Archive for July, 2008

Healthcare Technology: Taking the Good with the Bad

July 29th, 2008 by Melanie Matthews

When it comes to healthcare technologies, we are in the golden age. Need proof? Ladies and gentlemen, I give you Exhibit A: the Telemedicine clinic. Recently, My Healthy Access, Inc. and NuPhysicia signed off on a joint-operating agreement to run Telemedicine clinics in select Wal-Marts in the Houston area. The clinics, Walk-In Telemedicine Health Care, allow physicians to meet with patients virtually while on-site paramedics examine patients under direct supervision of a PCP.

“Simply put, the paramedic serves as the ‘hands’ of the physician, who uses medical devices such as an electronic stethoscope to listen to the heart, or other scopes that can see down the throat or in the ears — and the physician sees and hears everything live and in real time,” said Glenn G. Hammack, president of NuPhysicia. “The physician performs the exam as if he or she was in the room with the patient.”

These retail clinics boast taking convenient care one step further by essentially cutting out the NP and providing the patient with an interactive visit with the PCP.

Exhibit B: The Northwest Telehealth network — a service offered to Washington prisoners that allows them to attend sessions with their psychiatrists, obtain prescription medications via a vending machine and “teleconsult” with dieticians to manage chronic conditions like diabetes.

Telehealth’s benefits are threefold: These virtual visits save tax dollars, improve safety by cutting back on transporting prisoners to and from points of care and discourage prisoners from faking symptoms in order to leave the prison and go to the ED. This results in a decrease in ED visits from prisoners, which, according to Gram McGregor, ED manager at Deaconess Medical Center in Spokane, Wash., an ED in close proximity to Washington’s Ridge Corrections Center, 50 percent of the inmates that come to his ED do not need to be there.

But like everything else in life, you have to take the good with the bad, and healthcare technologies are no different. The director of the University of Pittsburgh Cancer Institute (UPCI) warned his faculty to limit their cell phone use as it could be linked to cancer. Dr. Ronald B. Herberman warns to take precautions now regarding cell phone use:

“Really at the heart of my concern is that we shouldn’t wait for a definitive study to come out, but err on the side of being safe rather than sorry later,” Dr. Herberman said.

And finally, Nintendo’s Wii Fit isn’t doing as much good as some gamers might like to think. The American Council on Exercise (ACE) announced the results of its study on the potential fitness benefits of the game.

“With interactive video games becoming more popular than ever before and Americans now spending an average of 19 to 25 hours per week watching TV and playing video games, we set out to discover whether or not the Wii is truly beneficial as an exercise tool,” said Cedric X. Bryant, Ph.D., chief science officer. “While they have managed to get traditional gamers off the couch and our results show that Wii Sports offer more of a cardio benefit than sedentary games, we believe there is no substitute for the real sport.”

Moreover, the study finds that boxing was the only Wii game intense enough to maintain or improve cardiorespiratory endurance, as defined by industry standards.

Closing Care Gaps Between Medical and Mental Health

July 28th, 2008 by Melanie Matthews

Where there is chronic illness, there is most likely depression. And despite the stigma attached to behavioral health problems and treatment’s impact on PMPM costs, health plans are making it their business to connect affected members and patients with appropriate care. That’s one of the messages that came through loud and clear at last week’s Health Management Congress. Whether in a statewide wellness program for 45,000 employees and spouses or virtual medical homes for the Medicaid-Medicare beneficiaries in a Portland, Ore. plan, a strong link to mental health resources is increasingly part of the care plan. The plans readily acknowledge — and the data indicates — that this connection will drive up pharma and utilization costs for this population. But they also expect that these patients will be more likely to follow doctors’ orders for their physical issues, avoiding costly hospitalizations. And as one attendee noted, “what the health plan data doesn’t show us is the employee that can now go back to work and be productive.”

DM Update: Live from the Health Management Congress

July 24th, 2008 by Melanie Matthews

This week we’re reporting live from the 13th annual Health Management Congress in Orlando. Against the backdrop of the 2008 presidential election, the congress’s opening speakers talked about the healthcare issues we won’t hear the candidates talking about — safety and security surrounding PHRs, dwindling numbers of PCPs and nurses, a lack of substantive research on how to change behavior and the impact of baby boomers on the healthcare system.

But in opening sessions and conversations with attendees, we’re hearing about some initiatives that can make a difference: a winning predictive modeling-health coaching model, a “virtual” medical home for the Medicaid population that successfully addresses the 20 percent with behavioral healthcare issues and a New Jersey health plan that will soon place caseworkers at employer sites as part of its “Case for Wellness” initiative.

Also in this edition, new research suggests a mother’s weight could have an effect on the weight of her child.

Live from the Health Management Congress: Virtual Medical Home Goes Where the Patient Is

July 24th, 2008 by Melanie Matthews

Ten years ago, disease management (DM) was being touted as the “silver bullet” of healthcare. But after 10 years of trying and experimenting, it’s not clear that DM is working, said Dr. Jeffrey Robertson during a keynote session during day 2 of the Health Management Congress in Orlando.

Citing data from a 2007 Rand study, Regence Blue Cross Blue Shield’s executive medical director said that while patients love DM programs, changing behavior is hard, required hospital and pharma data is not always timely and care providers are not always engaged.

But the news is not all bleak. Many health plans in attendance have found that addressing and managing a member’s behavioral health issues may be the key to improving compliance and outcomes. A case in point: A patient-centric model of delivery in place at Family Care Health Plan in Portland, Ore. provides a “virtual” medical home for its Medicaid/Medicare members, addressing the mental and physical health of it population.

Family Care’s COO Rebecca Chi described the the initiative as a “fluid, moving, mobile medical home that moves where the patient is.” Family Care’s service coordinators work within the network of IPAs and clinics the plan has created, reducing physicians’ workload by reviewing members’ care plans, conducting medication education and performing other tasks.

But for the 20 percent of Family Care’s population with behavioral health issues, “their medical home doesn’t start in primary care but in a mental health setting.” If a member’s care is primarily delivered by a mental health provider, Chi said, then that is where that member’s medical home is,”in a setting the member knows well so that they don’t have to re-tell their story.”

Family Care’s model eliminates redundancy and identifies barriers to optimal care delivery, such as transportation. “It’s more cost-effective to spend $20 on a taxi for a member than pay for an ER visit that could have been handled by the PCP.”

All data resides in one place and is easily accessible to all providers, which has cut down on the over-prescribing of mental health drugs.

Overall, Family Care has seen reductions in ER rates, hospitalizations and mental health in-patient days, as well as increases in immunization rates. “We (Oregon) no longer wanted to be the bottom of the barrel in immunization rates,” Chi said.

The success of the program has inspired Family Care in other areas. The health plan successfully boosted the number of members “established” with PCPs within 90 days by offering members a $10 gift card to visit their doctor. Members were greatly motivated by the incentive, Chi said.

Live from the Health Management Congress: High-risk Hoosiers Encouraged to Tell Own Health Story from First Coaching Call

July 23rd, 2008 by Melanie Matthews

The “secret sauce” in CARE GUIDE’s survey-based predictive modeling program supported with health coaching began saving the state of Indiana money after only six months by reducing healthcare encounters by the coached individuals. Jim Kenney, M.S., CARE GUIDE’s director of health coaching, and Jim Kerr, the company’s vice president of business development, shared the details of this initiative with population and DM specialists yesterday during a pre-conference workshop of the 13th Annual Health Management Congress.

Escalating healthcare costs and an unhealthy population prompted Indiana state officials to engage CARE GUIDE, who customized a health survey for the 45,000 state employees and spouses. Buoyed by strong leadership support that started with the governor, intense employee communication (486 meetings around the state to introduce the program) and powerful cash incentives, the program enticed more than 54 percent of the population to take the health assessment.

Predictably, about one-fifth of these participants were identified as high risk. But the health coaching effort that followed, which focused less on clinical compliance than on participants’ readiness to change, successfully engaged more than 90 percent of the high-risk employees in its first year. The program has maintained these levels of engagement in its second year.

“It all begins with the health survey,” said Kerr, who explained that the One Care Street survey was developed by Julie Meeke, who had been an ER nurse for 17 years in Indianapolis. “Julie saw a lot of people that didn’t need to be in the ER, and a lot of repeat visitors,” Kerr said. Meeke developed an assessment to measure gaps in perception — the difference between how an individual believes he should be feeling and how he is actually feeling. CARE GUIDE customizes the survey for each client, but the measurement of perception gaps is a constant, since it is a good predictor of when an individual will seek care. The model can be combined with claims data or biometric screening data if a client requests this.

Kenney provided a look at the health coaching component, which is done telephonically and has a basis in motivational interviewing. Coached participants leave the program better prepared to partner with care providers, manage their stress and embrace healthy habits. The keys to successful change are “a strong plan, a strong support system and seeing setbacks as an opportunity to develop a better plan,” he said. The support component can include “accountability calls” from coaches to make sure participants are still on track. All CARE GUIDE coaches come from a behavioral health background and “focus on whether and where the client should seek help” rather than the clinical data.

In the Indiana initiative, healthcare encounters by coached participants decreased by 30.5 percent, which provided the lion’s share of cost savings. Actual health trend changed from an average increase of 1.2 percent per month to a decrease of 3.3 percent per month.

Workshop participants wondered how the model could be adapted for a Medicaid population, who may not be gainfully employed or easily accessible by telephone. Kerr said a proposed pilot for Medicaid beneficiaries in Philadelphia could provide more insight.

Patient Registries: The Right Track to Better Healthcare

July 22nd, 2008 by Melanie Matthews

The Agency for Healthcare Research and Quality (AHRQ) defines a patient registry as “an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition or exposure.” In addition to creating realistic views of clinical practices, patient outcomes, safety and comparative effectiveness and supporting evidence development and decision-making, patient registries are associated with improved care for patients with chronic diseases.

HIN conducted an e-survey to find out if and how its responding clients — over 150 employers, health plans, hospitals and health systems, physician practices, service providers and other healthcare professionals — use patient registries in their organizations and compiled the results in this free white paper.

Medical Home-Buying: PCPCC Issues Purchaser Handbook

July 18th, 2008 by Melanie Matthews

The Patient-Centered Primary Care Collaborative (PCPCC), a coalition of the country’s national business leaders, consumer groups, organizations representing primary care physicians and other healthcare stakeholders, released its Purchaser Guide to the patient-centered medical home (PCMH). The Purchaser Guide, a handbook for understanding the medical home model and taking action to advance its implementation, is available from the PCPCC as a free download.

While targeted at employers and other healthcare purchasers, the guide is an excellent primer on the PCMH. It begins with a definition of the medical home concept and sets out advantages of its implementation for employers based on effectiveness for improving outcomes and lowering healthcare costs. A central impetus of the guide is to spur employer activity. One section illuminates a three-step “jump start” to help employers begin, plus six strategies purchasers can use to advance the PCMH model now:

  • Participate in a regional pilot;
  • Incorporate PCMH into insurer procurement and performance assessment activity;
  • Align payment strategy with PCPCC adoption objectives;
  • Build coalitions in support of PCMH;
  • Engage consumers; and
  • Integrate PCMH into other corporate health strategies.

To flesh out the model, the Purchaser Guide offers five case studies of PCMH initiatives and includes 21 summary examples of PCMH models in operation through the United States. One case study of the PCMH in practice in North Carolina saved the state’s Medicaid program approximately $124 million in a single year.

The guide also includes sample insurance contract language and a Request for Information (RFI) document designed to assist purchasers who want to work with health plans to advance PCMH.

For more information about the PCPCC, go to the organization’s Web site.

Threat of Medicare Physician Cuts Removed for Now

July 16th, 2008 by Melanie Matthews

What a difference a few weeks makes. After nine Republican senators had a change of heart, the Senate last week passed a Medicare reform bill that eliminates the threat of a 10.6 percent payment cut to physicians through 2009. The bill passed by enough votes in the Senate (and in the House of Representatives two weeks ago) to remove the threat of a presidential veto. (Update: As expected, President Bush did veto the bill on Tuesday, but the veto was quickly overriden by separate votes in the House and Senate.)

Last week’s Senate vote ends several weeks of drama and was met with relief by physician organizations. The AMA praised the Senate for “putting patients first,” and the AAFP said its “5,954 e-mails to Congress, 388 letters to newspapers, numerous phone calls from AAFP members and officers, and face-to-face conversations with legislators” helped convince the Senate to vote in favor of the bill. In recent weeks, 60 percent of physicians told the AMA that the proposed payment cut would have forced them to limit the number of new Medicare patients they could treat.

Older Patients More Satisfied with Care When Accompanied to Medical Visits

July 14th, 2008 by Melanie Matthews

A study by researchers at the Johns Hopkins Bloomberg School of Public Health found that 38 percent of Medicare beneficiaries are accompanied to routine medical visits. These accompanied beneficiaries tended to be older, sicker and less educated but more satisfied with their healthcare provider compared to unaccompanied patients. The study is published in the July 14 edition of Archives of Internal Medicine. Data for the study was gathered from the nationwide 2004 Medicare Current Beneficiary Survey, which for the first time included information on beneficiaries’ visit companions. The study included 12,018 Medicare beneficiaries 65 and older living in the community.

  • Visit companions were most often a spouse (53.9 percent) or adult child (31.9 percent). Less than 1 percent of beneficiaries were accompanied by a nurse, nurse’s aid or other professional.
  • More than 60 percent of visit companions participated in the communication process by recording the physician’s instructions (44.1 percent), providing information about the patient’s medical needs (41.6 percent), asking questions (41.1 percent), or explaining the physician’s instructions (29.7 percent).

Avatars Give Voice to Suicide Survivors, Prevention Counselors

July 14th, 2008 by Melanie Matthews

Suicide, while a serious and tragic issue, is often misrepresented in the media. Whether its the newspaper, television or any other outlet, the focus is too often on the negative outcomes and impacts rather than on the support available to enable suicide survivors, attempt survivors and suicide prevention supporters.

Enter LifelifeGallery.org, a new social online forum to help prevent suicide.

In this week’s Disease Management Update, I interview Dr. John Draper, director of the National Suicide Prevention Lifeline, and Amanda Lehner, technology communications coordinator for the National Suicide Prevention Lifeline, about this new initiative. In addition, find out how MySpace is reaching out to its users coping with depression.