VHA Customer Value Online Survey / Customer Value Focus Group

VHA Focus Group Moderator’s Guide

Introductions:

• Moderator introduces his/her name and BAH

• BAH’s involvement with VHA.

• VHA has embarked on a journey to put the Veteran at the center of their care; to focus less on diseases, hospitals and physicians and more clearly on helping Veterans achieve their optimal state of health. To accomplish the goal VHA must develop a deeper understanding of Veteran preferences.

• Explain the purpose of today’s group discussion:

• To help construct a questionnaire that will be sent to a random sample of veterans nationwide

• To explore current healthcare preferences and VHA service offerings

• Deliver the highest value services as defined by Veteran’s preferences (i.e., desires/choices in how they interact with VA)

• Plan and design service offerings with Veterans in mind

• Drive Veteran healthy outcomes & increase patient satisfaction

• To identify key attributes that drive healthcare decisions

• Moderator’s role as a facilitator, not a recommender or subject matter expert.

  • There are no right or wrong answers; we just want your perceptions, opinions, and suggestions.

• Let’s begin by introducing ourselves. Please tell us:

  • your first name

  • branch

  • years of service

  • experience with VHA

General Discussion:

• What does Patient-Centered mean to you?

  • -In general, what benefits would you expect a patient centered program to have?

• Do you consider the VHA to be patient centered?

  • Why/Why not?

  • What could the VHA do to become more patient centered?

• What Healthcare information do you value most?

The VHA is considering two new programs/services and the remainder of the discussion will center around these two programs/services. Remember that your feedback will help us to create a survey that will assist the VHA in designing these programs/services. The first program/service that we will be discussing is a personal health record.

PHR Section

• What does the phrase “personal health record” mean to you?

[May need to describe what PHR is – possibly use a product profile or demo]

• Have you had any experience using PHR?

• What is your initial opinion of PHR?

• What would you expect to be included in PHR?

• What would you expect the benefits/drawbacks of PHR to be?

• How would you expect to access PHR/How would you like to access?

• What would encourage you to use a PHR?

• The section of this session is to understand what attributes drive your decision most in adopting/using a PHR. As I mentioned earlier, the thrust of this discussion is to help the VHA develop a deeper understanding of Veteran preferences.

• What key factors could drive your decision to use PHR or not? [Record on whiteboard or flipchart]

  • Safety/Security?

  • Add other probes

• Now I’m going to mention four specific factors. I’d like to review your understanding of each one and how much of a factor each is in your decision to adopt/use PHR.

• [For each factor] Tell me in your own words what [factor] means to you

• Is any portion of the definition unclear? How might you change the wording to make the definition more clear to you?

• [For each factor] Does [factor] affect one’s decision to use PHR? If so, test levels by asking what amount of each

PHR Conjoint Task

Our next task is to review several tables that present different program/service offerings. Before I do that, let me ask the observers if they have any questions.

[Moderator: pose additional questions from observers]

The questions on the following tables will have different factors to consider. Each screen will show you two versions of a PHR program that could be developed by the VHA. The two versions on each of the following screens may have different characteristics.

Please compare the two versions on each screen carefully and choose the one you MOST prefer on each screen.

Your actual experience will likely differ from the specifics we will show you. There is no right or wrong answer. We are only interested in how you would react to the different characteristics.

[Display 5 Scenarios in the following section]

• Please tell me in your own words what we are asking you to do? Can you understand what to do?

  • Is the task easy or difficult for you?

    • If difficult, why?

• Based on what is being asked, are there additional items that should be considered?

This is the end of our discussion on PHR. The second program/service that we will be discussing today is health coaching. Before I do that, let me ask the observers if they have any questions.

[Moderator: pose additional questions from observers]

• What incentives would encourage Veterans to participate in Health Coaching?

• How should VHA design a coaching program to appeal to the highest number of Veterans?

• Would Veterans welcome unsolicited outreach by a caring coach?

• When, where, how and how often would Veterans prefer to interact with a coach?

Health Coach Section

• What does the phrase “health coach” mean to you?

[May need to describe what health coach is – possibly use a product profile]

• Have you had any experience using a health coach?

• What is your initial opinion of using a health coach?

• What would you expect a health coach to do?

• How would you expect to access a health coach/How would you like to access?

• What would encourage you to use a health coach?

• When, where, how and how often would you prefer to interact with a coach?

• If the VHA were to begin using health coaches, how would you expect to be contacted?

  • What if the health coach were assigned and they contacted you directly?

  • What could the VHA include to increase the appeal of a health coach?

    • Are there specific incentives that could encourage you to use a health coach?

[List of potential incentives]

• The section of this session is to understand what attributes drive your decision most in adopting/using a health coach.

• What key factors could drive your decision to use a health coach or not? [Record on whiteboard or flipchart]

• Now I’m going to mention five specific factors. I’d like to review your understanding of each one and how much of a factor each is in your decision to adopt/use a health coach.

• [For each factor] Tell me in your own words what [factor] means to you

• Is any portion of the definition unclear? How might you change the wording to make the definition more clear to you?

• [For each factor] Does [factor] affect one’s decision to use PHR? If so, test levels by asking what amount of each

[The attributes need a general description of what is included in the levels]

Who provides health coaching

How coaching is provided

Coaching duration

Coaching intensity

Motivators and incentives for participating

Health Coach Conjoint Task

Our next task is to review several tables that present different health coach program options. Before I do that, let me ask the observers if they have any questions.

[Moderator: pose additional questions from observers]

The questions on the following tables will have different factors to consider. Each screen will show you two versions of a health coach program that could be developed by the VHA. The two versions on each of the following screens may have different characteristics.

Please compare the two versions on each screen carefully and choose the one you MOST prefer on each screen.

Your actual experience will likely differ from the specifics we will show you. There is no right or wrong answer. We are only interested in how you would react to the different characteristics.

[Display 5 Scenarios in the following section]

• Please tell me in your own words what we are asking you to do? Can you understand what to do?

  • Is the task easy or difficult for you?

    • If difficult, why?

• Based on what is being asked, are there additional items that should be considered?

Wrap Up and Thank You

Health Coaching Conjoint Scenario Example

Over the next series of screens, you will be shown different sets of hypothetical program profiles related to health coaching, two at a time. Based on the information provided, please select the program that you prefer. There will also be an option to select neither program.

Each program profile will contain five attributes. Please review the following information carefully to become familiar with each of the different possible attribute options.

Who provides health coaching	Coaching by a clinician member of your VA care team Coaching provided by a clinician outside of your VA Care Team Coaching provided by a non-clinician (fellow Veteran?) outside of your VA care team Coaching provided by someone in your community and not-affiliated with VA
How coaching is provided	Individual coaching face-to-face or by telephone that a health coach initiates Individual coaching face-to-face by telephone that you the patient initiates Group coaching with peers through face-to-face or telephone sessions ”On demand” coaching through a telehealth device or MyHeatheVet website or smart phone
Coaching duration	Quick reminders Shorter informational or motivational coaching sessions Longer duration coaching over time until a goal is met or a health issue is under control
Coaching intensity	Coaching at the beginning to explain a procedure or disease-specific treatment plan Coaching that monitors progress, motivates and helps keep you on track with your self-managed health or treatment plan Coaching that is more tailored, intensive and integrated to help you with your life goals and/or longer term health issue (e.g., chronic diabetes)
Motivators and incentives for participating	The intrinsic reward of reaching your own personal goal Sharing in group recognition of achievements, such as an award presentation to a group, or news articles about individual accomplishments in a magazine read by Veterans Perquisites/ rewards for participating in health coaching, such as discounted gym membership

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Scenario 1]

	Program 1	Program 2
Health Coach	Coaching by a non-clinician outside of your VA care team	Coaching delivered by a clinician member of your VA care team	No program
Mode of Delivery	Individual coaching delivered face-to-face or by telephone that a health coach initiates	Individual coaching delivered face-to-face or by telephone that you the patient initiate
Coaching Duration	Shorter informational or motivational coaching sessions	Quick reminders
Coaching Purpose	Coaching at the beginning to explain a procedure or disease	Coaching that monitors progress, motivates and helps keep you on track with your life goals
Incentives	Rewards or recognition for meeting a personal health goal	Intrinsic reward of reaching your own goal

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Scenario 2]

	Program 1	Program 2
Health Coach	Coaching by a clinician outside of your VA care team	Coaching delivered by a clinician member of your VA care team	No program
Mode of Delivery	Individual coaching delivered face-to-face or by telephone that a health coach initiates	Group coaching with peers
Coaching Duration	Quick reminders	Quick reminders
Coaching Purpose	Coaching that is more tailored	Coaching that monitors progress, motivates and helps keep you on track with your life goals
Incentives	Rewards or recognition for meeting a personal health goal	Sharing in group recognition

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Scenario 3]

	Program 1	Program 2
Health Coach	Coaching by a non-clinician outside of your VA care team	Coaching by a clinician outside of your VA care team	No program
Mode of Delivery	“On demand” through a telehealth device	Individual coaching delivered face-to-face or by telephone that you the patient initiate
Coaching Duration	Shorter informational or motivational coaching sessions	Longer duration coaching over time
Coaching Purpose	Coaching at the beginning to explain a procedure or disease	Coaching that is more tailored
Incentives	Rewards or recognition for meeting a personal health goal	Intrinsic reward of reaching your own goal

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Scenario 4]

	Program 1	Program 2
Health Coach	Coaching by someone in your community outside of your VA care team	Coaching delivered by a clinician member of your VA care team	No program
Mode of Delivery	Group coaching with peers	Group coaching with peers
Coaching Duration	Longer duration coaching over time	Quick reminders
Coaching Purpose	Coaching that is more tailored	Coaching that is more tailored
Incentives	Sharing in group recognition	Intrinsic reward of reaching your own goal

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Scenario 5]

	Program 1	Program 2
Health Coach	Coaching by a non-clinician outside of your VA care team	Coaching by someone in your community outside of your VA care team	No program
Mode of Delivery	Individual coaching delivered face-to-face or by telephone that a health coach initiates	“On demand” through a telehealth device
Coaching Duration	Shorter informational or motivational coaching sessions	Shorter informational or motivational coaching sessions
Coaching Purpose	Coaching that monitors progress, motivates and helps keep you on track with your life goals	Coaching at the beginning to explain a procedure or disease
Incentives	Rewards or recognition for meeting a personal health goal	Intrinsic reward of reaching your own goal

Electronic Health Record Conjoint Scenario Example

Over the next series of screens, you will be shown different sets of hypothetical program profiles related to electronic health records, two at a time. Based on the information provided, please select the program that you prefer. There will also be an option to select neither program.

Each program profile will contain five attributes. Please review the following information carefully to become familiar with each of the different possible attribute options.

Convenience / access	Share information through a VA caregiver, either in-person or by telephone Share information through a VA caregiver as well as through MyHealtheVet website Share information through all channels (VA caregiver, MyHealtheVet website and smartphone app)
Type of health information shared	Medical information (VA health history, caregiver notes, medications, lab results) Medical information plus personal information about you (marital status, dependents, employment, housing) Medical information, personal information about you, as well as information you provide about your preferences, values, priorities and motivators
Confidentiality	Share information only with your VA care team With your consent, share your entire health record with VA care team and other healthcare providers or caregivers Share only the parts of your health record that you select with other healthcare providers or caregivers
Other health resources / tools	Access tailored educational/informational resources through your PHR Access tailored educational/informational resources, as well as health risk assessment tools that provide feedback about your health age Access all of the above, plus home monitoring tools and smart phone apps that you connect/upload to your PHR

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Sample Scenario 1]

	Program 1	Program 2
Convenience/ Access	Share information through a VA care giver	Share information through a VA care giver as through MyHealtheVet	No program
Health Information Shared	Medical information	Medical information, personal information about you, as well as information you provide about your preferences, values, priorities, and motivators
Confidentiality	Share information only with your VA care team	Share only the parts of your health record that you select with other healthcare providers or caregivers
Health Resources/ Tools	Access tailored educational/informational resources through your PHR	Access tailored educational/informational resources, as well as health risk assessment tools that provide feedback about your health age

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Sample Scenario 2]

	Program 1	Program 2
Convenience/ Access	Share information through all channels (VA care giver, MyHealtheVet website and smartphone app	Share information through a VA care giver	No program
Health Information Shared	Medical information plus personal information about you	Medical information, personal information about you, as well as information you provide about your preferences, values, priorities, and motivators
Confidentiality	With your consent, share your entire health record with VA care team and other providers	With your consent, share your entire health record with VA care team and other providers
Health Resources/ Tools	Access tailored educational/informational resources through your PHR	Access tailored educational/informational resources, as well as health risk assessment tools that provide feedback about your health age, plus home monitoring tools and smartphone app

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Sample Scenario 3]

	Program 1	Program 2
Convenience/ Access	Share information through a VA care giver as through MyHealtheVet	Share information through all channels (VA care giver, MyHealtheVet website and smartphone app	No program
Health Information Shared	Medical information	Medical information, personal information about you, as well as information you provide about your preferences, values, priorities, and motivators
Confidentiality	Share only the parts of your health record that you select with other healthcare providers or caregivers	Share information only with your VA care team
Health Resources/ Tools	Access tailored educational/informational resources, as well as health risk assessment tools that provide feedback about your health age, plus home monitoring tools and smartphone app	Access tailored educational/informational resources, as well as health risk assessment tools that provide feedback about your health age

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Sample Scenario 4]

	Program 1	Program 2
Convenience/ Access	Share information through a VA care giver	Share information through a VA care giver	No program
Health Information Shared	Medical information, personal information about you, as well as information you provide about your preferences, values, priorities, and motivators	Medical information plus personal information about you
Confidentiality	Share information only with your VA care team	With your consent, share your entire health record with VA care team and other providers
Health Resources/ Tools	Access tailored educational/informational resources, as well as health risk assessment tools that provide feedback about your health age	Access tailored educational/informational resources through your PHR

The program profiles may only vary SLIGHTLY and some attribute options may be the same. Therefore, it is critical that you read the information displayed very carefully in order to provide the most accurate possible response.

[Sample Scenario 5]

	Program 1	Program 2
Convenience/ Access	Share information through all channels (VA care giver, MyHealtheVet website and smartphone app	Share information through a VA care giver as through MyHealtheVet	No program
Health Information Shared	Medical information	Medical information plus personal information about you
Confidentiality	Share information only with your VA care team	Share information only with your VA care team
Health Resources/ Tools	Access tailored educational/informational resources, as well as health risk assessment tools that provide feedback about your health age, plus home monitoring tools and smartphone app	Access tailored educational/informational resources through your PHR

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