Patients Report Improved Experiences Overall in Massachusetts Primary Care
Patient experiences for commercially-insured patients in primary care in Massachusetts continue to improve, despite the backdrop of increased out-of-pocket expenses and significant uncertainty in the healthcare system. This is one of the key findings from a statewide patient experience survey conducted for the 13th year by Massachusetts Health Quality Partners (MHQP), an independent healthcare measurement and reporting organization.
“This is encouraging news for Massachusetts healthcare,” said Barbra Rabson, MHQP’s President and CEO. “Positive and constructive relationships between patients and primary care providers are key components of the quality and value we seek for healthcare in Massachusetts. Measuring patient experience over time enables us to track our progress and better understand where to focus improvement efforts.”
The results, which can be found at www.healthcarecompassma.org, show increases over the past three years across all topic areas explored in the survey for both adult and pediatric care. This includes communication, integration of care, knowledge of patient, adult behavioral health, organizational access, self-management support, office staff, pediatric preventive care, child development, and willingness to recommend.
Providers continued to score highest in the area of communication, with a mean composite score of 94 out of 100 for the last three years. Other strong areas included a patient’s willingness to recommend a provider (91), provider knowledge of a patient (88) and office staff performance (88).
Click HERE to open a PDF chart of the high-level trends for the past three years.
Perhaps most significant is the fact that these increases in positive patient experience come at a time of shifting policy and health benefits in healthcare, including the uncertainty about the future of the Affordable Care Act and the proliferation of high-deductible plans which have shifted out-of-pocket expenses to consumers.
“The plethora of policy issues currently disrupting our healthcare system do not appear to have impacted individual patient experiences at this point, at least not for the commercially-insured population,” explained James Roosevelt, Jr., MHQP’s incoming Board Chair. “It will be interesting to see how this evolves now that we have achieved essentially universal coverage in our state.”
The strongest steady gains in recent years have been made in how often primary care providers ask adult patients questions related to behavioral health. Behavioral health has become increasingly important for adult and pediatric primary care practices, given current trends in depression, suicide, substance abuse and other behavioral health concerns, and the U.S. Preventive Services Task Force recently added increased emphasis in this area to its primary care guidelines. MHQP added behavioral health to the patient experience survey in 2013, with questions about whether or not primary care providers asked their patients about feeling depressed, feeling stressed, or experiencing problems with alcohol, drugs, or a mental or emotional illness. The mean composite score in this category for all adult practices has increased from 50.8 out of a potential 100 points in 2013 to 61.7 in 2017, a statistically significant increase. One question in particular has seen the largest positive gain: “In the last 12 months, did anyone in this provider’s office ask you if there was a period of time when you felt sad, empty, or depressed?” The median score for this question has increased steadily by more than 16 points in three years:
Year Median Score Change vs. Previous Year
2014 54.5 —
2015 61.6 +7.1
2016 67.3 +5.7
2017 70.9 +3.6
McGrath Medical Group in Milford, MA, was the practice with the most significant gains on this question in the state, raising its score from 34.7 in 2014 to 88.0 in 2017, a 53.3 point increase in three years. Dr. Emmett Clemente, one of the primary care providers at McGrath, attributes the increase to the fact that “our medical assistants screen all patients with the PHQ-2 depression screen when they enter the exam rooms for all visits…and the physician then reviews the responses prior to entering the exam room and follows up as necessary with the patient.”
Like many other practices throughout the state, McGrath has taken steps to more closely integrate behavioral health services with primary care. Primary care providers are in the unique and powerful position to identify behavioral health concerns and to immediately collaborate with diagnostic and treatment services to promote positive lifestyle choices, prevent unhealthy behaviors, and proactively intervene when appropriate.
Despite the improvements in this area, adult behavioral health remains one of the lowest scoring categories in the survey.
“Clearly, we still have a long way to go to fully integrate behavioral health into primary care,” said Rabson. “It is challenging for providers to have difficult conversations with patients, but it’s extremely important and it’s encouraging to see good progress in this area.”
About MHQP’s Statewide Patient Experience Survey
Unlike satisfaction surveys that ask about general perceptions, MHQP’s patient experience survey asks people what actually happened when they or their children needed primary care. The survey was fielded in the spring of 2017 and sampled patients from 866 adult and 321 pediatric primary care practices statewide, representing over 4,000 primary care providers. First conducted in 2005, the survey asks patients to rate the quality of certain doctor-patient interactions and other aspects of care using a nationally developed standard survey instrument.
Complete results can be found on MHQP’s consumer-focused website at www.healthcarecompassma.org.
The following organizations invested resources to support MHQP’s 2017 Patient Experience Survey and sustain statewide transparency of patient experience in Massachusetts: Blue Cross Blue Shield of Massachusetts, Fallon Health, Harvard Pilgrim Health Care, and Tufts Health Plan. This year, ten provider organizations, representing nearly half of the state’s primary care physicians, added their financial support: Cooley Dickinson PHO, Lowell General PHO, Mount Auburn Cambridge IPA, New England Quality Care Alliance, Northeast PHO, Partners HealthCare System Inc., Pediatric Physicians’ Organization at Children’s Hospital Boston, Steward Health Care Network, UMass Memorial Healthcare, and Winchester PHO.
The 2017 survey was fielded with commercially-insured patients. In 2018, MHQP will also be surveying patients enrolled in MassHealth, the state’s Medicaid program, as part of a new contract recently awarded to MHQP by the Massachusetts Executive Office of Health and Human Services. This new contract means MHQP will be able to provide a more complete picture of patient experience for providers in the state, as more than 25% of the population in Massachusetts is insured through MassHealth.