Archive for August, 2006

Strategies for Reducing Unnecessary ER Utilization

August 31st, 2006 by Melanie Matthews

We all know the statistics about rising use of the emergency room (ER) for perhaps unnecessary care. And we probably can all relate a story about someone who waited too long to be seen in an ER when they did in fact need immediate attention.

As part of our industry’s quest to improve quality and reduce costs, the ER is a great place to look.

AmeriChoice, a Medicaid health plan owned by United Healthcare, is placing triage case managers in facilities where they’ve had high volume ER usage. These case managers help those members identify other ways for them to receive appropriate care, Penelope Kokkinides, national vice president of disease management with AmeriChoice, told participants in Healthcare Risk Stratification: Strategies for Identifying and Referring the Appropriate Service and Intervention, an August 16 audio conference now available on CD-ROM.

AmeriChoice is also trying to find doctors who have extended hours to see if those doctors would be willing to take members on a one-time urgent basis – even providing these doctors with some type of financial incentive to have longer office hours.

Another health plan, Keystone Mercy Health Plan, is surveying at-risk patients with frequent emergency room visits to identify the factors that led to the visit and, in turn, educate the patient about appropriate ER utilization and deliver information about primary care physician access. Reports from the survey will also help Keystone identify at-risk patients and enroll them in disease management programs that can reduce costs and improve patient health.

With these and other initiatives focused on reducing inappropriate ER usage, hopefully we will all be able to tell a story about someone who truly needed ER care and received it in a timely fashion.

Back-to-School Project

August 29th, 2006 by Melanie Matthews

We’re in full back-to-school mode at my house. We have new backpacks, new lunch boxes and new clothes. We’ve also already completed some of the usual paperwork — emergency contact forms, a list of who’s allowed to pick up the kids and health and allergy forms, to name a few.

Thankfully, my children do not have any allergies or chronic health conditions that affect this transition back to school, unlike parents of children with asthma cited by a new American Lung Association study.

This study found that despite evidence of spikes in asthma emergency room and hospitalization rates in September — a seasonal “back-to-school asthma” phenomenon, many parents of asthmatic children are not taking simple steps to manage their child’s asthma while at school.

According to the poll, 73 percent of parents of children with asthma report they are concerned about how their child’s asthma will affect their ability to participate in school. And yet, less than half the parents polled talk to the teacher about their child’s asthma (48 percent) or make sure the child’s medicine is available at school (42 percent). Less than one-third make sure their child is under medical supervision (31 percent) or talk to the school administration about the child’s health condition (27 percent).

Case managers at Pitt County Memorial Hospital, in Greenville, N.C., work with school systems to help patients get the resources they need to self-manage their chronic diseases, including asthma, said Michelle Brooks, RN, MSN, administrator of regional health plans for Pitt, which is part of University Health Systems of Eastern Carolina

This was just one element of her organization’s community-based disease management partnerships program described during Maximizing the Results of Your Disease Management Programs Through Community-Based Resources, a June 21, 2006 audio conference now available on CD-ROM.

Pitt also uses schools as a referral source for patients who might benefit from disease management programs. These simple strategies don’t take a lot of the case managers’ time, but just might pay off by reducing the number of asthma-related emergency room visits and hospitalizations come this September.

Obesity in Aging Population Taxes Medicare System

August 23rd, 2006 by Melanie Matthews

As in other populations, obesity rates and related healthcare costs are increasing at a fast rate in the Medicare population, according to a new study by researchers at Emory University in Atlanta and published online at Health Affairs.

The researchers found that 22.5 percent of Medicare enrollees were considered obese in 2002, up from 11.7 percent in 1987. More alarming, however, is that spending on medical care for obese Medicare patients was 9.4 percent of the federal government program’s budget in 1987 but 24.8 percent by 2002, according to the analysis.

Preliminary results of a July 2006 survey conducted by the Healthcare Intelligence Network on the impact of aging boomers on the healthcare system found that nearly 50 percent of healthcare organizations rate obesity as the single greatest health issue facing the baby boomer population.

During Maximizing the Results of Your Disease Management Programs Through Community-Based Resources, a June 21 audio conference, Judy Szilagyi-Neary, clinical care manager at Ovations, a United Healthcare company, outlined how her organization has established partnerships with gyms and some community exercise programs to ensure the physical activity programs are available to its members. Ovations also participates in state- or city-wide initiatives to promote physical activity, such as health fairs and educational programs.

While increasing obesity rates are alarming at all age groups, an obese elderly population is, in my mind, the most challenging to address. A concerted effort will be needed among not only providers and insurers, but also caregivers to change what in some cases might be life-long habits of poor diet and inactivity. With the comorbidities that are associated with obesity in general combined with those associated with obesity in the elderly, it is easy to see why costs related to obesity have increased at the levels reported by the Emory researchers. With efforts like those at Ovations, we could begin to reverse these statistics.

Incentives for Unhealthy Lifestyles

August 15th, 2006 by Melanie Matthews

Bucking the national trend of providing incentives for healthy lifestyles, my home state New Jersey recently passed a new state budget that includes a tax on health club memberships, among other revenue generating tactics.

Never mind the political reasons why there is a revenue shortfall in New Jersey (mostly attributed to home rule) and that this will only cost me about $50 a year. I still find it reprehensible. While the rest of the country is putting more healthcare responsibility in the hands of consumers, New Jersey is making consumers pay for it.

Where’s the logic here? Healthcare costs are increasing in large part due to chronic conditions that are caused by lifestyle choices. Why increase the cost to consumers for choosing to engage in activities that can only improve their health? Why not tax cigarettes, alcohol and high-fat foods? To me that’s a whole lot more digestible.