Archive for October, 2009

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.

Depression Casts Shadow on Healthcare Costs

October 12th, 2009 by Melanie Matthews

Even before the economic downturn, there has been a growing recognition that depression must be identified and treated because of its comorbidity with other chronic conditions. The National Council for Community Behavioral Healthcare reports that individuals with severe mental illness (SMI) are dying 25 years younger than the rest of the population — potentially as a result of the treatment system surrounding these individuals.

And in a featured story in this week’s Healthcare Business Weekly Update, a new survey finds that unemployed individuals are four times as likely as the employed to report symptoms consistent with SMI; workers whose hours or pay has been cut are twice as likely to have these symptoms. Also this week, read about the industry trend toward integration of primary and mental health, the targeted populations and optimal program delivery methods.

Obesity Impacts for Women

October 9th, 2009 by Melanie Matthews

In this week’s issue, learn how obesity can affect women during pregnancy and how being overweight can increase their chances of developing more health problems later in life. However, the good news is that workplace wellness programs can help to prevent obesity and lower healthcare costs.

Can Physicians Effect Behavior Change During Office Visits?

October 7th, 2009 by Melanie Matthews

Kristin S. Vickers Douglas, Ph.D., L.P., clinical health psychologist and medical director of Mayo Clinic’s EmbodyHealth program, discusses whether an office visit delivers enough time to effect behavior change in a patient.

Question: Does the brief duration of the typical physician-patient encounter allow enough time for a physician to effect behavior change?

Response: Powerful things can happen in seconds. Think about practicing motivation enhancement, relationship-building and patient-centered care, and embedding that in everything that we do, even if it’s taking vital signs. Make sure that you’re listening and positively reinforcing anything that a patient is doing, paying attention to how you talk to an individual and help elicit change talk. It’s important that physicians are practicing this patient-centered relationship-building. Research shows that not only is this a positive outcome in terms of patient satisfaction with the physician relationship, but also that it drives important outcomes, such as patient health status and adherence to medical recommendations, if the patient rates the relationship as positive and collaborative.

Physicians are aware that this goes beyond the nice extra of having your patients like you. These relationship skills are important and can be embedded within every second that they’re talking to the patient. There is compelling evidence about the feasibility of building in everything at the point of care that is physician-delivered. We need to have models of care, and this is happening across chronic conditions, diabetes, asthma and now even depression. There is emphasis in getting care teams that involve roles such as care managers — who have also been called health coaches — to extend beyond the patient-physician encounter. That is the work of collaborative goal-setting — identifying the next step and then having the critical follow-up to see how it goes. Setting a goal is one thing, but learning from that experience and figuring about where to go from there is perhaps the more important step. There’s a recognition that our current systems aren’t set up to do that within a patient-physician encounter. I’m excited to see that there are even reimbursement changes from third-party payors to start to help support these shifts in care. It all goes back to lifestyle. What happens outside of the physician’s office drives so much of gaining health and maintaining health.

Health IT Improves Care Management

October 6th, 2009 by Melanie Matthews

A new HHS report describing how Columbia Basin Health Association’s (CBHA) use of health IT is improving care for its 25,000 patients is a featured story in this week’s Healthcare Business Weekly Update. Using its EHR to more closely track key screenings in patients with diabetes over a five-month period in 2008, CBHA more than doubled the number of patients with diabetes who received foot and eye exams.

A quick look at our just-completed e-survey on the use of telehealth indicates that more than half of respondents use telehealth for clinical and non-clinical purposes. Like CBHA, key candidates for respondents’ telehealth efforts are patients with chronic illness, with remote monitoring in use by half of survey respondents. To get an executive summary of the completed results of the Telehealth in 2009 survey — including the top use for telehealth, telecommunications technologies in use, top funding sources and key metrics impacted by the use of telehealth, email me at pdonovan@hin.com.

Smoking Cessation in Communities

October 2nd, 2009 by Melanie Matthews

In this issue of the Disease Management Update, community-based efforts in smoking cessation — from smoking bans in three parts of the world to disease prevention programs on tobacco use — are improving heart health problems. Because of these community efforts, fewer neighbors are becoming sick from secondhand smoke.

3 Health Coaching Models for Behavior Change

October 1st, 2009 by Melanie Matthews

Roger Reed, chief consumer engagement architect for Gordian Health Solutions, describes three key health coaching models that engage patients and bring about successful behavior change.

As we move down this path toward “health coaching 3.0,” we note some of the foundations that have to be in place before you can develop a good model of engagement and behavior change through coaching. Some models having more impact than others are stages of change or transtheoretical model, which has been around for quite some time; positive psychology, patient activation and the enhanced collaborative care model. The components of a successful coaching model are going to blend all of these things with self-efficacy and risk perception, values, experiences, barriers and resources. In fact, there have been several researchers over the last decade who have tried to create a unified theory. Ralf Schwarzer attempted that in Germany, and Michael O’Donnell did some work in that area as well. You try to envision a person holistically, and look at how all of these theories come into play for any particular individual. We’re not quite there yet, but it’s an interesting mental exercise.

Positive psychology is a new field of psychology developed by Martin Seligman, probably the preeminent psychologist in the world today. Positive psychology is the study of the conditions or processes that contribute to the flourishing of optimal functioning of individuals, families, groups and organizations. His research has proven that personal belief, optimism and strength, which is a sense of personal control, are protective factors psychologically for mental health, and physically for physical health. He has a full array of information around building on strength, helping people learn optimism and take control of their lives.

Dr. Judith Hibbard can be credited with the Patient Activation Measure™ (PAM), which stages a patient or participant across four stages. If you can figure out where this person is using the PAM survey instrument, that gives you insight into the strategies you need to employ for that person, for their education and support. That’s a promising new area of study.

David Wennberg at Health Dialog has published a white paper on the enhanced collaborative care model. Its model is based on shared decision-making, when all options are known and considered, including advanced analytics for outreach and coaching. In a one-year study, they randomized 170,000 people and put them through this enhanced collaborative care decision-making support coaching model. It showed a decrease in hospitalizations and a reduction in medical expenses, and much of the savings that they measured came from preference-sensitive conditions. Those are conditions in which the individual, knowing all the facts about treatment options, made a decision based on their life preferences for a specific treatment modality. In terms of analytics, ROI and metrics, we’re all marching with Healthcare Effectiveness Data and Information Set (HEDIS) measures and URAC and National Committee for Quality Assurance (NCQA) measures that have denominators around specific evidence-based guidelines. When you start moving into areas of preference sensitivity, you’re going to have individuals who elect not to follow an evidence-based guideline because of the potential impact it would have on their future health or future social well-being. They may in fact choose a method of treatment that isn’t evidence-based, because that’s their preference. That starts to raise questions: Do we have the right denominator in that situation? What would the metric be if that individual’s choices are personalized for themselves?

3 Health Coaching Models for Behavior Change

October 1st, 2009 by Melanie Matthews

Roger Reed, chief consumer engagement architect for Gordian Health Solutions, describes three key health coaching models that engage patients and bring about successful behavior change.

As we move down this path toward “health coaching 3.0,” we note some of the foundations that have to be in place before you can develop a good model of engagement and behavior change through coaching. Some models having more impact than others are stages of change or transtheoretical model, which has been around for quite some time; positive psychology, patient activation and the enhanced collaborative care model. The components of a successful coaching model are going to blend all of these things with self-efficacy and risk perception, values, experiences, barriers and resources. In fact, there have been several researchers over the last decade who have tried to create a unified theory. Ralf Schwarzer attempted that in Germany, and Michael O’Donnell did some work in that area as well. You try to envision a person holistically, and look at how all of these theories come into play for any particular individual. We’re not quite there yet, but it’s an interesting mental exercise.

Positive psychology is a new field of psychology developed by Martin Seligman, probably the preeminent psychologist in the world today. Positive psychology is the study of the conditions or processes that contribute to the flourishing of optimal functioning of individuals, families, groups and organizations. His research has proven that personal belief, optimism and strength, which is a sense of personal control, are protective factors psychologically for mental health, and physically for physical health. He has a full array of information around building on strength, helping people learn optimism and take control of their lives.

Dr. Judith Hibbard can be credited with the Patient Activation Measure™ (PAM), which stages a patient or participant across four stages. If you can figure out where this person is using the PAM survey instrument, that gives you insight into the strategies you need to employ for that person, for their education and support. That’s a promising new area of study.

David Wennberg at Health Dialog has published a white paper on the enhanced collaborative care model. Its model is based on shared decision-making, when all options are known and considered, including advanced analytics for outreach and coaching. In a one-year study, they randomized 170,000 people and put them through this enhanced collaborative care decision-making support coaching model. It showed a decrease in hospitalizations and a reduction in medical expenses, and much of the savings that they measured came from preference-sensitive conditions. Those are conditions in which the individual, knowing all the facts about treatment options, made a decision based on their life preferences for a specific treatment modality. In terms of analytics, ROI and metrics, we’re all marching with Healthcare Effectiveness Data and Information Set (HEDIS) measures and URAC and National Committee for Quality Assurance (NCQA) measures that have denominators around specific evidence-based guidelines. When you start moving into areas of preference sensitivity, you’re going to have individuals who elect not to follow an evidence-based guideline because of the potential impact it would have on their future health or future social well-being. They may in fact choose a method of treatment that isn’t evidence-based, because that’s their preference. That starts to raise questions: Do we have the right denominator in that situation? What would the metric be if that individual’s choices are personalized for themselves?