Archive for March, 2009

Keeping Medicare enrollees with multiple chronic conditions out of the hospital

March 30th, 2009 by Melanie Matthews

When you consider that about a fifth of hospital readmissions are preventable, the findings in a March 2009 Mathematica Policy Research report are particularly noteworthy. The report identifies three types of interventions with potential for reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions — a group accounting for the lion’s share of Medicare spending. Of special note are transitional care interventions — in which patients are first engaged while in the hospital and then followed intensively over the four to six weeks after discharge from the hospital; self-management education interventions that engage patients for four to seven weeks in community-based programs designed to “activate” them in the management of their chronic conditions; and coordinated care interventions that identify patients with chronic conditions at high risk of hospitalization in the coming year.

While the report notes that no single program has yet combined all three types of interventions, it mentions two approaches that show great promise: the patient-centered medical home (PCMH) model of care and the Guided Care model developed by Dr. Chad Boult and colleagues at the Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health. We recently spoke to Dr. Boult about the Guided Care Model, in which the Guided Care Nurse administers a patient care plan developed by the physician and nurse with data from the EHR. Listen to the interview.

Parkinson’s Awareness Month

March 27th, 2009 by Melanie Matthews

As we approach April and Parkinson’s Disease (PD) Awareness Month, the DM Update highlights two new developments in PD treatments.

Health Program ROI Won’t Happen Overnight

March 23rd, 2009 by Melanie Matthews

When times are tight — and even when they’re not — the promise of ROI gets people’s attention. That appears to be the case even when substantial ROI may be years away. In preparing separate webinars on achieving ROI from health coaching and the patient-centered medical home (PCMH), respectively, it seems that a certain amount of organizational patience is required in each case. In this week’s Healthcare Business Weekly Update podcast, StayWell Health Management’s Paul Terry explains that a health coaching program might increase costs the first year and break even the second year before returning substantial savings during its third year.

And in a separate interview to be featured in a future issue, Aetna’s mid-Atlantic regional medical director Dr. Don Liss told me that while an overall reduction in healthcare costs resulting from medical home adoption may take three to five years, some leading indicators — such as reduced hospital readmissions, non-urgent ER use and duplication of services — can be assessed in the shorter term.

Premature Births

March 19th, 2009 by Melanie Matthews

According to the most recent statistics from the CDC, 12.7 percent of births are preterm, which is defined as less than 37 weeks of gestation. This week’s Disease Management Update explores some risks associated with premature births, as well as techniques being used to improve poor organ function as a result of preterm births.

Offering Incentives for Health & Wellness Programs

March 19th, 2009 by Melanie Matthews

In light of the current economic climate, its no wonder that more healthcare purchasers and payors are turning to incentives and rewards to drive participation and engagement in health and wellness programs. In a survey of over 200 healthcare organizations, HIN asks healthcare professionals to share their organization’s experiences with health incentives and rewards in its newest complimentary white paper, “Offering Incentives for Health & Wellness Programs.”

4 Ways Employers Can Better Manage Chronic Illness

March 19th, 2009 by Melanie Matthews

A new Hewitt Associates survey recommends four key steps for employers to ensure condition management programs achieve optimal results:

  • Analyze members’ claims
  • Improve techniques used to engage targeted enrollees
  • Implement more compliance incentives
  • Communicate and market effectively

    The survey found that number of companies taking action to combat the chronic health conditions of employees and their families jumped almost 30 percentage points over the past year, as organizations attempt to balance rapidly rising U.S. healthcare costs with a growing population of unhealthy Americans.

    Hewitt’s survey of 343 large U.S. employers found that almost two-thirds (65 percent) continue to make significant investments in improving the health and productivity of their workforce. Their efforts go beyond general condition management programs to pinpoint and subsequently reduce the most prevalent chronic illnesses within their employee populations.

  • 4 Ways Employers Can Better Manage Chronic Illness

    March 19th, 2009 by Melanie Matthews

    A new Hewitt Associates survey recommends four key steps for employers to ensure condition management programs achieve optimal results:

  • Analyze members’ claims
  • Improve techniques used to engage targeted enrollees
  • Implement more compliance incentives
  • Communicate and market effectively

    The survey found that number of companies taking action to combat the chronic health conditions of employees and their families jumped almost 30 percentage points over the past year, as organizations attempt to balance rapidly rising U.S. healthcare costs with a growing population of unhealthy Americans.

    Hewitt’s survey of 343 large U.S. employers found that almost two-thirds (65 percent) continue to make significant investments in improving the health and productivity of their workforce. Their efforts go beyond general condition management programs to pinpoint and subsequently reduce the most prevalent chronic illnesses within their employee populations.

  • If You Recast Chronic Pain as Persistent Pain,

    March 16th, 2009 by Melanie Matthews

    does it hurt less? Cheryl Pacella, a nursing instructor and the performance improvement advisor at Masspro, offered this interpretation during a recent conference on relieving the costs and consequences of chronic pain:

    I’d like to review the definitions of “chronic” versus “persistent,” directly from Webster’s Dictionary. Chronic is “lasting a long time or recurring often.” In terms of disease, chronic can be defined as — “having an ailment for a long time, continuing indefinitely or habitually.” The word chronic usually has a negative connotation. Usually the next word that comes to mind is “complainer.” In fact, this is an example listed in the dictionary. “Persistent” is a much more favorable term. The definition is “refusing to relent, continuing, especially in the face of opposition, continuing to exist or endure.” Chronic or persistent pain is any pain that persists for at least one month beyond the usual course of an acute illness or typical healing time following an injury. Examples include some cancer-related pain, arthritic pain, fibromyalgia or post-herpetic neuralgia.

    In terms of interventions and pain management, Pacello advises that all pain is individual:

    Every patient is different. The goal of pain management is improved function, mood, sleep and decreased pain severity. There are both pharmacologic and non-pharmacologic approaches to pain management. It’s important to base the intervention on the response of the patient.

    Wasted Time During Hospital Discharge

    March 16th, 2009 by Melanie Matthews

    Have you ever spent half a day at a hospital waiting for a family member to be discharged? If you think it was an inefficient use of your time, consider the financial impact of these delays on hospitals. According to a new study from the University of Maryland’s Robert H. Smith School of Business — a featured story in this week’s Healthcare Business Weekly Update — these kinds of communication delays and failures cost hospitals $12 billion a year. That loss equals about 2 percent of hospital revenues nationwide. The researchers prescribe a healthy infusion of IT to help streamline communication among hospital caregivers. In a related story, the CHOICES program at St. Peter’s Hospital pays attention to critical care transitions for elderly patients and their caregivers — such as the hospital discharge — to improve care delivery and reduce wasteful practices.

    Early indicators point to a honing-in on healthcare waste by the Obama administration. In its budget brief, the HHS notes that “reducing fraud, waste, and abuse is an important part of restraining spending growth and providing quality healthcare service delivery to Medicare and Medicaid beneficiaries. The budget proposes to dedicate additional resources that will initially be targeted to improving oversight and program integrity activities for the Medicare Prescription Drug Program (Part D), Medicare Advantage, and the Medicaid Program.”

    Effects of Wine

    March 12th, 2009 by Melanie Matthews

    They say everything should be done in moderation — and alcohol consumption is no exception. This week’s Disease Management Update exemplifies this saying, examining how the choice and quantity of wine affects risk levels for two types of cancer.

    As always, we hope you find the news articles and interviews in the Disease Management Update useful to you and your organization. In this issue, we’re asking for your feedback on this newsletter so we can tailor future issues to better meet your information needs.