Archive for November, 2007

Health Plan Uses Secret Healthcare Shoppers in Emergency Room Management

November 30th, 2007 by Melanie Matthews

Many healthcare organizations monitor patient satisfaction as part of their overall quality improvement initiatives. As part of an initiative to divert non-essential ER cases to primary care, Wellpoint utilized secret shoppers to evaluate consumers’ experience at its network physician offices and identify ways to improve access. In a recent audio conference on redirecting non-urgent ER cases to more appropriate healthcare settings, Dr. Karen Amstutz, Wellpoint’s regional vice president and medical director of state-sponsored business, described how it went:

We wanted to look at what our members experience when they try to access care appropriately through our physician offices. We began with a secret shopper program to physician offices, which revealed that one of our offices were dropping phone calls and patients were unable to complete a call successfully through to the office. The staff was also directing patients to the ER when the primary care doctor was not available or the clinic was too busy to offer an appointment. Finally, we identified that often the staff didn’t triage our members and ask them questions about what was going on to help them decide how urgent the visit was — whether it was the same day or could be handled the next day.

Based on these findings, we made recommendations to our providers about scheduling appointments and about walk-in hours. … Part of the reason that our providers were willing to accept our interventions is that there’s a very close relationship between our network education representatives and our provider offices. So when we went back to them with secret-shopper information, we already had a very good longstanding relationship on which to say, “Here’s what we’re seeing. Can we talk about how we might work together and help you solve these problems which will help us and our members?”

This was just part of Wellpoint’s approach, which reaped some great reductions in ER visits and hospital admissions per member. It also focused a lot of attention on educating its members about self-care—knowing when to head to the ER and when a visit to the primary doctor should suffice. Extended hours (with special reimbursement codes), nurse triage lines and hospital-health plan collaborations helped, too.

Disease Management Update: Healthy Diets

November 29th, 2007 by Melanie Matthews

You know what they say — you are what you eat. And what you eat can have a great impact on your health. This week’s DM Update discusses some recent studies that show diets rich in some ingredients can help reduce the risk and stunt the growth of certain types of cancer. Visit HIN’s blog to read about some problems that diet can create.

C-Suite Support is Key for Corporate Health

November 28th, 2007 by Melanie Matthews

Participation in wellness programs and initiatives at the executive level can yield great results, according to Gregg Lehman, president and CEO of HealthFitness, a provider of integrated health and fitness management services for employees and individuals.

However, levels of C-suite involvement can vary greatly, ranging from verbal encouragement and support (via newsletters, emails, videos, and general letters of support for programs), to recognizing employees working to improve their health status, to executives becoming active participants in health management programs and sharing their success stories.

In a recent interview with HIN, Lehman cited some valuable techniques that are effective – and essential – in obtaining optimal wellness program success and creating a corporate culture of health. His list includes:

  • Generating corporate mission and vision statements that support employee health and well-being;
  • Encouraging workers to participate through financial incentives and easy access to programs while at work;
  • Incorporating an integrated approach to managing employee health programs, aligning previously segmented functions like HRA, workers comp, risk management, long-term disability, occupational health and DM programs;
  • Conducting an annual assessment of baseline health through an HRA and biometrics screenings;
  • Engaging employees and encouraging employee input (i.e. creating a committee or task force);
  • Offering fitness programs, prevention programs, etc., and
  • Enforcing no-smoking policies, offering healthy food choices in the cafeteria, and addressing other environmental factors.

Reducing risk factors of chronic diseases in the workforce is one of the best long-term investments CEOs and CFOs can make, says Lehman.

Antidotes to Expensive Medication

November 28th, 2007 by Melanie Matthews

Attention consumers, providers, pharmacies and health coaches: MedFriendly Blog suggests alternate avenues for obtaining prescribed medication when cost, lack of insurance or other financial obstacles get in the way. Pass these suggestions on to patients, clients and friends who find themselves in this situation.

How Healthcare Will Measure Up in 2008

November 26th, 2007 by Melanie Matthews

As we see it, 2008 will largely be about measuring up. In response to expected quality and performance initiatives, doctors, hospitals, health plans and just about anyone involved in health and wellness will have to validate their effectiveness to both consumers and payers. This week’s Worth Repeating shows how data mining can turn up surprising trends in health coach effectiveness (for example, whether former smokers make better coaches) and coaching ROI. In New York, the state and physicians hope a joint analysis of “near-misses” today will help reduce tomorrow’s hospital errors. And in What’s New at HIN, an audio interview with HealthFitness President and CEO Gregg Lehman yields a blueprint for constructing a corporate culture of health — and the very measurable benefits that can accompany this attitude shift.

How well does your organization measure up in MRSA education and prevention? Just a few days remain to take HIN’s monthly e-survey on this subject and receive a complimentary e-summary of the results.

Connecting with Medically Underserved Populations

November 21st, 2007 by Melanie Matthews

Locating, making contact with and staying connected to members of medically underserved populations is a challenge for many organizations that administer disease management (DM) programs. Challenges include working with outdated addresses and phone numbers and the generally transient nature of such populations. HIN’s non-scientific online survey in September 2007 yielded some out-of-the-box ideas from 67 healthcare organizations — including hospitals, physician organizations and health plans — on how they deal with hard-to-reach clients. Here are just a few suggestions excerpted from the complimentary white paper of survey results, Making Contact:
How Healthcare Organizations Locate and Communicate with Hard-to-Reach Clients

  • Provide home outreach.
  • Get updated demographics while patient is still in the hospital.
  • Offer incentives for attendance or participation.
  • Develop distribution lists from programs and events that patients have participated in.
  • Offer work site initiatives and collaboration.
  • Put stickers on the member ID cards instructing them to call a number to update information.
  • Connect every visit with personal benefit so the patient has something to gain from each contact.
  • Rely on vendors to supply us updated/improved data.

Please share any successes your organization has had in this area.

NY Times Magazine: Conspicuous (Healthcare) Consumers vs. the Categorically Needy

November 19th, 2007 by Melanie Matthews

Did anyone notice how yesterday’s New York Times Magazine juxtaposed two of the greatest problems facing the healthcare industry and the U.S. population as a whole — the country’s rampant obesity problem and the 47 million uninsured Americans?

In The Stomach-Surgery Conundrum, Freakanomics authors Stephen J. Dubmer and Steven D. Leavitt ponder the rationale of thousands of obese Americans opting for expensive bariatric surgery despite the physical and psychological complications and replacement addictions that may result.

There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn’t this what progress is all about?

On the other hand, why is such a drastic measure called for? It’s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that’s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that “the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn’t changed in that time.”

So the cause is, essentially, that people eat too much; and the cure is, essentially, to eat less. But bariatric surgery seems to fit in nicely with the tenor of our times. Consider, for instance, the game shows we watch. The old model was “Jeopardy!,” which required a player to beat her opponents to the buzzer and then pluck just the right sliver of trivial knowledge from her vast cerebral storage network. The current model is “Deal or No Deal,” which requires no talent whatsoever beyond the ability to randomly pick a number on a briefcase.

In stark contrast in the same issue are emotive photos accompanying the article “Patients Without Borders” by Sara Corbett. The article/photo essay describes the efforts of Remote Area Medical (RAM) — a corps of volunteer dentists, doctors, nurses, hygienists and X-ray technicians. Normally deployed to thirld world nations, they are spending increasing amounts of time tending to the uninsured in this country.

The setting for the article was a three-day period this summer when RAM treated more than 2,500 patients who had lined up for care beginning at 3 a.m. Working in animal stalls and makeshift tents on a fairgrounds in Appalachia, Virginia, the corps had to turn away several hundred more from this medically underserved population.

Imagine the good that might result if future candidates for bariatric surgery modified eating behaviors and rerouted some of those billions toward the uninsured population. Then perhaps we’d all sleep better. (That, by the way, was the subject of a third article in the NY Times Magazine.)

When Caregivers Are Homebound

November 19th, 2007 by Melanie Matthews

Healthcare in general and long-term care in particular are emerging as particularly volatile issues in the 2008 presidential election. More than 70 percent of respondents to a survey mentioned in this week’s news say they’re not prepared to handle either their own long-term care needs or those of a loved one. In a related story, caregivers are in desperate need of support programs and education. A new white paper issued this week reveals how your organizational peers are caring for the caregivers. Program innovation and ingenuity are called for when caregivers are frequently unwilling or unable to leave their charges alone to attend your program.

Exercise is Pivotal in Disease Management

November 14th, 2007 by Melanie Matthews

Over two-thirds of patients would be more interested in exercising to maintain good health if they received advisement from their doctors and were given additional resources, according to a new study from the American College of Sports Medicine. And while 41 percent of physicians talk about the importance of exercise with their patients, they don’t always offer suggestions on the best ways to be physically active.

Exercise isn’t all about looking great — in fact, the benefits of exercise are far greater than fitting into your favorite pair of jeans. According to the Mayo Clinic, daily exercise can improve one’s mood, help fight chronic diseases, help manage weight, strengthen one’s heart and lungs and more.

However, possibly the hardest part of exercise is sticking with it. Often times people are discouraged when they do not see instant results from their efforts. Here are some tips from the American Heart Association that healthcare providers can suggest to their patients to keep them looking — and more importantly feeling — great!

  • Choose activities that are fun, not exhausting. Add variety. Develop a repertoire of several activities that you can enjoy. That way, exercise will never seem boring or routine.
  • Wear comfortable, properly fitted footwear and comfortable, loose-fitting clothing appropriate for the weather and the activity.
  • Find a convenient time and place to do activities. Try to make it a habit, but be flexible. If you miss an exercise opportunity, work activity into your day another way.
  • Use music to keep you entertained.
  • Surround yourself with supportive people. Decide what kind of support you need. Do you want them to remind you to exercise? Ask about your progress? Participate with you regularly or occasionally? Allow you time to exercise by yourself? Go with you to a special event, such as a 10K walk/run? Be understanding when you get up early to exercise? Spend time with the children while you exercise? Try not to ask you to change your exercise routine? Share your activity time with others. Make a date with a family member, friend or co-worker. Be an active role model for your children.
  • Don’t overdo it. Do low- to moderate-level activities, especially at first. You can slowly increase the duration and intensity of your activities as you become more fit. Over time, work up to exercising on most days of the week for 30-60 minutes.
  • Keep a record of your activities. Reward yourself at special milestones. Nothing motivates like success!
  • If you’ve been sedentary for a long time, are overweight, have a high risk of coronary heart disease or some other chronic health problem, see your doctor for a medical evaluation before beginning a physical activity program.
  • Medical Homes and the Medically Homeless

    November 12th, 2007 by Melanie Matthews

    This week’s Patient Centered Primary Care Collaborative summit on the medical home highlighted the healthcare industry’s endorsement and clarification of this model as well as the need for reimbursement reforms to support it. In the meantime, physicians can avail themselves of assessment and implementation tools to help transform their practices into true medical homes. It shouldn’t be long before there are metrics and measurements in place to separate true patient-centered practices from the wannabes. Read the summit highlights in this week’s news as well as in the HIN blog.

    However, until medical homes are available to all, there still will be a significant population of medically underserved. A new complimentary white paper that reports on strategies for connecting with hard-to-reach patients and clients may trigger some new outreach at your organization, as might this week’s profile of a member-centered care management program.