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Reasons to Light a Fire Under Smoking Cessation Efforts

August 2nd, 2011 by Patricia Donovan

A recent study published in the American Journal of Preventive Medicine found that obesity is statistically a greater threat to overall public health than tobacco. However, there is still a burning need for programs to reduce tobacco use, according to findings from HIN’s 2010 survey on tobacco cessation and prevention efforts.

The percentage of respondents with programs focused on tobacco cessation and prevention remained constant (75 percent) from 2008 to 2010. However, 2010 respondents from more than 80 healthcare organizations are both planning future programs and adopting smoke-free policies in greater numbers, a trend perhaps fueled by federally mandated reimbursement of these programs.

There’s also another reason to light a fire under smoking cessation efforts: metrics on these preventive measures are increasingly included in value-based reimbursement models. In a recent interview, Dr. Mark Shields, senior medical director with Advocate Physician Partners, explained the business case behind the dedication of three of Advocate’s 41 physician performance measures to smoking cessation and prevention as part of its clinical integration effort:

“Smoking cessation is one of the very hot interventions. Our doctors know that it’s important, but don’t appreciate the major financial impact of this effort. We have documented that in our value report. Smoking cessation is a big deal as far as our ability to be successful at the bargaining table with managed care organizations. We point this out to our clinicians.

We have formal ways to gather the information about our performance and point this out. We have disease registries and patient and professional information that is Web-based and online for our providers, as well as face-to-face education programs for our providers.”

While 2010 survey respondents mostly rely on the honor system and self-reports to monitor relapses, 18 percent of respondents are reporting quit rates of 0 to 10 percent. That’s enough to extinguish some of the exorbitant healthcare costs associated with tobacco use.

Posted in Disease Management, Health Coaching, Healthcare Costs, Patient-Centered Medical Home, Physician Practices, Uncategorized, Wellness/Prevention | No Comments »

States Hungry for Obesity and Weight Management Programs

July 27th, 2011 by Patricia Donovan

Almost a third of people in 12 states were obese in 2010, according to a new CDC report. Also, no state met the national Healthy People 2010 goal to lower the prevalence of obesity to 15 percent.

Our country in general and the healthcare industry in particular are hungry for obesity and weight management interventions, according to this CDC report and recent market research by the Healthcare Intelligence Network. Among the program challenges reported by 130 survey respondents was an inability to respond to overwhelming demand for obesity and weight management programs. Some even had to limit the number of participants in programs.

The most revealing trend has been the increase in obesity and weight control programs for children and adolescents — up sevenfold in the two years since we last surveyed on this topic. Payors in particular are focused on these early interventions, launching obesity and weight management programs in schools, including family in weight management education efforts, and dedicating case management resources to this population.

Healthcare providers also are taking on a larger role, as more organizations rely on physician referrals to recognize weight and obesity issues in patients and educate patients on nutrition, the value of physical exercise and its potential to trigger more serious and costly health complications.

The survey results indicate that it doesn’t seem to take much to motivate and engage participants, and that efforts in this area need to be fun. Many are modeling competitions on television’s popular “Biggest Loser” program. While there are some high-priced incentives for profound weight loss, it seems that a $25 gift card or a discount to a weight management program or gym is enough to get people moving in the right direction.

Posted in Disease Management, Health Coaching, Patient-Centered Medical Home | 1 Comment »

Meet Health Coach Claudine Reilly: Engaging Employees in Health Behavior Change

July 6th, 2011 by Jessica Papay

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 July 2011 HealthCoach Huddle.

Claudine Reilly, RN, MA, COHN-S, CHES, Certified Intrinsic Coach®, and wellness manager at CVS Caremark.

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

Reilly: My first job was as an RN in the operating room and intensive care unit. One day I looked around at my patients in the ICU and said to myself, “At least half these people could have prevented their illness/injury with better lifestyle choices.” They were dying and it was all preventable. Some were young and it was heartbreaking.

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

It was in my very first class with Totally Coached in 2005 — I knew then I wanted to spend many years doing health coaching.

In brief, describe your organization.

Although I am the wellness manager at CVS Caremark, which is a Fortune 20 company with over 200,000 employees, my coaching work is part time with Progress Health Coaching. Progress is a small company that specializes in Intrinsic Coaching®.

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

Intrinsic Coaching® methodology. I view everyone as creative, capable and complete. My purpose is to listen, serve and help my clients widen their thinking and get clarity about what is important to them. The goal is for clients to find their own path through increased intrinsic capacity.

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

CVS Caremark is focusing on increasing the engagement of employees in health behavior change initiatives: biometric screenings, health assessments, activities and challenges on a wellness portal.

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

The trend is risk factor reduction to help employees feel better and avoid chronic illness. We may see a change in incentives trends: from participation-based to outcomes-based incentives.

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

Watching people develop and grow as they expand their thinking and create goals that are important to them.

Where did you grow up?

Central Massachusetts.

What college did you attend?

I attended Emmanuel College (BS in Psychology) and Framingham State College (MA in Health Care Administration).

Is there a moment from that time that stands out?

One important moment that stands out was leaving hospital nursing in 1986 and moving into occupational health nursing. That was the first time I was not taking care of “the sick” and began working with “the working well.” I gradually moved into wellness and prevention in the workplace. I began coach training in 2005.

Are you married?

Yes

Do you have children?

I have four grown married children and nine grandchildren. There are five nurses in my immediate family: me, one daughter, two sons and one daughter-in-law. One of my sons is also a health coach. They all live within 15 minutes of my home.

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

Photography. I am a “serious amateur” and love taking candid photos of children. When I retire, I plan to have a business called “Kids at Play Photography: Candid, Creative Photography of Children.”

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

South of Broad by Pat Conroy (I love all his books), anything by Maeve Binchey or John Irving and all the best-selling “dog books” like Marley and Me, The Art of Racing in the Rain and A Dog’s Purpose.

Posted in Disease Management, Health Coach Profile, Health Coaching, Healthcare Trends, Wellness/Prevention | No Comments »

5 Rules for Engaging Employees in Health and Wellness Programs

June 20th, 2011 by Jessica Papay

“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.:

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).
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.
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.”
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.
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.

Posted in Behavioral Health, Disease Management, Health Coaching, Healthcare Administration, Healthcare Costs, Healthcare Trends, Wellness/Prevention | No Comments »

24 Ways to Avoid Harmful Prescribing

June 20th, 2011 by Jessica Papay

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.

Posted in Health Coaching, Medication Management, Patient-Centered Medical Home, Physician Practices, Prescription Drugs | No Comments »

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.

Monday is the last day to respond to our Patient
Satisfaction Survey. Let us know what you’re doing
to improve patients’ and members’ experience and satisfaction with their care by taking the survey , and you will receive a free summary of survey results once it is compiled.

Posted in Accountable Care Organizations, Avoidable ER Use, Health Coaching, Healthcare Costs, Uncategorized | No Comments »

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

June 15th, 2011 by Jessica Papay

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.

Posted in Disease Management, Health Coaching, Healthcare Trends, Wellness/Prevention | No Comments »

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.

Posted in Accountable Care Organizations, Health Coaching, Healthcare Quality Ratings, Wellness/Prevention | No Comments »

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.

Posted in Avoidable ER Use, Behavioral Health, Case Management, Consumer-Driven Healthcare, Disease Management, Health Coaching, Health IT, Healthcare Trends, Telehealth & Telemedicine, Uncategorized, Wellness/Prevention, e-Health | No Comments »

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

June 9th, 2011 by Jessica Papay

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?

Do you have children?

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.