Archive for December, 2009

Avoiding Care Breakdowns That Lead to Readmissions

December 7th, 2009 by Melanie Matthews

Five potential care breakdowns and how to avoid them are detailed in this week’s Healthcare Business Weekly Update. Also profiled is a groundbreaking Baton Rouge pilot pairing a hospitalized patient with a health coach to prepare for post-discharge and getting great results — an 80 percent reduction in unnecessary readmissions. As Aetna’s national medical director for Medicare Dr. Randall Krakauer said during last week’s conference on Aligning Reimbursement to Readmissions, “If we can cut even a minority of these avoidable readmissions, the savings and cost is considerable and the quality issues are even greater.” Dr. Kraukauer describes Aetna’s focus on the post-discharge period in its care transitions program for Medicare beneficiaries.

Our November survey on readmission reduction strategies is now closed, but you can still request a free summary of the results when they are compiled later this month to learn how more than 100 healthcare companies are working to reduce avoidable readmissions.

Diabetes Cases, Costs on Rise

December 7th, 2009 by Melanie Matthews

Diabetes cases are expected to double in the next 25 years. In this issue of the DM Update, you will learn about CVS Caremark’s medication adherence program for diabetics, trends in diabetes cases and costs for the next 20-some years, and a new pilot program from BCBSA to help reduce the rates and cases of childhood obesity and diabetes.

Could the Use of Incentives Drive Participation in Health and Wellness?

December 3rd, 2009 by Melanie Matthews

Three industry experts discuss the use and impact of incentives in gaining participation in health and wellness initiatives.

The number of employers who are using incentives today to drive participation in health and wellness initiatives is on the rise, notes Jennifer Hidding, former director of interactive health management of consumer solutions at OptumHealth. “In 2007, 62 percent of employers were engaging in some incentive program supporting their behavior change or health and wellness programs. By 2008, that had jumped up to 71 percent — almost a 10 percent increase in one year as employers recognize the need to drive engagement and motivate employees through incentives. From 2007 to 2008, gift cards and premium reductions have made a huge swing in the marketplace. The increase in gift cards is almost exactly offset by the decrease in premium reductions. We believe this is happening because gift cards offer an instant gratification access. It’s the world we live in today — people want it now. Once they’ve completed the activity, they want their payout almost immediately. Gift cards are very tangible, and they offer consumer choice.”

Ted Borgstadt, co-founder and CEO of TrestleTree, Inc., advises that organizations give careful thought to incentive programs. “The whole concept of incentives is a very critical one to understand for your population, but it’s also dangerous. The first question that arises is, ‘What do you do when you take that stimulus away?’ Is it truly behavior change, or is there a stimulus, and you’re only going to do something while the stimulus is there? We all have to make sure we align incentives to get people into the program. With the individual, there may be some incentive for participation, and incentives can still be used to help drive success. But if that is the key lever to say, ‘Let’s just give accountability and then let’s put an incentive in place,’ you’re going to be very limited on the number of people that you’re going to enroll in the program and have sustainable change on the back side.”

Many organizations have noted a dramatic impact on enrollment when incentives are used. Notes Roger Reed, chief consumer engagement architect for Gordian Health Solutions, “If the program is incentivized — typically a $20 to $30 per member per month (PMPM) incentive or premium differential — the enrollment rate rises dramatically to between 65 and 85 percent. Those individuals who know that their paycheck is going to be touched every month will enroll if they’re eligible. Virtually nobody drops out. We have an incentive program whereby we ‘touch’ their paycheck. We change their premium contribution based on their compliance with the coaching effort that month. We turn this contribution off and on.”

If participants are incentivized, they don’t drop out, Reed continues. “Close to 90 percent remain enrolled for the entire year because they don’t want their paycheck touched. If participation is voluntary, half of them will have dropped out by the six-month point, and another 25 percent between the six- and 12-month point, so only about 25 percent will continue.”

Could the Use of Incentives Drive Participation in Health and Wellness?

December 3rd, 2009 by Melanie Matthews

Three industry experts discuss the use and impact of incentives in gaining participation in health and wellness initiatives.

The number of employers who are using incentives today to drive participation in health and wellness initiatives is on the rise, notes Jennifer Hidding, former director of interactive health management of consumer solutions at OptumHealth. “In 2007, 62 percent of employers were engaging in some incentive program supporting their behavior change or health and wellness programs. By 2008, that had jumped up to 71 percent — almost a 10 percent increase in one year as employers recognize the need to drive engagement and motivate employees through incentives. From 2007 to 2008, gift cards and premium reductions have made a huge swing in the marketplace. The increase in gift cards is almost exactly offset by the decrease in premium reductions. We believe this is happening because gift cards offer an instant gratification access. It’s the world we live in today — people want it now. Once they’ve completed the activity, they want their payout almost immediately. Gift cards are very tangible, and they offer consumer choice.”

Ted Borgstadt, co-founder and CEO of TrestleTree, Inc., advises that organizations give careful thought to incentive programs. “The whole concept of incentives is a very critical one to understand for your population, but it’s also dangerous. The first question that arises is, ‘What do you do when you take that stimulus away?’ Is it truly behavior change, or is there a stimulus, and you’re only going to do something while the stimulus is there? We all have to make sure we align incentives to get people into the program. With the individual, there may be some incentive for participation, and incentives can still be used to help drive success. But if that is the key lever to say, ‘Let’s just give accountability and then let’s put an incentive in place,’ you’re going to be very limited on the number of people that you’re going to enroll in the program and have sustainable change on the back side.”

Many organizations have noted a dramatic impact on enrollment when incentives are used. Notes Roger Reed, chief consumer engagement architect for Gordian Health Solutions, “If the program is incentivized — typically a $20 to $30 per member per month (PMPM) incentive or premium differential — the enrollment rate rises dramatically to between 65 and 85 percent. Those individuals who know that their paycheck is going to be touched every month will enroll if they’re eligible. Virtually nobody drops out. We have an incentive program whereby we ‘touch’ their paycheck. We change their premium contribution based on their compliance with the coaching effort that month. We turn this contribution off and on.”

If participants are incentivized, they don’t drop out, Reed continues. “Close to 90 percent remain enrolled for the entire year because they don’t want their paycheck touched. If participation is voluntary, half of them will have dropped out by the six-month point, and another 25 percent between the six- and 12-month point, so only about 25 percent will continue.”

Healthcare Trends for 2010: Reform, Revenue & Resources

December 2nd, 2009 by Melanie Matthews

In a year when healthcare reform shared the spotlight with the health of the economy, just over two-fifths — 41.7 percent — of respondents said 2009 was a better year for their organization than 2008, according to results of a new study of healthcare trends for 2010 by the Healthcare Intelligence Network (HIN).

The year’s weak economy had the most significant impact on business operations, said almost three-fourths of respondents (71.2 percent). Just over half of respondents — 52.1 percent — expect some version of healthcare reform to be enacted before the close of 2009, with cost containment the most important aspect of healthcare reform for one-sixth of respondents (16.8 percent).

The HIN Healthcare Trends for 2010 e-survey examined the most pressing issues for healthcare organizations as they prepare for the new year and documented the ideas and programs that contributed to respondents’ profitability as well as healthy outcomes for patients, members and employees.

“These survey results leave no doubt that healthcare reform — particularly those areas dealing with coverage, reimbursement, quality and performance, and access — are of paramount importance to the healthcare executives responding to this survey,” noted Melanie Matthews, HIN executive vice president and chief operating officer. She noted the value of the survey data to executives planning for the coming business year and praised the entrepreneurship and creativity of organizations that launched new products and streamlined operations to maximize profitibility — examples of which are contained in the Trends 2010 survey summary.

Healthcare Trends for 2010: Reform, Revenue & Resources Top of Mind is a complimentary executive summary of responses from 100 healthcare organizations who ranked top-of-mind concerns for the year ahead and reported their organizations’ best and worst business decisions in 2009.

According to healthcare consultant William DeMarco, president and CEO of DeMarco and Associates, the seeds of reform have already been planted. “We’re watching what’s happening on a state-by-state basis in Minnesota, Wisconsin and Massachusetts, and other places around the country, and seeing reform happen before our very eyes,” DeMarco observed during a recent webinar on 2010 Healthcare Marketplace and Health Reform Drivers. “Things like funding for comparative effectiveness are already here. This isn’t something companies have to wait for under a healthcare reform plan; it was part of the stimulus package.

“The conversion to ICD-10 has been talked about for years and years,” he continued. “The more programs that give providers severity-adjusted information, the more clearly the providers and payors will see eye-to-eye to determine what needs to be done. It doesn’t have to be done from on high. It can be done at a local level, a regional level or a statewide level.”

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