Archive for September, 2009

Health Coaching Trends in 2009: Banking on Behavior Change

September 29th, 2009 by Melanie Matthews

A healthy majority of healthcare organizations — 63.4 percent — offer health coaching programs to their populations with the goal of reversing unhealthy behaviors and reducing the economic and clinical burden of chronic illness, according to a new survey conducted by the Healthcare Intelligence Network.

The downloadable executive summary for Health Coaching in 2009: Banking on Behavior Change highlights responses from 212 health plans, hospitals, physician practices and others on key aspects of health and wellness coaching, including the number one lifestyle factor targeted by health coaching interventions in 2009; average monthly case loads for health coaches; key coaching candidate identification methods; top tool for measuring patient satisfaction and improvement; Health IT that is transforming health coaching; Which organizations are measuring ROI from health coaching; and much more.

Readmissions Rise at PA Hospitals

September 28th, 2009 by Melanie Matthews

Pennsylvania hospitals got good and bad news last week: while mortality rates for 158 hospitals fell significantly from 2002 to 2008, readmission rates for this same period increased significantly from 18.3 to 19.1 percent, with 38.2 percent of readmissions due to complications or infections. These readmissions accounted for almost $1.1 billion in charges and 157,000 hospital days, according to the state’s Hospital Performance Report. The largest significant increase in readmissions over this time period was in diabetes medical management, where the readmission rate increased from 19.4 percent in 2002 to 21.3 percent in 2008.

The use of technologies to engage patients in chronic disease improvement programs is beginning to pay off in reduced hospital admissions. In a featured podcast in this week’s Healthcare Business Weekly Update, learn how remote monitoring of heart failure patients reduced hospital readmissions for the Henry Ford Health System by more than a third. Preliminary results from this month’s e-survey on the use of telehealth indicate that 50 percent of respondents remotely monitor patients with chronic illnesses, with some very positive results. Take this survey by September 30 and receive an executive summary of the results.

Tackling Healthcare Fragmentation

September 24th, 2009 by Melanie Matthews

Through the implementation of innovative health management programs, we can improve the performance of our healthcare system, says Steve Wigginton, president of Health Integrated, a leading health management solutions company.

Listen to a podcast featuring Steve Wigginton in which he discusses how health plans that make investments in wellness, chronic condition management and technology can enjoy a healthy return on investment with improved health outcomes for their members:
http://www.hin.com/podcasts/podcast.htm#hi2

To download a case study of one health plan’s successful use of health management solutions that improved
outcomes and reduced costs, and for more information on Health Integrated, please visit:
http://www.healthintegrated.com/HIN909A

Diabetes Diagnoses, Costs and Treatment

September 24th, 2009 by Melanie Matthews

Diabetes care is the main cause for concern in this week’s Disease Management Upate. According to a report from Texas, this state is experiencing a higher percentage of patients being diagnosed with Type 2 diabetes compared to national averages. This report also ranks Texas in terms of cost of treatment, care and patient compliance with medication. While on the topic of diabetes medication, a related story discusses the impact of insulin or the diabetes drug Metformin on inflammatory biomarkers and glucose levels in patients with type 2 diabetes.

Engaging Physicians in Telemedicine ‘Curbside Consults’ Leads to Quality Care

September 24th, 2009 by Melanie Matthews

Kim Dunn, M.D., Ph.D., director of the HealthQuilt Project, assistant professor at the University of Texas School of Health Information Sciences and founder and CEO of Your Doctor Program, L.P., explains how to engage physicians in telemedicine to provide quality care.

The medical doctors who will participate in the HealthQuilt Quality Health Record (QHR) pilot will look at the protocol and customize it to their practice, which takes about two minutes per protocol, explains Dr. Dunn. 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. It also overcomes the reluctance of the 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. He’s contractually obligated to answer his cell phone and speak with me. I ask the psychiatrist to look at this patient’s 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. This is a form of Continuing Medical Education (CME) for the physician as we incorporate that into their annual practice-based CME program. “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. “We are now piloting payment to physicians for this.”

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.

“Also,” Dr. Dunn continues, “We don’t want to impact the usual referral patterns of the medical home doctors. We’re not trying to upset the apple cart with the specialists in the community. That would be a very bad decision on our part. We’re not trying to change the physician’s usual referrals pattern. We’re trying to augment that with new knowledge, processes to improve care, practice-based continuing education and specialty care access via quick ‘curbsides.’ Our telemedicine is a DM strategy and a continuing education strategy provided by the Your Doctor Program, L.P. The medical home doctors can choose to use it or not. They may decide to use usual care processes, which is fine.”

Medicare Moving into Medical Home

September 21st, 2009 by Melanie Matthews

Medicare is moving into the Medical Home in a big way. Last week the federally administered health insurance system for persons 65 and older got the green light to participate in state multi-payor patient-centered medical home (PCMH) initiatives — a featured story in this week’s Healthcare Business Weekly Update. Medicare is also set to launch its own three-year PCMH demo that will pay eligible physicians a monthly care management fee for medical home services for high-need patients — those with prolonged or chronic illnesses that require regular medical monitoring, advising or treatment.

This is good news on all fronts. With the management of chronic conditions in older adults taxing healthcare resources, Medicare should be participating in multi-payor PCMH collaborations. In 2008, Medicare’s annual costs were 3.2 percent of the GDP. According to the CMS Chronic Condition Data Warehouse, 50 percent of Medicare FFS beneficiaries were receiving care for one or more chronic conditions in 2005. The medical home is built to manage the complexity of care and multiple medical providers required by multi-morbid patients.

With evidence mounting that the medical home produces better care at no added cost, it makes sense for Medicare to adopt the patient-centered team approach for its beneficiaries. Participating physicians are likely to see results well before the pilot’s end, especially among baby boomer patients that embrace disease management e-health tools wired into the medical home.

Medicare Moving into Medical Home

September 21st, 2009 by Melanie Matthews

Medicare is moving into the Medical Home in a big way. Last week the federally administered health insurance system for persons 65 and older got the green light to participate in state multi-payor patient-centered medical home (PCMH) initiatives — a featured story in this week’s Healthcare Business Weekly Update. Medicare is also set to launch its own three-year PCMH demo that will pay eligible physicians a monthly care management fee for medical home services for high-need patients — those with prolonged or chronic illnesses that require regular medical monitoring, advising or treatment.

This is good news on all fronts. With the management of chronic conditions in older adults taxing healthcare resources, Medicare should be participating in multi-payor PCMH collaborations. In 2008, Medicare’s annual costs were 3.2 percent of the GDP. According to the CMS Chronic Condition Data Warehouse, 50 percent of Medicare FFS beneficiaries were receiving care for one or more chronic conditions in 2005. The medical home is built to manage the complexity of care and multiple medical providers required by multi-morbid patients.

With evidence mounting that the medical home produces better care at no added cost, it makes sense for Medicare to adopt the patient-centered team approach for its beneficiaries. Participating physicians are likely to see results well before the pilot’s end, especially among baby boomer patients that embrace disease management e-health tools wired into the medical home.

How to Decrease Heart Failure Rehospitalizations

September 16th, 2009 by Melanie Matthews

Lenore Blank, administrative manager of the heart failure team and pulmonary hypertension program at Hackensack University Medical Center, describes a three-tiered approach to keeping heart failure patients from returning to the hospital.

The goal is to decrease re-hospitalizations for this patient group, and empower and assist patients to develop self-management skills critical to keeping themselves out of the hospital. The outpatient center is modeled after the chronic care model. We have one heart failure physician and an office staffed with heart failure nurses. When patients call, they know they’ll be able to speak with a heart failure nurse, and that it’s an open-door policy. Patients know they can come in if they’re not feeling well, if they’re symptomatic, or if they are concerned about something they ate and want to check their Basic Metabolic Panel (BNP) level. We have very active, informed patients, and we try to give them the tools they need to succeed. For example, if they do not have a scale at home, we’ll provide one. We also have a support group that meets monthly, and we have added a consumer group as a spin-off of the support group. This allows us to check in with patients to find out what we can do better and whether we’re covering everything that’s important to them.

We have two nurses that job-share the telephone follow-up program. We developed the telephone follow-up program to reduce the gaps for patients who may not be eligible for or who refuse home care. The program provides education. The goal is to catch things early and then follow-up with the physician. Since they’ve formed healing relationships with the physician, the patients often want to come in. They want to meet the nurse they’d been talking to — the call may be one of the few calls they get in a week. The goal of the program is to decrease re-hospitalization by providing seamless care, including self-management skills and tools.

We developed the subacute care initiative because we saw the high readmission rate for patients discharged to skilled nursing facilities. We focused on one consortium of subacutes, and helped them with the management of these patients. The first thing we did was to put patients on a two-grams-of-sodium-per-day diet. We also made sure patients were being weighed daily. We offered nurses many in-service training programs, and went in once a week on rounds to check on these patients. We would make sure the nurses were brought in to look at a particular patient’s edematous legs or listen to their lungs. There’s been a huge improvement in this population.

How to Decrease Heart Failure Rehospitalizations

September 16th, 2009 by Melanie Matthews

Lenore Blank, administrative manager of the heart failure team and pulmonary hypertension program at Hackensack University Medical Center, describes a three-tiered approach to keeping heart failure patients from returning to the hospital.

The goal is to decrease re-hospitalizations for this patient group, and empower and assist patients to develop self-management skills critical to keeping themselves out of the hospital. The outpatient center is modeled after the chronic care model. We have one heart failure physician and an office staffed with heart failure nurses. When patients call, they know they’ll be able to speak with a heart failure nurse, and that it’s an open-door policy. Patients know they can come in if they’re not feeling well, if they’re symptomatic, or if they are concerned about something they ate and want to check their Basic Metabolic Panel (BNP) level. We have very active, informed patients, and we try to give them the tools they need to succeed. For example, if they do not have a scale at home, we’ll provide one. We also have a support group that meets monthly, and we have added a consumer group as a spin-off of the support group. This allows us to check in with patients to find out what we can do better and whether we’re covering everything that’s important to them.

We have two nurses that job-share the telephone follow-up program. We developed the telephone follow-up program to reduce the gaps for patients who may not be eligible for or who refuse home care. The program provides education. The goal is to catch things early and then follow-up with the physician. Since they’ve formed healing relationships with the physician, the patients often want to come in. They want to meet the nurse they’d been talking to — the call may be one of the few calls they get in a week. The goal of the program is to decrease re-hospitalization by providing seamless care, including self-management skills and tools.

We developed the subacute care initiative because we saw the high readmission rate for patients discharged to skilled nursing facilities. We focused on one consortium of subacutes, and helped them with the management of these patients. The first thing we did was to put patients on a two-grams-of-sodium-per-day diet. We also made sure patients were being weighed daily. We offered nurses many in-service training programs, and went in once a week on rounds to check on these patients. We would make sure the nurses were brought in to look at a particular patient’s edematous legs or listen to their lungs. There’s been a huge improvement in this population.

Remote Monitoring for Heart Failure Reduces Readmissions, Reaps ROI

September 16th, 2009 by Melanie Matthews

Remote monitoring of heart failure patients by Henry Ford Health System’s patient-centered team care program reduced expected all-cause hospital admissions for enrollees by 36 percent after six months and generated a return of 2.3:1 vs. program costs. The Michigan non-profit healthcare enterprise began using Tel-Assurance, Pharos Innovations’ device-free remote patient monitoring (RPM) platform, at its clinics on July 21, 2008 as part of its patient-centered medical home (PCMH) model; the reporting period ran through December 31, 2008.

In describing the telemedicine outreach during a recent HIN interview on the value of health IT in behavior change, Katherine Scher, a program manager for Henry Ford Health System, said that the remote monitoring effort relieved the burden on Henry Ford’s case managers, who were “busy contacting and working with patients with various conditions and trying to move them into a healthier state.” She also shared a program strategy that likely contributed to enrollment and engagement rates of greater than 60 percent.

“We made sure that when we delegated the enrollment to the Pharos team, that they knew the correct pronunciation of the physicians’ names. That seems like a small thing, but it’s not. If you’re a patient receiving a call from someone asking you to participate in a program and the person doesn’t pronounce your physician’s name correctly, it takes all credibility away. That’s the level of detail and preparation that went into developing this outreach process.”

Get more information on the study.