Archive for February, 2012

Meet Case Manager Stacey B. Hodgman: Patient Advocacy, Resource Utilization, Discharge Planning Keys to Success

February 29th, 2012 by Cheryl Miller


This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

Stacey B. Hodgman, MS, RN-BC, CCDS, CPUM, District Director of Case Management for Kindred Healthcare, Board of Directors for the Case Management Society of New England

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

Stacey Hodgman: My first career out of nursing school was working for the VA Hospital in New Hampshire. I only worked there for a short time before transferring to a local acute care hospital where I worked the night shift to avoid having to place my three children in day care. About eight years out of nursing school, and in addition to working at the acute care hospital, I accepted a part-time job as a work site wellness nurse for a steel manufacturing plant. Although the job title was not ‘case manager,’ I found that my daily interactions with the employees were in fact all about case management. I was listening, evaluating, educating, promoting lifestyle changes and optimal health and found sincere satisfaction in this role. Building trusting relationships that helped the employees make healthy changes to their lifestyle was truly rewarding.

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

About two years later, a new managed care organization (MCO) came to town. They were hiring case managers. My children were all in school and I loved the idea of working a ‘normal’ schedule and being home together as a family at night. So I accepted a position with the MCO and learned so much about case management, utilization review and the business side of healthcare, which I found fascinating. I couldn’t learn enough, fast enough.

In brief, describe your organization.

I am currently district director of case management for Kindred Healthcare, a national post acute for-profit healthcare company; I work in the Long-Term Acute Care Hospital (LTACH) division. Our company has over 120 LTACHs, 224 skilled nursing facilities (SNF), five inpatient rehabilitation facilities and 47 home care and hospice locations. We consider ourselves to be the provider of choice for patients, post acute care needs.

What are two or three important concepts or rules that you follow in case management?

First and foremost; patient advocacy. I tell new case managers that if they have a need to be popular, case management may not be the career choice for them. Case managers have an obligation to the patient first, then to the organization. Oftentimes, this can cause conflict between administration and case management.

Secondly, ensuring stewardship for both the patient and for the organization one works for. Simply said, this means ensuring that the patient receives the right care, in the right setting, at the right time. Continuing inpatient care in the hospital longer than a patient needs to be there not only places them at risk for hospital-acquired conditions, but also continues to utilize their hospital benefit and in the Medicare population, this is limited. Hospitals are often paid as a prospective payment system, meaning they receive one amount regardless of length of stay or resource consumption. The case manager helps ensure appropriate utilization of resources and timely discharge planning.

Lastly, that discharge planning is probably the case manager’s most important responsibility. Ensuring resources are in place, that patient/caregiver teaching has been completed, and that they are able to verbalize an understanding of the discharge plan are critical steps in facilitating a safe appropriate discharge plan. The role of the case manager is to facilitate this through the entire interdisciplinary team; ensuring pharmacy has reconciled medications, diabetic teaching has been completed by the nurse, equipment needs and use have been reviewed by physical or occupational therapy, care for a percutaneous endoscopic gastrostomy (PEG) tube or wound has thoroughly been reviewed with the patient and/or their caregivers. The case manager also ensures that there is a solid understanding of who the post discharge caregivers are, what appointments need to be made or kept and a phone number to call if there are any issues that arise post discharge from the hospital. Not only is thorough discharge planning critical to patient safety, but also to preventing rehospitalizations.

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

We continue to improve our efforts with care coordination and care management as we strategize to become the post acute care provider of choice for our market areas in the country. We are working with the Pioneer ACOs to identify ways we can help ensure progression of care through the continuum and reduce readmissions. This is an exciting time for us, as it is for our nation, as we embark upon a new healthcare delivery system.

Do you see a trend or path that you have to lock onto for 2012?

It is critical that we do not lose sight of what is happening with healthcare reform, and continually plan for the effects it will have on balancing patient outcomes through care transitions along with pay for performance and changes to provider reimbursement methods.

What is the most satisfying thing about being a case manager?

There are so many potential answers to this question! But personally, I would say that as a case manager, I learn something new every day of my practice, that it is continually both challenging and rewarding and there is never a day where I look at the clock and say ‘It’s only 3:00?’ On the contrary, I look at the clock and say ‘It’s already 3:00?!’

Where did you grow up?

I was born and raised in Boston, Massachusetts on the North shore. Being near the sea is something I would never sacrifice!

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

I attended Rivier College in Nashua, NH for my undergraduate degrees and George Washington University for my Master’s degree. The most important thing I took away from my master’s program was gaining an understanding of the value of other’s perspectives — perception is reality — and the extremely positive impact that has had on my world view.

Are you married? Do you have children?

My husband and I will be celebrating our 30th wedding anniversary this year. We have three children in their 20’s whom we are very proud of; one is an attorney, one is a teacher, and one is a nursing student.

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

My absolute favorite hobby is travel. I have created a ‘bucket list’ of things I would like to do, places I would like to visit. Hopefully, Italy and Hawaii will be next on our itinerary! I also enjoy research, writing and have an interest in historical fashion trends.

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

I am currently reading ‘Transforming Ourselves and the Relationships that Matter Most’ by Lisa Oz, wife of Dr. Mehmet Oz. I enjoy ‘self-help’ books and always look for ways to better understand human behavior and relationships. As a case manager, it is imperative that we understand human behavior and how we can help influence patients to make lifestyle changes that they want to make while promoting optimal health. Relationships define us both personally and professionally and understanding how to make the best of each one can only lead to a happier, more fulfilling life.

Any additional comments?

I would be remiss to let this opportunity to ‘add a comment’ go by without espousing that I believe case management is one of the top professions for nurses and social workers. Patients need case managers to help them navigate the ever-changing world of access to healthcare and other resources. It is a very rewarding career that is always challenging, never boring and always manages to bring a tear of joy along with those of sadness as we continually advocate and empathize with our patients and families.

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6 Challenges of Medical Home Transformation

February 28th, 2012 by Cheryl Miller

Providing team-based care, improving patient access and encouraging self-management support were some of the steps taken in transforming to a medical home, explains Dr. Paul Kaye, medical director at Taconic IPA.

The real change is in looking at your practice as a team-based population-oriented practice, and this is where the challenge hit home for many of our individuals. The community health centers had the advantage of thinking that way in the past but the disadvantage was also being large, somewhat bureaucratic and in some ways responding to a regulatory world. Private practices had the disadvantage of not having that experience, but the advantage of being able to nimbly and quickly change direction. When we started to talk about team care, everyone in the group began to realize that changing the way a team was composed and how it functioned was the most profound change for the practice.

The team changes resulted in the largest single change — in A1c’s, for instance. That was an area where we spent some time; everyone thought they were already a medical home until they started to examine what they were doing. We had many interesting confessionals amongst the people in the group saying, "I never realized how things were working in my practice." Or, "how my relationships with my support staff became relationships with their team." Formal tasks like communication huddles, meetings and using the tools under the EHR for interoffice communications, became the subjects of a few meetings and of the practice’s works.

Another important issue for individuals was the understanding that in the medical home, the patients that you are responsible for are not only the people who come into your office, but are all of the patients in your panel. That was a light bulb that took about four or five months to go off. We had interesting discussions that were never heated; they were always collegial and the different points of view were helpful, as was getting to hear about each other’s professional lives and understanding what they could learn from each other.

There are also issues of access; how to provide easy access for patients both through the phone and by appointment was a subject that some of the practices struggled with early on.

Other challenges were care management and self-management support; these are not taught to physicians and are not naturally documented, even when they are doing it. Providing structured documentation of controllable conditions, goal-setting and progress were all concerns.

CMS to Release Stage 2 Meaningful Use proposals

February 27th, 2012 by Cheryl Miller

CMS and the Office of the National Coordinator for Health IT have just announced proposed regulations for Stage 2 Meaningful Use and Medicare and Medicaid EHR Incentive Programs.

Incorporating recommendations from the Health IT Policy Committee, they stress the need for hospitals and physicians to improve quality and efficiency through HIT. The rules focus on increasing the electronic capturing of health information in a structured format, and increasing the exchange of clinically relevant information between providers of care at so-called "care transitions."

At this time of writing, some of the new Stage 2 recommendations will include the following: the percentage of orders entered via computerized physician order entry (CPOE) will rise from 30 percent to 60 percent and include medications, labs and radiology; E-prescribing in the emergency department will increase from 40 percent to 60 percent; and recording objectives, such as problem lists, vitals and smoking status will increase from 50 percent to 80 percent.

The proposed Stage 2 regulations will keep some Stage 1 criteria unchanged, revise others, and include new requirements. Once published in the Federal Register, there will be a 60 day comment period; these regulations are expected to be released this summer.

In related news, the use of HIT by hospitals and physicians has more than doubled in the last two years and CMS reports that nearly 2,000 hospitals and more than 41,000 doctors have received $3.1 billion in incentive payments for ensuring meaningful use of health IT, particularly certified EHRs. EHR incentive payments can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.

Want to know the secrets to launching a successful ACO pilot program? Thomson Reuters has published a report showing four key metrics that can predict success; the first metric is the number of attributed members. The others are detailed in this issue.

And unfortunately, there is no secret formula to reducing avoidable hospitalizations; according to a new study from Delta Health Technologies, which was based on data from more than 1,000 homecare agencies across the U.S., while most agencies are taking steps to reduce avoidable hospitalizations, with patient care a strong concern, there was no one magic formula for success in this area. But there were a number of findings on successful hospitalization reduction strategies.

And don't forget to participate in our latest e-survey: our third annual Healthcare Case Management survey. Participants receive a free, downloadable executive summary of the results once compiled.

Motivational Interviewing Helps Patients to Say ‘Yes’ to Behavior Change

February 20th, 2012 by Patricia Donovan

Nurse case managers, health coaches and even pharmacists are employing motivational interviewing to engage patients and health plan members in disease management programs.

Once the domain of psychiatrists, motivational interviewing (MI) is "a directive, client-centered counseling style — it’s not necessarily a technique," explains Dr. Ruth Wolever, a clinical health psychologist and director of research at Duke Integrative Medicine.

"It’s a style that is designed to invite or elicit behavior change specifically through the process of helping clients to explore and to resolve ambivalence that they may have toward that specific behavior change."

Clinical data backs up the benefits of MI in decreasing resistance and enhancing individuals' motivation to change. And now, pioneering efforts in MI use at Aetna, Highmark and elsewhere are helping to build the business case for training staff in motivational interviewing.

Aetna introduced motivational interviewing (MI) to disease management nurses in its Care Management Disease Management programs on a limited basis in 2009 and fully implemented it in 2010. Today, more than 50 Aetna "MI champions,” have been trained, in consultation with MI pioneer Kenneth Resnicow, Ph. D., professor, Health Behavior & Health Education, University of Michigan School of Public Health, to deliver and support MI practices within Aetna.

In total, more than 1,800 Aetna clinicians and clinical support staff in Aetna sites around the globe are using MI to help members reach better health.

Since the introduction of MI, Aetna reports significant improvements in member engagement, health outcomes and member satisfaction. The payor notes that member engagement in its Disease Management programs has increased 43 percent — from 53.1 percent before the program to 76 percent at the end of the September 2011.

Equally important, says Aetna, members are remaining in the programs. Dropouts decreased 55 percent during the third quarter of 2011 compared to pre-MI days.

“We are creating a highly personalized member experience with real conversations, not scripted interactions. Members take greater responsibility for their actions and health, and we are seeing improved results in treatment adherence, condition maintenance and overall health,” says Michael Golinkoff, Ph. D., head of Aetna’s Behavioral Health Clinical and Service Delivery.

Elsewhere, community pharmacists are being trained in the principles of "motivational interviewing light" to boost levels of medication adherence. A collaboration between the University of Pittsburgh School of Medicine, Highmark Blue Cross Blue Shield and Rite-Aid pharmacies deployed motivational interviewing training to 120 participating pharmacies. Pharmacists were taught overall interviewing techniques and strategies for dealing with patients’ resistance to taking medication.

Preliminary results showed that standardized screening and brief (2 to 5 minutes long) therapeutic conversations between patient and pharmacist helped to reduce patient risk.

"We are evaluating some interim results and looking at changes," notes Janice Pringle, Ph.D., director of the Program Evaluation Research Unit (PERU) and an associate professor at the University of Pittsburgh School of Pharmacy.

"There is an indication that there are statistically significant changes in adherence for the participating sites. However, this will be borne out by more thorough evaluations, which will occur in mid-2012. We will not only be comparing changes over time amongst the intervention pharmacies, but also comparing to a group of what we consider control pharmacies for the same time period and the same metrics."

Medication non-adherence accounts for nearly $290 billion in avoidable medical spending each year, according to a recent New England Healthcare Institute estimate.

6 Ways Parents Can Help Children Lose Weight

February 14th, 2012 by Jessica Fornarotto

High involvement by parents and other adult caregivers of obese children in the context of treatment programs is linked to better outcomes of behavioral change, says the American Heart Association (AHA).

The AHA suggests six ways parents should be involved in treatment programs for their obese children:

  • As a family, identify specific behaviors that should be changed.
  • Set goals and monitor progress. The goals should be clearly defined, such as reducing or limiting television screen time to no more than two hours per day.
  • Provide a home environment that encourages healthier choices. For example, limit temptations at home, such as higher calorie desserts, while providing access to a variety of fruits from which children can choose.
  • Parents should praise their children’s progress and, instead of criticizing, use “slips” as an opportunity to help children identify ways to make different choices if the same situation arises again.
  • Food shouldn’t be a reward or withheld as punishment.
  • Keep track of progress toward goals, using a written or online tracker.

The treatment programs that were evaluated for this research were typically multi-disciplinary — implemented by a team of psychologists, medical staff and dieticians in a university or hospital clinic setting. Access to such intensive treatment programs is limited for many families across the country.

Previous research has yielded mixed results on the effectiveness of parental involvement in family-based treatment for childhood obesity. The researchers noted that not all types of parental involvement is helpful, which could explain inconsistent findings across studies. More research is needed to identify specific parenting strategies that will help children be successful with weight control in the short and long term, and the studies should include more ethnic diversity, the statement authors wrote.

Other research gaps include the need for better data on improving the accuracy of parental perception of their child’s overweight/obese status, the involvement of grandparents or other caregivers in implementing/reinforcing desired diet/lifestyle behaviors, and quantifying the impact of technology-based strategies (e.g., internet, smart phones) for different age/gender/socio-demographic groups.

Direct and Indirect Incentives for Physicians in Medical Home Programs

February 13th, 2012 by Patricia Donovan

Physician performance-based reimbursement in the same state can vary widely, as evidenced by this interview with representatives of two Colorado medical home initiatives.

Dr. David West, Grand Junction hospitalist, family physician and healthcare consultant, describes the indirect rewards for specialists in Grand Junction's shared savings model while Julie Schilz, co-chair of the Center for Multi-Stakeholder Demonstrations and IPIP manager for the Colorado Clinical Guidelines Collaborative, explains how the collaborative determines PMPM care management fees and some of the challenges of a multi-payor initiative.

Note: This interview was excerpted from MORE Medical Home Reimbursement Models: ROI from Risk Adjustment, Shared Savings and Multi-Payor Partnership.

HIN: Dr. West, which incentives are built into medical home reimbursement models for Mesa County specialists taking care of a patient whose care is managed by a medical home?

Response: (Dr. David West) The specialists are looked at by specific procedures from our IPA data. Using orthopedic surgeons as an example, maybe we will have a hip replacement, which is done by most orthopedic surgeons in our area, and the orthopedic surgeons’ total cost for doing a hip repair — their hospital fees, medical supply fees and anesthesiologist fees — may all be tabulated. That information is then listed from the most cost-effective doctor to the least cost-effective. This is tricky; it takes much input from the orthopedic surgeons to make it as fair as possible. One orthopedic surgeon at the top of the list may have cost for a total hip replacement that is half of the cost for another surgeon at the bottom of the list.

The reward to that orthopedic surgeon is, when that data is known to all the members of the IPA, they can simply say, “I will send my patients to that orthopedic surgeon because they do it cost-effectively.” It’s an indirect reward, but a substantial one, when these medical home models share worthwhile, important data.

HIN: Ms. Schilz, which health plans participating in the Colorado program are paying a PMPM capitation or sub-capitation, and what is the payment range? Are the payments risk-adjusted in any way?

Response: (Julie Schilz) All of our health plans are paying a PMPM care management fee. We have Anthem, Aetna, CIGNA, Humana and United HealthCare as our private payors, and the Colorado Medicaid program and our safety net insurer CoverColorado.

The ranges for the PMPM are based on the level of NCQA PPC-PCMH that was achieved by the practices: Level 1, Level 2 or Level 3. The thought was, and this was not done through actuarial analysis, if you were performing at Level 1 in NCQA PPC-PCMH, you probably are not implementing as much of the PCMH concept as you would be if you are a Level 3. The ranges are: $3 to $4.50 for a Level 1, $4.50 to $6 for a Level 2 and then $6 to $8 for a Level 3. Some of the health plans may fall inside or outside of these ranges, but that gives you a general idea.

There was no risk adjustment for our private payors. Our Medicaid looked differently at their population, which was an adult population with some more intense needs. CoverColorado made some adjustments in their PMPMs to account for what they felt was to be a higher-risk population.

HIN: What are the challenges evaluating ROI and patient satisfaction in multi-payor programs and how can these be addressed?

Response: (Julie Schilz) There are many challenges. One is that we have 16 practices and 17 sites — anywhere from a single doctor practice to an eight-doctor practice. To build enough patient lives within those practices to get to data that feels statistically significant has been challenging. Because of that, we decided to pool the practices for utilization metrics, such as the ER and hospitalization, and generic e-prescribing use. But we did decide to keep their clinical measures separate; each practice will be evaluated on their own clinical measures.

The other challenge is having multiple payors at the table and making sure that we’re thoughtful in our discussions so that we don’t impact anti-trust considerations. We also want to be thoughtful when it comes to their competition: the components that need to be consistent among all the payors and providers and those that have a little flexibility. For example, when we first started, we thought we would want one standard contract that each health plan would use with each participating pilot practice. We found that this was probably not doable because of each health plan’s systems. We stepped back and asked which components would we want in an addendum or a contract with each practice and handled it that way.

Health Insurers Must Provide “Plain English” Summaries of Benefits, Coverage

February 13th, 2012 by Cheryl Miller

Transparency and clarity are the objectives in HHS’s "Plain English" ruling on health plan benefits and coverage. Under the rule, health insurers must provide consumers with simple, understandable summaries about their plans. Roughly 150 million Americans have private health insurance today, and should benefit from the ruling. More on this in our feature story.

Transparency is also a key objective in CMS’s new data for its Hospital Compare Web site consumers can now access hospital infection rates at the more than 4700 hospitals listed. According to the CMS, hospital-acquired infections result in thousands of deaths each year and nearly $700 million in added costs to the U.S. healthcare system.

Healthcare costs are key to a recent study from Virginia Commonwealth University, which finds that the managed care medical home for the uninsured will help curb costs and reduce ER visits for the uninsured. The study, which focused on nearly 27,000 uninsured adults over a seven-year period, found that when they had access to regular healthcare their ED visits and inpatient admissions declined, while their primary care visits increased. Researchers concluded that savings in healthcare costs were cut by nearly half.

And lastly, costs are also key to a recent Rand Corporation study on declining prescription drug costs. While costs on brand name drugs have decreased because of increased purchases of generic drugs, drug costs in general remain a hardship for many American families.

Diverse Population Requires Communication, Trust in Managing Diabetes

February 10th, 2012 by Cheryl Miller

Hudson River Healthcare's (HRHC) successful strategy for diabetes management begins and ends with the patient, says its chief operations officer Katherine Brieger.

How a patient communicates with their health systems, their providers, their communities, and their families is integral towards their success in managing their diabetes, Brieger says in Healthcare Intelligence Network's recent webinar, Patient Centered Medical Home: Diabetes Management. But what if the patient comes from a diverse population with challenging problems?

That's the perspective behind Brieger's honest, compassionate discussion about HRHC's Diabetes Collaborative program, which has been in place for over 12 years, and combines attributes from both the Institute for Healthcare Improvement (IHI) and the Wagner Chronic Care Model, to manage diabetic care for more than 3,400 adult patients.

A large percentage of those patients are migrant farmworkers and homeless people, Brieger, also an RD and CDE, says. Care management does work, and getting patients involved in programs is key to their success, she says.

To do this, HRHC implements a patient-centered team approach to treatment, incorporating a full range of clinicians, MDs, (licensed and unlicensed, as in patient care coordinators) LPNs, and case managers to help patients manage their illnesses. Patients are stratified according to severity of health, and self management support and education, including community education days, group visits, and sessions with social/psychiatric workers, dentists, CDEs and RDs, are regularly scheduled to help evaluate and direct the patients.

Opening up access hours for patients, providing language interpretation, and teaching at low literacy levels are also keys to the program's success, she continues.

Because weight loss is the most challenging aspect of diabetes management, HRHC offers innovative weight management programs like walking clubs, diet programs, mindful eating, and prevention services, Brieger continues.

Certified Diabetes Educators (CDE) are crucial to patient care, says Brieger, who is a CDE; as are case managers. And registries are an important element of the program; "It's not enough to have a registry, but to know how to use it," she says. Even telepsychiatry is used in remote areas lacking specialists, Brieger says, contrary to what people might think of New York's densely populated area; "we have a lot of remote areas," she says. Continuity and follow up are also key, medications are issued electronically; high risk patients are followed closely, and nurse care managers are implemented for the most complex patients.

To promote quality and continuity, site quality reports are sent out each month, and every nine months sites are visited by site teams.

Brieger shares other elements of the Diabetes Collaborative Program, including:

  • How to identify and assess patients for diabetes management, including an analysis of literacy and learning and social barriers that could impact outcomes for complex patients;
  • How to train staff and report quality data to drive further performance improvement;
  • How to assign measures for program evaluation and reimbursement, along with the results Hudson River has achieved.
  • But basically, it all begins and ends with the patient, Brieger concludes. Taking in the patient as a whole, and instilling a level of trust into the relationship, is what gets the best results.

    Q&A: Lessons on Physician Payment Reform from CDPHP

    February 9th, 2012 by Patricia Donovan

    CDPHP's medical home project aims to reform not only the practice of primary care in its network but also the payment to its physicians. We recently spoke with CDPHP's Dr. Bruce Nash, senior VP of medical affairs and CMO, about motivating physicians for practice and payment reform, positioning for accountable care organizations, and replacing current productivity-only models.

    HIN: Are the primary care physicians (PCP) becoming involved in practice reform because they know it is the right direction for healthcare or because of the mandates and the additional funding opportunities?

    Response: (Dr. Bruce Nash) In our marketplace, our physicians are doing it because they view it as the only hope for primary care, not only for medical students who chose it as a career. The practice of primary care for many of them has become a drudgery in this hamster wheel of trying to see more and more patients faster and faster. The compensation simply doesn’t support them. We have a great deal of enthusiasm among our physicians.

    One of the younger physicians came to me about halfway through the project and said she wanted to thank me. She had stopped taking medical students to precept them some years before because she didn’t know what she should tell them about why to go into primary care medicine. Now her hope is rejuvenated and she has resumed that activity.

    HIN: In multi-specialty groups, how do you incorporate the PCMH and quality payments for PCPs into a current productivity-only base formula with specialists?

    Response: (Dr. Bruce Nash) One of the real challenges you get with payment models, and one of the undoings of capitation in the ‘90’s, was that, although a global payment would be paid out within a large multi-specialty group, that global payment would be divided up by productivity measures. You never dealt with the overall driving factor of that. It would be important to maintain a form of global budgeting for the overall group.

    Whether it is this model or something similar, the PCPs are operating under this, and it is a salary equivalent. A capitation is a fixed amount of money for one person. A salary is a fixed amount of money for a panel of patients. Allowing the physician and charging the physician with the responsibility of managing the patients effectively within that doesn’t mean face-to-face visits on a repeated basis. It means looking at it and saying, “What is the highest quality, most cost-effective approach for the care of that population?”

    HIN: How is CDPHP positioning for ACOs?

    Response: (Dr. Bruce Nash) The ACOs are conceptually entirely aligned with everything I’ve spoken about. We are discussing the word ‘accountable’ for a population of patients being paid on a global basis. The challenges are numerous, whereas on the West coast, there are delivery systems that are fairly well configured to function as the ACO. However, it is less common throughout most of the country.

    We have circumstances where hospitals are taking the lead in trying to develop ACOs, sometimes by buying up physician practices for as much as they did in the ‘90s, although for a different purpose. However, it is unclear how the hospital sector can lead that initiative given that is where the bulk of the savings need to come from to change the reimbursement incentives. We are in an active dialogue because of who we are, our close ties with the physician community and our physicians. In our markets, large would be 85 to 150 physician groups. If they want to enter into the ACO model as being put forward for FFS Medicare, they don’t have the infrastructure to manage it in the way it needs to be managed, because that is what the health plan does. We view ourselves as a Medicare Advantage Plan and an ACO with our providers.

    We are having dialogue with our physicians and talking about how the health plan can partner with them to make them successful. Not only for our members, but for all their members.

    Meet Health Coach Judith Beaulieu: Network of RN Health Coaches Empowers Women and Children

    February 8th, 2012 by Cheryl Miller

    Judith Beaulieu
    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 February 2012 Health Coach Huddle.

    Judith Beaulieu, RN, BSN, MIS, Health Coach, President and CEO of FEMTIQUE Associates, Incorporated

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

    Judith Beaulieu: When I graduated from Widener College in 1978 I had already been working as a nurse aide on an oncology unit in a city hospital. After passing my state boards and becoming a registered nurse, I continued to work as an oncology nurse. It was during this experience that I encountered coaching the family members of patients. Most of it was comprised of emotional support encompassing the spiritual realm of life (and death). Coaching patients to use relaxation techniques for their pain and anxiety was included in their care plans. These are only a few of the many ways nursing utilized coaching patients and their families.

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

    February 2012 will be the completion of my 40-week webinar graduate level certification curriculum in health coaching from Health Coach Alliance. The standards of practice as well as the board certification are based upon the International Coaching Federation (ICF) of which I am a member.

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

    The professional term “Health Coach” is only five years old in the United States. RNs have been health coaching when teaching patients, implementing care plans, hospital discharge instruction, grievance counseling, breastfeeding counseling, and so on for as long as the vocation of nursing has been in existence. When the health coach profession surfaced into existence as a separate entity, I jumped into searching the opportunities for RNs to become credentialed as Certified Nurse Health Coaches. I discovered that there were only a few programs out there specific to nurses and that most health coaches did not encompass the education nor experience to be able to best serve the consumer about health and wellness information. This was the ah ha moment that created FEMTIQUE Associates Incorporated.

    In brief, describe your organization.

    FEMTIQUE Associates, Incorporated is incorporated under the non-profit corporation law of 1988 as a ((501)(c)(3). We are a healthcare advocate and health coach organization providing health and wellness care information and resources for women and children. Our services are provided by professionals who have accrued knowledge and skills grounded in their professional education, clinical training, and experience with the aim of achieving and maintaining better health outcomes for those we serve.

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

    1: Our ability to hold attention on what is important for the client, and to leave responsibility with the client to take action.
    2: To make plan adjustments as warranted by the coaching process and by changes in the situation.
    3. Develop the client's ability to make decisions, address key concerns, and develop himself/herself (to get feedback, to determine priorities and set the pace of learning, to reflect on and learn from experiences)

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

    Providing financial aid to RNs that affords them an opportunity to become certified health coaches through Health Coach Alliance. Providing to the consumer the availability of qualified professionals that have an optimal level of health coach knowledge, experience and continuing education training is FEMTIQUE’s primary goal.

    Do you see a trend or path that you have to lock onto for 2012?

    Health communication and health information technology is congruent with one of the Healthy People 2020 objectives and the one that FEMTIQUE is positioned to lock onto in 2012. The FEMTIQUE Web site, Healthcare De-Mystified blog and tweets are aimed at providing helpful health and wellness information ranging from the physical, psychological, spiritual, social, financial, environmental, professional/vocational and academic realms of life.

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

    Using an appropriate amount of time to devote to the client’s needs. The client is the only entity to which a private practice RN health coach devotes time and energy. One client at a time and one goal for the health coach to help the client formulate and strategize within a 60-minute coaching session. Spending the time necessary to effectively help consumers achieve health and maintain wellness is not available in the medical care arena.

    Where did you grow up?

    I spent my elementary years growing up as an only child in a small suburban town in Southeastern Pennsylvania. My parents sent me to a Catholic boarding school for my high school education. I loved it. Living with other girls supplemented for the lack of siblings. We were very close to each other.

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

    When I graduated from high school I wanted to become a nurse so I applied to about three or four nursing schools. My high school advisor helped me to apply to two diploma programs and two college programs but there were waiting lists only. I ended up getting into Widener College six years after high school graduation. What stands out for me during this time was what I fit into the six years of waiting. The first year I went to a community college for secretarial studies and ended up working as a secretary while continuing to take college business courses in night school. These courses transferred into the nursing curriculum at Widener. I applied the typing skills learned as a secretary into typing term papers for other students in order to make extra money. The college did not permit nursing students to work full-time while in the BSN program.

    Are you married? Do you have children?

    I am happily married to Russell J. Beaulieu for 19 years. No children.

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

    I love to garden. It has always been in my family starting with my late grandfather who came to America in the early 1900s, bought a plot of land and cultivated a huge garden. When my cousins and I were old enough, our grandfather would take us out to the garden and teach us how to pick ripe berries, fruit and vegetables. It cultivated a love of nature as well as a healthy diet. We were never overweight in our families. Today, I live within an Amish community where I share with other women within the Amish culture many healthy recipes made with vegetables that we all grow from our gardens.

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

    There are so many that I have enjoyed it is hard for me to say which one stands out. Biographies and autobiographies are my favorite types of literature. My heroes are people such as:
    Life Without Limits by Nick Vujicic
    Mother Teresa by Kathryn Spink
    Steve Jobs by Walter Isaacson
    Beauty Fades, Dumb is Forever by Judge Judy Sheindlin
    The Woman Behind the New Deal by Kirstin Downey
    My favorite movie of all times is “The Miracle Worker” which is the story about Helen Keller. And recently I went to see “The Help” which I loved! I laughed and cried.