The Power of Supporting Patients Between Visits - Geri Baumblatt, Co-Founder of The Difference Collaborative

SHIV GAGLANI:Hi, I'm Shiv Gaglani, and today on Raise the Line, I'm really happy to be joined by Geri Baumblatt. Geri co-founded The Difference Collaborative, which collaborates with organizations to understand how caregiving currently impacts employee and team productivity, health, acquisition, retention, and well-being. She's also currently the Chief Engagement Officer at Docola and was the Executive Director of Patient Engagement at Emmi Solutions. For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams. So, Geri, it's a pleasure to have you on the show today.

GERI BAUMBLATT:Thank you for having me.

SHIV GAGLANI:So can you start by telling us a bit about your background and what led to your interest in patient engagement communications in the medical field?

GERI BAUMBLATT:Yeah, sure. So I grew up in a medical family working in my dad's primary care office, and I actually fully intended to go into medicine and I ended up taking a detour, going to grad school for literature and writing. And while I was there, end of my first year, I was in a really bad car accident, where a semi jackknifed and hit us. I don't even know, honestly to this day, how many cars and semis we hit. Luckily we were mostly okay, but I ended up in physical therapy and as somebody from a medical family who was otherwise young and healthy and just wanted to get better and be able to get back to school, I was surprised by just how difficult and frustrating it was to engage in my own care, follow instructions. I'd go to physical therapy dutifully, I'd do all the exercises, and then I'd go home to practice them and I'd come back and I'd hear, "Oh, you didn't point your toe down," or, "You didn't do that exercise quite right."

I was like, "Well, where in the little stick figure drawing was I supposed to see my toe pointing down?" And it was just surprisingly hard to get better and to understand what was going on, let alone navigating the insurance and everything else and the hours and hours that took. And I really was like, “There just has to be a better way.” The internet back then, this was the 90s, was new. And I was like, there's probably a way to help people when they go home remember what it is they're supposed to do, and understand why, and follow those instructions. Because you think you have it and your working memory fails you, but even more so, there's often not a lot of sense-making. You're just being told to do things and you don't really understand why and that makes it harder to troubleshoot when there are problems or to even recognize if something's working or helping you or not

SHIV GAGLANI:Having been through all of that physical therapy and rehab, I can clearly see why you've dedicated your career to patient education and empower consumers. So can you tell us a bit, from there, I'm most familiar with your work at Emmi, but we'd love to hear career highlights about the work you did at Emmi and then now at Docola, what you're doing, as well as the Difference Collaborative.

GERI BAUMBLATT:Yeah. I mean, they all come together because really so much of what's happening now, even more so with COVID, we see that there's a lot that can be done virtually and to really support people before, after, and between clinical conversations and encounters. Because most of your healthcare is what happens in between all those visits when you just have 15 or 30 minutes with clinicians. So it's a great way to think about it as asynchronous communication, because I can send you information before a visit that might help you track your pain, or think about how to talk about your pain or your symptoms, so that when you come in, I'm not just sending you away with a tracker or something and saying, "Come back again in a few weeks." I can also ask people questions about things like social determinants of health, mental health, food insecurity, sexual orientation or all these different issues that people are really scared and embarrassed to bring up.

They actually feel more comfortable, honestly, disclosing those things in an online environment. I was recently talking to a patient who created four questions for her chronic conditions, so that if her doctor sees her answers to these every time before she comes in, it creates a completely different conversation about her goals of care and really understanding her lived experience. I think so much of this as a way to build relationships and to educate people and make them really feel supported, but also normalize all of these questions people have. Whether it's about something like anxiety or depression or even something like a scar that they have. I found that a lot of times people are even embarrassed to ask about things like that because they think, "Oh, that's going to sound like I'm really vain. That I care about how my scar is going to look after surgery," which is a perfectly normal question.

So there's so many things that we can help educate people about, help them make sense of, and that way, when they come back together with the clinician, they have better questions. They have a better understanding and they can really spend more time together talking about, "Here's what's matters to me and here's what I'm worried about in my case." It's a better experience for everyone, and I think people are able to really make more progress and come together more as partners, instead of just going in and hoping that this person can help you and trying to tell your story in five minutes and seeing where you can get in 15 minutes.

SHIV GAGLANI:Yeah. I mean something we've been focused on at Osmosis is around curriculum, around things like shared decision-making, and empowering patients. Some of the guests we've had on the Raise the Line include Eric Topol who wrote the book, The Patient Will See You Now, and Mel Hall, who was the CEO of Press Ganey, which made patient satisfaction front and center for a lot of health systems. I'd love to hear any evidence you can cite around patient engagement and what are some of the proudest outcomes you have, whether it's Emmi, Docola, or some other part of your career, as far as things that really made a difference. Like when did patient education or consumer education lead to better outcomes, whatever those may be, how would you define them?

GERI BAUMBLATT:Well, I mean, there were certainly a number of studies and pilots that I've been involved in. At one point I was creating our care transition product where we really saw that we could combine interactive, automated phone calls about heart failure and collecting information from patients about things like their weight and any symptoms they were experiencing. And then short educational pieces. And we found that we really could reduce readmissions, and in other cases, we found that helping to educate people did improve satisfaction scores. Just educating them in general about a hospital stay, could improve their experience and their understanding about what happens when you hit the light to call a nurse or the button to call a nurse? What are they doing? Why don't they just immediately run to the bedside? Why does it matter about visitor hours and how many people come to see you?

Even just simple things like that make a big difference for people because they're so disoriented and confused by what's going on when they're in a care setting. One of my favorite things I worked on was actually around things like GI colonoscopy and IBD. So, for colonoscopy, I partnered with a physician at Dartmouth and they did a great study showing that when you prescribe information that helps people understand an upcoming procedure, like a colonoscopy, which nobody's looking forward to, and just help them understand what's that experience going to be like? What are they going to learn? How treatable is cancer or polyps or anything, if something is found? And they did a double-blind study and they found that we could reduce patient anxiety and improve patient understanding.

A couple other studies also showed that we could reduce things like no-shows, so people were more likely just to show up for their procedure. And a lot of times what we were finding is, people had an issue and they were too embarrassed to call about it, so they just wouldn't show up. Or they were scared, so they just wouldn't show up. So reducing that anxiety was actually really important, even though it sounds like, oh, that's nice, they had a better experience. They're more likely to show up, and when they looked back at the data, they also found that those patients who had viewed something like education beforehand had shorter procedure times and needed less sedation medication. So you start seeing how, oh, now it's not just, oh, the patient's happier and they had a friendlier experience and they were less anxious. They actually showed up for their appointment and now, we improved quality and safety as well.

So you really start to see how this can play out when you have patients who truly understand what's going on and really feel like they're being cared for. In other cases, we also found that we could do things like reduce length of stay. And one of the things I'm actually really interested in studying, that has not been well-studied, is how we can look at the provider experience as well. Because there's lots of studies out there showing that asynchronous care communication can improve the experience, can improve understanding, can improve self-efficacy, and even reduce things like A1C and blood pressure. But I think that there's an even broader application in terms of building those relationships, where people really feel safe and cared for.

SHIV GAGLANI:I couldn't agree more that there's so many different outcomes that patient education can lead to, not just satisfaction, but actual filled appointments, which is really important. Especially in the current healthcare system. So one reason we launched the Raise the Line podcast was we were talking about ways to improve and increase health care capacity. And right now we're obviously in the COVID pandemic and you hear healthcare workers who are trying to urge people to stay at home, to socially distance, to wear masks, just because they're so burned out from having to treat all these folks. And so, one element of patient education that really excites me is if people actually listened to advice, they lost weight, they quit smoking, those kinds of things, then we wouldn't actually need that many healthcare professionals or that much health care in general. Could you comment a bit about what you think COVID-19 has done to the patient education community or the idea for an empowered patient, misinformation, any of that?

GERI BAUMBLATT:Certainly, I think we see that there's more receptivity, at least so far, to virtual visits, which is great. But I think what I still see is people not necessarily snapping up the opportunity to use technology between those visits. And that's where I think there's a huge opportunity to really let things sink in, and not just educate people, but pull them into more of a conversation and coaching. So you brought up shared decision-making before, and that's a great example. Decision aids are incredibly powerful. However, part of what people really need is time to process the information. So if you're making a big treatment decision about something like breast or colon or prostate cancer, or how you're going to treat your Crohn's or ulcerative colitis, it's a lot to think about because it usually means that your first-line therapy hasn't worked and you have a bigger decision to make.

What we know is that it's not great to make those decisions during that same conversation where you're just learning about your options. You really need to go home, talk to your family, think about things, let it sink in, try the decisions on in a few different ways. And there's other ways to use virtual tools to help people do that, too. Like, okay, if you had something like breast cancer and you're thinking about, "Well, do I need to get a mastectomy?" How would you feel changing in a gym or a locker room if you don't get reconstruction versus if you do? There's just a lot more ways that we can really walk people through these things. And I think, right now what we see is, oftentimes we're giving people this new information about a diagnosis, or the way their chronic condition is progressing, and it's kind of a deer in the headlights moment. And they don't know how to make this decision.

So a lot of times they say, "Well, just tell me what to do." And really what we need to do more of is using these tools to say, "Well, why don't we do this? You should go home, think about this, and I'm going to send you some questions that will help you think through this. Like about what matters to you, what are your goals? All these different things that play into your decision." And I think so much of the time, clinicians feel really burdened, in a way, by having to try and make these decisions almost for people when they don't have enough information about what they want. We haven't been giving people the tools and the resources to really think these things through. And I think the same thing goes when you think about helping people manage chronic conditions, too.

People go through different phases where they get tired of dealing with their diabetes or tired of having to test their blood sugar or whatever it may be. And finding ways to help people set small goals and do those types of things is actually pretty easy with technology. I think part of it is we just need to give clinicians a little bit of experience with how well it can work. Just like everybody's like, "Oh, video visits actually can work for a lot of things." I think we can find the same thing, we just need to give them those experiences so that they can see that it's just going to extend the care and the time that they have with their patients.

SHIV GAGLANI:Absolutely. That's the major reason you joined Docola, right? Do you mind giving our audience a bit of background on Docola and how it works and any engagement metrics you can share to date?

GERI BAUMBLATT:Yeah, absolutely. So to date it's been used by about 1,000 clinicians, but over hundreds of thousands of patients have utilized it. It is a simple, free platform. It's not ad driven or selling patient data or upselling people. It's a social good effort where I'm helping them create a patient education content clearing house. So all different organizations are contributing patient education resources, including the CDC and the Merck Consumer Manual and lots of great organizations are adding their resources on kidney disease and almost everything there is. But then organizations can also create their own resources and upload them, and then make courses and E-prescribe them to patients. So for example, a bariatric practice that's working with a lot of rural patients -- where it was already hard for them to come in, but that much more difficult with COVID where you don't want people coming in -- was recording their patient education and now they're sending that out to people.

They're finding that the clinicians are having a better experience too, because patients come in, they've already done the education, and they can actually spend more one-on-one time with their patients, getting to know them, and making sure that they're looking at the right approach for them and timing and all of those sorts of things. It really does just track everything that you do. So if I put together two or three videos and, say, a decision aid or a quiz for a patient, I can send it to them, see if they started it, see if they completed it. Patients can also rate content. So it's really like a whole care communication community, where instead of everybody reinventing the wheel and saying, "Oh, I need to create a decision aid for colon cancer screening," it's like, well, did you know, there's probably actually three or four really good ones out there?

And a lot of them are actually free and you can just go in here, search for these resources, find them, curate the content that you want to use with your patients, upload your own resources, and actually E-prescribe them to patients. And it's really working incredibly well to bring all these pieces together. One of the physical therapists who created it, he actually shoots short videos for his patients. So he'll reiterate the instructions for them, and it only takes him about 90 seconds to make that video and send it to them. It's a way for people to be like, "Oh right, this is what he told me to do and that's why he wanted me to do it that way."

Just those little reminders really help people, but again, just build those relationships and people feel so grateful and cared for that their clinician would bother to take a few moments just to make sure they understood what they were doing when they went home. So that's how it's working right now. And increasingly, we're trying to also add resources for family caregivers, which is another huge focus that I think we often miss in patient education, is that, yes, there's the patient, but their care partner and their family members are often just as important to what they eat and if they get exercise and taking their medications. Especially as our population ages and more of us are caring for older family members as well.

SHIV GAGLANI:Yeah, that resonates a lot and it's very consistent with what previous guests on Raise the Line have said. Alan Patricof and Abby Levy were telling us about the caregiver crisis that we're facing as a nation, and frankly, globally. And it's really great to hear the stories of clinicians and providers who are recording these short snippets, as you were saying, like 90 second video on how to do a certain physical therapy maneuver. They don't have to be high production quality. The word doctor in Latin, as you probably know, means to teach and so it's interesting to hear about how you all are flipping the clinic, just like the Khan Academy and others, like Osmosis, have flipped the classroom. I know we're coming up on time, so I wanted to make sure to squeeze in this question which is, what advice would you give to our audience, which primarily comprises current and future healthcare professionals…anything you would give them about meeting the challenges of COVID-19 or beyond?

GERI BAUMBLATT:I think a lot of it, for me, is asking patients and families what they need. I think it's very easy right now to use a lot of technology to proactively communicate out with patients. Again, like you're saying, a short video doesn't have to be high production quality. In some ways, I think it's better if it's not. You really show that, no, this is just our office or our clinic trying to make sure you have up-to-date information. But here's what our clinic is doing to keep you safe during COVID, here's what we want all our patients with diabetes or lupus to do proactively. But then solicit questions from them, instead of everybody just calling your office. And those frontline staff often know what those questions are, but ask the frontline staff, and ask the patients and families, what is it you're worried about? What is it that you need? Because we can proactively answer those questions for people.

And it's strange to me how often, even as I've been doing this for 20 years, I'll go in, I'll interview patients, I'll create a resource for them, and then when I test it with patients, I'm always surprised that there's key things that we missed. And sometimes it's because people were embarrassed to ask a question about something, but people can tell us what they need from us. So if we just reach out and say, "Here's some initial information, what else do you need to know?" I think we can create these loops where we can say, "Oh, 20 people just wrote back with the same three questions. Let's do another video and just reach back out to them and answer everybody's questions.” Instead of people just wringing their hands at home or calling our office with simple questions that we could proactively answer. I think that would go a long way to opening up that two-way communication. I think what we learn from patients is often really simple, but really surprising at the same time.

SHIV GAGLANI:That is some excellent advice to leave our audience with. Is there anything else we didn't talk about that you wanted to get across to our audience at Osmosis?

GERI BAUMBLATT:I think that, really, it comes back to this same piece about talking to patients and family members. Anytime we're creating anything, any kind of resource, it doesn't take much to put it in front of a couple of real patients and ask them what they think and people love giving that feedback. All they want to do is help other people have a better experience and avoid making some of the same mistakes they made. So anytime that we're creating resources for patients, we have to do it with patients and we have to put it in front of them and just ask them what we think. I continue to be amazed at the very simple, but often really profound, feedback that I get from people. No matter how long I've been doing this.

SHIV GAGLANI:That's awesome. Geri, thanks so much for taking the time to be with us today and more importantly, for the work that you're doing to put the patient voice front and center and educate so many of them. Because as I mentioned, the better you do your work and people like you are doing your work, the less we'll need to increase healthcare capacity because people will be empowered.

GERI BAUMBLATT:Definitely. Thank you so much for having me.

SHIV GAGLANI:And with that, I'm Shiv Gaglani, thank you to our audience for checking out today's show. And remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.