Archive for June, 2009

Measuring the Performance of Health Coaches

June 25th, 2009 by Melanie Matthews

Two industry experts in health coaching describe how their organizations measure the performances of telephonic and online coaches.

Question: Are there different measures for evaluating the efforts of telephonic and online coaches?

Response: (Darcy Hurlbert, Ceridian LifeWorks) For telephonic coaching, we look at outcomes — quit rate, percent weight lost — metrics around that. We administer satisfaction surveys at three months post-enrollment. We look at coach satisfaction and on-time rates. How many calls are they completing within the allotted number of days and on time within a 24-hour turnaround? We also look at reach rate — how many individuals are they able to successfully reach and complete calls with? Those have been the core measures that we’ve looked at, along with record and quality assurance reviews by our clinical consultant.

Response: (Sean Slovenski, Hummingbird Coaching Services) Conceptually, while I’m sure there are some subtle, nuanced differences in the measures we’re looking at [for online health coaches], the reality is they’re the same general measures of customer satisfaction, quality of the work output, time spent and responsiveness. The biggest factor is determining what percentage of goal achievement they having with their client base. It’s really outcomes-related.

Reality TV: Delivering Specialty Care via $100 Webcam

June 19th, 2009 by Melanie Matthews

Telemedicine is one way to address specialty care needs of safety net populations, says Dr. Kim Dunn, a Texas physician who has practiced telemedicine since the ‘90s. Then, as now, she notes, compensation for telemedicine is an issue. “The problem is that nobody pays for it. It’s starting to be paid for, but this trend is not very widespread.”

Dr. Dunn is director of the HealthQuilt initiative, a pilot health information exchange, and founder and CEO of the Your Doctor Program L.P. HealthQuilt launched its telemedicine feature with depression management — the number one behavioral health problem identified in the safety net community. “The Your Doctor Program, L.P. took the national guidelines for depression and put them into a base protocol in HealthQuilt’s Quality Health Record (QHR).

Academics-based telespecialists provide the base protocols for the project’s teleconsults, explains Dr. Dunn. “The medical doctors who will participate in the HealthQuilt pilot will look at the protocol and customize it to their practice, which takes about two minutes per protocol. That training, provided by the Your Doctor Program, L.P., overcomes the traditional provider barrier of, “I practice differently,” which often prevents physicians from participating in quality initiatives, she says, and also overcomes the reluctance of specialists who often have big concerns about telemedicine source locations.

“Let’s say I’ve seen a patient, and I’m diagnosing him with depression,” says Dr. Dunn. “There are about five medications I feel comfortable using for depression. Or let’s say the patient’s case is really complicated — they’re elderly or have major problems and I’m feeling out of my league. We have two ways to use telemedicine to access specialty care in this case. First, via the QHR, I can go to our telepsychiatrist’s cell phone. [As part of the pilot, that specialist] is contractually obligated to answer his cell phone and speak with me. I ask the psychiatrist to look at this patient because he’s already cued up to look at the QHR when he gets the cell phone call. We have a one- or two-minute conversation, and then he messages me with his recommendation. The whole “curbside consult” takes about four minutes. Since I as a medical home physician manage the care plan, we automatically follow up on the outcomes of care.

“Through this collaborative practice model we’ve been able to impact that patient’s care through that process, and the patient hasn’t had to have an additional appointment. There hasn’t been a delay in their treatment,” says Dr. Dunn.

But in some cases, the psychiatrist may say, ‘I don’t really know what to do with the patient.’ HealthQuilt’s second option is its embedded live interactive telemedicine inside the QHR via a $100 webcam that enables the team to do acceptable quality video so there can be specialist-to-patient interaction, Dr. Dunn explains. The project is now piloting payment to physicians for this service.

Live interactive consults can also be scheduled, she adds. “Often, you really just need to talk about the problem and get a few questions answered, and then you can schedule either a live interactive follow-up via telemedicine or an in-person exam.”

Three Prerequisites for Health Coaching 3.0

June 19th, 2009 by Melanie Matthews

Roger Reed, chief consumer engagement architect for Gordian Health Solutions, describes the three basic cornerstones of the next generation of health coaching.

There are three basic cornerstones to health coaching 3.0. It needs to be individual-centric — whole person, one-on-one, and multiple modes preference-based. Today that person may want to send the coach an e-mail. Tomorrow that person may want to pick up the phone and call that coach. The next day that person may want to use self-service options available to them through a Web portal or a platform. They may want to engage face-to-face in a community-offered support program. Mode and frequency in this individual-centric model is going to be driven by the individual and their needs, and they’re going to address simultaneous health issues. If someone has 20 or 30 pounds to lose, wouldn’t it be good if they were moving a little bit? Wouldn’t it be good if we could talk to them about caloric intake? Wouldn’t it be good if we could talk to them about the stress that triggers their eating behaviors? You begin to say, “We’re doing that already in many of our coaching models,” but let’s make that more formalized and start to address simultaneous health issues with these patients. Set goals that are holistic in nature.

Second, it needs to be strength-based. Health coaching 3.0 is going to address individual strengths, identify their resources, overcome barriers and look for those pathways to long-term health improvement, which is what we all want as health coaches.

The last cornerstone is its relationship-driven component. Sometimes relationships are Web-based, telephonic or face-to-face, but think of these more in terms of personal training, personal coaching and coaching that create a partnership and foster that motivation that creates behavior change.

As you dig down into health coaching 3.0, you’ll find the multi-platform world where platforms all talk to each other — telephones, land lines, cell phones, e-mail, “anytime” coaching and personal data assistants (PDA). Companies are leveraging television sets and connecting devices to them for individuals to self-report weight and other biologic data through their television sets, via cable connections. There are many self-service options, such as connectivity to providers’ offices. One thing that has been missing in many coaching models is the full connectivity of the health coach and health coach services to the physician, and we need a solution in the future. Health coaching 3.0 will have real connectivity to that patient or that member’s physician, and they will be need-based and holistic. We’ll look at preferences, context and social networks, and we’ll get into this convenience and transparency issue.

Pain Management

June 18th, 2009 by Melanie Matthews

According to a national pain survey conducted for Ortho-McNeil Pharmaceutical, about 50 million Americans live with chronic pain caused by disease, disorder or accident, and an additional 25 million people experience acute pain as a result of surgery or an accident. This week’s Disease Management Update looks at pain, from relief to education for PCPs.

Meet the Medically Bankrupt

June 15th, 2009 by Melanie Matthews

A study conducted before the economic downturn found that medical problems contributed to nearly two-thirds (62.1 percent) of all bankruptcies in 2007. At the outset, most of the “medically bankrupt” had health insurance, were solidly middle class, owned homes and had gone to college. In many cases, illness led to job loss, and with it the loss of health insurance. The study will be published in August’s American Journal of Medicine.

There’s more. A new HHS report on healthcare disparities (a featured story in today’s Healthcare Business Weekly Update) finds that 40 percent of low-income Americans do not have health insurance, about one-third of the uninsured have a chronic disease, and they are six times less likely to receive care for a health problem than the insured.

According to preliminary results of our May e-survey on the impact of the uninsured and underinsured, nearly three-fifths (58.5 percent) of 125 responding healthcare organizations are taking steps both to mitigate the financial impact of these trends and to make healthcare more affordable for these populations. To get a free e-summary of the survey results, including respondents’ top strategies for reducing cost and improving affordability and access, email me at I’ll make sure you get your
copy when it is ready.

Prevention Tips

June 12th, 2009 by Melanie Matthews

This week’s DM Update picks up where last week’s left off, featuring part two of Melanie Matthews’ coverage from the National Medicare Readmissions Summit and the 2009 Medicaid Congress. In this issue, Matthews talks toolkits as she provides insight on what is needed for for health reform. And in our newest feature “Ounce of Prevention,” find out which five basic preventive services can save over 100,000 lives a year.

Health Reform Toolkit Needs Focus on Health Management and Prevention

June 11th, 2009 by Melanie Matthews

The toolkit needed for healthcare reform is more broad-based than containing costs and improving quality, says Kenneth Thorpe, executive director, for the Partnership to Fight Chronic Disease. Thorpe is also a Robert W. Woodruff Professor and Chair of the Department of Health Policy and Management at Rollins School of Public Health, Emory University.

Reform efforts must also include population health management, health prevention and care coordination, Thorpe said during a panel discussion in conjunction with last week’s National Medicare Readmissions Summit and the 2009 Medicaid Congress.

“Getting to the Value Quadrant of Healthcare Reform,” sponsored by Pharos Innovations, highlighted several care management programs achieving positive returns, as well as the role of care coordination in health reform.

Thorpe underscored the importance of the primary care system in any reform efforts to help achieve the goals of population health management and care coordination especially among those with chronic conditions.

While declaring that he has pilot and demonstration fatigue, Thorpe called on the healthcare industry to build out the medical home engine to coordinate this care and to collaborate with smaller physician groups to bring the opportunity that the medical home model of care offers to these smaller groups.

Medical Home Lesson 12: Coordinate PCMH Roles Between Practice and Health Plan Partners

June 9th, 2009 by Melanie Matthews

Barbara Wall, J.D., a consultant who advises healthcare organizations on development and implementation of patient-centered medical homes (PCMH), shares one of 15 lessons learned from her recent consulting roles with two separate medical home models used in pilots in the Northwest. It’s a viewpoint enhanced by more than 10 years in health plan management.

“Many health plans are looking at the medical home as a way to supplement some of the things that disease management (DM) programs are not doing or cannot do. The health plans that I’ve worked with on these pilots are looking for ways to support the practice in information exchange. This works as long as the practice had identified the patients currently enrolled with each carrier and both parties consider privacy rules.

Once you have gotten past that hurdle, you have a way to send information back and forth. There are often DM programs in place that are owned or coordinated with the health plan. The medical home practice can do things that the health plans and the DM and case management vendors cannot do — that is, call the patient and say, ‘I want you to come in and see the doctor,’ or ‘You need to come in and get this blood work done.’”

That’s the piece that the health plans have recognized that they can’t do through a telephonic approach, says Wall. “The physician can see and touch and examine the patient. The health plans that I’ve been involved with are making sure that there’s an information flow point of contact — usually nurse to nurse — between the medical home practice and the health plan care management department so that when there are episodes of acute crisis, the practice and health plan can immediately coordinate on the plan of care.

“In the Northwest, health plans are increasingly looking for ways to integrate with the practices on patients that they have in common to improve quality of care and outcomes,” Wall concludes.

Lessons Learned from Model Medical Home Tour

June 5th, 2009 by Melanie Matthews

Ask early adopters of the medical home for one piece of advice for newbies and responses are varied:

Don’t wait for development of perfect automated reporting system. Start working on process change and gradually incorporate essential reporting pieces into EMR. Barbara Wall, president of Hagen Wall Consulting, which advises healthcare organizations on PCMH development and implementation.

You need one doctor per practice to initiate [the medical home] in a group practice. Dr. Kim Dunn, HealthQuilt Director and Founder and CEO of the Your Doctor Program, L.P.

Redesign of primary care practice is important; performance feedback to providers is critical; case managers must be part of the team, embedded in the practice; team must be accountable for efficiency outcomes, transitions in care a huge opportunity. Janet Tomcavage, RN, MSN, vice president of medical operations for Geisinger Health Plan.

Connect with community resources rather than trying to duplicate them in the practice. Elizabeth (Liz) Reardon, a healthcare consultant, president of Reardon Consulting and a member of the National Integration Consulting Team.

I’ve spent a lot of time recently speaking with these individuals, who were among respondents to HIN’s Medical Homes ’09 online survey. From our conversations, I developed detailed profiles of their medical home experiences. Each either belongs to an organization that is testing the patient-centered medical home model or has advised businesses on specific aspects of this process. They come with expertise in health information technology, behavioral healthcare, health plan management — one even worked as a diabetes clinical care nurse for more than 20 years. Following are key excerpts from our conversations that can guide providers, payors and purchasers in their exploration of the PCMH:

The more formalized the [staff] training — whether outside resources or modules developed by triage nurses within the practice — the better the results in terms of the MAs taking the initiative and following up to make sure patients complied with evidence-based guidelines for the care protocols. Over time, as MAs became better educated and more sophisticated providers of patient education, they found that the relationship with the patient grew for a couple of reasons. They had more contact with the patient, but also had more to offer the patient in terms of information. Barbara Wall, consultant

[HealthQuilt] is going to do two things: First, it’s going to improve the quality of care, because if doctors have good data they’ll improve their care. Secondly, it is reconciling the data, archiving it in a data warehouse and identifying it so that we can start doing community-based comparative effectiveness research. That’s a new paradigm within healthcare reform. Dr. Kim Dunn, HealthQuilt and Your Doctor Program, L.P.

Physician practices can run themselves ragged sometimes trying to be everything for everybody [in the medical home]. Spend some time to find the key people or organizations in your community and develop that relationship with them so you’re not necessarily taking over everything. Liz Reardon, consultant

While many care teams think that they do a good job on medication reconciliation, there are still many opportunities for improvement. For example, patients often go home [from the hospital] on a second beta blocker and end up taking double their beta blocker dosage because the one that was written at home was perhaps a generic brand and the one that the hospital doctor prescribed is a brand name. They end up getting into some difficulties post-discharge. Janet Tomcavage, Geisinger Health Plan.

Care Management’s Role in Health Reform

June 4th, 2009 by Melanie Matthews

Care management and care transitions are critical to achieving cost savings in healthcare, according to a panel discussion in conjunction with this week’s National Medicare Readmissions Summit and the 2009 Medicaid Congress.

“Getting to the Value Quandrant of Healthcare Reform,” sponsored by Pharos Innovations, highlighted several programs already achieving positive returns from a more focused approach to care management.

Dr. Joseph Kdevar, founder and director of the Center for Connected Health at Partners Healthcare, shared results from a program at Partners that provided accurate information on patient diagnosis to the physicians that was reported back to the patient in a manner that was motivating to the patient combined with data-driven coaching, which resulted in significant reductions in
readmission rates.

Dr. Tom Kline, medical director for Iowa Medicaid Enterprises, highlighted results from a program that monitored heart failure patients in Iowa’s Medicaid population that achieved significant reductions in hospitalizations among a population with its own inherent health management challenges.

In next week’s issue of the Disease Management Update, we’ll share insight from Dr. Ken Thorpe, professor and chair, Rollins School of Public Health at Emory University and former deputy assistant secretary for the U.S. Department of Health and Human Services on the toolkit needed for health reform.