Archive for 2005

iPods and Healthcare: Where’s the Connection?

December 30th, 2005 by Melanie Matthews

Like most Americans, we too here at the Healthcare Intelligence Network have been caught up in the iPod frenzy. We watched our children blaze the path with the technology, but are now seeing the possibilities beyond just downloading music.

A study by the nonprofit Pew Internet & American Life Project found that as many as 22 million American adults, or about 11 percent of the U.S. population, own iPods or other MP3 players.

At Duke University, the number of students using iPods in the classroom has quadrupled and the number of courses incorporating the devices has doubled in the second year of an effort to mesh digital technology with academics. Last spring, 280 students in 19 courses used iPods as part of the Duke iPod First-Year Experience.

In a Spanish for Health Communications class at the University, students are required to work as volunteers in the Latino community. During this service work, students use iPods with microphone attachments to record interviews with community partners and audio postcards recounting their experiences in their service placement. Students will also expand their knowledge of immigration and health issues in the Latino community by listening to audio programming obtained from the bilingual radio program "Que Pasa."

The Arizona Heart Institute and Hospital is offering a podcast on how to recognize risk factors for heart disease and how to modify those risk factors to better health.

Is the iPod the next business training tool? Or a new way to deliver health education to customers?

I think it's just a natural extension of both. As a business training tool or a means to provide health education to patients and members it really is just another way to deliver the message.

Is Massachusetts Ban on Baby Formula Marketing in Hospitals The Right Way To Encourage Breastfeeding?

December 27th, 2005 by Melanie Matthews

In an attempt to encourage breastfeeding among new mothers, the state of Massachusetts last week banned hospitals from giving out free formula company diaper bags to new parents.

The state cited studies that have shown that the bags interfere with breastfeeding, causing moms to switch to formula sooner, or quit nursing altogether-- even when the bags do not contain formula samples.

I am a strong advocate for breastfeeding, noting among my own circle of friends of those who opted not to breastfeed. Their children really do seem to get sick more often than those who were breastfed.

While I appreciate the rule's effort in promoting breastfeeding, I don't know that a ban on the distribution of formula is the right way to achieve it.

Instead of banning the distribution of the formula, why not take the opportunity to hold group classes with new mothers while they are in the hospital on breastfeeding techniques and encourage them to breastfeed. I can remember when I had my first child, the feelings of frustration and discouragement the first week or so of breastfeeding. Without a strong network of support from my family and my friends, I may not have continued.

How great it would have been to sit in a room in the hospital with other frustrated new Moms with a nurse educator, to learn techniques and share experiences. Just knowing that other Moms were probably as uneasy as I was would have gone a long way toward easing my mind. Most of the Moms I know who stopped breastfeeding, did so out of frustration of “not getting it,” fear that the baby was not getting enough food or their own discomfort; not because they were given a diaper bag from a baby formula company.

This ban also may have other implications beyond just the hospital's distribution of formula. Will physicians' offices also be banned from distributing formula? How will this impact families who rely on the samples of formula that they receive to offset the cost of formula, which can run about $40 per week?

Teen Healthcare Needs More Than a Phase

December 21st, 2005 by Melanie Matthews

While the teen years are among the healthiest in a person's life, behavior choices during that period result in relatively high mortality and morbidity rates for this age group. To quote just one sobering statistic from the Centers for Disease Control and Prevention , more than 5 million of all young people in the United States under age 18 will die prematurely from a smoking-related disease. But when's the last time your pediatrician asked your teen what they say when someone offers them a cigarette?

Posing these types of questions to the teen set is likely to open a dialogue on behavior choices, says the Society for Adolescent Medicine (SAM), but most doctors treating this population don't have the time or the skill set to do so. So putting aside for a moment the recent research blaming brain development rather than raging hormones for teen behavior, it's gratifying to see more doctors are choosing adolescent medicine as a sub-specialty.

According to Robert T. Brown, SAM president-elect and chief of adolescent health at Children's Hospital in Columbus, Ohio, nearly 1,000 doctors have been certified in the subspecialty of adolescent medicine since 1994. Brown was interviewed in a recent Newsweek magazine article.

According to its website, SAM is a multi-disciplinary organization of health professionals committed to enhancing access to high quality health care for adolescents by supporting the training of all health professionals who care for adolescents. The website even offers a resource for locating an adolescent health professional.

SAM hopes that by highlighting this need and providing training and role models, their specialists will pass on their methods to many more doctors. Most teens are currently seen by pediatricians trained to address the needs of infants and small children, or family practitioners who interact chiefly with older patients. Both specialists are generally overworked and don't have the time to delve into the social issues that might affect a teenaged patient. Arming these specialists with teen-friendly tools like tips for talking with adolescents about sensitive issues such as drinking, drugs, sex and violence might get more mileage out of physician-teen visits during this transitional developmental phase.

This age-based approach makes sense. Having helped my teenager through a lingering illness over the last year, I have spent more time than usual in our pediatrician's offices. While the level of care and concern was outstanding, the décor and information is largely geared to infants and children. My teen has long since outgrown the plastic play tables and is no more interested in reading Highlights magazine than I am. However, we expect to visit this office for at least a few more years.

Nobody said the teenage years would be easy. But having a doctor who considers the emotions, pressures and stresses of this age in an overall healthcare approach is a step in the right direction.

# of Gastric Bypass Surgeries Soars as Coverage Shrinks

December 21st, 2005 by Melanie Matthews

As obesity rates continue to rise across America, so are the number of gastric bypass procedures.

According to a new article at Forbes.com , researchers at the University of California at Irvine found through an analysis of the Nationwide Inpatient Sample from the
Healthcare Cost and Utilization Project (HCUP) at the Agency for Healthcare Research and Quality, the number of gastric bypasses and other bariatric surgeries conducted in the United States more than quadrupled between 1998 to 2002, from 12,775 procedures to 70,256.

And experts at the American Society for Bariatric Surgey estimate that this number may have doubled again since then, to more than 140,000 bariatric procedures performed in 2004.

But there's a misbalance in the industry about the cost-effectiveness of the surgery. BlueCross BlueShield of Florida, which serves more than 6 million people in Florida and is one of the largest health insurers in the state, stopped covering obesity surgery on January 1, 2005.

Also in Florida, Cigna, United Healthcare and Humana dropped obesity surgery from standard coverage in 2004 or earlier. The companies do tailor certain policies to include the coverage when employers want to offer the benefit.

The Centers for Medicare and Medicaid Services, meanwhile, has proposed national coverage for Medicare beneficiaries under age 65 for open and laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding under certain clinical circumstances and when performed in a facility meeting evidence-based standards for bariatric surgery; but is seeking comment on coverage for Medicare beneficiaries aged 65 and over.

With the ever-increasing number of gastric bypass surgeries, what should the coverage be? Our report, “Disease Management & Obesity: Healthcare Impacts and Initiatives,” looks at the approach that MediCorp Health System has taken for its weight management/obesity management programs. MediCorp is a not-for-profit regional system of 28 healthcare facilities and wellness services in the Fredericksburg, Va., area.

MediCorp believes that for an obesity weight management program to succeed it must take a very strong behavioral approach with patients, covering the following areas: dietary; pharmacological; mental well-being; physical activity; and surgical intervention when applicable and only when all other venues have failed or a person's life is at risk.

Is self-management a first step in the possible 140,000 bariatric procedures performed in 2004? I wonder?

Is the Black Bag Really Back?

December 15th, 2005 by Melanie Matthews

A regional health insurance company in the New Jersey tri-state area has recently been promoting its products and services through the slogan, “The Bag Is Back.”

Is it? We've found several instances where yes, indeed the black bag is coming back.

Take for instance, Care Level Management, which, along with six other organizations received a Centers for Medicare and Medicaid Services contract to operate a three-year demonstration project to help Medicare beneficiaries with chronic conditions improve outcomes, while reducing costs by preventing complications.

Care Level Management will provide an-around-the clock physician home visiting program in select counties in California, Texas and Florida.

In a pilot study, Care Level's Personal Visiting Physician Delivery System has reduced acute hospital admission by an average of 60 percent, resulting in an average net savings of 30 percent in institutional costs alone to managed care payers. Additional savings are realized in hospital specialist consultation fees, ambulance, diagnostic tests during admissions, pharmacy and ER costs.

Group visits and e-visits are just some of the other ways that physicians are providing more personalized, more convenient access to healthcare services.

At Kaiser Permanente, group doctor visits were developed to offer pregnant women an alternative to traditional prenatal visits. They are done in a group setting, where between seven and 10 pregnant women attend in a group and are joined by a nurse and physician. A study on the group doctor visits showed healthcare costs were reduced by 7 percent, hospitalizations were reduced by 12 percent, and fewer calls were made to nurses.

With this type of group visit, I can also imagine the therapeutic effect of sharing experiences with fellow expectant Moms.

These out-of-the-box approaches might just be a way to bring that black bag back into healthcare.

Fighting Back: Circling the Wagons around Domestic Violence Victims

November 22nd, 2005 by Melanie Matthews

Fighting Back: Circling the Wagons Around Domestic Violence Victims

Domestic violence—also called spouse abuse, battering or intimate partner violence (IPV)—strikes more than 32 million Americans each year, with more than 2 million injuries and claims and approximately 1,300 deaths, according to a new study by the Centers for Disease Control and Prevention (CDC). Its victims may be beside you at work, in the next chair at your hair salon or flipping through a magazine in your dentist's waiting room. The thing is, you'll never know, because its victims are so mired in fear and shame that they would never share this in casual conversation. So we're applauding a number of initiatives that alert those who cross victims' paths to the signs of domestic violence and give them resources they can share with suspected victims.

The workplace is a logical place to start. The CDC says one in three women will be abused by a spouse or partner at some point. And 96 percent of these victims say the problem follows them to work, where they are immobilized with anxiety and frequent physical pain. Other CDC statistics bear this out: eight million days at work are lost every year to domestic violence—time away from the office due to injury or just plain fear. Employers are indirect victims, paying $5 billion in productivity losses and related healthcare costs.

To combat these distressing findings, Safe Horizons, the nation's leading victims' assistance program, has launched an initiative called SafeWork to teach corporations to own up to the problem of IPV in the workplace. Before you reject this idea, consider the statistics put forth by Safe Horizons: homicide is the leading cause of death for women on the job, and 17 percent of those were murdered by their partner at the workplace.

According to a recent New York Times article, SafeWork trains employers to recognize the problem and refer employees to appropriate resources. A sister program called Safe@Work was established in 2000 by a coalition of private employers, trade unions, domestic violence advocacy groups and government organizations, Safe@Work's mission is to demystify domestic violence for employers and unions and provide guidance on creating an environment where this historically "private" problem can be openly and effectively addressed.

Safe@Work helps employers shape corporate domestic violence policies and consider measures such as secure parking places, flexible work hours, escorts from work to public transportation and changed work phone numbers to help protect targeted employees. Liz Claiborne Inc. was an early adopter and is today an avid supporter of the program. Employers and health plans should follow this example and invest the time to draft a policy, develop a contingency plan and elevate staff awareness and sensitivity before a crisis occurs.

Cut It Out is a nationwide program of the Salons Against Domestic Abuse Fund dedicated to mobilizing salon professionals and others to fight domestic abuse. Originating in Alabama in 2002, the Cut It Out initiative joined forces in 2003 with the National Cosmetology Association and Clairol to take the program nationwide. The program builds awareness through posters and brochures displayed in salons and trains salon professionals to recognize warning signs and safely refer clients to resources. As their clients' confidantes, hair stylists often see and hear first-hand the ravages of this abusive behavior. Educating hairstylists on the signs of abuse is another tool in the arsenal to reduce domesstic violence.

And finally, a domestic violence toolkit developed by Blue Cross Blue Shield (BCBS) of Michigan for its healthcare providers crossed our desks recently. The toolkit was their response to a 1999 article in the Journal of the American Medical Association that indicated that nine out of 10 physicians routinely do not screen patients for signs of domestic violence and abuse. BCBS of Michigan toolkits teach providers to recognize potential victims and provide take-home resources in English, Spanish and Arabic for victims in the form of tear-off cards doctors can display in their waiting rooms.

The BCBS of Michigan packet helps healthcare professionals screen for, identify and document confirmed or suspected cases of domestic abuse. According to Shoma Pal, project leader in the Social Mission Health Policy department of BCBS of Michigan, the toolkit has been in great demand by physicians, dentists, medical students, social workers and nurses. More importantly, three months after distributing toolkits and related training, BCBS of Michigan reports a 70 percent increase over baseline in the number of providers aware of the mandatory requirement to report cases of suspected domestic violence and abuse. (P.S. The judges of HIN's 2005 healthcare toolkits contest awarded this effort third prize.)

Domestic abuse is a delicate subject with violent consequences; it is fraught with privacy, security and legal concerns. More states are legislating that employers provide a safe workplace and protect them from being stalked or threatened. There are lives to be saved as well as healthcare dollars, but the most valuable payoff of programs like Safe@Work, Cut It Out and the BCBS of Michigan toolkit will be the victims' realization that in a sea of co-workers, clients and patients, they are not alone.

Giving Youth Credit for Emergency Preparedness

November 10th, 2005 by Melanie Matthews

America's kids have been taking a beating health-wise in the press for a while now. If we were to believe all that we hear and read, most of the country's youth are riveted to their couches or their computer screens. Even at school they're getting a bad rap for making poor health choices, putting all the wrong foods on their cafeteria trays.

That's why it's gratifying to hear some good-news stories about children in recent days. This morning I heard about an 8-year-old boy who knew enough to call 911 when his mother collapsed in another room of their house. The emergency operator talked the child through the administration of CPR, and while he admitted it was “kinda gross,” his actions saved his mother's life.

In the same vein, the smiling faces of a seventh-grader and her mom appeared in our local paper several weeks ago. They were recounting the events of a recent evening when her mom began choking on her food. Realizing that her mother was in distress, Samantha (who also happens to be an awesome goalie on our soccer team...so much for couch potatoes) began performing the Heimlich maneuver. She successfully dislodged the food stuck in her mother's throat, a lifesaving gesture on her part. No wonder Sam's mom was smiling.

Even closer to home, my high school junior took her physical education mid-term exam this morning. The subject was CPR, and by the end of the marking period there will be a crop of students newly certified in this procedure (those who studied, that is). This summer, my sixth-grader proudly displayed the certification she and her friends received at the culmination of the American Red Cross babysitting program.

These events may not have a lot to do with nutrition, but they indicate that many kids are equipped with the good sense to prepare for and react in an emergency. To paraphrase a popular poem on parenting, children learn what they live. With the proper guidance at home and in school, they'll also eventually get that a healthy diet rich in exercise and low on screen time can also be a life-saving, life-enhancing strategy. Sweet.

Parental Responsibility: A Recipe for Addressing Childhood Obesity

October 28th, 2005 by Melanie Matthews

Childhood obesity – it's in the newspapers, on the radio, on TV and yet parents still are not driving home the need and the ingredients for proper nutrition with their children.

My five-year-old daughter is playing soccer this fall. At a recent game, the self-appointed team mom brought the kids some half-time treats – juice boxes, cupcakes and single serving bags of cookies. While her intentions were good – providing something special for the kids – she actually did the kids a disservice.
The kids didn't play a decent second half because of this “treat” – not that the game is very competitive at this beehive stage, but they were loaded down with carbs and sugar.

Thankfully, the coach found a tactful way to tell the mother that while her efforts were appreciated, water and orange slices might be a better alternative than sweets during a soccer game.

While chaperoning my daughter's class trip a few days later, I was amazed at the lunches that the parents packed for their children. One little boy in the class had a lunch that consisted of a single serving package of potato chips, a bag of carton character cookies, a snack bag of sugar cereal and a candy bar – I guess for dessert. Several of these kindergarten kids had cans of soda with their lunches.

On another recent occasion, I stopped for a cup of coffee at a local coffee shop. I stood in line behind a family of four. The two children in this family – in the seven to nine age range -- were ordering frozen coffee drinks.

While these three incidents should not have amazed me given the statistics on childhood obesity, they still did. In HIN's report, Childhood Obesity: Truths, Trends & Program Design, we provide an overview of how far reaching this epidemic is -- more than 9 million overweight American children and adolescents---triple the number identified in 1980. This report also looks at the type of programs that healthcare organizations are launching to address childhood obesity.

My lesson learned – despite the fact that schools, communities, health plans and provider organizations are launching programs to address childhood obesity, nothing will address this epidemic as much as educational programs aimed at parents.

The impact of educational programs aimed at parents could even have a two-pronged effect – better nutritional habits for both parents and for kids, which might go a long way in reducing the rate of obesity and its comorbidities across the whole population.

Winning Toolkits

October 19th, 2005 by Melanie Matthews

Congratulations to the winners of our first annual Healthcare Toolkits contest. We are so impressed by the breadth of content and creativity exhibited in the nearly 60 toolkits we received that we've decided to make this contest an annual event. We applaud all of these efforts and thank our independent panel of judges for their painstaking evaluations.

Toolkits is an industry buzzword referring to just about any concerted effort to inform a target group about a subject of interest to them—via print, CD-ROM, the Internet or any combination thereof. Being in the business of communicating ourselves, we wanted to see this concept in action, especially with the industry call to arm consumers with enough information to intelligently craft their own healthcare coverage and care. Hence, the contest.

The winning toolkits identified by our judges go beyond information by attempting to alleviate the fear and confusion inherent in three difficult scenarios: coping with a breast cancer diagnosis, recognizing and reporting domestic violence, and returning to daily life following an inpatient stay at a psychiatric facility.

During National Breast Cancer Awareness Month, we're happy to coincidentally but fittingly award first prize to The Eden Communications Group of Maplewood, N.J. for the MyHealth, MyJourneyâ„¢ patient navigation kit, which walks breast cancer patients through their diagnosis and care. By giving these patients motivational and physical tools to plan and document their treatment, this toolkit empowers the patient to take charge of their own care. The artwork that accents the kit comes from breast cancer survivors, providing a visual reminder of hope, support and solidarity. Bravo to Eden, which developed this toolkit for Pfizer Oncology.

Second place went to PacifiCare® Behavioral Health for the Treatment Plan Toolkit it developed for persons hospitalized for mental health disorders. This toolkit's goal is to ensure continuity of care after an inpatient stay in a psychiatric facility. The kit educates patients about their care plans, communicating with their physicians and developing a support network among other resources.

Blue Cross Blue Shield of Michigan won third prize for its toolkit sensitizing providers to the problem of domestic violence. This packet of resources and patient handouts helps healthcare professionals screen for, identify and document confirmed or suspected cases of domestic abuse. There are even displays for waiting rooms.

Have a look at our winning entries and judging panel, and send us an email at info@hin.com if you'd like to be notified about the 2006 Healthcare Toolkits contest.

Customer Service in Healthcare – Yes It Can Exist!

October 14th, 2005 by Melanie Matthews

Like most people in the United States, it's not often that I'm struck by the customer service given in the healthcare industry. But this week I have to admit I was.

My almost three-year-old son had his first visit to the dentist office and two days later, he received a letter in the mail welcoming him to their practice. It was a friendly, conversational, personalized letter that left me with a very positive view of this practice – I am sold on this practice!

This simple letter probably took only about three to four minutes to write, sign and mail, but will, I believe, have a greater impact than they even know. I have told at least the proverbial 10 people -- this time on the good side -- about this letter since receiving it – and I only got it yesterday. I'm even writing about it here!

There are so many times that the customer touch points in the healthcare system fall short of anything related to customer service – and yes, patients and members are customers. I challenge all healthcare provider and payor organizations to take a look at their touch points and see what small changes you can make that might have such a big impact.