health. I would venture to say that nobody cares about you more than you. Sometimes patients don't know what is this? How do I engage? So I'm looking forward to our discussion because we'll talk a little bit about how you can engage with your own health care.

Scott Fortin
Absolutely. And you know I think one of the things I'll point out as being a person who's in communications and media is one of the things we've done here at Kepro and the healthcare environment in general is that people are much more educated and savvy about their care and about ways that they can engage in better quality care and also asking those right questions. So I guess speaking of questions that leads me to my first one. Could you tell me a little bit more, in your opinion, on that person-centered care and person and family engagement? When we say engagement, what do you mean as far as the person's care and their engagement?

Jessica Whitley
OK, I'm so glad that you asked that Scott because these are terms that are very, very popular in the healthcare environment because it has been determined that this is really a key aspect to improving quality of care for patients. There are two definitions here. One is person-centered care, and person- centered care really is about making sure that the person that is getting the care is really engaging with their providers, whether it be physicians that are taking care of you or nurses or if you are in therapy to really talk about, hey, these are my preferences in my care. These are my goals of care, and it is saying that you are the center of this. Don't be afraid to raise your voice and to express your concerns, your goals for your outcomes of care. Really the care should center around the patient. So it's not for the convenience of the doctor; it's not for the convenience of the hospital. The care is about taking care of the patient, and it's so important for patients to understand that. When we talk about patient and family engagement or person and family engagement, it's about the patient and their families or whomever else you have as your caregiver to be partners in this. Like I said earlier, the healthcare system is stretched. So part of being a partner is helping to provide information that's going to help improve your quality of care, to speak with the doctors, to let them know what's important, to try to make sure if you have multiple doctors involved in your care that you know what's going on, so that you can make sure that doctors are aware. 

As a patient, you really have to see yourself as a part of the healthcare team and not just a recipient of healthcare services. You are part of the team, and when you are a part of the team, then it really helps everybody involved. It's going to help the doctors. It's going to help you. It's going to help the nurses or therapist or people that are drawing your labs. Don't just kind of sit back and wait for the care to happen to you.

Be involved in helping to plan the care and watching the care that is happening to you in informing not only yourself about certain things that are going on, or certain tests that you're having or certain conditions that you've been diagnosed with but also informing the team about perhaps they weren't aware that you saw a specialist for this condition, or perhaps they weren't aware that you just had this test done.

And somebody may be ordering the same test. You are that one constant member of your healthcare team. Now primary care doctors function in that capacity, but again, primary care doctors, they do have a lot of patients that they are seeing, but you as the patient, you are your only patient, you should be your only and most important patient. Sometimes we have to take care of our family members, but you have a lot less patients than the doctors. So you are really in a key position to be able to be an extraordinary help to that care team, and I encourage you, I can't encourage you enough to play that role as a partner in your health care.

Scott Fortin
Absolutely. I couldn't agree more. And you know one of the things that we hear and we talk about a lot as a quality improvement organization is people's rights. Everyone as a patient or as a resident or a rehab visitor to a long-term care facility or whatever setting you're in, you have rights, and that is something I think that sometimes people overlook is the fact that they are the chief of their own care. They are the center, as you stated, of the universe as far as being the one constant person that is at all of these various different settings and  different appointments and that they do and their family also plays a large role in in that that presence of the family member should be encouraged and assisted, as you said, with patient and family engagement, so kind of playing off of that engagement portion. What kind of ideas do you have for the audience to be encouraged themselves or to encourage people to actively engage in their own health care? How would you lead them down that path?

Jessica Whitley
That's an excellent question Scott, and a lot of people do not engage in their own health care or families don't engage in the health care of their loved ones because they don't really know how. So I have some tips for you. I have some things that I think that all patients should do for their health care and anybody that's a caregiver and that's helping a patient to navigate through their healthcare issues. 

So the one thing that I would say first is do some research if you can. If you don't have access to a computer, there are different agencies that you can call. One of the things that you can call is the hospital or the physician’s office that you're getting care from to say, hey, say for instance, you've just been diagnosed with diabetes. I really don't understand this disease condition. Where can I get some information even if a lot of times you will get handed a pamphlet or some written material. 

If you have difficulty understanding that material, speak up and say hey, I need somebody to explain this. Sometimes if you are not able to read, say that; that is something that as healthcare professionals we are prepared to deal with. Even if you are able to read and read a lot, healthcare language is sometimes a different language, so even if you get material and you're not understanding, speak up. 

What I would say is if you have access to the Internet in your home and if you don't have it in your home, then perhaps you can go to a library. The internet is a wonderful resource to look up things. Now although I'm telling you that the Internet is a wonderful resource, that doesn't mean that everything on the Internet is true. So what you want to do is you really want to find good sites, any sites with.gov because Medicare, especially in the Centers for Medicare & Medicaid Services, they put out a lot of educational information.

Websites that end in.org; these are usually coming from say healthcare institutions or organizations that that are there for patient education and also when you see websites that end in .edu, this could be coming from medical schools. A lot of these sites are gearing their information towards the patient and not speaking at a level that only providers can understand. I think that that's very important; you really need to understand your health conditions. In that is understand what's being done to treat your health- care conditions. I can't tell you how many times I talked to patients in the hospitals, and they don't know what medications they're on.

As a patient, know what you're taking. You don't have to memorize it; write it down. Or sometimes if you're going to a doctor's office, just bring the pills that you're taking with you. But you want to know what you're taking, what the dosage is of the medication, and how frequently you're taking it. So you really want to inform yourself. Remember, you are a partner. You need to have this information. You need to understand what medicines are being used for what condition; you may have diabetes. You may have high blood pressure. You also want to know what the medications are for. Again, you can look up these medications through the Internet. If you go to a library, there may be some patient education books there. And like I said, if you have trouble understanding what you're reading, always go to your healthcare provider, and say where can I get somebody to talk to me about these things? That's only number 1. And I said I had a few. 

Another thing I want people to know, don't ever settle for any kind of treatment that you're not comfortable with, meaning if you feel uncomfortable, if you don't feel like that care provider is listening to your concerns, if you feel that they have not done adequate testing, if you feel like they've given you a treatment and you've tried the treatment and you're still not feeling well and you tell that provider you're not feeling well, don't be afraid to go and look for another opinion.

You really have to find a care provider, whether that be a physician or nurse practitioner, that you can have this type of relationship where there's that back and forth communication where you feel comfortable that your physician or your nurse practitioner is really listening to you and is making those efforts to care for you. So if you don't feel like it's happening, don't be afraid to go and get another opinion.

Scott Fortin
OK.

Jessica Whitley
Another point Scott is like boy, you have a lot of points.

Scott Fortin
They're all good.

Jessica Whitley
That I told you, Scott, this this is this is my passion, and I want all the patients out there to be informed. When you go to the doctor, I recommend or when you go to a care provider, I recommend that you bring any notes that can help clue you into what's important for that visit. Please understand that Rome wasn't built in a day. Neither are all of your healthcare problems going to be taken care of in a day.

But you want to have what is my priority for this visit? What do I need to get out of this visit? So if you're going in because you're having some symptoms, if you have notes that you've talked about, OK, this is the symptom that I'm feeling. Write that down, whether it's pain and try to describe it rather than giving a word, say like, I feel dizzy. Well, dizzy means a lot of different things to many people. Say more what it feels. I feel like I'm on a ship, and it's wobbling, or I feel like the room is spinning around me. So try to be descriptive like you're telling a story and you, you know, like when we were in grade school and they say use lots of adjectives, try to paint the picture, try to help the doctor to get a sense and a feeling of exactly what you feel like. When did that symptom begin? How often is that symptom happening?

Is it constant? Is it coming and going? Were you doing something when it started? What makes the symptom feel better or worse? What have you tried to help it feel better? So you really want to keep a journal on how you're feeling and what you've done. You also want to have in your notes any key questions that you may want to have. Say I heard something on the news, and it said I should get this test. Do you think this test is going to help? 

Write that down because you'd be surprised that when you get into the doctor's office, a lot of this just it was in your brain, but somehow when the doctor comes in, it floats right out of your brain. So if you have these things written down, that is really going to help the visit to go well, it's going to help you to accomplish your goals for the physician. And it's actually going to help the physician. I would also say to prepare for a visit with your doctor if you've seen different physicians, or if you've gotten tests other places, it's always good to either have signed a record release and ask them to send it to your primary care physician. Or if it's your primary care doctor that needs to send something to a specialist, make sure you've asked that doctor to send those things beforehand, so that the provider that you're seeing has access to the previous test that you have. I often also recommend that you get copies. When you talk about patient’s rights, you have a right to your healthcare information.

So whenever a test has been done, ask for a copy of the report of that test, read it yourself, understand what it says. You can ask your doctor questions about it. And so all of this is about being engaged in your health care. Also having somebody with you is very, very helpful; lean on whatever support system that is whether it's family, friends whether you need somebody. Sometimes you can ask the hospital. I'm having difficulty. Do you have a patient advocate that could help me in this visit? Sometimes if you don't have a family member that can be with you on that particular visit, if you have a phone or some other kind of recording device, ask the doctor. Do you mind if I record this visit and everything that you're telling me because my family will have questions? And I'm sure I'm not going to remember everything that you're telling me. So those are the things that you can do to make sure that you're well informed and that you are a partner on that healthcare team. So those are some of my suggestions.

Scott Fortin
Well, that's wonderful. I had some notes and questions of what I was hoping to ask you. And I think one of the biggest ones that you just talked about, to kind of go back to it for a second, is the continuity of people's care. And that is when you are seeing multiple providers, multiple doctors, you're going to one hospital and then an outpatient center I think it's important to as Dr. Whitley said, to make sure that you have those notes at your disposal and know that, for example, if Dr. A. provided a prescription to you and then you get to hospital A, and they are wanting to change something for some reason, you should certainly let that hospital or other provider know why maybe that doctor chose or told you why they chose to put you on the particular medication or something as an example. So that would be that continuity of care I think that Dr. Whitley was just referring to, and to get back to one of your other points that I really thought was really valid is in today's world of just a ton of healthcare information out there, one of the things we talk about in the healthcare industry is what's called health literacy, and that's people reading about and being able to understand the concepts of their health and of some of these chronic and debilitating conditions that people face.

And so I think my last question to you would be when we're looking at something like health literacy, you've got websites all over the place, WebMD and different hospital systems and different advice everywhere as you said. But how can a person making themselves better educated and being literate in their health, how can that provide a better outcome for them with their health, Dr. Whitley?

Jessica Whitley
Let me tell you; doctors are human beings. Doctors are not always right. There's so much information that we have to keep in our head as doctors. We can't possibly contain everything. But as I said, you are  the patient. Whereas doctors we have usually you know if there's a primary care doctor, you have over 1,000 patients that you're taking care of, of course not at one time, but these are the patients that you're responsible for. So there's so much information that you have to have. So if you have as a patient have looked up things and have said, hey, I heard about this medicine or I've been researching my symptoms, and I'm wondering, do you think I have this condition? 

It's always helpful for the doctor to hear that perspective and then that doctor can tell you, that is possible. Let's run this test, or are you interested in this medicine? Yes, this medicine can possibly be beneficial for you. So it helps you to have a conversation with the doctor. It also helps you to know what types of things should be done for you, the things that should be occurring in your health. And so if something maybe is forgotten, then you can be a reminder and say, for instance, let's just take a diabetes example. For diabetics, oftentimes to have a measure of how their diabetes is doing, we check a lab, and it's called a Hemoglobin A1C. And we check that lab every three months. 

What if your doctor forgot to order it, and it's been five months since you've had one. You may want to say, hey, Dr. Jones, I had a Hemoglobin A1C five months ago, but I haven't gotten one recently. I really want to make sure that I'm keeping track of how my diabetes is doing. And you want to know what these key numbers are. Doing that research gives you that information that you need to have these conversations, these engaging conversations with your provider. 

Now one thing that I would really, really like to stress is to understand that your physicians, that the people that are caring for you, the nurse practitioners, the nurses in the hospital, the people drawing your labs, these are all people, and they all have stress in their lives, whether it's job related or not job related, just like you do. So we really want to try to work together rather than being accusatory. If your doctor forgot something, that doesn't mean that doctor is a bad doctor. It just means that that doctor is human. I think it's a good thing that we have humans taking care of us. You don't want to get to the point that you just go up to a little robot and plug in your symptoms. And the robot tells you what you have. So that human interaction is important and so for us to give that human grace to one another. So if your doctor missed something, then it's not so much something that you should say, oh, you're a bad doctor or it's really again a partnership. And in any kind of partnership, you're there to help your partner just like your partner is there to help you. And that's when the partnership works optimally, when we're both on the same team; we're both helping one another to get to the goal, and that's when we can really arrive at that goal. And we're like, huh, we're here, aren't we both happy? Your doctors really want you to get better, but they definitely need your input to make sure that that is happening.

Scott Fortin
I'm hearing a pattern. I think if I were to break this down into some simple one word directions for our audience. I think what I'm hearing from Dr. Whitley today is learn, communicate, and advocate. Would those be fair?

Jessica Whitley
Wow Scott. That was impressive. Can you write that down? Can we do a commercial with that? Because it is very good to simplify that. Can you say that again, Scott?

Scott Fortin
Yes, absolutely, people, we would encourage you to learn, communicate, and advocate for yourself.

Jessica Whitley
That's it. That's really it in a nutshell. And if you do that, your health and your body will thank you for it.

Scott Fortin
Absolutely. Well, Dr. Whitley, anything else you care to share with our audience today?

Jessica Whitley
I can't think of anything at this point. But Scott, I look forward to more discussions. Certainly, I don't know if the audience has any ability to send messages about things or topics that they may be interested in hearing about on another one of our podcasts. But I think we've covered quite a bit today. We'd be happy to address any other issues. I'm happy to always come back as a guest. So just let me know.

Scott Fortin
And we're always happy to have you. And for those of you that do have questions, as Dr. Whitley is saying, we do have the ability on our website to ask those type of questions for those of you that are listening to the podcast, if you so desire. You can find that at www.keproqio.com, our website, which you can find a lot of these other great topics that Dr. Whitley has talked about in the past and today, we've talked about ways to advocate for yourself. And one of the things we do is Immediate Advocacy and appeals and reviews. So those are great as well. I would encourage you to look at our website and sign up for our beneficiary and family newsletter on there as well. 

And if you are a provider or stakeholder, we also have that type of newsletter available to you as well. So again, I would urge you to go back and listen to some of our previous podcasts but also take a look at some of our Enewsletters that we have had as well as other great resources that we have along with people like Dr.  Whitley placed out onto our website for you, our audience, to be able to learn more about your health and to just expand your capability to have better health each and every day. So once again, Dr. Whitley really appreciate you, all of your energy for this topic and for the people in general that we work with and just really thank you for your time today.

Jessica Whitley
Thank you so much for having me, Scott.