Archive for January, 2006

Assessing Readiness to Change

January 27th, 2006 by Melanie Matthews

Motivational interviewing, readiness to change, stages of change, modifying patient behavior, we’re hearing a lot of these terms thrown around in discussions on disease and lifestyle management.

My dad often relays the story of how he quit smoking 30 some odd years ago: his physician at the time was a Navy-trained physician who said, if you don’t stop smoking, you will get “f*&%ing” bronchitis, you will get “f*&%ing” emphysema, you will get “f*&%ing” cancer and you will “f*&%ing” die.

While I don’t think what his doctor told him would fall under motivational interviewing, it was enough to do the trick. He stopped smoking that day and never went back.

This story came to my mind after reading an article on a study by researchers at The Children’s Hospital of Philadelphia and the University of Pennsylvania who found that a mother’s cigarette smoking increases the risk that her newborn may have extra, webbed or missing fingers or toes.

While I’m not advocating that OBs be as harsh as this particular doctor was about the impact of smoking, maybe we do need to be a little bit stronger in our approaches. Would it have an impact on pregnant smokers if they were to learn as this study found that women who smoked more than a pack of cigarettes a day during pregnancy were 78 percent more likely to have babies with digital anomalies?

I hope so. But are we giving patients this information? Or are we so busy assessing their readiness to change that we fail to give them the cold, hard facts about the impact that their behaviors can have not only on their own health, but their baby’s health as well.

Don’t get me wrong. I think these tactics – motivational interviewing, stages of change and modifying patient behavior – are important steps in getting patients to accept responsibility for their own behaviors, but maybe some facts should also be added into the mix.

In our report, “Motivating Resistant Patients: Influencing Behaviors to Improve Outcomes,” we discuss why patients are resistant to change and how to approach these patients who are resistant. It may not be all about the lecture, but it has to have some role.

Getting back to my dad, 30 years later, he was sitting in a physician’s waiting room yesterday next to a girl who was four months pregnant. She revealed that she has been able to cut down to just five cigarettes a day now that she is pregnant. He asked, “What does your doctor say about that?” Here’s hoping the doctor is saying something.

Outcomes Compromised When Transplant Patient Rejects Medical Advice

January 24th, 2006 by Melanie Matthews

With each month, the medical community grows more comfortable with the idea of the pioneering face transplant surgery performed in France last November. Subsequent reports of the patient’s actions that may have led to the surgery are unsubstantiated and won’t be repeated here. However, last week’s CNN report that the transplant recipient had resumed smoking—even when that behavior can trigger infection and seriously compromise her recovery—deserves a comment.

There was a lot of post-op debate about the psychological readiness of this patient—identified only as “Isabelle” to protect her privacy—to undergo the radical surgery after her dog allegedly mauled her. Many said that for optimal results, someone undergoing a life- and image-altering surgery of this sort must be as mentally fit as possible. Barring emergencies, doctors must take the time to assure that the prospective patient is equipped with the psychological tools to cope with short- and long-term results of any procedure.

This argument is not new. I’ve heard it from healthcare experts concerned about the rapid rise in persons undergoing gastric bypass surgery. The American Society for Bariatric Surgery (ASBS) estimates that more than 144,000 patients had bariatric surgery in 2004, compared with more than 103,000 people in 2003 and 67,000 patients who had the surgery in 2002. A corollary: the number of body contouring operations performed for post-bariatric patients increased at least 36 percent in 2004, according to the American Society of Plastic Surgeons.

Back in 2004, Zoe Consulting’s Population and Individual Health and Productivity Management Specialist Rob Foust told our Disease Management and Obesity audio conference audience the same thing: “The person (undergoing gastric bypass surgery) must be well motivated. Most of the time, a psychologist evaluates the patient to ensure there is no psychopathology that would jeopardize the patient’s informed consent going into surgery. This screening looks at current stressors, depression, mood, sleep, hopelessness, self-esteem, memory, concentration, libido, the availability of social support, anticipated lifestyle changes, reasonable outcome expectations, substance abuse, and psychiatric history. The (patients) are also evaluated by nutritionists, dieticians, internists and their primary care physicians.”

Foust also said that in addition to other requirements, many insurers now require candidates for gastric bypass surgery to undergo a psychological assessment before they agree to pay for the surgery. Considering that this surgery can cost up to $35,000, this is a good business move that can only speed recovery and enhance outcomes.

In terms of pre-op scenarios, we cannot equate gastric bypass surgery and organ transplants. There is a finite window when the latter intervention can be performed. But when conditions permit, providers should make sure patients are psychologically and physically strong enough to fully participate in their recovery. As for Isabelle, I wish her a complete recovery and the strength to follow her doctors’ orders.

Cellphone Health Connection a Good Call

January 19th, 2006 by Melanie Matthews

I’m a reluctant cell phone user who calls and is called mainly to assure the safe comings and goings of my offspring. Under duress, I only recently learned how to send a text message. I’m not a technophobe. It’s just that I feel that some time in the day should be reserved for good old-fashioned face time or quiet.

So you’d think I’d be outraged by the word in the New York Times this week that if marketers have their way, we may soon be receiving brief ads on our cell phones. A spokesperson for the Mobile Marketing Association, a consortium of wireless carriers, ad agencies, technology companies and advertisers, is calling this tactic “the silver bullet we’ve been looking for in advertising for a long time.” But I personally wouldn’t be adverse to this idea, especially if it’s bundled with the promised reduction in calling rates.
(With my usage patterns, advertisers probably wouldn’t make much money off of me anyway.)

This advertising avalanche of video, audio and text won’t arrive tomorrow. It’s against the law for wireless carriers to sell customer phone numbers, and cell phone companies don’t want to scare off customers who might be annoyed by an advertising invasion.

But some other elements of the story made me wonder whether the healthcare industry is adequately plugged in to this technology. Many cell phone users who are way more attached than I am (and you know who you are) subscribe to services that send sports scores, stock market updates and other can’t-live-without information to their cell phones. Have health plans, employers, providers, health coaches and other resources behind health and wellness programs considered this application? Telephonic coaching is now a mainstay of disease management programs, but are coaches sending scheduled reminders via cell phones to remind diabetics to test their glucose, prompt asthma patients to record their peak and low monitor readings or heart patients to take their blood pressure? How about pumping out daily nutritional or exercise guidance to wellness program enrollees? Contacting homebound patients on their home phone makes sense, but more healthy employees and health plan members than ever are signing on to preventative programs. The cell phone’s portability and multi-media capabilities make it a logical means to catch people on the go.

We recently pondered the healthcare applications for iPods beyond just downloading music in this space. How about cell phones? If they are an important link to your members, patients and employees, you can advertise it right here by posting a comment to this blog. (But don’t call my cell phone—I probably won’t answer.)

Physicians as Disease Management Referrers

January 17th, 2006 by Melanie Matthews

Late last week, my colleagues and I were discussing the NY Times series on diabetes. Our discussion centered on a statistic quoted in the article “Diabetes and Its Awful Toll Quietly Emerge as a Crisis:” — “One in three children born in the United States five years ago are expected to become diabetic in their lifetimes, according to a projection by the Centers for Disease Control and Prevention. The forecast is even bleaker for Latinos: one in every two.”

My colleagues and I wondered how parents can let their children take the risks of not exercising and not eating right when there is so much at stake. But for these parents who are unable or unwilling to take the responsibility for the children, health plans and healthcare providers have to step in. These are hard conversations, but they need to take place.

When these children visit a primary care doctor, make an emergency room visit or have any type of interaction with the health system, we need to take advantage of the opportunity and broach the subject as delicately, but as strongly as possible. Physicians have to be willing to address the risks that lifestyle choices that in most cases parents are making and the impact that they can have on the future health of their children. Providing information on a disease management program or a lifestyle management program could make the difference for these families.

Physician behavior can influence the success of disease management programs, said Dr. Maureen Mangotich, medical director, provider and community outreach, McKesson Health Solutions, during a recent audio conference, we hosted on the role of Primary Care Physicians in Disease Management.

“They can influence our enrollees’ decisions to participate,” said Dr. Mangotich. “They are a necessary component for us to involve improving quality in a meaningful way, certainly clinical quality.”

The New York Times article provided a frightening look at the impact diabetes is having on New York City — An estimated 800,000 adult New Yorkers – more than one in every eight – now have diabetes, and city health officials describe the problem as a bona fide epidemic. Montefiore Medical Center officials estimates that on any given day nearly half the patients are there for some trouble precipitated by diabetes. Public health officials in New York are warning that left unchecked this epidemic could overwhelm the public health system in New York.

This is just one city. We have to reach these at risk people before it’s too late. And maybe one physician interaction at a time, we can begin to stem this tide.

It’s All About Patient Engagement

January 13th, 2006 by Melanie Matthews

The key ingredient to disease management programs was missing from a CMS disease management demonstration project that PacifiCare Health System is ending early.

The reason for terminating the project a little less than a year ahead of schedule: not enough participants, according to an article in Modern Healthcare. PacifiCare said two years into the HeartPartners project it enrolled only 3,750 seniors, 25 percent of projected participants.

Patient engagement – for disease management programs to be successful you have to fully engage your members into the program. It goes without saying that unless you have patients enrolled in a program, the best disease management strategies won’t work.

How do companies achieve this?

In our report, Modifying Patients’ Behaviors to Optimize Disease Management Outcomes, several industry experts shared their theories, applications and results of behavior modification and patient engagement strategies.

In this report, Michael Montijo, senior vice president of government relations at American Healthways, talks about the benefits of using an engagement model for disease management programs as opposed to an enrollment model. Other industry experts weigh in on other strategies that organizations are using to fully engage potential members in enrollment models.

In the engagement model, patients have to opt-out of the program. Montijo says that the most successful disease management programs are usually of the engagement or opt-out type because they’re able to reach critical mass within the population faster and deeper and longer than the enrollment model.

Moving Beyond Traditional Healthy Habits

January 10th, 2006 by Melanie Matthews

I like to think of myself as a person who practices a pretty healthy lifestyle, but this year two of my New Year’s resolutions have extended beyond what many might consider preventive healthcare measures.

An acquaintance of my family was killed on Christmas Eve in a car accident. The family of this 32 year-old woman was, of course, devastated by this tragedy. What makes this far more tragic was that in some ways this was preventable. Word on the street was that the accident was caused by excessive speed and cell phone use.

Here in New Jersey, cell phone use in the car is banned, but it is only a secondary offense. Since it is a secondary offense, it really has not had a huge impact on the number of people who talk on the phone while they drive.

I used to be one of them – but not since January 1, 2006. Granted it’s only been a week, but my resolve is strong. I will not use a cell phone while driving.

My husband who is a police officer comes home from work every day with a story about someone who “blew a red light,” didn’t stop at a stop sign, swerved, or committed some other type of motor vehicle infraction while talking on a cell phone.

My other resolution, driven by this tragedy, is as silly as it sounds “to obey posted speed limits.” I’m always rushing – whether it’s to work, to pick up the kids, to get home, to go wherever. It seems that no matter where I go, I’m always in a hurry to get there. If I don’t say on the way to school in the morning, “Hurry, we’re late,” my children ask “Aren’t we late today?”

It got me to wondering whether health plans and employers probe these two areas when seeking to assess the risk of their population. How about educational materials? Are we paying as much attention to educating our members and our employees on these health risks as we do to heart disease, obesity and other potentially preventable health conditions?

Hunting for Healthcare Treasure: Get the Word Out to Members

January 6th, 2006 by Melanie Matthews

I joined a health club on New Year’s Eve. I’d like to say I was overcome with New Year’s resolve, but in fact had been pondering this commitment for several months. A too-good-to-pass-up promotional rate persuaded me to sign on the dotted line.

Aware that the healthcare pendulum has begun to swing from disease management to prevention, it occurred to me that my health insurer might reward me for this decision. Armed with the eight login and password combinations that unlock my benefits web sites (general site login, health savings account, vision, dental, general benefits, claims information, etc.), I set out to answer this question.

From the general coverage site, I first visited the Health Topics and Tools tab. Nothing there, although I did find an option to take a Health Risk Assessment. From there, I explored the My Coverage and Costs tab. The Special Services menu item there sounded promising, but while it provided partial coverage on everything from acupuncture to speech therapy, there were no rewards for healthy choices.

I then clicked on the Other Benefits link, which led to contacts for vision and dental vendors. There was also a link to a Discount Program Vendor here that I nearly ignored. However, with no other avenues to pursue, I followed this to a site that (after forcing me to register yet again) offered me a “health discount program” designed to save my family up to 50 percent on health-related products and services not covered by our benefit plans. After entering my zip code, I learned I was eligible for a slight discount at a health club in the vendor network. However, the closest club was 30 minutes from my home.

Don’t get me wrong. I’m happy with my decision and grateful to have adequate healthcare coverage. And offering me a health club discount is truly a step in the right direction. But if the industry mantra is really about living healthy, then get the word to members and employers. Communicate these added incentives front and center instead of burying them six or seven clicks deep on a web site. Send me an email, mail me a letter or add a bold link to my benefits login page to alert me to this healthy lifestyle incentive. Maybe a member like me who’s poised to adopt a healthy habit will be swayed by this carrot. In any event, the cost of this communication has got to be less than the financial consequences in healthcare claims.

And okay, maybe I do have one resolution for 2006: to thoroughly familiarize myself with all that my health plan has to offer, even if it takes a little digging.