Improving the Health Care Response to Intimate Partner Violence ...

Improving the Health Care Response to Intimate Partner Violence: The Business Case for IPV Programs Patricia R. Salber, MD, MBA Co-founder and Co-President Physicians for a Violence-free Society PHYSICIANS FOR A VIOLENCE-FREE SOCIETY What is the optimal health care response to IPV? • • • • • Identification Validation Referral to IPV experts Documentation A prepared health care setting PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Identification • Early identification via routine screening – No typical victims – Indicator based screening fails to ID many individuals at-risk – Documented to increase number of women identified – Studies document that women accept/appreciate screening – Many doctors still reluctant to screen PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Validation • Definition: confirm and support on a sound basis • Therapeutic messages – – – – “Battering is wrong” “You don‟t deserve it” „I am worried about your health and safety” “Help is available. I can help you get in touch with experts” – “Any time you need or want to talk about what is going on, I am here for you” PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Referral to IPV experts • Large systems: hospital or clinical based social workers and/or IPV advocates • Smaller systems and “non-systems” – Close connections with community-based advocates – Plan ahead – Know what their capability and limitations – Provide on-going support PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Documentation • Record history as told – Non-judgmental – Current and past history – Photos and body map • May serve as the only record that the abuse has occurred • Supports victims that interface with the criminal and civil justice system PHYSICIANS FOR A VIOLENCE-FREE SOCIETY A prepared health care setting • Supportive environment – Posters, lapel buttons, educated staff • IPV response as a high priority – Recognition, time, incentives, CME, QI • IVDR taken as seriously as any other health care evaluation: responding to IPV, another way to save a life PHYSICIANS FOR A VIOLENCE-FREE SOCIETY What is the current state of affairs: the downside? • • • • • Few providers are routinely screening Even when identified, limited response Poor documentation IPV experts underfunded, underresourced Still marginalized in medicine PHYSICIANS FOR A VIOLENCE-FREE SOCIETY What is the current state of affairs: the upside? • Dramatic progress in the last decade – Now part of the curriculum for many specialties • ER, OB-Gyn, Family Practice, Nursing, Mental Health • Some health plans and health systems developing innovative approaches • Research community engaged • Resources available – Family Violence Prevention Fund – Physicians for a Violence-free Society PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Health Care Decision-Makers Balancing Act Consumer groups Advocates Laws and regulations Impact on affordability Accreditation Measurable results Medico-legal liability Consumer preferences Purchaser demands Political concerns Employee satisfaction Provider buy-in Competition/competitiveness Social mission PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Profits and losses Shareholder value The Business Case for IPV Programs • IPV is common – >800,000 cases per year • Impacts not only the victim, but her children and her abuser • Health effects are wide reaching • • • • • Injuries Acute and chronic illnesses Mental health problems Injurious health behaviors Lower preventive health adherence PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Unaddressed IPV is Costly • Victims of IPV cost one health plan $1775 more per year than non-victims • Health care utilization, including use of mental health services, is increased in women experiencing IPV compared to women not abused • Children of victims have short and longterm adverse health effects PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Interventions Efficiently & Effectively Address the Issue • There is peer-reviewed literature and expert opinion that routine screening increases identification of “at risk” individuals • Successful models and programs IPV programs already exist and are readily available PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Interventions Efficiently & Effectively Address the Issue • There is evidence that being asked about IPV by a health care practitioner provides validation and may plant the seed for positive change • Screening, combined with validation, has been documented to be beneficial to the health and safety of victims PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Experts, Patients and Purchasers Support IPV Programs • National health care organizations have policy recommendations that support routine IPV screening and intervention • Multiple papers in the peer-reviewed literature call for implementation of such programs • National consensus screening guidelines exist and have been promulgated PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Experts, Patients and Purchasers Support IPV Programs • The Institute of Medicine recommends comprehensive research and education on the training needs of health care professionals on abuse • Purchasers, such as the National Business Coalition on Health have included IPV questions in the “request for information” used to assess health plan quality • Published literature documents that patients support screening for abuse PHYSICIANS FOR A VIOLENCE-FREE SOCIETY There is Evidence that Failure to Implement the Program May Lead to Unsatisfactory Outcomes • The literature has documented that the status quo has failed IPV victims and their families – Multiple visits without recognition of the abuse – Unnecessary visits, evaluations, and testing – Victims not asked, validated nor provided with information about abuse and available IPV services – Children have continued exposure to violence with short and long-term health consequences PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Other Potential Adverse Consequences • As response to IPV becomes the standard of care, health care organizations may be held liable for not identifying and responding appropriately to patients Cranstoun, J. Health Law, Fall 2000 PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Calculating the Specific Costs/Savings to Implement the IPV Program • Physicians for a Violence-Free Society and the Family Violence Prevention Fund have developed an Excel spreadsheet that can be used by advocates and decisionmakers to calculate the ROI of IPV programs PHYSICIANS FOR A VIOLENCE-FREE SOCIETY PHYSICIANS FOR A VIOLENCE-FREE SOCIETY There are Areas in which Needed Information is Not Available • We cannot prove that health care IPV programs decrease injuries/illness and/or mortality – Lack of defined outcome measures – Referral to community-based organizations who do not share outcome information with health care systems – Victims who leave may lose insurance, move to another locale – Confidentiality and safety concerns PHYSICIANS FOR A VIOLENCE-FREE SOCIETY There are Areas in which Needed Information is Not Available • We cannot prove definitively that IPV programs save all or part of the additional dollars spent when a victim goes unidentified • Build in an evaluation component and/or start by implementing a pilot PHYSICIANS FOR A VIOLENCE-FREE SOCIETY Summary: IPV Programs Make Good Business Sense • IPV programs increase identification and provides validation to victims • Can favorably impact the bottom line • Status quo is not acceptable from an ethical, clinical or financial perspective • Fits with the social mission of health care organizations • It is simply the right thing to do PHYSICIANS FOR A VIOLENCE-FREE SOCIETY How can employers help ensure an optimal health care response to IPV? • Ask – Discuss with health care plans/systems you contract with… • Let them know you are concerned • Expect programs designed to improve the health care response to IPV – More than training programs – Supported by measurement, feedback & QI – Implemented in multiple health care settings PHYSICIANS FOR A VIOLENCE-FREE SOCIETY How can employers help ensure an optimal health care response to IPV? • Look for linkages with community based services necessary for a robust response – CBOs, shelters, mental health carve outs, legal services, police • Elevate the issue – Add to RFI/RFPs – Consider incentives PHYSICIANS FOR A VIOLENCE-FREE SOCIETY How can employers help ensure an optimal health care response to IPV? • Provide support for community-based organizations – Serve on boards – Help them with business issues – Financial support • Workplace programs PHYSICIANS FOR A VIOLENCE-FREE SOCIETY PHYSICIANS FOR A VIOLENCE-FREE SOCIETY