Archive for August, 2009

Heart Disease

August 27th, 2009 by Melanie Matthews

Heart disease and gestational diabetes — two conditions that affect women in the United States — are the topics of this week's DM Update. A new study shows a possible link between heart disease — the number one killer of women in the United States and Canada — and gestational diabetes, while a hospital's heart failure (HF) program has shown promising results by substanially decreasing hospital admissions for HF patients.

Minimizing Medication Adherence Gaps

August 27th, 2009 by Melanie Matthews

Thom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy with CIGNA Pharmacy Management, discusses how CIGNA identifies medication adherence and the solutions for improving this issue.

How do we identify medication adherence gaps and assess the barriers? CIGNA’s overall approach of identifying medication adherence is through our Outcome Improvement Program. Through our program, we strive to:

--- Promote a more active physician/patient dialogue. In other words, identify where medication adherence issues may exist, and then provide the information to the physician and patient so it can be discussed.

--- Influence adherence to appropriate medications. Give the individual patient information so that they understand why the medication is important.

--- Maximize the potential for positive health outcomes.

--- Reduce unnecessary drug costs associated with inappropriate utilization. Improve those outcomes to get the total medical cost reduction.

Medication adherence is not the single issue of importance in looking at evidence-based standards of care. Rather, when you look at medication adherence, it’s one of many evidence-based standards that U.S. healthcare is not achieving in terms of treating patients. A study in the New England Journal of Medicine said that 55 percent of Americans don’t receive the care that is identified in evidence-based standards. It’s important that when you look at medication adherence, it’s in the context of a condition overall, and in the context of other therapies and things that may not be occurring for an individual.

As much as improving adherence is important to us, we’re also interested in ensuring that the patient is adherent with going to the physician’s office and getting the appropriate monitoring of the condition. Are they having an office visit every 12 months? Is that leading to appropriate monitoring of the condition? Has the patient had a low density lipoprotein (LDL) cholesterol test in the past 12 months? Are they achieving the targets that are identified as the clinical marker for the condition? If they’ve had a cholesterol test, have they achieved an LDL of less than 100 milligrams per deciliter? Are they getting the appropriate medications to treat the condition? While we’re concerned about adherence — getting refills and taking medications in an appropriate time frame — we’re also making sure that they are on appropriate medications and haven’t fallen off that medication. Once we’ve established all those points, what’s left is to identify where adherence might be an issue for an individual.

One of the most important and critical starting points that we’ve identified is a systematic approach to evaluating the evidence-based standards, and one of those is looking at medication adherence on a frequent basis. We’ve done this by taking our 10 million members and setting up evidence-based standards as rules in a rule engine. You can then assess those evidence-based standards and medication adherence for the previous six months on a monthly basis. This allows us to review each month if a patient has been medication adherent. Are they getting their refills on time? Do we see a pattern in the date that would indicate that they are medication adherent? Once this information is identified, we create a profile for that individual. The profile includes all of their evidence-based standards, including medication adherence, and indicates whether they are or are not meeting those.

The Activated Patient

August 21st, 2009 by Melanie Matthews

Today's health improvement climate advocates a patient-centered approach in a coordinated care setting. That doesn't mean, however, that patients are relieved of responsibility for their health status. This week's DM Update explains why it pays for today's patient not only to be active but also activated.

Healthcare Reform Ripples from Across the Pond

August 20th, 2009 by Melanie Matthews

The healthcare reform debate continued last week — not only across party lines and but also across the pond. Defenders of the British National Health Service Twittered support for their country's health system after it took a beating during some of the town hall meetings around the U.S. Meanwhile, funds from this year's American Recovery and Reinvestment Act are quietly being put to work to alleviate critical shortages of healthcare workers and faculty as well as increase and improve healthcare quality and access.

In a featured story in this week's Healthcare Business Weekly Update, the HHS allocates $13.4 million in loan repayment funds to support nurses. About a third of these funds will go to schools of nursing to train masters and doctoral nursing students who plan to become nurse faculty after completing their education; the rest will help repay educational loans for RNs in exchange for two years of service at facilities with a critical shortage of nurses. Tennessee is particularly hard hit; the list of facilities where the first 100 eligible nurses have been placed shows that 14 nurses will serve at eight Tennessee hospitals.

Nurses figure prominently in patient education and outreach programs. More than 70 organizations have already responded to HIN's survey of the month on patient education and engagement efforts. Add your responses by August 31 and you'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

Aligning Communications and Incentives for Behavior Change

August 20th, 2009 by Melanie Matthews

Industry experts describe how having a combined communication and incentives program can lead to behavior change in patients.

Blending incentives and communication programs to drive health coaching participation is an effective strategy, says Jennifer Hidding, former director of interactive health management of consumer solutions at OptumHealth. “Incentives are very effective and powerful in a communication program. They are crucial in driving participation and eventually behavior change. There are several different steps we go through as a part of developing that strategy. When we work with an employer who wants to have a robust and committed strategy around behavior change, we highly recommend having a communication strategy that is aligned with and driven off of the overall incentive strategy.”

“The primary lesson we’ve learned is the importance of communication,” agrees Tami Collin, principal with the National Health and Productivity Management specialty practice at Mercer Human Resource Consulting. “Programs with the most effective communication efforts were aligned with incentives appropriate to behavior. Often, a clear connection with benefits was the most powerful indicator of success for individual participation as well as family enrollment. In such incentives, the employee spouse had to enroll in the program in order for the employee to receive the incentive. More often than not, this secured enrollment and continued participation.”

Efficient communication is critical for beginning and maintaining an effective incentive program, Collin concludes. “To that effect, you must be careful with the size of enrollment populations. You want to encourage participation, but be wary of having too many applicable enrollees. Once people enroll, it is difficult to eliminate them.”

“Ultimately, there are several essential principles to consider in crafting incentive programs,” Collin adds. “First, employees must comprehend the rationale behind the incentives, along with the potential benefits. Taking the time to effect quality communication is critical for an effective incentive program.”

There are myriad ways to promote these programs, adds David Chenoweth, Ph.D., president of Chenoweth & Associates Inc. “Opt for the most efficient means with the widest audience reaches. Consider the timetable. It is wise to start months ahead of your launch, depending on how many sites you include and how many people you have to reach at different locations. The awareness and promotional messages you generate should intensify as the program launch nears. First promotions may be monthly, then weekly. You should promote vigorously in the last month to remind participants the start date is right around the corner. Build excitement and impending enthusiasm to secure engagement.”

Financial Lifeline for Strapped Suicide Crisis Call Centers

August 13th, 2009 by Melanie Matthews

Calls into suicide crisis centers have substantially increased during the past year — 54,054 calls in the last recorded month alone — with between 20 to 30 percent of calls being specifically linked to economic distress. In a featured story in this week's Healthcare Business Weekly Update, SAMHSA offers a financial lifeline to these centers, many of which have had state and local funding cuts at a time when they're needed most.

Healthcare providers can intervene by being alert to signs of depression in patients. The MacArthur Foundation Initiative on Depression and Primary Care offers a free downloadable Depression Tool Kit intended to help providers recognize and manage depression. Also available is a sample Patient Health Questionnaire (PHQ-9), a nine-question depression screening tool, as well as instructions for using the PHQ-9 to make a tentative depression diagnosis. Depression is often a hidden comorbidity for patients with multiple chronic health issues. Getting depressed patients the behavioral health support they need can raise patient activation and engagement levels and put the patient on the path to improved self-management.

Meeting ROI Expectations in Health Management

August 13th, 2009 by Melanie Matthews

Craig Nelson, M.D., director of health services research for American Specialty Health, which provides telephonic coaching programs for weight management, tobacco cessation and general fitness, describes the challenges of meeting expectations of wellness program purchasers.

"What's the ROI?" is a direct quotation from virtually every client, potential client, broker and health plan to whom we might offer our services. This question might be the first question they ask — or the second or the third or the last — but inevitably they will want an answer to that question. Our challenge is to provide an answer that is credible and generalizable and can be applied to more than just one employer or health plan. The answer must also be timely — people don’t want to wait two, three or four years for an answer to this — and practical; it must be an answer that can be provided with the data and resources that are available.

Why should we expect an ROI? The clinical logic is well understood by everyone. We have modifiable risk factors — most notably diets, tobacco use, exercise and stress. These modifiable risk factors will affect biometric variables like blood pressure, serum glucose, and serum cholesterol and ultimately lead to changes in health status. Those changes in health status will result in increased healthcare costs and reduced productivity. Our program and others intervene at this level of modifiable risk factors to alter the trajectory of this cascade.

That very simple model has been expanded in a much more complex way by the Disease Management Association of America (DMAA). The DMAA's wellness outcomes workgroup has found that health and behavior risks and associated behavior change in areas of nutrition, exercise, tobacco, medication adherence, etc., will lead to changes in health and clinical outcomes and ultimately to changes in utilization and medical costs. While this time line is not very precise, it does suggest that some of these changes may take place over years and months, so we don’t necessarily expect an instantaneous result from a program that changes some of these behaviors.

Expectations by purchasers of wellness programs regarding programs are supported by science and by vendor claims that a workplace wellness program will reduce morbidity and associated healthcare costs. Further, the expectation is that these cost savings will more than offset program costs and thus generate a positive ROI. This expectation is entirely warranted. Frankly, there wouldn’t be a market for these programs if this wasn't the logic behind them. We can hardly cry foul if purchasers are asking us to provide them with information about the ROI of our programs; this is entirely a legitimate and sensible thing to ask.

Our first challenge as a provider of these services is to deliver on the actual program results of reducing risks, improving health and saving money. Further, the challenge is to measure all of those results. Frankly, the latter is in some ways more problematic than actually delivering the outcomes. The measurement is part of the problem.

Healthy Habits

August 13th, 2009 by Melanie Matthews

In the fast-paced society we live in today, healthy habits are too often substituted by what's quick and convenient. But this week's DM Update illustrates how a healthy lifestyle can reduce one's risk of some serious diseases. Read on to find out how to reduce the chances of these conditions.

Infectious Disease

August 6th, 2009 by Melanie Matthews

A report from the CDC indicates that in 2007, healthcare-associated infections (HAIs) cost the industry an estimated $6.65 billion. Considering approximately 4.5 nosocomial infections occur for every 100 hospital admissions, hospitals are doing all they can to reduce these occurrences. In this week's DM Update, find out what Johns Hopkins did to combat infectious disease in their hospitals. Also, read on to learn which population is more vulnerable to contracting some diseases and why.