Archive for May, 2006

Partnering with Community To Put Kids on the Right Track to Health

May 24th, 2006 by Melanie Matthews

A recent article in a local paper caught my eye about a simple, but effective program to combat childhood obesity put into place at an elementary school in Middletown, N.J., by a special education teacher at the school.

Beth Fitzpatrick, a physical education teacher at St. Mary's School, helped start Marathon Kids, a twice-a-week after-school program for kindergartners through eighth-graders. The program encourages kids to walk, jog or run the track at the school. Fitzpatrick modeled the program after a similar one she had read about.

Twice a week, students go to the adjoining high school's track where they warm up with stretches led by high school track team members and volunteer parents. They circle the track as many times as they can at their own pace. The children in Marathon Kids are also given healthy-eating tips, which include staying away from candy and eating smaller portions.

Simple, fun, yet effective: one 11-year-old participant admitted she joined Marathon Kids because her friends did. But now she likes running, and she's improving each week. "At first I could go five laps; now I can run 13," the pre-teen said.

A similar program targeted at schools is being implemented by BlueCross BlueShield of Tennessee (BCBST) in the fall. BlueCross WalkingWorks for Schools is a voluntary in-school walking program, which BCBST will roll out to all public and private K-5 Tennessee schools this fall.

BlueCross WalkingWorks for Schools incorporates the importance of walking in the classroom and teaches children in grades K-5 the benefits of proper exercise as part of a healthy lifestyle. The program was developed by BlueCross and the Governor's Council on Physical Fitness in partnership with the Tennessee Department of Education, Tennessee Department of Health and Tennessee Association for Health, Physical Education, Recreation and Dance.

Participating classrooms commit to walking at least five minutes a day, equal to walking one lap around a track or a quarter mile, over a 12-week period during both semesters. Teachers are provided with an easy-to-use tracking poster that allows classrooms to record their progress. Students receive a WalkingWorks wristband, which reminds them to be active and make healthy choices. Teachers, students and parents can log on to the BlueCross WalkingWorks for Schools Web site, full of nutritional and exercise resources. At the end of the program, students and teachers are awarded a certificate signed by Governor Phil Bredesen.

In an upcoming audio conference, “Maximizing the Results of Your Disease Management Programs Through Community-Based Resources,” two industry experts, Michelle Brooks, RN, MSN, regional health plan administrator with University Health Systems and Danielle Butin, director of health services at Oxford Health Plans, a United Healthcare Company, will discuss how their organizations improved outcomes through community-based partnerships.

The community partnership being implemented by BlueCross BlueShield of Tennessee will surely lead to improved health status among children in its community, just as the program at St. Mary's School is helping its Middletown, N.J., community.

A few weeks back I blogged about our company's participation in Take Your Daughters and Sons To Work Day. I mentioned that our kids joined us that day in a walking program in which we're participating. My daughter, age 6, talks nearly every day about the lessons she learned that day – aiming for five fruits and vegetables a day and the benefits of daily physical activity. I believe that reaching our children with these messages during these habit-forming ages can truly begin to stem the incidence of childhood obesity and all of its effects not only on our children, but on the healthcare system as well.

Whether it's a volunteer-based program after school, a health plan initiative during school or some other educational and activity program, these types of programs will surely benefit our communities.

I'm off to recruit some fellow PTAers and schedule an appointment with my daughter's school principal to launch a similar program at her school come this fall.

Stay Tuned for More Talk About Physician Quality Ratings

May 19th, 2006 by Melanie Matthews

Sometimes art imitates life, and sometimes television hospitals resemble real ones. This season, a hospitalized Tony Soprano was assigned a health plan champion who scrubbed his care plan of unnecessary and costly procedures while “T” worried about his missing insurance card. And this week, between the dream rantings of Scrub's central character Dr. John “J.D.” Dorian, doctors at the mythical Sacred Heart Hospital debated physician quality ratings. J.D. overhears his gruff mentor Dr. Cox berate a female surgeon over her decision not to operate on an elderly patient. Dr. Cox accuses her of rejecting the patient because his less-than-optimal chances of recovery might torpedo her professional quality ratings. “You got me,” she admits.

When Turk (J.D.'s amiable surgeon sidekick) admits that quality standings are a common concern among surgeons, J.D. overlooks his colleague's decision and pursues a relationship with her. At this quirky television hospital where most but not all endings are happy ones, the surgeon ultimately decides to operate on the elderly patient, quality ratings be damned.

All this to say that if make-believe hospitals are caring about healthcare costs and quality issues, you can bet that real-life ones are, too. Health plans, employers, consumers and even the federal government are leaning on providers to document quality initiatives. The U.S. Department of Health and Human Services' (HHS) Hospital Quality Initiative already links reporting of 10 quality measures to the payments these hospitals receive for each discharge. An HHS division, the Centers for Medicare and Medicaid Services (CMS) also recently launched the Physician Voluntary Reporting Program. While physician reporting is voluntary for now, this initiative provides a peek into the future of pay-for-performance (P4P) programs for physician practices.

In CMS Physician Voluntary Reporting Program: Weighing the Benefits of Participation, we take a look at the CMS request for doctors to voluntarily self-report adherence to certain evidence-based quality measures beginning in January 2006. The initial set of standards aims to hit as many specialties as possible. While the IT requirements of reporting this data can be challenging, the benefits of getting in on the voluntary reporting effort are many. Julie Baker, director of healthcare advisory practice at PricewaterhouseCoopers, says participating now when confidentially is assured, results unpublished and feedback readily provided “allows physicians to prepare for P4P in a safe environment” and prepares them for the eventuality of mandatory reporting. We think this is the way to go, too.

Like the curmudgeonly Dr. Cox, critics of healthcare report cards fear their dominance will drive physicians to select only those patients likely to have the healthiest impact on their quality standings. However, we're more optimistic. Consumers are a savvy bunch. Just as they gave a thumbs-down to pudding in a tube, smokeless cigarettes and aerosol toothpaste, consumers will eventually smoke out healthcare providers operating in this manner. These physicians will have to build their practices equitably and honestly or risk getting an “F” in customer service on their report card.

Simple Strategies Can Improve Identification and Documentation of Domestic Violence

May 17th, 2006 by Melanie Matthews

During an audio conference last week sponsored by HIN, “Designing, Implementing and Analyzing Effective Healthcare Toolkits," Carolyn Wiener, project leader, health policy and social mission with Blue Cross Blue Shield of Michigan described how a relatively simple toolkit on domestic violence has increased the awareness of domestic violence among its network providers; and won an award along the way.

Prior to the toolkit distribution:

* 36 percent of the physicians were unaware of Michigan's reporting mandate for domestic violence; after the toolkit launch, 100 percent were now aware of the mandate.

* Prior to the toolkit launch 40 percent had little or no knowledge of domestic violence, but after the session 100 percent reported moderate to very knowledgeable in understanding domestic violence.

* Before the launch, only 58 percent routinely screened for domestic violence as compared to 96 percent who reported that they now screened all patients for domestic violence.

In light of the results of a new study by the Group Health Center for Health Studies that found that 44 percent of women reported having experienced intimate partner violence (IPV) during their adult lifetime, Blue Cross Blue Shield of Michigan's efforts should be recognized and mimicked.

There's not only a social responsibility here for healthcare organizations, but a fiscal one as well.

The Group Health Center for Health Studies also found that the more recent a woman's IPV, and the longer it has gone on, the worse her physical and mental health and social network are likely to be.

Compared to women with no IPV, women with recent physical IPV were four times as likely to report symptoms of severe depression and nearly three times as likely to report poor or fair health and more than one additional symptom. They also reported lower social functioning by several measures.

By employing a toolkit or other educational measures similar to Blue Cross Blue Shield of Michigan, healthcare organizations can not only help reduce the number of women (and men and children) who are affected by domestic violence, but also possibly reduce some of the comorbidities associated with domestic violence.

On Mothers, Daughters and Healthcare: The Role of Report Cards

May 11th, 2006 by Melanie Matthews

Report cards are a hot topic. On the home front, my husband and I are closely watching the report card of our 17-year-old daughter. Like many parents of high school juniors, we gently but firmly remind her how heavily this year's results will weigh when the college application process begins in just a few months. After sitting through countless college information sessions, we're convinced that the quality of her effort rather than the quantity of activities, associations, etc. will sway most admissions counselors. At least that's how the admissions pendulum seems to be swinging these days.

With Mother's Day a few days away, a sobering global healthcare quality report card was issued on May 10 by Save the Children, a U.S.-based independent global humanitarian organization. According to the organization's State of the World's Mothers 2006 report, 2 million babies die in the first 24 hours of life each year worldwide. Further, the study found that the United States has the second worst newborn mortality rate in the developed world, with five newborn deaths for every 1,000 births. The United States tied for 10th place with the United Kingdom, despite having more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom. Sweden, Denmark and Finland topped the list of countries with the best mother-child outcomes, while countries in sub-Saharan Africa dominate the bottom of the list.

The report ranks the status of mothers and children in 125 countries based on 10 indicators of mother and child well-being, such as a country's adult female literacy rate and the percent of children under age 5 suffering from moderate to severe nutritional wasting.

As a mother, I am deeply saddened by these global statistics. As a developed nation, we have a huge responsibility to improve our own standing and share our knowledge and resources with developing nations. As a healthcare communicator in America, I am compelled to address the national impact of this study. It's inconceivable to me that the United States, a global business leader, would not also head the list of best places for mother-child outcomes. Then again, disparities in the quality and availability of healthcare in this country abound. This report, which analyzed data from governments, research institutions and international agencies, found higher newborn death rates among U.S. minorities and disadvantaged groups.

In preparing an upcoming report on maternity disease management, I'm hopeful that some relief can come from this effort. Report contributor Joseph Stankaitis, MD, MPH, who is also chief medical officer at Monroe Plan for Medical Care, notes the high number of Medicaid enrollees among his high-risk ob-gyn patients---more than 40 percent---and the unique socioeconomic challenges this group faces. Dr. Stankaitis believes “attending to Medicaid members' non-medical as well as medical needs” affords the greatest impact.

His industry colleague Thomas Smith, RN, MA, director of medical care management at Health Management Corporation, is helping his clients drive down the number of modifiable risk factors among the Medicaid population. To overcome outreach barriers, Smith and his team employ telephonic coaching, direct mail and home visits to encourage pregnant Medicaid patients to stay in their maternity disease management program and collaborate in their care with their primary care physician. Perhaps as other U.S.-based providers and health plans adopt these targeted approaches, the overall level of pre-natal care will improve and next year's Mother's Day report will paint a brighter picture for mothers and babies around the world---just about the time our daughter will be opening those college acceptance letters.

Lesson for a Parent on Take Your Child To Work Day

May 2nd, 2006 by Melanie Matthews

Our company's purpose last week in participating in the annual Take Your Daughters and Sons To Work Day sponsored by the Ms. Foundation for Women was to not only give our children the opportunity to see what we do at work each day, but also to educate them on some of the healthcare issues we cover each day as a healthcare publisher.

Our schedule last week included publishing “healthy calendars,” conducting a web-based survey among our network members on their families' healthy habits, analyzing and reporting on the survey results and recording podcasts of what our children learned.

We also equipped our youngsters with pedometers and taught them about a 10,000 steps program that our office has just launched, which has us aiming to walk 10,000 steps and eat five servings of fruits and vegetables each day.

After listening to the children's podcasts about what they learned yesterday, I was proud to hear that they got our message. Through these podcasts, our kids reported back to us that they would aim to eat more healthy items each day and try to walk 10,000 steps a day (which I'm sure that they already do when they play outside).

It turns out, though, that I had something to learn, too. While I do eat my five servings mostly every day, I haven't been reaching that goal for my children. Based on my child's response to our survey yesterday, I need to make some behavior changes in our family to get my children to eat healthier each day. Maybe a little bowl of grapes next to their breakfast dish and some raw vegetables in their lunch box for school will be the extra boost needed to get five servings in each day.

Many of the resources that we've published this past year have focused on healthcare behavior change, including: Motivating Resistant Patients: Influencing Behaviors to Improve Outcomes, Modifying Patients' Behaviors to Optimize Disease Management Outcomes, e-Health Initiatives: Driving Behavior Change and Fostering Consumerism.

I have extended many of these behavior changes to my own lifestyle; now it's time to focus on my children's, too.

Perhaps there's a lesson in there for healthcare professionals in charge of wellness and health promotion programs – offering educational programs and resources on healthy eating and activities not only for employees and health plan members, but their children as well.