Retention of patients is critical to family planning financial sustainability
Executive Summary
A new free resource, "Patient Experience Improvement Toolkit: A Guide for Family Planning," is available to help family planning agencies develop patient experience goals; measure and use patient experience data; enhance interpersonal skills; and improve clinic sites, online and offline.
• Expansions in public and private health insurance under the Affordable Care Act will allow more people to gain coverage for family planning and related reproductive health services.
• The toolkit serves as a resource to help agencies to help retain patients in light of their increased options. It can be downloaded at http://bit.ly/1m0jxNB.
New toolkit helps clinics improve patient experience
A focus on patient experience in family planning is no longer just the right thing to do. "It is now a matter of agency survival," says Jennifer Kawatu, RN MPH, a consultant at Boston-based JSI Research & Training Institute, Inc. (JSI), a public health management consulting and research organization.
"If it takes patients three hours to wait for a visit, if they feel like the staff are unfriendly or uncaring, if they don’t see evidence of systems being up to date and of providing high quality care, they are likely to say that’s not worth it’ and go elsewhere. The difference is now they can," says Kawatu. Kawatu serves as the quality improvement advisor for the Title X National Training Center for Quality Assurance, Quality Improvement, and Evaluation, which JSI operates under a cooperative agreement with the Department of Health and Human Services’ Office of Population Affairs (OPA). The center is one of five national training centers funded by OPA to develop and deliver training and technical support to Title X family planning grantees and service sites.
According to statistics from the New York City-based Guttmacher Institute, 8.9 million family planning clients in 2010 received publicly funded contraceptive services, representing 47% of women in need of publicly supported care.1 Family planning centers provided services to 6.7 million contraceptive clients, with Title X-supported centers serving seven in 10 of those clients.1
Expansions in public and private health insurance under the Affordable Care Act (ACA) will allow more women and men to gain coverage for family planning and related reproductive health services. It is critical that family planning agencies focus on patient experience, say leaders in the field. "As ACA rolls out, and the number of Americans with insurance increases, they will have more choices of where they can go for healthcare," says Kawatu. "We want patients who have been served by family planning agencies to keep coming back and to choose to stay with these agencies for their quality care, even if they gain health insurance coverage and their options increase."
However, to keep patients coming back, patients will need to have a really good patient experience, Kawatu says. The standards for what constitutes a positive patient experience continue to rise, and what used to be acceptable is no longer sufficient, she states. Members of the public have much higher expectations for customer service in general, and these expectations apply to healthcare as well, notes Kawatu.
With changes in available coverage, it also will be important to maintain access to care for those who are ineligible for coverage, temporarily uncovered, or choose not to use their families’ coverage for confidentiality reasons, such as young adults on their parents’ insurance plan, says Kawatu. "Family planning agencies play a vital role in offering access to contraception and other reproductive healthcare, including cancer screening, immunizations, sexually transmitted infection screening and treatment, and it is imperative that we maintain access to care — regardless of healthcare insurance status — even as these changes in the healthcare system take place," she states.
Put toolkit to use
To improve patients’ experiences, JSI developed the "Patient Experience Improvement Toolkit: A Guide for Family Planning." (Download the free toolkit at http://bit.ly/1m0jxNB.)
The toolkit helps family planning agencies by:
• developing patient experience goals;
• measuring and using patient experience data to make such improvements;
• using interpersonal skills to enhance every visit;
• giving the clinic site a makeover (online and offline);
• respecting patient privacy;
• sustaining improvements in the long term.
An important part of the ACA is its focus on the "Triple Aim": improving the experience of care for individuals, improving the health of populations, and lowering per capita costs. To achieve these goals, existing payment models and healthcare delivery systems are being reformed.
For family planning clinics to improve revenue as the ACA rolls out, clinics are contracting with third-party payers. To do that, clinics have had to set up and refine electronic health records to use them for quality reporting, set up assistance for claims administration, and have clients enrolled in health insurance programs. Because health insurance companies and networks of care collect and use patient experience data to measure quality, what are some key ways to make sure an agency will do well in patient experience assessment?
There are three ways that family planning agencies can improve their patient experience while preparing to report data to health insurance companies and networks of care, says Katie Saul, MPH, JSI consultant and manager of the Family Planning National Training Center for Quality Assurance, Quality Improvement, and Evaluation. "The first [step] is to create a culture of quality," says Saul, who co-developed the toolkit with Kawatu. "It is imperative for leadership to embrace quality improvement and promote positive change."
Second, agencies should regularly measure patient experience, notes Saul. It is important to know how the patient population defines quality and the extent to which services meet their expectations, she explains. To the extent possible, agencies should align patient experience assessments with Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measures, a multi-year initiative of the Agency for Healthcare Research and Quality (AHRQ) to support and promote the assessment of consumers’ experiences with healthcare. Such surveys look at items as the timeliness of appointments, care, and information; provider communication with patients; and staff courtesy and respect.
Finally, clinics need to establish quality improvement systems in order to consistently and promptly act on assessment findings, says Saul. Staff members should be aware of what they do well and what needs improvement. Furthermore, they must be empowered to initiate and sustain change. "A supportive work environment provides all employees access to training, resources, and mentorship to help them provide the best patient experience to their patients," Saul states.
Use videos for training
At the Family Planning National Training Centers web site, www.fpntc.org, clinics can obtain practical guidance developed for family planning service sites to improve patient experience, with consideration given to service site limitations in staff, time, and funds.
Links to the toolkit are available there, as well as two videos developed by JSI to help family planning clinics in the patient experience improvement process. The first video, "The Family Planning Patient Experience Video: Skills to Improve Every Visit," helps staff improve their interactions with patients by modeling five key interpersonal skills. The second video, "Prioritizing the Patient Experience: Strategies for Family Planning," highlights patient experience best practices and successes from Title X-funded family planning clinics. The video includes practical information on ways to reduce patient wait times and to provide patient-centered care. (To watch the videos, go to the web site and click on "Resources," "Video," then the name of the video.)
"Early experience with healthcare reform in Massachusetts has shown that as people gain more choices for care when they obtain insurance coverage, they often choose to go elsewhere, such as to a primary care provider," say Kawatu and Saul in a blog entry on the subject. "Patient retention is vital to family planning clinics’ financial sustainability and the availability of high quality family planning services is paramount to comprehensive health care." (Read the blog entry at http://bit.ly/1eqY26b.)
- Sonfield A, Hasstedt K, Gold RB. Moving Forward: Family Planning in the Era of Health Reform. New York: Guttmacher Institute, 2014.
