Archive for October, 2009

New Treatment for Heart Disease Patients

October 30th, 2009 by Melanie Matthews

According to the American Heart Association, cardiovascular disease (CVD) is America’s leading health problem and the leading cause of death. At least 80 million people in this country suffer from some form of CVD. In this week’s issue, you will discover new uses for two existing medications in the treatment of a certain type of heart disease as well as the results of a study of doctors’ attitudes toward obese patients.

Plus, learn how employers can leverage health plan support for smoking cessation.

Improving Patient Motivation for Medication Adherence

October 29th, 2009 by Melanie Matthews

Connie Commander, past president of the Case Management Society of America and president of Commander’s Premier Consulting Corporation, suggests guidelines to improve patient motivation for medication adherence.

Case management adherence guidelines from the Case Management Society of America (CMSA®) use validated tools to improve adherence. We’ve gotten many variations; some are disease-specific. This tool has concepts presented by the World Health Organization (WHO). The guidelines provide an interaction and management algorithm. We built in some concepts that strive to improve a patient’s knowledge and motivate them to take their medications. That’s how it started, but now it’s grown to the complete treatment plan. If you can get a person to follow the medication regime, you can probably get them to follow the whole treatment plan. The guidelines provide great flexibility so that each patient’s needs can be taken into account.

A WHO white paper on medication adherence in long-term therapies focused on the clinical model and chronic care conditions. It determined that you must have three pillars: information, motivation and behavioral skills. You can rest upon them and get a behavior change. However, without one of them, you won’t get a sustained behavior change. We evaluated tools that were already being studied. We came up with an algorithm to assess patients within the adherence guidelines. The results of the assessment are literacy, knowledge, willingness to change and peer support. We must have those four components, and then we measure the degree of each component. In other words, is the patient’s knowledge or motivation high or low? That tells the case manager the type of intervention that patient needs. Obviously, we’d like to move everyone into a level four where they’re highly motivated and have all the knowledge they need to maintain and take care of themselves. But that doesn’t always happen.

Patients are constantly switching quadrants. There is a way of measuring, and case managers utilize tools to determine if their interventions are working to improve on this algorithm as to the patient’s knowledge or motivation.

Health literacy is defined as the ability to read, understand and act on health information. There are three validated tools currently in use to assess health literacy. They are:

Rapid Estimate of Adult Literacy in Medicine — Revised (REALM-R)
Medication Knowledge Survey
Modified Morisky Scale

Rise in Remote Monitoring Means No Patient Left Behind

October 28th, 2009 by Melanie Matthews

Half of respondents engaged in telehealth remotely monitor health conditions of certain patients, especially those with heart failure, according to a new study on telehealth and telemedicine by the Healthcare Intelligence Network (HIN).

Nearly 84 percent of respondents who monitor patients remotely are focused on patients with heart failure. The HIN September 2009 Telehealth Benchmarks e-survey examined the application of telehealth for clinical and non-clinical purposes, the prevalence of remote monitoring, the medical conditions most often targeted by remote monitoring and the impact of telehealth on healthcare access, efficiency, cost and outcomes.

“With rising healthcare costs fueling much of the debate surrounding healthcare reform, many healthcare organizations are turning to telehealth and telemedicine to lower costs and improve efficiencies while expanding patients’ access to services — particularly in rural areas,” noted Melanie Matthews, HIN executive vice president and chief operating officer. “The survey results offer a glimpse into a healthcare future where no patient is left behind because of a lack of access.”

2009 Telehealth Benchmarks: Wired for Access and Efficiency, a complimentary executive summary of responses from 139 healthcare organizations, captures trends and metrics in the use of telehealth and telemedicine and identifies emerging applications of these technologies.

Remote monitoring of heart failure patients by Henry Ford Health System has been credited with reducing hospital admissions in this population. A September 2009 study found that the health system reduced expected all-cause hospital admissions for enrollees by 36 percent after six months of enrollment and a return of 2.3:1 vs. program costs.

Dr. Randall Williams, CEO of Pharos Innovations, the developer of the Tel-Assurance® remote patient monitoring platform used in Henry Ford’s medical home pilot, says the daily engagement of Medicaid beneficiaries in self-care health monitoring programs can help healthcare organizations avoid many of the challenges of working with an underserved population. Click here to listen to Dr. Williams describe participants’ receptivity to the daily contact once they are identified, which has resulted in extremely high program engagement rates.

Dr. Williams referred to the AHRQ report, “Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill and Underserved,” which concludes that from a consumer’s perspective, programs and technologies that support disease management programs need to have a perception of benefit to the individual who will be using them. Also, they have to be perceived as convenient and as something that can be easily integrated into the daily activities of that individual patient or member.

The Healthcare Intelligence Network conducts monthly e-surveys on topics of interest to the healthcare industry. To review results from recent surveys, please click here. HIN survey results are indicated by the red and blue “HIN” logo.

Resources for the H1N1 Emergency

October 26th, 2009 by Melanie Matthews

President Obama’s declaration of H1N1 as a national emergency late last week allows healthcare systems to quickly implement disaster plans if necessary. As health officials worldwide strive to separate H1N1 hype from reality, hospitals, governments, businesses and schools are bracing for swine flu fallout.

In a featured story in this week’s Healthcare Business Weekly Update, nearly all ER docs who responded to an American College of Emergency Physicians survey are worried that their ERs won’t be able to handle an influx of additional flu patients.

England’s CMO reported that H1N1 cases doubled last week to 53,000 from 27,000 the previous week, during the same period when thousands of U.S. citizens queued up for a shot at a swine or seasonal flu vaccine. A Boston high school is closed through tomorrow due to high numbers of sick students. (The school Web site recommends that “students NOT co-mingle with each other” during this period.) Citing the vaccine shortage, New York last week backed away from mandatory vaccination of healthcare workers, who had earlier protested that the mandate was a violation of civil rights and put them at risk of serious illness and even death.

While flu vaccines may be in short supply, H1N1 and seasonal flu information and resources are not, and more than half of healthcare organizations who responded to a survey on patient education are teaching patients about H1N1.

Here are just a few helpful resources that can be found online:

Transition Coaching Targets Adults at High Risk of Readmission

October 23rd, 2009 by Melanie Matthews

Danielle Butin, former director of Northeast Health Services for SecureHorizons, a division of UnitedHealthcare, discusses how health coaching programs have benefited managed care members’ health.

Using a health coaching model in a managed care environment has positively impacted our membership in a number of ways. We have seen a steady reduction in claims based upon this program. Members have reported improved functional status and quality of life. In monitoring diabetics over several years, for example, we have seen a reduction in the related complications that one would anticipate in a Medicare population over such long periods of time. It is important to note that this is contrary to the way care is rendered to older adults in this country. There is definitely a dependency/age bias in the way care is delivered, the expectations of the older adult and people making decisions for them. Our premise is that cognitively intact older adults are capable of learning a new set of skills. In other words, “you can teach an old dog new tricks.” That is the basis for our belief system around this program. It means that members must learn a new language, use a whole new set of tools and take control of their own health.

One practical application of the programs we currently run is the transition coach program.

We are currently enrolling Medicare members into our transition coach program using a tool developed within Oxford. It weighs in aspects of hospital performance around specific Diagnosis-Related Groups (DRGs), physicians’ performance around specific DRGs and the Ingenix Impact Pro(TM) system. These factors come together to provide a predictive tool score that is sensitive and specific to those members who, within 30 days, will be back in the hospital. We assign those members a nurse practitioner (NP) to call them and initiate a home visit. It is not a visit where the expectation is to call their doctor or pharmacist or take care of them in the traditional sense. Primarily, the NP will review the medications the member was on prior to their hospitalization, as well as those they’re on following their discharge. The most powerful point in this entire intervention process is reconciling discrepant medications, since discrepant medications are the major factor that causes readmission. Therefore, the NP creates a discrepant medication list for the patient to take to their PCP. The goal is to see the patient within the first week of discharge prior to their first follow-up PCP visit.

Ideally, an informed, empowered, educated, confident member will go to their PCP with a list of medications, developed and noted by a credible and reliable NP. Typically, doctors are grateful to know that an NP reviewed these medications. They can then make decisions based on this information. There are usually two to three follow-up calls from the nurse practitioner to the patient. The goal of this program is not long-term case management. Rather, the goal is to empower members at risk for hospitalization with the knowledge they need to feel confident in taking control of their healthcare.

Connecting the Dots in Alzheimer’s and Dementia Studies

October 23rd, 2009 by Melanie Matthews

Researchers are connecting the dots in their studies of Alzheimer’s disease and dementia, learning how skills tests can be an indicator for Alzheimer’s disease and why advanced dementia is considered a terminal illness.

Also in this week’s DM Update, discover how lupus patients can better manage their condition and avoid cardiovascular disease.

H1N1 Facts Among Top Lessons Taught by Patient Educators

October 22nd, 2009 by Melanie Matthews

Almost half of healthcare organizations that conduct patient education and outreach teach about the diagnosis, spread and treatment of the H1N1 flu, according to a new survey on patient education and outreach efforts conducted by the Healthcare Intelligence Network (HIN).

Simple interventions such as the education of patients in the self-care and prevention of medical conditions can help to reduce hospitalizations and readmissions, explains Melanie Matthews, HIN executive vice president and chief operating officer. The HIN August 2009 Patient Education and Outreach Benchmarks e-survey examined the prevalence of patient and member education programs, the health areas addressed by these efforts, healthcare education delivery methods, the chief impact of patient education programs and the measurement of ROI from education and outreach programs.

Benchmarks in Patient Education: Prevention, Self-Care Top Lessons, a complimentary executive summary of responses from 134 healthcare organizations, offers lessons in the value of educating patients and members about disease management and self-care.

“A patient or health plan member who grasps their healthcare options, the plan of care for a chronic condition and the impact of their behaviors on health status is far less likely to wind up in the hospital or the emergency room for treatment of an avoidable condition,” adds Matthews. “Healthcare organizations are learning that an investment in patient and member education is money well spent.”

Healthcare providers looking to jump-start patient outreach should reach no further than their appointment calendar, recommends Barbara Wall, a healthcare consultant who advises organizations on adoption of the patient-centered medical home (PCMH) model of care. Click here to listen to Ms. Wall describe the simple steps that medical home staff can follow to turn the appointment calendar into a patient teaching, recall and outreach tool.

Ms. Wall provides an example of how a medical assistant trained in patient teaching and outreach can impact health outcomes: “When the MA identifies that the patient hasn’t had a diabetic foot exam, she may call the patient prior to their visit and say, “Can you come in 15 minutes early? I’d like us to sit down, we’ll do the foot exam, and I can teach you about what you need to look for.”

The Healthcare Intelligence Network conducts monthly e-surveys on topics of interest to the healthcare industry. To review results from recent surveys, please click here. Survey results are indicated by the red and blue “HIN” logo.

How to Move Doctors Along the Improvement Curve

October 19th, 2009 by Melanie Matthews

Sometimes a little healthy competition in a quality improvement effort gets results, whether at the practice level or hospital-wide. To encourage its five physicians to use evidence-based guidelines, Greenhouse Internists’ health educator posts monthly physician-reported results of HEDIS diabetes measures — the percentage of diabetics who had A1C’s over 9 or under 7, for example — over the microwave in the practice’s kitchen.

“When you go to put your sandwich in the microwave oven, you can’t help but stare at this chart and see where you are relative to your colleagues,” explains Greenhouse Internists President Richard J. Baron, M.D., F.A.C.P. Dr. Baron says presenting comparative performance data helps motivate the doctors to change, gives them a sense of how they’re doing with respect to evidence-based guidelines and moves them along the improvement curve.

This week’s Healthcare Business Weekly Update features a study from the Center for Studying Health System Change that suggests strategies for increasing participation by time- and funding-strapped physicians in quality improvement programs. Beyond a visible program champion and clear communications, the study recommends the use of “credible data to identify areas that need improvement…physicians assume they are providing good quality of care until they are shown data proving otherwise.”

And as healthcare reform moves into the next phase, did last week’s passage of the Senate Finance Committee healthcare bill affect your expectations for the coming year? Take the 2010 Healthcare Trends e-survey by October 31 and find out how your colleagues are gearing up for the next 12 months.

Brain and Breast Cancer Trends

October 16th, 2009 by Melanie Matthews

In this issue, you will discover the link between physical activity and brain cancer and the relationship between pathological complete response rates and race in women with breast cancer. On the H1N1 front, the CDC and pharmacists are working together to promote appropriate antibiotic use during this flu season.

Benchmarks in Integration of Primary and Behavioral Health

October 15th, 2009 by Melanie Matthews

Several strategies to minimize the direct and indirect impacts of depression on healthcare utilization and cost include the screening for depression by disease management programs, particularly for patients with chronic illnesses associated with high rates of depression. In addition, the adoption of the patient-centered medical home (PCMH) model, which coordinates all aspects of an individual’s care under one medical home roof, is another vehicle for improving the care delivered to individuals with severe mental illnesses.

The Depression and Disease Management in 2008 survey set out to measure the prevalence of depression management programs in the healthcare industry and identify successful program elements and delivery methods.

Responses to the 2008 survey were submitted by 261 organizations. Of 122 respondents with depression management programs that identified their organization type, 20.5 percent were disease management organizations, 19.7 percent were health plans, 12.3 percent were behavioral healthcare providers, 9 percent were PCPs and almost 5 percent were employees. Almost a quarter of respondents — 23.8 percent — categorized their organization type as “Other,” a category that included health systems, health departments, healthcare consultants, population health management and employee assistance programs, among others.

Prevalence of Depression Management Programs

More than two-thirds — 67.2 percent — of healthcare professionals responding to the e-survey target depression as part of their disease management programs. Of 82 responding organizations that do not target depression, almost half — 47.4 percent — plan to do so in the next 12 months. While some programs that will be launched in the next 12 months are still in development, some of these respondents indicate that they plan to target employees of self-insured companies, a percentage of the elderly population (aged 60 and over) and commercial and Medicare Advantage plans.

In other future initiatives, a health and wellness organization plans to target employers for group coaching for depression and stress management, while a PCP will respond to high teenage suicide rates with regular screening for depression among this group.

Twenty-one percent of respondents noted that their depression management programs were stand-alone efforts, while 68.9 percent responded that their efforts were integrated programs. Others described their programs as “integrated to a point,” “a multiple-modality behavioral health intervention,” based on the “pyscho-social rehabilitation model” and “referring to community mental health agencies.”

According to survey responses, depression management programs are delivered via several methods, including:

  • Telephonic (67.2 percent);
  • Printed materials (58.8 percent);
  • In-person (48.7 percent); and
  • Web-based (31.9 percent).

Respondents also noted other methods of program delivery, including direct presentation, remote monitoring technology/interactive voice response (IVR) and community referrals to mental health agencies.