Archive for 2005

HIN’s Pyramid Scheme

April 29th, 2005 by Melanie Matthews

Guest Blogger: Patricia Donovan

We took our sons and daughters to work yesterday. Even with our extra “staff,” we worked harder than usual! But their youthful perspective on our work—and the subject of healthcare—was refreshing.

The theme of this year’s event was “Sharing Power and Possibility.” Since knowledge is power, we decided to test our—and your—children’s awareness of MyPyramid, the USDA’s overall food guidance system released last week that presents a more individualized approach to improving diet and lifestyle.

It’s a timely topic. More than 9 million American children and adolescents are overweight—triple the number identified in 1980. Pediatricians are seeing alarming increases in asthma, Type 2 diabetes, hypertension and orthopedic complications among these overweight youths—conditions that normally beset a much older population. Perhaps most sobering is the medical community’s fear that if current trends continue, our children’s life expectancy will be shorter than our own—a devastating step backward.

With parental guidance, our offspring electronically surveyed their peers—daughters and sons of 20,000 HIN customers also at work with their parents yesterday—about the “MyPyramid” food guidelines. We received more than 50 responses from “working” youngsters across the country. Our guest editors compiled the results into a report titled The Food Pyramid: What Kids Think and sent it to respondents.

Unscientific as they were, we were heartened by the survey results. Maybe it’s because their parents work in healthcare, but nearly all respondents already knew about the week-old guidelines. More than half had heard about them in school, giving us hope that educators are on top of this life-threatening issue. Some had a unique take on the information: “There’s more than one pyramid and all of them are pointy,” one respondent reported. The respondents offered a wealth of suggestions for healthy snacks (“cucumber with lemon and a dash of salt” among them) and a multitude of reasons for eating healthy.

With the virtual ink barely dry on the guidelines, it’s too early to tell whether we should be intimidated or inspired by them. Incorporating 30 minutes of moderate to vigorous exercise each day is daunting, unless we’re allowed to count the morning out-the-door-to-school rush. So is planning meals that include two and a half cups of vegetables and two cups of fruit daily. Recommending this to a population already mired in bad eating habits and a sedentary lifestyle may set up the average American for failure.

But we have to start somewhere. We may not be able to scale the federally mandated pyramid overnight, but we can chip away at the e-habits (TV, hand-held games, the Internet) that are slowly killing our children. Because we want them to be around long enough to take their own sons and daughters to work.

Consumer-Driven Healthcare: A Lesson in Moderation

March 15th, 2005 by Melanie Matthews

Guest Blogger: Jennifer Millman

Healthcare consumers rightfully have grievances. But complaints of insufficient access to information are losing ground in today’s healthcare environment. We fill out health risk assessments and survey data to equip physicians with personal knowledge prior to the first appointment. We reap benefits of e-health initiatives; online calculators assess condition-specific risk, suggest treatment regimens and approximate account balances from flexible savings to reimbursement. We have referral resources, program brochures and health plan representatives that remain connected through e-mail and company meetings – educating and ensuring that consumer-driven philosophy is maximized and understood.

We are liberated healthcare consumers, making treatment choices of our own volition, questioning the experts and fending for ourselves. Yes, consumers are driving healthcare. Yet, there remains one unresolved question that drives us away: Yes, we have the resources. But … what are we supposed to do with them?

If the consumerism movement intends to empower consumers through information, it appears to be succeeding. However, power is diminished when a more powerful confusion inhibits one’s ability to use it.

As the saying goes: You can lead a horse to water but you can’t make it drink. So too with healthcare consumers. Providers, professionals and policy leaders alike can inundate e-mail boxes, send mass direct mail and post calculators and decision-support tools online. But in doing so, they may overlook one vital point. Consumers aren’t doctors. Many treatment decisions deal with patients’ utmost vulnerability, somewhat limiting their capacity to make objective, rational choices, especially regarding the quality of their own lives. Consider this fictitious example:

Aside from an eight-year-old daughter, a husband of 22 years and a fulfilling career, 44-year-old Mary has stage-four metastatic ovarian cancer. After a hysterectomy and five rounds of chemotherapy, her doctors offer a bleak prognosis. A week later, her doctor tells her there is a nearby research group seeking volunteers for a high-risk experimental procedure that may help her condition. Complying with consumer-driven trends, the doctor gives Mary all the information – packets, statistics and related materials – and asks her what she would like to do.

Consumer-driven healthcare is a double-edged sword. Yes, we want to take charge of our healthcare decisions, choosing the treatment design that best suits our needs. Still, the era of consumer-driven healthcare is young. As youngsters tend to be, we’re bold, vibrant, attending to account balances, driving down costs and engaging in more preventative measures. We want the information, we want the power, we want the choice … but we don’t want to make the difficult decisions. That’s when we need our doctors to hold our hands.

No two patients will have identical conditions, mindsets, or case histories. Some patients are enlivened by the freedom of consumer-driven healthcare; some are frightened and others are just frustrated. Since the healthcare system must have some structure, I would venture to guess — and I suspect Aristotle would agree – that a moderate approach by providers would be most efficient. Give patients information; let them ask questions but if they neglect something important, tell them. If you, as a professional, have an opinion that could fuel your patients’ ability to make a rational decision, let them know. Give Mary some advice. She’s got the information. But she still needs support from someone who knows better.

Healthcare Toolkits: The Medium is the Message

February 27th, 2005 by Melanie Matthews

Guest Blogger: Patricia Donovan

We’ve been talking toolkits lately at HIN. Whether the topic is disease management or motivating resistant patients, nearly every healthcare expert presenting at our regular audio conferences has underscored the value of healthcare toolkits. From CDs to journals to kitchen magnets to online resources, healthcare organizations are banking on information toolkits to influence consumer and member behavior for the better, and pocketing the benefits in reduced healthcare costs.

It occurs to me that with the mountain of healthcare information propagated by the healthcare industry, consumers in most cases have no one to blame but themselves for the state of their health and their healthcare. Our physical and virtual mailboxes are awash in information that, if heeded, could significantly improve their health and their medical bills. But is it working?

Take me, for example. I consider myself Internet savvy—paying my bills, checking my teen’s cell phone usage and reviewing my family’s healthcare claim status online. But after hearing yet another speaker laud his organization’s newest online toolkit, I decided to see for myself whether my healthcare provider’s website had more to offer than a method for tracking my FSA reimbursements.

Sure enough, when I logged in to the site, I found a wealth of free information—online tools and resources to help me manage my family’s healthcare and costs. There’s a care consultant on call to respond to my health-related questions, and an encyclopedia of alternative therapies like using flower essences to treat emotional problems. Without leaving my kitchen, I can take a virtual tour of a facelift or any of the dozens of other surgical procedures listed there. (Note to the squeamish: my provider uses tasteful sketches instead of actual footage to illustrate these procedures.) There’s a calculator to help me gauge my healthcare costs and contributions and a tool that rates hospital quality and safety. And much more.

Quite honestly, if I hadn’t been motivated by professional interest, I’m not sure when I would have stumbled upon this data gold mine. But now that I know it’s there, I’d like to think I’ll turn to this resource more often, and not wait until a loved one was seriously ill. But the reality is, with no (knock wood) family health problems on the horizon and a million other admittedly menial matters demanding my attention, reading up on preventative care is not at the top of my to-do list. I suppose it’s a little like the parents’ voices in the animated Charlie Brown specials…an insistent but muffled background sound largely ignored by the characters.

Thankfully, at least some members of my health plan are tapping into this resource: the website notes that more than 10,000 people contacted a care consultant in 2004. Who are these people? I’m guessing the lion’s share of toolkit ROI is generated by the payoffs of reduced care costs—educating the chronically ill to manage their care and costs.

The challenge, then, to healthcare payors and providers—the architects of these information portals—is motivating consumers to realize the preventative potential of these resources and tap into them sooner rather than later—before a serious health crisis arises. It’s my guess that incentives for healthy behaviors—including seeking out health-related information—will play a larger role in the months and years to come. Because for better or worse, when life is good, that may be what it takes to get some people’s attention.

Medication Noncompliance: A Prescription for Disaster

January 18th, 2005 by Melanie Matthews

Guest Blogger: Jennifer Millman

A HIN colleague recently told me a disturbing story:

My friend’s 25-year-old son was prescribed Xanax for short-term relief of mild to moderate anxiety. He had one drink at a party last summer and the chemical interaction knocked him out. He died without ever regaining consciousness. Doctors attributed his death to an adverse drug reaction – a side effect explicitly warned about in prescription instructions.

This anecdote stung me, but almost more horrifying than its particular details was its striking familiarity. I’d heard it before – stories of other people, other chemical interactions and other scenarios. Although not always deadly, such incidents are, unfortunately, all too common.

So why don’t we just start heeding the labels? It’s not that simple; prescription noncompliance occurs for multiple reasons. Maybe it’s poor physician communication. It may be language barriers, inadequate aftercare plans, insufficient patient education and small prescription labels, cultural norms and practices, lack of social support, feelings of invincibility, futility or any combination of these causes, among others.

My colleague’s anecdote was particularly timely for me because I had stumbled across a journal article on medication nonadherence while surfing the Internet earlier that morning. In his report, Harold Gottlieb, PhD illuminated the daunting pervasiveness of noncompliance:

  • Estimates from 30 to 60 percent, highest when symptom-free;
  • For long-term prescriptions, compliance rates dropped to 50 percent for either cure or prevention;
  • Twenty to 80 percent of patients make errors in taking medication;
  • Twenty to 60 percent stop taking medications before instructed;
  • In older populations, compliance rates average less than 45 percent;
  • Forty to 60 percent of patients could not correctly report medication expectations 10 to 80 minutes after physicians provided information; and
  • More than 60 percent of patients misunderstood prescription directions immediately after doctor visits.

This is a problem. And I don’t think there’s an isolated explanation.

But I do think we’ve got to increase awareness – focus groups, detailed diagnostic summaries, explicit treatment plans, adherence contracts and enhanced communication. We’ve got to address both physicians and patients – gear educational materials toward motivating resistant patients, improving pharmacy management and assuming more personal responsibility for our healthcare decisions. Capitalizing on top-of-the-line research and technology, pharmacy has explosive potential to manage and improve conditions. But if physicians don’t clarify their instructions and patients don’t heed doctor’s orders, what are they doing? And if all this stems from a rapidly evolving healthcare industry with too little time, too much spending and too many patients, what can we do to change it?

I don’t have a sure answer and persistent, unchecked noncompliance suggests a systemic perplexity more profound than my own. The ambiguity disturbs me. For a moment, I put myself as the lead character in my colleague’s story. Would I have had one drink one night? I can’t say, unequivocally, the answer would be no.