a special program of the National Emergency Medicine Association (NEMA)

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Week: 591.6b 

Guest: Dr. Jeffrey Koplan, fmr. Asst. Surgeon General, President of Research, Prudential HealthCare 

Topic: HMO research into patient trust 

Host/Producer: Steve Girard 

NEMA: Thanks for joining us. What do you know about the structure of the practice where you visit your doctor? Do you know what he or she is paid, or if the salary depends on patient volume? And does it affect how you feel about your doctor, or the treatment you receive? Those are the questions propelling a two year study on patient trust being conducted in Baltimore by the Prudential company...one of many such projects in progress. With us today is Dr. Jeffrey Koplan, president of the Prudential Center for Health Care Research, and former Assistant Surgeon General...  

KOPLAN: The Prudential Center for Health Care Research does research on a wide range of health service, health care delivery issues. We choose them on the basis of what seems to be major health care concerns and causes of illness for our membership and for the population at large. So that we’ll tend to pick things like heart disease, diabetes, childhood immunizations. And we also pick subjects where we can do something about a perceived barrier or problem, so as to improve health care. So, that’s the way we choose studies, and thus we have a wide range of different types of studies that we do.  

NEMA: Is this effort one that’s grown from a couple of centers ....how long has the company been doing this?  

KOPLAN: The research center has been doing studies for about three years...and we try to make them national...we try to do studies all around the country, involve all of our plans, because Prudential has 40 health plans around the country. And some cities are more appropriate for doing studies than others. Baltimore, where you’re located, has been very eager and very interested in doing different kinds of studies, and it’s been a very productive place for us and for them to have studies done.  

NEMA: Specifically about the study on patient trust...what were the flags that went up that indicated you had to do this study...what was wrong with the system that you thought had to be looked at?  

KOPLAN: The patient trust study has been going on for about two years now, and it grew out of our collaboration with Harvard Medical School...we have a very close collaboration with Harvard Medical School, where many of their faculty in their department of health policy are associated with our centers, and many of my colleagues here have faculty appointments in their departments. They have been interested for some time in the issue of whether...how physicians get paid, and what kind of administrative structure those physicians work in - managed care....non-managed care, salaried positions versus non-salaried, whether that affects the way that patients perceive their physicians, what kind of trust they have in them. And through that, we’ve done this fairly large study, looking at sets of patients and their doctors and looking at how patients feel about their doctors...whether they know about their payment mechanisms, whether it makes any difference to them in the way they think their care is delivered.  

NEMA: How long will the study go on?  

KOPLAN: We’re collecting the last pieces of information, so the analysis of this should be taking place within days or weeks from our conversation today. So I don’t have the final results to discuss with you or your listeners yet, but we hope that that will be out quite shortly.  

NEMA: Any early indications as to how the study has gone?  

KOPLAN: We did an early pilot study before we started the large scale study on the subject of patient trust. And some of the early findings on that...again, from a small group of doctors and their patients...were that most patients, most consumers of health care, don’t know how their doctors get paid, and most...to be blunt...don’t really care. If they have a good relationship with their doctor, or if they’ve seen that doctor several times and like them, they develop trust in what that doctor does, and other factors seem to be secondary  

NEMA: From that pilot study...was there one important factor that came up that you wanted to refine in the larger study?  

KOPLAN: Well, one of our interests is in seeing what are the key determinants of patients’ trust in their doctor...what makes them more comfortable with any given doctor, any given health plan. To try to make people as comfortable as possible with the doctors and the health system...it’s a larger issue than Prudential, it’s for the country as a whole, and certainly that’s that’s of interest to both us and Harvard...is what drives consumers in this, and what makes a difference in them being comfortable. And I think the strongest factor is familiarity and comfort over time with a doctor...that repeated visits and development of a relationship seems to override everything else. So, that it doesn’t matter if you’re paid by the number of people you see, by an outside HMO, or whether you’re paid on a salary or whether you’re given fee-for-service. If a given patient has seen that doctor several times, and has found they like that doctor and thinks they provide good care...then payment doesn’t cloud their level of trust in that doctor.  

NEMA: You mentioned your relationships, your collaborations with Harvard....and I know you’ve worked with the Centers for Disease Control...what issues have you done with them that have been most productive or exciting?  

KOPLAN: We seek out collaborations with units, universities, hospitals, medical centers around the country that have more expertise in an area that we can bring with the resources we have. So we kind of combine our resources with them. We’ve done some interesting work with the University of Washington on low back pain, some work on mammography, early breast cancer detection with Duke. We’re trying to develop an agenda for injury control and prevention...possibly with Emory University and the Centers for Disease Control. We’re doing a lot on immunizations with the Centers for Disease Control. I guess if you were to ask me which of these things is most exciting, the number one item is, I think, some of the work we’ve been doing on immunizations with the Centers for Disease Control is very exciting to me. I’m interested in prevention, and we’ve found that through some of our studies, we’ve been able to markedly increase immunization levels in some of our plans, and we’re seeking to broaden that and disseminate it both in our own health plans, but also in the broader population.  

NEMA: Will we see a trend in health care companies involved in research projects? Will all of them be doing it soon?  

KOPLAN: I hope so, I think it provides better care for both the members of the given plan and the community at large. I think the better managed care organizations, the better HMO’s, will have some part of their resources dedicated to research, particularly research that’s applicable and practical and meant to make changes and improve the quality of care. I’m not sure everyone will do it, but I think the better ones will.  

NEMA: Our thanks to Dr. Jeffrey Koplan, former assistant Surgeon General and President of the Prudential Center for Health Care Research in Atlanta.  

NEMA: Thanks for joining us for today’s program. If you have any comments or suggestions, contact this station. Or visit our home page at: www.nemahealth.org/ ...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I’m Steve Girard at The Heart of the Matter.