Archive for June, 2011

8 Ways EHRs Can Enhance Care Coordination for the Chronically Ill

June 27th, 2011 by Cheryl Miller

Care planning, provider-patient communications and intra-office coordination are just some of the ways that EHRs can significantly improve care coordination for the chronically ill in a medical home, finds a new report from the eHealth Initiative. The report based its results on a 12-month project that tracked 119 patients with Type 2 diabetes and heart disease at two test sites. Notably, the EHR systems used at both sites had functions to support care coordination that were not utilized. This week’s Healthcare Business Weekly Update issue provides the details.

Also this week, we report on consumers worldwide who are tightening their belts in response to the current tenous economic climate, according to a new Deloitte Center for Health Solutions’ survey of more than 15,000 global healthcare consumers in 12 countries. In the United States alone, more than a third said they were using generic instead of brand name drugs to save money; one fourth of those surveyed in the United States admitted to skipping doctors’ visits entirely.

Eliminating claims payment errors could help to defray some portion of healthcare costs, says the AMA. According to the association’s fourth annual National Health Insurer Report Card, commercial health insurers have an average claims-processing error rate of nearly 20 percent, an increase of two percent from last year. AMA estimates that eliminating health insurer claims payment errors would save $17 billion annually.

And finally, a significant segment of the healthcare industry is reframing its care delivery structure as an accountable care organization (ACO) or will do so in the near future. You can find out more in our new video, 2011 Benchmarks in Accountable Care Organizations: Healthcare ACO Readiness Assessment:

Fast-Tracked Emergency Department Intervention Targets Adult Dental Frequent Utilizers

June 23rd, 2011 by Cheryl Miller

A pilot to reduce emergency room visits by adult dental frequent utilizers in Ohio’s Medicaid population has met with early success, reports Mina Chang, Ph. D., of Ohio’s Department of Job and Family Services.

Unbearable tooth pain and unawareness of dental benefits are two factors behind adult dental frequent ED utilizers, one of three populations targeted by Ohio’s ED collaborative, explained Dr. Chang, chief, health services research and program development section, Bureau of Health Services Research, during today’s webinar. The five-region ED collaborative identified three ‘hot spot’ EDs where there was a high need for dental services as well as local providers for dental care intervention, and secured fast-tracked dental appointments for these patients.

The trial provided a resource for EDs to make dental appointments for its Medicaid members, and the collaborative hopes to expand the initiative.

The dental fast-tracked referrals were among a number of rapidly deployed interventions to reduce ER visits by the Medicaid population. The ED collaborative also targeted upper respiratory infections (URI) with separate interventions for children and adults, as well as frequent ED utilizers with either severe mental illness, chronic back pain or non-mental health conditions. The collaborative’s four-pronged URI intervention for children statewide included a colds toolkit, while an interdisciplinary team approach to reducing ED visits in the other priority populations satisfied patients, changed patient behavior, and increased the number of follow-up appointments kept by the ED visitors.

All of these interventions were deployed using a rapid cycle quality improvement approach, which meant that the collaborative didn’t have to wait years to see results, Dr. Chang explained. The collaborative has a ‘spread team’ so that the interventions can be expanded to other regions in the state. Listen to an interview with Dr. Chang.

5 Rules for Engaging Employees in Health and Wellness Programs

June 20th, 2011 by Jessica Fornarotto

“Employee engagement is the holy grail of well-being, health, and productivity programs. Employers that have achieved real returns from wellness programs recognize the role of engagement — not just in health programs, but in the interconnected health, work, and personal factors we call life. Fortunately, employee engagement is easier than many employers think. Simply following these five ‘rules of engagement’ will help maximize company performance,” suggests Henry Albrecht, CEO of Limeade, Inc.:

  1. Be Relevant
    It’s elementary: self interest drives behavior. In other words, human beings respond to what’s important to them. If you want employees to engage in any type of wellness (or well-being) program, hit them where they live. The most successful programs speak to all of the interests and concerns of employees (I want to feel and look better, have more energy, meet new people, have fun); are clearly and obviously aligned with corporate goals (we want you to be healthier so you cost less to insure, we want to build a strong culture to reduce employee turnover); and are linked to incentives that are personally or financially meaningful to employees (put dollars in my wallet, save on my healthcare premium, give me days off).

  2. Make it Social
    In some ways, social is a logical extension of relevant, as in: “I like to do the things my friends, family and colleagues are doing.” Human beings are social animals (and no one wants to be singled out for behavior modification). Some recent groundbreaking research is demonstrating how things like obesity, alcohol consumption and smoking travel through social networks. According to a social learning theory, peers — those we like and respect — encourage behavior change by modeling and supporting it. Successful programs take a “we’re all in this together” approach with relevant health-enhancing activities (challenges) within a social network. An added benefit: social programs extend beyond work to family and friends.

  3. Stay Positive
    Successful social movements are almost always hopeful and positive. Positive, well-being improvement-oriented approaches encourage rather than threaten; reward rather than punish. Looking at one’s strengths objectively can be a life-altering experience, and can help reframe thinking away from what’s wrong toward what’s possible. When people feel good about themselves and what they’re doing right, they have the fortitude to tackle what isn’t working. And positivity is infectious. Make a list of five employees who have the biggest impact on your workforce (those who lead the most successful teams and the most profitable business units, and attract and retain the best talent), and note how positive these people are. It never occurs to you to think of them as “health cost drivers.”

  4. Integrate, Integrate, Integrate
    Making things complicated is easy. Many employers just keep adding more “point solutions” until their multiplicity confounds and confuses. Ironically, making things hard for employees is easy, and making things easy is hard. Employers typically contract with multiple vendors to provide a variety of wellness, training, ergonomics, EAP, disease management, screening, vaccinations and other services. Some are buried in the bottom drawer of your employees’ filing cabinets — paid for, but unused. It’s your job to help employees navigate the various offerings. The only way to do this is to insist your vendors integrate — and seek those who are open, partner-friendly, integration-optimized, and most importantly, obsessed with making what can be a complex user experience simple for your people.

  5. Play it Safe
    The new era of wellness — including results-based wellness — is uncharted ground for most companies. It is fraught with perceived risk — and some real risk too. Make sure you’ve covered all your bases regarding data integrity, safety, security and regulatory compliance. Your incentive program needs a clear set of rules that are reasonable and fair. Getting these details right will inspire your employees’ confidence, earn their respect and win their engagement. Clear communication at every juncture about what your approach is (and isn’t) reassures people. Perception can easily become reality when you are talking about privacy (and money).

Limeade GreenLine™ is a turn-key solution for results-based wellness programs that combines onsite screenings, advocacy and coaching from Worksite Wellness, assessment, social improvement and incentive management from Limeade, and comprehensive communications consulting from Benz Communications. It was designed to help high-performance employers launch and maintain a results-based wellness program that links meaningful financial savings to independently measurable health results.

24 Ways to Avoid Harmful Prescribing

June 20th, 2011 by Jessica Fornarotto

A new article published online in the Archives of Internal Medicine series Less is More entitled “Principles of Conservative Prescribing” outlines 24 principles for prescribers to learn and practice to avoid many of the pitfalls leading to excessive and harmful prescribing:

  • Think beyond drugs: Consider and learn how to better prescribe non-drug therapies such as diet, exercise or physical therapy; look for and treat underlying causes rather than just masking symptoms with drugs, emphasize prevention rather than just treatment.
  • Practice more strategic prescribing: Defer drug treatment if drugs can be safely started after a trial of non-drug therapy; avoid frequent and unwarranted drug switching; being circumspect about unproven drug uses; start treatment with only one new drug at a time.
  • Maintain heightened vigilance regarding adverse effects: Suspect drug reactions when patients report problems while taking a medication; be aware of drug withdrawal syndromes; educate patients about side effects so they can anticipate and report reactions.
  • Exercise caution and skepticism regarding new drugs: Seek out unbiased information sources; wait until drugs have sufficient time on the market to be proven to be safe; be skeptical about surrogate markers of benefit (such as improving a lab test) rather than true clinical outcomes benefit; avoid stretching indications to include patients or diseases different than those in the clinical trials; avoid seduction by elegant molecular pharmacology without proven outcome benefits; beware of selective drug trial reporting that highlights the positive trials and hides those that fail to show benefit.
  • Work with patients for a shared agenda: Do not automatically accede to patient requests for drugs they have heard advertised, consider non-adherence before adding additional drugs; avoid restarting previously unsuccessful drug treatments; discontinue any medications that are not needed or not working; and respect patients’ own reservations about drugs.
  • Consider long-term, broader impacts: Weigh not just the short term benefits but also long-term patient outcomes and ecologic impacts, recognize that improved prescribing systems and better monitoring of patients on medications may outweigh marginal benefits of new drugs.

The concept of “conservative prescribing,” also referred to as more judicious, rational, cautious, or skeptical prescribing, embodies lessons from recent studies demonstrating that many medications are inappropriately used and at times are associated with significant harm. The 24 lessons suggest the need to more thoughtfully weigh claims for drugs, especially new drugs. The principles also draw upon an important construct from ecological thinking — the precautionary principle — which stresses the need to anticipate potential adverse effects, even when cause-and-effect relationships are not fully established. It urges prescribers to err on the side of precaution when uncertain about long term impacts.

Health Savings Account Enrollment Reaches 11.4 Million

June 20th, 2011 by Cheryl Miller

An estimated 11.4 million Americans are covered by health savings account (HSA)-eligible insurance plans, an increase of more than 14 percent since last year, according to a new census from America’s Health Insurance Plans (AHIP). New healthcare reform laws could pose concerns for HSA policyholders, in particular, restrictions on over-the-counter (OTC) medications, medical loss ratio (MLR) regulation, and the minimum actuarial value requirement, which will go into effect in 2014. This week’s Healthcare Business Weekly Update contains more information on this.

Healthcare reform laws are also the impetus for the partnership between Scripps Health and North American Medical Management, California, Inc. (NAMM), who will jointly develop an integrated healthcare network. In discussion are commercial and Medicare/Medi-Cal ACOs, bundled payments, capitation and other quality incentive models.

Also in step with the changing face of healthcare, St. Christopher’s Hospital for Children has launched a mobile application that puts ER wait times, a list of frequently called hospital numbers, and even maps
and directions right at patients’ fingertips, while ironically, a new HIMSS survey on clinical transformation shows that only 35 percent of today’s hospital and healthcare system executives have easy access to electronic data.

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The Case Management Monitor is Here!

June 17th, 2011 by Cheryl Miller

Yes, it’s here – our inaugural Case Management Monitor. It’s HIN’s newest bi-weekly e-newsletter, dedicated to providing the latest news, tools and trends in the healthcare case management arena.

And it’s arrived not a moment too soon. The role of today’s healthcare case manager is constantly evolving, moving beyond the health plan office to co-location with primary care physicians, hospital discharge planners and long-term providers.

Not only are more healthcare organizations using case managers, but the practice of embedding them at the point of care is becoming the norm, as we saw in our second annual Healthcare Case Management survey, conducted in January 2011. In just the last year alone, the number of case managers working in hospital admissions offices nearly doubled. And embedding case managers in emergency departments is becoming a critical part of many hospitals’ case management programs, proving beneficial both clinically and financially. The embedded case manager can act as the first line of defense, determining medical necessity, and also helping to reduce patient visits and the number of claims denials for a hospital stay, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center, whom we profiled in a recent podcast that is featured in our newsletter.

And the contemporary case manager’s job description has evolved: it is much more likely to include home visits, crisis management and quality improvement responsibilities in 2011 than it did in 2010. Today’s case manager often helps patients to understand what their treatment is and what their goals of care are. The case manager acts as a liaison between the patient, family, healthcare delivery team and community, enabling their clients to achieve their goals more effectively and efficiently. This includes everything from helping with insurance to medication adherence to home care follow ups, subjects we cover in our newsletter.

And the role of today’s patient is changing as well. With round the clock access to the web, on-line medical records, mobile applications and connected devices, there is a new kind of health delivery system in place — a system that gives patients far more information, and control than they’ve had in the past. What are the implications, risks and opportunities for case managers and case management organizations?

So, please take a moment to read the first Case Management Monitor, and don’t forget to subscribe to the second one, set to arrive in email boxes on June 21st. In the meantime, please provide us with feedback on our newsletter, and share with us any subjects you’d like us to address.

We also have a wealth of information on our Case Management Monitor web site: interviews, podcasts, white papers, videos, blogs, and much more. Again, any feedback on this site is also welcome.

Because interaction is key, isn’t it, to successful case management?

New Market Research Finds Benefit-Based Incentives Best for Behavior Change

June 15th, 2011 by Jessica Fornarotto

A gift card to Starbucks just might encourage employees to spend more time on the treadmill, but reducing their health premiums is a better long-term strategy.

At least, that’s what the results of the Healthcare Intelligence Network’s (HIN) third annual Health and Wellness Incentives Use e-survey showed. According to the survey completed by 156 healthcare organizations, more and more healthcare organizations are offering health and wellness incentives to their employees, in an attempt to get them to adopt healthier behaviors that will ultimately decrease escalating healthcare costs and shift more health ownership to the consumer.

In the third annual Health and Wellness Incentives Use e-survey, HIN captured the expanding focus, utilization and impact of health and wellness incentives in the healthcare industry, from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives. The 156 responding healthcare organizations reported a growing interest in offering incentives for participation in health improvement programs and the continued popularity of incentives for HRA completion.

Other highlights from the survey include:

  • About 70 percent of responding organizations currently offer incentives and rewards for participation in health improvement programs.
  • Almost half of respondents offer gift cards as incentives.
  • Nearly 86 percent of respondents state that employees/members are eligible for incentives, a 15 percent increase over 2009, while almost 40 percent of respondents say that employee/member’s spouses are eligible, a figure that decreased by 5 percent from last year’s survey.
  • 54 percent of respondents said that they used contests and/or drawings to facilitate incentive programs.
  • Nearly 80 percent of responding organizations said they did not penalize their employees for health risk factors or non-compliance.

Release of Medicare Claims Data Reshapes Quality Measurement Landscape

June 13th, 2011 by Cheryl Miller

HIN Content Editor Cheryl Miller

In a move that could redefine the quality measurement landscape and increase transparency for stakeholders, CMS has proposed rules that will grant qualified organizations access to patient-protected Medicare data for use in provider performance reports. These vetted companies will combine Medicare claims data from CMS with private sector claims data to help consumers more easily identify hospitals and doctors providing the highest quality, cost-effective care.

We also report this week on a project that could transform patients’ perceptions of cellphone use — a new mobile application to encourage simple lifestyle changes through personalized expert guidance for individuals with diabetes and pre-diabetes. The mobile device is transformed into a virtual coach that personally guides users to better health through healthier nutrition, fitness, weight loss and tips on self-management. It’s part of an emerging mHealth technology that has important implications for healthcare not just here, but in the developing world as well. You can read more about it in this week’s issue, and in a separate post.

And to get employees away from their phones, we’ve published the results of our third annual Health and Wellness Incentives Use e-survey, which shows that benefits-based incentives, like offering to reduce employees’ health premiums, will encourage them to adopt healthier behaviors. And a gift card to Starbucks wouldn’t hurt, either.

Lastly, if you’ve been waiting to make any move at all toward applying for CMS’ Pioneer ACO Model, procrastinators take note: you get a few more weeks to file your applications. CMS has extended its deadlines, so you now have an additional month — until August 19th — to submit your applications.

Beginning this week, Cheryl Miller takes the reins of the Healthcare Business Weekly Update.

Sensei mHealth App Coaches Diabetics Virtually

June 10th, 2011 by Cheryl Miller

Forget Angry Birds. There’s a new app on the market, and it’s promising to be a lot better for your health.

Sensei, Inc., a technology company that designs mobile health, or mHealth solutions, has been awarded a National Institute of Health (NIH) grant for diabetes and prediabetes research in association with the University of Miami, the Miami VA healthcare System, and the Health Foundation of South Florida. Together, they will trial Sensei’s new mobile application for diabetes and prediabetes users.

The application encourages simple lifestyle changes through personalized expert guidance. Users’ mobile devices are transformed into virtual health coaches that personally guide them to better health through healthier nutrition, fitness, weight loss and tips on self management.

Research shows that modest lifestyle changes, including losing weight and increasing activity, can improve or delay the onset of diabetes in almost 50 percent of cases, according to the Diabetes Prevention Program. Participants in this trial will be prompted to measure key biometric data, eat healthier, and learn and practice appropriate self management of diabetes, hypertension and hyperlipidemia. There will be daily health coach alerts that teach and create calls to action supplemented by a daily agenda and reference information around the different conditions and wellness.

Mobile Health, or mHealth, the utilization of mobile devices to improve health outcomes, is emerging as an important technology not only for developed countries but for developing countries as well. According to a survey conducted by the World Health Organization (WHO), more than 80 percent of countries across the globe are using mobile phone technology in different ways to improve their health services. In fact, only 19 of the 114 studied countries have no mobile health initiative, although many of the initiatives in place are at the pilot stage. The most popular mHealth programs globally are mobile technology call centers, emergency services management, including toll-free telephone services, telemedicine services like text messaging with pill reminders and health information and transmission of tests and lab results, and managing emergencies and disasters. The survey goes on to state that many of these countries’ citizens have no other means of access to health care.

If this technology can be so beneficial for some of the poorest countries in the world, it isn’t hard to see how beneficial it can be for some of the richest countries in the world. And if users, like the diabetes and prediabetes patients being trialed with Sensei’s app, devote only a fraction of the time, passion and commitment to these kinds of health apps that others do to apps like Angry Birds, then they are sure to be an important resource for healthcare.

Meet Health Coach Laurie Johnson: Active Listening Lets Client Decide Path

June 9th, 2011 by Jessica Fornarotto

This month’s inside look at a health coach, the choices he or she has made on the road to success, and the challenges ahead.

Excerpted from the June 2011 HealthCoach Huddle.

Laurie Johnson, BFA, PPC, Personal Coach & Workshop Facilitator for Details Coaching.

HIN: What was your first job out of college and how did you get into health coaching?

Johnson: I did not attend college. I returned to the university as a mature student 20 years after graduating high school. I have worked in the healthcare industry for the past 14 years. I completed a certificate in personal and professional coaching…and decided to mix the two.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road.

The first class of coaching! I just knew this was perfect for me (and my talents and skills).

In brief, describe your organization.

Details Coaching focuses on helping people identify the areas in their life that they need to focus on more (health) — and work collaboratively to begin to make those changes.

What are two or three important concepts or rules that you follow in health coaching?

Active listening and letting the client decide on their path.

What is the single-most successful thing that your company is doing now?

Marketing on a strict budget.

Do you see a trend or path that you have to lock onto for 2011?

A focus on health.

What is the most satisfying thing about being a health coach?

Helping people discover and stick to their goals.

Where did you grow up?

In a small town in Quebec, Canada.

What college did you attend?

I only attended a university.

Is there a moment from that time that stands out?

My graduation!!

Are you married?

No

Do you have children?

No

What is your favorite hobby and how did it develop in your life?

Painting. My father was a painter, and I always used to watch him and paint beside him.

Is there a book you recently read or movie you saw that you would recommend?

A book called “The Power of Now” by Eckhart Tolle.