Posts Tagged ‘diabetes’

Infographic: Download a Health App and Call Me in the Morning

March 6th, 2013 by Patricia Donovan

Physicians have strong feelings about mobile apps tied to EHRs, according to a January 2013 online survey by eClinicalWorks. Results from the survey, taken by 2,291 healthcare respondents and including 649 physicians, show providers want their patient engaged and see clear benefits in health outcomes with this connection.

As shown in this infographic, the survey found 93 percent of physicians find value having a mobile health app connected to EHRs. The same survey found that 93 percent of physician respondents believe that mobile health apps can improve a patient’s health outcome, and 89 percent are likely to recommend a mobile health app to a patient.

Apps and EHRs

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You may also be interested in this related resource: Futurescan 2013: Healthcare Trends and Implications 2013-2018.

Using Registries to Improve Population Health

March 5th, 2013 by Jessica Fornarotto

Patient registries help to provide a bigger picture view of a specific patient population, making it easier to identify patients at high-risk and those who need certain tests, states Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare. Crystal Run’s use of registries has helped patients to maintain their health, including those with poorly controled diabetes, and to identify gaps in care. However, meaningful use does pose some challenges for Crystal Run registries.

Question: What results have you achieved from your registry data?

Response: Early on, we used registries for routine health maintenance issues, specifically for women that were due for a mammogram. We went from about 60 or 65 percent of women getting mammograms early on to the high 80 percent range. Similarly, prostate specific antigens increased to above 90 percent. Registries do work when there is a concerted effort of everybody thinking about these groups of patients, reporting on it on a regular basis and then sharing results with people.

Through our dashboard, we can show people where they stand. We are incorporating more of these registry data into dashboards. People that are due for prostate specific antigens, for instance, are incorporated onto the dashboard. The other more dramatic use has been a list of patients who have diabetes with an A1C greater than 9; very poorly controlled. We use that registry for our quarterly calls. We have a primary care physician who is on a conference call once a quarter with a dietician and an endocrinologist, and we go over the registry of patients who have poorly controlled diabetes. We talk about the patient, look at them in detail and have the dietician reach out to them. We could also have the patient schedule an appointment or have them make a change to their behavior to help them better manage their diabetes. We have had a dramatic improvement in the A1C’s, where currently, poorly controlled is below 9 percent at this point.

Question: Besides mammograms and diabetes, what other measures do you use to identify gaps in care?

Response: We use most of the common quality measures such as mammograms, prostate specific antigens, colonoscopies, and most of the shots specifically for adults such as Pneumovax®, tetanus and flu shot. For kids, we have all the childhood immunizations. We have a program that tracks immunizations as well as high-risk patients with diabetes with A1C’s greater than 9.

And we have good registries. For patients with well-controlled diabetes or hypertension, there are positive and negative lists. If you are going to gather the information, you know where the blood pressure field is kept. You know that there are good quality measures and bad quality measures, and you can leverage that. Then, you have two items to look at rather than just one. We are developing a library of these, and we are going from meaningful use that has many measures in registries that are required and we are working toward that as well.

Question: What lessons have you learned in terms of meaningful use?

Response: We try to keep the measures and the list standard to the quality measures that already exist. We do many of the NCQA clinical quality measures already. The difficult areas that we have are the same that many other companies have. We are having a difficult time getting an extensive clinical summary out to a patient within three days of a visit. Then, there is e-prescribing rates. Depending on the patient population that is served, patients insist on a printed prescription. We told the staff that if they want it printed, they get it sent electronically as well. You need the threshold there.

Infographic: The Rising Cost of Diabetes

November 21st, 2012 by Patricia Donovan

The national cost of diabetes in the United States now exceeds $174 billion, as shown in this infographic released by Clinical Trials GPS. This includes $116 billion in excess medical expenditures attributed to diabetes, as well as $58 billion in reduced national productivity. On average, people diagnosed with diabetes have medical expenditures that are more than double of those who do not have diabetes.

Diabetes Cost
Courtesy of: Clinical Trials GPS

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Infographic: Health Data in One Drop

November 16th, 2012 by Patricia Donovan

A drop of blood can provide a rich picture of an individual’s health state — risk of heart attack, cholesterol levels, likelihood of pre-diabetes, and much more. This infographic from WellnessFx illustrates the health information stored in a drop of blood, valuable biometrics for disease self-management and health risk assessment.

Health Data in Blood
Courtesy of: WellnessFx

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Infographic: Understanding the Diabetic Patient’s Experience

October 30th, 2012 by Melanie Matthews

Some 65 percent of surveyed diabetic patients report that the services they receive should be greatly improved, according to a new infographic by DHP Research.

Learn the high priority areas for these patients and key perceptions and contextual considerations in improving diabetes care.

Interpreting the Diabetes Patient Profile

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Integrated Health Coaching: Spanning the Risk Continuum with Health Behavior Change Management

October 5th, 2012 by Cheryl Miller

Adam is 40 years old, married, and father to two children. He doesn’t smoke, but he’s overweight, with biometric risks that, if left untreated, could lead to chronic disease.

Sally is 52 years old, married, and mom to two busy teenage boys. She was diagnosed with diabetes five years ago and is diligent about her diet and medication regimen, but she doesn’t exercise and needs to lose 20 pounds.

Bob is 56 years old, suffered a myocardial infarction (MI), has been diagnosed with coronary artery disease (CAD), recently underwent cardiac rehabilitation, but isn’t sure he can stay on course.

All three patients require different levels of health coaching, says Dr. Dennis Richling, HealthFitness’ chief medical and wellness officer during a recent HIN webinar, Integrated Health Coaching: The Next Generation in Health, Behavior Change Management. And HealthFitness’ person-centric, integrated health coaching approach addresses participants’ needs across the health continuum — from those needing lifestyle and health behavior changes to those requiring help managing chronic, comorbid diseases, while delivering results via a reduction in healthcare utilization, improvements in clinical and HEDIS measures and a return on investment.

In addition, the program aligns with many of the key principles of post-ACA care delivery models like the patient-centered medical home (PCMH) and the accountable care organization (ACO), Dr. Richling continues.

He and Kelly Merriman, HealthFitness’ vice president of service delivery, shared key features of HealthFitness’ program, from how participants are assessed and assigned to coaches to the program’s impact.

First steps include assessing a patient’s health risk factors and using a predictive modeling algorithm to determine patients’ eligibility for coaching, and then matching them with the right one.

“We see our coaching solution as being population-based, so that it’s not a separate silo-type of solution, but a continuum. We did not want a situation where a lifestyle management coach and a nurse worked with an individual at the same time,” explains Dr. Richling.

Which means that Adam, with no chronic disease, but who is at risk and doesn’t know it, will be matched with a health coach. Sally, who is managing her chronic disease, has no other comorbid diseases, but has underlying lifestyle issues, will meet with an advanced practice coach. And Bob, who is not following his care plan, is seeing multiple doctors, and not adhering to medication as prescribed, will see a nurse coach.

Once patients and coaches are matched up, coaches must discern participant values during the coaching intervention, and utilize the art of ‘appreciative inquiry’ – an essential coaching skill that helps to define an individual’s ‘exceptionality.’

It’s a step away from the traditional method of disease management to one of active listening, Ms. Merriman says. “We’ve changed the traditional, clinical nurse coaching model by adding the element of positive engagement that really is what motivates people to change,” says Ms. Merriman. By using such tools as motivational interviewing, stages of change, positive psychology and appreciative inquiry, coaches are able to produce change, says Ms. Merriman. And risk is reduced when behaviors are changed.

Ways that technology supports these interactions include monitoring risk and changes in health status and providing information back to the coaches, via a dashboard they can interact with. Providing the patient with tailored educational material is another resource, and even handing the patient off to a more effective source of support, and maintaining strong interactions with primary care and specialist physicians, all lead to reduced risk and utimately reduced utilitization and healthcare costs.

“The keys to a successful population health management offering is effective tools that help align the individual with the right service at the right time,” says Dr. Richling. “That type of alignment is really leading to healthier lives in general within a population.”

Adult Obesity Rates Could Exceed 60 Percent in 13 states by 2030

September 25th, 2012 by Cheryl Miller

A reduction in BMI by just 5 percent could dramatically reduce the rates of obesity-related diseases and healthcare costs

The number of obese adults, along with related disease rates and healthcare costs, could increase dramatically in every state in the country over the next 20 years, according to a new report from Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

Thirteen states in particular could see obesity increases upwards of 60 percent if things don’t change, with Mississippi set to have the highest numbers. The number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis could increase 10 times between 2010 and 2020 and double again by 2030. Medical costs associated with treating these diseases could increase by $48 billion to $66 billion per year in the United States, and the loss in economic productivity could be between $390 billion and $580 billion annually by 2030.

But if Americans reduced their average body mass index (BMI) by just 5 percent by 2030, the rates of obesity-related diseases and healthcare costs could be significantly reduced, the report claims. Every state could help thousands or millions of people avoid obesity-related diseases, while saving billions of dollars in healthcare costs.

“We need more effective interventions with the population as a whole,” says Dr. Dennis Richlin, chief medical director and wellness officer for HealthFitness, an integrated health coaching program, in a recent HIN webinar. “There is a whole sub-population within employers, and some have taken on employees with programs that have resulted in risk reductions, cost savings and weight change,” he said. “We can make a difference, but it’s not a quick fix…but we could start to see significant changes over the next five years.”

Patient satisfaction could be one of the most significant changes among those involved in health and wellness programs, according to our currently running Population Health Management survey. But getting patients to embark on and remain engaged in such a program remains the greatest challenge for those considering launching one, say nearly half of our respondents at this point in the survey.

In other news, another way to lower healthcare costs could be by extending physician office hours. A new study links the two, finding that patients whose usual source of care offers extended hours by remaining open during evening and weekend hours had less use of and lower associated expenditures for office visits, prescription medications, ED visits and hospitalizations than patients without such access.

And one way to use those extended hours in the waiting room could be by reviewing healthcare benefits, because, according to a new survey from Aetna, choosing them is the second most difficult decision to make behind savings for retirement. In fact, choosing benefits is considered to be tougher than purchasing a car, making decisions about medical tests or treatments, and even parenting. The main problem is complicated, conflicting information. See what our managing editor has to say about this in her blog post Is Choosing Healthcare Coverage Really Harder Than Parenting?

But there is some uncomplicated good news for Medicare Advantage members: it continues to remain strong, with a projected enrollment increase of 11 percent in the next year, and no increase in premiums, according to the CMS.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

RN Clinical Care Coordinators: Rocks in Granite State’s Newest Accountable Care Program

May 29th, 2012 by Patricia Donovan

In what is believed to be the largest accountable care program in New Hampshire, the Granite Health Network (GHN) and Cigna are launching a collaborative accountable care initiative to expand patient access to healthcare, improve care coordination, and chip away at escalating healthcare spend associated with high risk, high utilization patients.

To benefit from this collaboration are more than 23,000 individuals covered by a Cigna health plan who receive care from more than 900 healthcare professionals across GHN’s five independent charitable healthcare organizations. Patients who need help managing a chronic condition such as diabetes or heart disease will be among the first to reap the new program’s benefits.

The new accountable care initiative will receive solid support from a team of registered nurse clinical care coordinators who will be embedded in care sites, according to a Cigna press release:

Critical to the program’s benefits are registered nurses, employed by each of the five GHN healthcare organizations, who serve as clinical care coordinators and are integrated into the care delivery team to help patients with chronic conditions or other health challenges navigate their healthcare system. The care coordinators will enhance care by using patient-specific data provided by Cigna to identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators will contact these individuals to help them get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

The care coordinators will also help patients schedule appointments, provide health education and refer patients to Cigna’s clinical programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management. This initiative is unique in using data and analytics at the health system level to focus healthcare professionals more fully on engaging patients to improve the coordination of their care as well as develop best practice clinical initiatives across the GHN member health systems.

Cigna will compensate GHN for medical and care coordination services it provides. Additionally, GHN organizations may be eligible for financial incentives if they meet specified clinical and financial targets, Cigna said.