Archive for December, 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.