program).1 Policies of private insurers and of Medicaid, the State Children’s Health Insurance Program (SCHIP), and other government programs also are discussed as data are available.

Policies Addressing Effective Patient–Provider Communication

As indicated in Table 6-1, a few large-scale policy initiatives are under way to promote more effective patient–provider communication in general.2 The Cancer Survival Toolbox (available free of charge) teaches people living with cancer how to obtain information, make decisions, solve problems, and generally communicate more effectively with health care providers (NCCS, 2007). The Questions Are the Answer Campaign (AHRQ, 2007b) and Ask Me 3 initiative (Partnership for Clear Health Communication, undated) also encourage all patients to ask questions of their providers.

Policy support for the provider side of the patient–provider partnership is illustrated by the efforts of the Veterans Health Administration, whose Employee Education System provides mandatory and optional classes on such topics as clinician–patient communication to enhance health outcomes, communication to affect behavior change, and disclosure of unanticipated outcomes and medical errors. Other initiatives to improve patient–provider communication by organizations such as Kaiser Permanente, Geisinger Health System, the American Academy of Orthopedic Surgeons, Affinity Health System, and Washington State University are chronicled by the Institute for Healthcare Communication (2005), which has conducted more than 9,000 workshops for more than 120,000 clinicians and health care workers on improving communications between clinician and patient. Further support is provided by the Agency for Healthcare Research and Quality’s (AHRQ’s) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey Instruments. This ambulatory care survey tool has separate versions for adult specialty care and adult and child primary care, each containing multiple questions specifically asking patients about how their physician communicated and shared decision making with them (AHRQ, 2007a). In addition to these instruments’ potential use as performance measures, the American Board of Medical Specialties (ABMS) is pursuing use of the specialty version to help determine physician competency in effective communication as part of its Maintenance

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1MA plans serve approximately 17 percent of Medicare beneficiaries (MEDPAC, 2007).

2Many more initiatives are in place to improve provider communication with members of cultural and ethnic minorities and other vulnerable populations.



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