Archive for October, 2011

More MGMA Highlights: Changing Where and How Healthcare Is Delivered

October 27th, 2011 by Patricia Donovan

The only way to revamp the existing healthcare system is to “change the places and the ways in which we deliver care,” advised Eric Dishman, Intel Fellow and director of health innovation and policy, during Tuesday’s opening session of the MGMA 2011 annual conference.

To illustrate, Dishman held aloft a small computer about the size of a pedometer that Intel gave to homebound elderly to wear. The computer generated data on their gait, information the scientific community can use to better understand how to prevent falls in this population, he explained during “Changing Practices: Home- and Community-Based Care Technologies for Independent Living.”

It’s just one of the ways Intel is studying the entire “human” system to better design the technologies to support their care, Dishman said.

Out in the conference exhibit hall, home monitoring technology by Alere supports the shift in care delivery locations that Dishman is proposing. The technology allows patients who take the anticoagulant Warfarin to test PT/INR levels regularly. Keeping PT/INR levels within a safe range can help individuals to avoid serious complications such as bleeding or stroke.

“These rapid and real-time diagnostic tests in home allow for more frequent testing, which provides additional data,” explained Clint Brown, Alere home monitoring national business director. “We can catch an INR drifting out of range, which is the essence of preventive care.”

By helping to reduce risk and adverse events, the technology helps to reduce the likelihood of readmissions, Brown added, “while contributing to the efficiency conversation.”

Patient portals were also part of the efficiency conversation at the conference, since they help to optimize EHR use, enhance patient engagement and clinical information exchange and shift some care management tasks to the patients themselves — everything from making appointments to paying bills to reviewing lab results. Most EHRs have a portal component that can be activated.

The conference’s Healthcare Innovations Pavilion featured a case study Tuesday on patient portal use, co-presented by Intuit and St. Vincent Medical Group. The 34-site, 150-physician multispecialty group launched the portal in May, explained Patti Ballman, St. Vincent’s director of operations, but is already experiencing improved patient flow, a decrease in telephone calls and an ability to see more patients.

The portal, which the medical group has branded “MySV,” positions the group well for the patient engagement requirement of meaningful use, but that wasn’t the primary driver for portal implementation, noted Ballman.

“We wanted to improve the care experience for the patients in the office. The online portal allows us to focus more on the patients who are in front of us rather than the ones on the phone.”

Physician practices considering the use of a patient portal should start collecting patients’ e-mails now to make the launch easier, Ballman recommended.

Portals are just one of the technologies that are helping physician practices to improve collections by providing a more private transaction. Another is automated voice messaging, contributes Marc Tumminello, vice president of healthcare practice sales for Televox, another exhibitor at the conference.

“Using automated reminders for accounts receivable is far less costly than call centers,” noted Tumminello. “Practices can also build in the option to speak to a live person. Giving the patients various payment options reduces the potential embarrassment of this transaction.”

Phreesia, which calls itself “The Patient Check-in Company,” puts this transaction back in the waiting room by building payment options into the self check-in process. Patients can check themselves in on the company’s bright orange portable tablets, then render their co-pay or outstanding balance by swiping their credit card on the side of the tablet. The technology verifies eligibility, and also offers customized disease management education at the end of each transaction.

Patients have been receptive to this technology, notes Phreesia representative Katie Ray, who was demonstrating the tablet. “Patients are used to self-service in other aspects of their lives; why not in healthcare?”

On the clinical side, several presenters described how they are embedding case managers in the primary care practice. In separate sessions, both Advocate Physician Partners (APP) and Marshfield Clinic said they have embedded case managers in physician practices in the last year.

Sixty colocated outpatient case managers were added to APP’s clinical integration program in early 2011, explained Dr. Mark Shields, senior medical director and vice president of medical management for Advocate Physician Partners and Advocate Health Care. “They will focus on the sickest 2 to 3 percent of our population.”

Marshfield Clinic has embedded 55 nurse care coordinators in its 35 NCQA-recognized level III patient-centered medical homes, explained Dr. Theodore Praxel, medical director of quality improvement and care management. On average, the nurse care coordinators have been working for about six months in the practices, which have been very positive about this addition to the care team.

Watch this blog for more detail on these hot topics for practices — as well some innovative strategies for coping with HIPAA compliance, physician shortages, acquisition, decreased reimbursements and other challenges.

MGMA 2011: Monday’s Highlights

October 24th, 2011 by Patricia Donovan

The world’s best managers are most productive when they play to their strengths and neutralize and manage around weaknesses, reports Marcus Buckingham, today’s keynote speaker. Buckingham is an independent consultant and author of several books on strengths in the workplace.

It’s a concept physician practice leaders might want to keep in mind when engaging staff in the new technology, care delivery systems and reimbursement models that are part of a value-based healthcare system.

Not surprisingly, the accountable care organization (ACO) delivery model is getting a lot of attention at this year’s conference. “The ACO time frame is short and the learning curve steep for organizations that enter the ACO field late,” notes Deborah Walker Keegan, president of Medical Practice Dimensions, during a session on the structure, operations and financial strategies of ACOs. “The ACO train has left the station.” In the room of about 300 people, only three or four raised their hands to indicate they were already participating in an ACO.

Keegan explained the four flavors of ACOs currently in demonstration or pilot form, setting the stage for Bruce Johnson’s explanation of ACO models available to practices interested in pursuing the model. Johnson, JD, MPA, a partner and shareholder in Polsinelli Shughart, Denver, described the final ACO rule released last week by CMS as “kinder and gentler.”

How to prepare for the ACO experience? Practices should begin to innovate so that they can demonstrate accountable care, recommends Walker Keegan. These innovations should begin with expanding patient access through the use of patient portals, expanding the role of the nurse, anticipating needs, and rejecting the sequential visit as “historical.”

Patient portals are also useful in streamlining workflows in the use of EHRs, notes Ron Anderson, who led a session on optimizing EHR and practice management workflows to improve efficiency and the bottom line. While about half of the room’s participants are already using EHRs, none felt they were optimizing them.

Anderson encourages practices to have all active users involved in analyzing and revamping workflows when the EHR is introduced. “Don’t just ask them for support; demand involvement.”

Staff should be trained on new equipment and programs first, before the physicians, he suggests.

Down the hall, Dr. Farzad Mostashari, National Coordinator for Health Information Technology, answered a range of questions on meaningful use, whether quality measures could be “harmonized” across all federal quality initiatives, health information exchanges (HIE) and patient ID cards.

Inroads have been made on some of the protocols and standards for HIE, but the business case and privacy, security and trust requirements must still be defined, he said.

Down in the Innovation Pavilion, I heard how one DO is using a smartphone app for e-prescribing developed by NaviNet. Leonard Sukienik, DO, Primary Care Solutions, said he uses the app on his iPhone and iPad during the patient visit. Because the app provides a full picture of the patient’s compliance, its use “opens the door to a lot of conversations we as physicians need to start having.”

Far from being upset that they weren’t being handed a paper copy of the prescription, his patients were thrilled that the prescription was sent directly to the pharmacy. (He can still print out a paper copy for the patient, as well as generate “care messaging” tailored to the patient’s needs.)

ACO Final Rule Accompanied by Advance Payments for Care Coordination Tools

October 24th, 2011 by Cheryl Miller

The anxiously awaited final rule on accountable care organizations (ACOs) for Medicare beneficiaries is finally out. Based on the more than 1300 comments CMS received on its proposed ACO ruling first released in March, this new rule will make it easier to establish ACOs by providing organizations with additional funding for support tools, such as new staff or information technology systems. Under this new initiative, the Advanced Payment Model, these payments would be recovered from any future shared savings.

The second initiative, the Medicare Shared Savings Program, will provide incentives for healthcare providers who agree to work together and become accountable for coordinating care for patients. Participants who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program. Both initiatives launched on October 20th.

The United States earned low marks in healthcare access and affordability in the Commonwealth Fund’s third annual scorecard report. According to the report, the nation received a 64 out of a possible 100 when compared to best performers. Among the findings that contributed to the score were the percentage of overweight or obese children (32 percent), the number of prescription errors among elderly Medicare beneficiaries (one out of four) and the percentage of adults that reported not having a primary care provider in 2008 (44 percent).

Despite the low scores in key quality indicators, the United States is doing something right in the area of heart failure (HF) care. New research from the Yale School of Medicine shows that hospitalization rates for HF dropped by 30 percent from 1998 to 2008. One year mortality rates also dropped slightly during this period. HF ranks as the most frequent cause of hospitalization and re-hospitalization among older Americans, with related costs estimated at $39.2 billion in 2010.

In other news, 46 percent of physician practices do not meet NCQA standards for medical homes. The news, from a recent University of Michigan-led study, found that while larger, multi-specialty practice groups can more easily meet the standards, one in nine Americans receive healthcare from smaller, often solo practices. Researchers recommend initiatives to help these smaller practices team up with larger organizations to establish more medical homes.

More than 50 percent of physicians and hospitals are looking at ways to team up, a trend that is causing medical malpractice concerns. Aon’s 12th annual Hospital and Physician Professional Liability Benchmark Analysis states that healthcare systems will face significant risk management challenges associated with integrated physician-hospital arrangements. The study details the growth of integrated self-insurance strategies and highlights the challenges faced by systems as they pursue the cost of risk savings.

And lastly, what are you doing to staunch the flow and expense of avoidable emergency department use? Describe your efforts in this area by October 31 and you will receive a free executive summary of results from this second annual survey. These stories and more in this week’s issue of Healthcare Business Weekly Update.

CMS Seeks Innovation Advisors

October 24th, 2011 by Cheryl Miller

CMS has rolled out a lot of solid initiatives this year; now the latest, the Innovation Advisors program.

The CMS Innovation Center is looking to recruit up to 200 healthcare professionals, including clinicians, allied health professionals and health administrators, to test and refine new models of healthcare delivery for Medicare, Medicaid and CHIP beneficiaries. Program officials hope to deepen skills that will drive improvements to patient care and reduce costs. 

Those who are selected for the program will have to commit up to 10 hours a week for the first six months of the program attending on site and remote sessions to expand their skills and knowledge. The rest of the year-long program will be spent implementing what they learned in their organizations and communities.

Participants will be asked to:

  • Support the Innovation Center in testing new models of care delivery.
  • Utilize their knowledge and skills in their home organization or area in pursuit of the three-part aim of improving health, improving care, and lowering costs through continuous improvement.
  • Work with other local organizations or groups in driving delivery system reform.
  • Develop new ideas or innovations for possible testing of diffusion by the Innovation Center.
  • Build durable skill in system improvement throughout their area or region.
  • This initiative is just one of a number of efforts proposed by CMS this year; to date, more than 5,000 organizations have joined the Partnership for Patients and pledged to reduce hospital-acquired conditions and improve transitions in care.  The Bundled Payments for Care Improvement initiative will give providers flexibility to work together to coordinate care for patients over the course of a single episode of an illness.  The Comprehensive Primary Care Initiative will allow CMS and other payers, such as employer-based health plans, to align strategies designed to strengthen primary care services delivered to Medicare beneficiaries.

    Applications for the Innovation Advisors program are due on November 15, 2011.  Applications will be reviewed and Innovation Advisors will be notified of their selection by mid-December 2011. 

    More information, including a fact sheet, frequently asked questions, application and terms and conditions can be found here.

    Q&A: 2012 Healthcare ABCs — ACOs, Bundled Payments and Case Managers

    October 18th, 2011 by Patricia Donovan

    Expect continued activity in accountable care, bundled payments and case management in the coming year, predicted Steve Valentine, president of The Camden Group, in an interview with the Healthcare Intelligence Network. Valentine will present during HIN’s eighth annual healthcare trends forecast on November 2 at 1:30 pm Eastern.

    1. This time last year you advised the industry to prepare for bundled payments. Our own market research has found that 9 percent of healthcare organizations are experimenting with bundled or case rate payments. Where do you see this trend headed in 2011, and will the new CMS bundled payments initiative encourage more companies to explore this payment model?

    (Steve Valentine): Medicare has requested that hospitals group any DRGs together and go for a case rate for that DRG or group of DRGs. This is somewhat of an expansion of its Acute Care Episode (ACE) project from two years ago. The difference is that the new program doesn’t allow economic incentives to be offered by hospitals and physicians to attract volume. Also, they can’t select one or two providers in a given market. There’s no ability to direct the market as there was in the ACE pilot.

    We expect most health systems and hospitals will not participate, although many hospitals will address their costs in a bundled payment fashion, and begin to drive down their costs through much greater standardization. They’ll do so through clinical protocols, comanagement agreements with doctors, economic incentives and standardization of the devices to drive down supply costs.

    Bundled payments will continue to grow. We expect more health systems to approach health plans to try to move Medicare Advantage and commercial insured individuals into bundled payments. But pure Medicare bundled payments won’t be as attractive to most, because you can’t direct volume or offer economic incentives.

    2. You also encouraged companies to better manage utilization in 2011 through coordinated operational infrastructure and clinical processes. We’re seeing a lot more embedding of case managers within primary care practices – for example, 80 percent of medical homes have a case manager on site. What is the case manager’s contribution to utilization management?

    (Steve Valentine):The case manager is very effective at accessing the most appropriate resources required by the patient in the clinical protocol being followed. There’s lots going on in the post-acute care arena, which traditionally has been woefully inadequate and poorly maanged. By embedding case managers back into the medical groups and the medical home, where they are accountable and responsible for the care across the continuum, these case managers are very effective at utilizing the most appropriate and least expensive medical resources to care for that patient.

    The bigger trend we’re now seeing is evaluating is whether case management should be centralized between the health plan, the physicians and the medical group and the hospital, including post-acute care — centralized case management in one area, so we don’t have duplication of effort and have smoother handoffs. We are getting rid of this silo thinking where everyone is managing their part of the economic equation, but not the total economic equation.

    What will this centralization look like?

    (Steve Valentine:) A system office will work with all the various health plans. Only case managers in the health plans will be centralized, with the health plans like many large non-profit organizations (Bay State, Summa,Sutter and Sharpe come to mind) turning around and moving their case managers out of their plan and placing them into a central function with their physicians, with the hospital and at the post-acute.

    Finally, even without a definitive rule on ACOs from CMS, a lot of companies are forging ahead with this model. Is there any danger in this approach?

    No danger. Everyone was extremely disappointed with ACO regulations put out in June. They were a huge disappointment; they were politically correct but not designed to manage costs and resources. We have seen about 50 applicants for Pioneer; hard numbers for those coming in to interview are at about 35. Some have chosen not to participate, saying there’s not enough leeway in terms of managing the care.

    ACO activity is now on the health plan side. Health plans have started to go to groups and health systems and look at types of ACO arrangements where they can manage this cost and trend. This approach will be appropriate for organizations that are already pretty good at managing care, that have the systems and IT in place. If your organization is not good at this, you probably want to avoid the ACO for a period of time until your systems get much stronger.

    60 Percent Increase in ED visits for Sports Injuries Among Youths

    October 17th, 2011 by Cheryl Miller

    There’s been a 60 percent increase in ED visits for sports injuries over the last 10 years. Experts attribute the increase to the public’s growing awareness of the risks of suspected traumatic brain injuries (TBI), CDC officials said. Research indicates that young athletes with a TBI experience longer recovery times and are at greater risk of serious outcomes than adults. The injuries, the majority of which occurred from bicycling, football, playground activities, basketball, and soccer, may appear mild but lead to significant lifelong impairment.

    But the prevalence of avoidable emergency department use still continues, an issue we tackle in our second annual survey, Reducing Avoidable ER Visits in 2011. What are you doing to staunch the flow and expense of avoidable emergency department use? We are seeking input on organizations’ efforts in this area, and if you respond by October 31 you will receive a free executive summary of the results.

    In other news, one third of people 65 years and older are undergoing surgeries in their last year of life, with 1 in 10 having surgery in their last week of life. Researchers from the Harvard School of Public Research, where the study was conducted, say the surgeries vary substantially with age and region, and express uncertainty as to the necessity of many of the surgeries. More details in this issue.

    ACO regulations have entered the final stage of the review process. The CMS sent the final Medicare Shared Savings Program regulations to the Office of Management and Budget for review on October 5th , one of the last steps in the approval process. No word yet on when the final rule will be published; we will keep you posted.

    Q&A: How to Survive and Thrive Under Bundled Payments

    October 14th, 2011 by Patricia Donovan

    Time in the trenches with Acute Care Episode (ACE) pilot participants qualifies Jim Reilly to comment on CMS’s latest Bundled Payments initiative specifically and bundled payment trends in general. The managing partner of TRG Healthcare Solutions shares three lessons CMS learned from the ACE pilot and more in this interview with the Healthcare Intelligence Network (HIN).

    (This interview was conducted in advance of Reilly’s presentation on “Evaluating the Bundled Payment CMS Initiative — Legal, Financial, and Clinical Considerations,” an October 19, 2011 HIN webinar.)

    HIN: To begin with, what did CMS learn from the ACE Pilot and how is that influencing its newest payment initiative?

    Mr. Reilly: First, CMS learned that episodic payments or bundled pricing is a very effective way to incentivize hospitals and physicians to work closer together. They firmly believe combining the fees for an episodic period will lead to better coordinated care, not only between hospitals and physicians but across different specialties, to work together for optimal outcomes. They also learned that it will save CMS money. Through their bundled pricing experience in the past, this has led to lower rates that CMS pays for providers. And they also feel, finally, that it’s going to improve beneficiary health and outcomes. So it’s something that they’re investing in and moving forward with aggressively nationally.

    HIN: ACE Pilot participant Baptist Health System, one of the companies that you worked with, refers to its ‘Hallmark moment’ of distributing gainshare checks to participating physicians. What are some other benefits of participation for health systems?

    Mr. Reilly: Physician alignment is number one. The level of collaboration has truly increased within that health system. That then drives a greater focus on quality metrics and service metrics — not only the cost side, but also a different level of engagement in trying to move those important cardiovascular and orthopedic metrics in this case. That’s been a great benefit to the health system.

    The health system is also benefitting from this experience because CMS is not the only payor that’s going to be adopting bundled payments as a way to pay for care. There will be other payors outside of CMS — outside national payors that will be active in bundled pricing. And a system like Baptist Health is well positioned to take advantage of that as well.

    HIN: And finally, our fifth annual survey on the patient-centered medical home (PCMH) found that 9 percent of respondents have already begun experimenting with bundled payments. From your perspective, is this an adequate representation of the marketplace? Where do you think this trend is going?

    Mr. Reilly: I don’t think it’s an adequate representation. Sometimes in this industry, we’re a little bit slow to move and be as innovative as we should be. The trend here, particularly with specialties like cardiovascular services and orthopedic services, is definitely more toward acceptance of risk in contracting with Medicare and other payors. You’ll see a great deal of activity beyond CMS, with other payors following suit.

    And in order to succeed in that environment, we need more providers out there becoming clinically integrated — not only for the acute care episode, but for post-acute care services, so that we can survive and thrive under bundled payment for CMS. And other payors are going to adopt this. This current CMS bundled pricing initiative is going to escalate to other providers out there moving forward in this direction.

    HIN: To follow up on that, could you define ‘clinical integration’ and explain why that needs to happen first?

    Mr. Reilly: Certainly. The care process requires multiple caregivers and providers to get the optimal outcome and service. And today many times, we have competing interests among doctors and hospitals. We’ve got physicians that are dealing with challenges of running private practices; sometimes that takes away from collaborating in what is the optimal episode in amounts and levels of care provided for patients.

    Once we move into alternative payment methodologies such as bundled payments, it breaks down some of those barriers. We’ve got surgeons and cardiologists and anesthesiologists and radiologists and consultants working more in a united way to ensure that that patient is getting optimal care and efficient care. That’s clinical integration.

    Caring Communication Can Boost Patient Satisfaction Quotient

    October 13th, 2011 by Patricia Donovan

    “Do what you do so well that they will want to see it again and bring their friends.” Jack Welch’s words on customer satisfaction may not strictly apply to healthcare; after all, the former chairman and CEO of General Electric wouldn’t wish a hospital stay on anyone, no matter how elevated the quality of care.

    However, in a value-driven environment, high marks in patient satisfaction are expected and rewarded, both by prospective patients seeking care at reputable facilities and by payors formulating reimbursement strategies.

    To make the grade in patient satisfaction, healthcare organizations must clear the communication channels between providers and patients, say respondents to the 2011 Healthcare Intelligence Network survey on Improving Patient Satisfaction and the Healthcare Consumer Experience. That means everything from beefing up call management to increasing the number of touches while a patient is waiting for a doctor.

    “Patient satisfaction might sound like a soft outcome, but patients get very dissatisfied when they are lying in an ED for long periods of time,” notes Toni Cesta, Lutheran Medical Center senior vice president of operational efficiency and capacity management.

    “The most dissatisfying thing for patients in EDs is the time from triage until they are seen by a physician. That is the typical time in which the patient will walk out of the ED — if they have been triaged, put in a room and are waiting for a long period of time to be seen by the physician. If you can reduce that time from triage to seen by the physician in concert with ED leadership, that can help reduce the number of patients who walk out without being evaluated by a physician.”

    So important is patient satisfaction that it has become a benchmark in its own right — to measure the success of healthcare initiatives from case management to accountable care organizations (ACOs). Beginning in April 2012, the National Committee for Quality Assurance (NCQA) will award extra credit to patient-centered medical homes (PCMHs) that submit CAHPS results twice a year.

    Organizations preparing to join or transition to an ACO should immediately assess their patient satisfaction quotient, suggests Greg Mertz, senior project director with the Healthcare Strategy Group.

    “One of the [ACO] obligations that is going to be placed on at least primary care providers is patient education, so if they haven’t spent a whole lot of time on patient compliance, or on patient satisfaction, that’s [going to be] a real learning curve issue for them…The government has said that it’s up to the physician to tell the patient that they are in an ACO. They’re going to have to convince [the patient] on no other basis than it makes good sense for your health, that you should really work with us to better manage your care.

    “And since part of the evaluation of ACO shared savings is going to be based on patient input and patient satisfaction scores, [PCPs] are going to have to do it so that the patient accepts the value and is willing to give them good grades. A lot of physician behaviors are going to have to change; not that many have formal patient feedback loops at this point. It’s a different culture.”

    (Excerpted from 2011 Benchmarks in Patient Satisfaction Strategies: Improving the Healthcare Consumer Experience.)

    Meet Wellness Coach Michelle Greenman: Ascribes to 7 Principles of Wellness

    October 13th, 2011 by Jessica Fornarotto

    Here we take an inside look at a wellness coach, the choices made on the road to success, and the challenges ahead.

    Michelle Greenman, certified health and wellness coach.

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

    Michelle Greenman: My first job out of college was working at a private school teaching English as a second language (ESL). I had been teaching and tutoring before graduating and now was ready to move on. My husband and I moved to Lillooet, British Columbia from Toronto, Ontario and after two years of teaching and working with bands, I wanted to take on more of what I felt was my calling. My mom sent me the information for coach training, but I was in a car accident and couldn’t go to the training. I spent three months away from work and reading health books. After recovering about 40 percent, I decided to go and do the health and wellness coach training in South Dakota.

    Have you received any health coaching certifications? If so, please list these certifications.

    I am certified as a Christian health and wellness coach from Black Hills Health and Education Center in South Dakota. It is a lifestyle center that handles illness, drug and surgery free. Although I do consider myself a Christian, the certification means that we did not study hypnotism and neuro linguistic programming (NLP) like other coach programs teach. Instead we learned and I practice the art of hydrotherapy, herbal medicine and natural drug free healing.

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

    At the training, through the help of classmates and teachers, I was able to make huge strides in recovery. Leaving there I was pretty close to pre-accident status. This was my own miracle, because the doctor suspected I might suffer from chronic back pain for the rest of my life; a scary prognosis for anyone. By using what I had learned, I was able to lose weight and recover from the accident injuries. I couldn’t wait to share all of what I had learned with others, and that’s when I started writing my first book, “Lose Weight Gain Health.”

    In brief, describe your organization.

    I am the sole proprietor of Michelle Greenman — Natural Health Educator and Wellness Coach. We teach classes, facilitate workshops and do individual and group coaching. We utilize proven comprehensive health principles and goal-oriented development to reach an international audience as an expert and activist for holistic natural healing and wellness. Our aspiration is that each client will recognize, prioritize and achieve their health potential and to enable each to experience wellness.

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

    We are committed to the audience of one, dedicated to providing each client with honesty and confidentiality. We exhibit genuine respect for values, caring for experiences and honor for personal truths.

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

    We teach people and write newspaper articles on RENEWAL; seven accessible, comprehensible, principles to wellness. These seven principles are the foundation of health for body, mind and soul. We believe each part must grow in unison to achieve wellness. RENEWAL stands for Rest, Environment, Nutrition, Exercise, Water, Alternatives and Limits. I also produce personalized health plans for clients based on these seven ideals.

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

    We are working to set up monthly coaching by subscription; delivering beneficial information and coaching questions to subscribers. However, we are almost finished with 2011, and looking forward to 2012, we want to have corporate coaching contracts.

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

    Results! Seeing people get better and reach their health goals. Giving them hope that they can reach their goals, then seeing or hearing them do it. For instance, getting the notes back that say, “I have lost 30 pounds since we finished.”

    Where did you grow up?

    I was born and raised in downtown Toronto.

    What college did you attend? Is there a moment from that time that stands out?

    I graduated from the University of Toronto. At the end of my second year, I had a dream and woke up thinking I am not going to be a psychologist, but a teacher. Teaching would allow me to positively mold impressionable minds like some of my favorite teachers did.

    I lived in Taiwan for a year, teaching before returning to Toronto. I changed majors and got married the end of my third year. Changing my major was definitely for the best, and getting the experience teaching and traveling definitely served me very well.

    As a side story, the winter holidays of my first year at the university I traveled to the U. A. E. to visit my aunt who was working as a nurse there. Together we vacationed in Istanbul for a week. That experience as well as attending the university, told me that anything was possible to achieve. My plan after returning from Taiwan was to graduate and go back to the Middle East to teach. Getting married changed that, but coaching to me is a way of achieving the career and life I want.

    Are you married? Do you have children?

    I just celebrated my five-year anniversary with no children and no plans for children either.

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

    My favorite hobby is to study the Bible. I love to search its pages and build studies to teach and publish. I have always had a connection to God. I have learned much about the best, holistic practices to regain health from the Bible. It does say “Beloved, I wish above all things that thou mayest prosper and be in health, even as thy soul prospereth.”

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

    I will always recommend the Bible. It is an anchor of a book that has worn out many hammers. It is profound, angering, loving and hope filled all at the same time. Movies that have impacted me profoundly are “The Day My God Died” (difficult to watch), “Earthlings” (very difficult to watch), “Stuff” (makes you want to change), and “Food Inc.” (always gets me a bit upset).

    Any additional comments?

    This is a career that does all I ever wanted and I love it very much. No matter how much work there is, it’s great to help others. I encourage people to check out my Web site and contact me for any questions or help. Plus I am on Twitter and Facebook.

    My vision is to change the world by empowering the individual with holistic natural health activism, education and coaching and encouraging each to achieve wellness.

    Mount Sinai Research: $6.7 Billion Spent on Unnecessary Treatment in One Year

    October 10th, 2011 by Cheryl Miller

    Are physicians prescribing unnecessary medications or performing unnecessary tests?

    That is the $6.7 billion dollar question this week, given the results of a recent study from Mount Sinai Research. The answer? Well, according
    to this data, 86 percent of the excess spending is attributed to the prescription of brand-name rather than generic statin medications for the treatment of high cholesterol. Other reported areas of excess spending included the over-prescription of antibiotics for sore throats in children ($116 million in costs) unnecessary bone density scans ordered for younger women ($527 million in costs) and needless CT scans, MRIs, and x-rays for people with back pain ($175 million) We list more details in this week’s issue of Healthcare Business Weekly Update.

    Also contributing to excess healthcare costs — $17 billion annually — are hospital readmissions, which persist, especially among the elderly. According to a new Dartmouth Atlas Project Report, roughly one in six Medicare patients end up back in the hospital within 30 days of being discharged for a medical condition. Given the upcoming financial penalties from CMS for excessive readmissions, hospitals need to address this problem.

    One place to start could be by maintaining contact with the patient upon discharge: the Dartmouth study also found that more than half of Medicare patients discharged home do not see their primary care physician within two weeks of leaving the hospital.

    And here’s one possible solution: embedded case managers. They were crucial to CDPHP’s clinical transformation, helping chronically ill patients to better manage their diseases and helping to reduce
    hospitalizations and costs and improve quality of life.

    Another possible strategy? The new medication adherence tool being introduced by Merck. Targeting the high percentage of Americans that fail to take their medications as directed, Merck is hoping its online Web site will help consumers stay on course with treatment and have more informed discussions with their physicians about the medications they have been prescribed.