Posts Tagged ‘Disease Management’

HealthFitness Refines Population Health via Engagement, Tools and Technology

November 19th, 2013 by Jessica Fornarotto

Integrated health coaching continues to move the needle on population health management with interventions that keep the healthy, healthy without compromising the clinical support needed for high-risk, high utilization individuals. Dr. Dennis Richling, chief medical and wellness officer for HealthFitness, and Kelly Merriman, vice president of service delivery for HealthFitness, believe coaching offers a great opportunity to change the health status of a population.

In HIN’s special report, Integrated Health Coaching: Reducing Risk and Empowering Change across the Health Continuum, these industry experts detail HealthFitness’ move toward integrated health coaching, including the rules of participant engagement, the role of technology, and the range of self-management tools provided for participants.

Question: What strategies reach the population and increase engagement in health and wellness coaching?

Response: (Dr. Richling) One of the key strategies has been the use of an incentive that draws people toward the program. Incentives are fairly effective in getting people to do certain kinds of activities. If we provide an incentive for taking a health assessment, for instance, then we can engage them in a health advising session. We can take that external incentive and try to leverage it into an intrinsic motivation to go into our health coaching program. We see a better engagement rate when we offer an HRA, and when we provide screenings and advisement.

(Kelly Merriman) Engagement is also how long participants are choosing to engage with their coach. One of the main reasons we created our EMPOWERED Coaching program, or coaching across the continuum, is to more appropriately assign those individuals who have a chronic condition that is being well managed with somebody specially trained in lifestyle engagement techniques. Individuals working with our advanced practice coaches are much more likely to remain engaged with their coach because they’re focusing on those things that are most important to them.

Question: What is the role of technology in the various levels of health and lifestyle coaching?

Response: (Dr. Richling) We have developed a sophisticated algorithm that uses claims data and HRA data to decide which coach would be the best coach for the participant. The algorithm evaluates whether the individual has the appropriateness of care compared to chronic care guidelines, whether they are compliant to those guidelines, if they are having trouble with functions of daily living, and it also evaluates the risk for high cost in the future. These all go into identifying which professional coach would be the best fit for an individual. Technology continues to play a role after a person and coach are matched:

  • Assessment of risk is ongoing; HealthFitness’ data and technology platform can reassess a participant’s health status whenever new data becomes available.
  • Health coaches access a unique dashboard of participant-specific information via a proprietary HealthFitness technology platform. The technology populates a record with personal health risk factors, claims data, biometric screening results and previous contact with the coach and other program personnel, as well as complete activity and program information feeds.
  • The platform also displays a 360-degree interactive view of client-specific program options so the coach can reference participants to health management activities and programs from their employer, whether HealthFitness provides the services or not.

Question: What tools do you provide to your coaching participants to help them self-manage their conditions?

Response: (Kelly Merriman) We have a series of educational and self-management tools available for participants via their wellness Web site and/or the mail. For example, a coach can share documents and resources with a participant through a toolbox, which then integrates with the wellness portal. Additionally, participants are able to set up and track their focus area goals of interest. The coaching program has a mobile phone interface that allows users to track their progress remotely and stay in touch with their coach.

3 Ways to Use Registries to Close Care Gaps

September 3rd, 2013 by Jessica Fornarotto

There are many benefits to registries, including identifying groups of patients who require certain tests, as well as those who are at high-risk, says Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare. Dr. Spencer also explained how registries are useful for identifying gaps in patient care in three areas: health maintenance, disease management and quality measures.

Health maintenance looks at who is due for what and when, based on a subset of people that you are looking at. The lines blur as to why this registry is different than just saying it’s everybody over 50; it’s the same thing. That is part of the demystification of registries; you are doing this already in the areas of health maintenance, quality measures and then disease management (DM). The two registries that we often use are for patients with diabetes — first, those that are poorly controlled, and second, patients on Coumadin®, because they are very high risk for serious health events.

In using the registries in our practice, we have 12 clinical divisions. Each one is headed by a physician from that specialty. Quality efforts and information is dealt with on the front line there. We have a quality committee that works with the divisions to develop these registries and then implement them for quality efforts. We then have a higher practice-level committee for quality and patient safety. In addition to clinical people, there are also facilities people and the billing office, to name a few. This way, we have a more broad-based view of these data.

We try to collect necessary data only once and not have people re-enter things. Use data over and over and over. If you gathered it and spent the effort, you might as well try to use it for many purposes.

For our quality measures, we collect what we can easily measure and there are repeated themes. We involve the IT team early and often. The more specific you can be, the better; they will want detailed specifications. But at the same time, if you spend a lot of time thinking about something and it turns out to be completely undoable, you wasted some of your time, too. Having a good relationship with somebody who can work with you on the back end is important because they help shape that.

Also, know where the data is kept and entered. This requires somebody that knows your system, hopefully somebody in-house who has gotten to know it, perhaps a vendor. It has been very useful for us to have somebody who can work as a clinician. In our practice, that is me. I am also the chief medical information officer, so I meet with the IT experts all the time. I am able to act as an information broker. I can rephrase questions if there is confusion, and then also assure that the data coming out is appropriate. You need somebody that can talk the talk and make sure that the right information is being delivered and gathered.

Case Management, Disease Management Top Skills Sought in Burgeoning Health Coach Field

August 23rd, 2013 by Cheryl Miller

University of Delaware's Health Coaching Certificate recipients' presentation. Mike Peterson, top left, Kathleen Matt, Dean of College of Health Sciences to his left; faculty members, Katherine McCleary, Emily Davis, students.


Motivated by a recurring lament among local physicians and health professionals that patients weren’t following through on certain behaviors, the University of Delaware (UD) launched its first Health Coaching certificate program in 2011, and honored its first two recipients at a ceremony this past May. The 18-credit hour post-baccalaureate program prepares health professionals to work in a clinical setting as part of a team that facilitates behavior change among at-risk patients, decreases demand for healthcare services, and reduces morbidity across the life span.

To create this program, curriculum leaders consulted the Delaware Health Sciences Alliance, which comprises the UD, as well as the Christiana Care Health Systems, Alfred I. DuPont Children’s Hospital, and Thomas Jefferson University, a Philadelphia-based medical school. The school received valuable insight from a team of local physicians and health professionals, including nurses, clinical psychologists, nutritionists, behavioralists, and pharmacologists on perceived needs and deficiencies in the healthcare system, and the kinds of skills and competencies they would like to see in a health coach.

According to the report “Market Demand for Certificate Programs in Health Coaching,” from the Education Advisory Program in Washington, D.C., which stated that employer demand for health coaches has grown 408 percent since 2007, with the number of health coach job openings peaking a year after the ACA was passed.

And the top five skills sets employers are seeking in health coaches? Case management, disease management, motivational interviewing, chronic disease, and clinical experience.

Following is our discussion with Mike Peterson, chair of UD’s Department of Behavioral Health and Nutrition.

HIN: What prompted you to offer this program now?

Mike Peterson: We created it to address the primary determinate of health, which is behavior, which accounts for about 40 percent of morbidity, according to the World Health Organization (WHO). Most doctors, because of the current health system, can only spend from seven to 15 minutes with a patient, which really isn’t a lot more than diagnosis and treatment.

The other thing is that most medical professionals, doctors and nurses don’t get any behavioral change expertise, knowledge or skills. They are trained in diagnostics and prescriptive treatment.

HIN: What insights did you receive from physicians and health professionals regarding skill sets and competencies needed for the certificate?

Mike Peterson: They have to have case management, disease management, and motivational interviewing experiences or knowledge. They have to have a basic understanding of chronic disease, which we provide; a course that covers about 20 of the major, common chronic diseases, their ideology, their treatments, diagnosis, pharmacology. They have to understand how to change people’s behavior, have good communication skills and a good working knowledge of basic health promotion and health education principles.

There’s clearly a skill set that’s currently not being taught in the other health disciplines. How do you extract information? How do you work with an individual? How do you motivate an individual? How do you communicate with them in a way that actually gets them to do the behaviors that are necessary to improve their health?

HIN: What recommendations were made on motivational interviewing techniques?

Mike Peterson: Motivational interviewing is important, but it doesn’t work in all cases. It’s somewhat oversold as a panacea for all problems. It’s a good tool to have but not every problem is a nail. Sometimes you need other tools in your toolbox to facilitate behavior change. So we teach other types of behavior change strategies as well: the use of contracting incentives, things to help facilitate and promote behavior change.

HIN: You would like to see health coaches affiliated with doctors’ offices and clinics. Should they be embedded or co-located in the practice or clinic?

Mike Peterson: Yes. We’re trying to get them placed right in the clinical office and become part of the healthcare team, for example, the medical home model where the doctor is in charge and the health coach is part of that team. We see health coaches not necessarily dealing with every patient a doctor has, but the primary, high-risk patients, or people of moderate risk who could have potential for high risk.

HIN: What about reimbursement for them?

Mike Peterson: That’s a good question and the one we’re all wrestling with right now. There’s been a shift in the demand for health coaches from payors to providers; we are seeing health coaches paid right from the insurance industry or hospital; they see that the coach is a good idea and so they decide to fund them privately within their own coffers. And under the new healthcare bill doctors are paid for outcomes. If they get better outcomes with patients they get a percentage of the potential savings reimbursed back to them. Some of those funds could be used to fund a health coach.

HIN: What insights did you receive on recommended caseloads for health coaches?

Mike Peterson: Ideally, if you have a 40-hour work week, about 25 hours could be engaged in client time, one-on-one face time. The other 15 hours would have to be a record keeping and perhaps telephonic communications with previous patients or communications with the medical staff about what’s going on with specific patients. So we figure in any week you could see 25 individuals.

HIN: How can health coaches help to improve care transitions, from hospital to home?

Mike Peterson: Again, going back to their primary role, which is helping people deal with behavior changes, their role in terms of transitions from hospital to home would be to follow up with some of the behaviors that they would need to do, such as out-clinic or out-patient activities. For example, if they just had physical therapy following a knee replacement, it could most likely be due to their being overweight. Health coaches could help them maintain a physical therapy program, and also help them with strategies to lose weight. They would work in tandem with the patient and healthcare professional.

HIN: Where do you see the profession of health coaches in the future?

Mike Peterson: Ultimately, we would like to see health coaches licensed, because too many people now are calling themselves health coaches and not anyone knows what it is. Someone says they’re a health coach and they deal with ADHD and another person says they’re a health coach and they deal with personal training, so they’re basically a glorified personal trainer.

Healthcare Business Week in Review: Yoga for Caregivers, Diabetes Management, Healthcare Coverage

August 2nd, 2013 by Cheryl Miller

Offering yoga and meditation classes to caregivers of seriously ill patients just prior to starting clinical meetings on palliative care issues is one detail that sets Mount Sinai Hospital’s palliative care program apart from others. Together with Denver Hospice and Optio Health Services in Colorado, and UnityPoint Health Palliative Care Program in Iowa and Illinois, these three palliative care programs received the 2013 Circle of Life Award®, along with five others that were awarded Citations of Honor from the American Hospital Association (AHA).

Other programs involve a community-wide program to embrace the growing Hispanic community, and regular outpatient and home visits to ensure proper care transitions, and help avoid unnecessary emergency room visits and readmission to the hospital. All of the programs set out to reexamine the roles palliative care plays in healthcare by creating and championing end-of-life care for patients and caregivers throughout the healthcare system.

Providers need to reexamine certain diabetes monitoring practices that solely target acute individuals, and instead take a population health management approach to improving diabetes care, according to a Phytel study published in the American Journal of Managed Care.

Researchers found that despite national attention, uncontrolled diabetes was growing, and those patients at real risk were those that waited to seek care until their condition was exacerbated to an acute phase. A broader population-based approach was required to catch at-risk patients. Researchers recommend that provider organizations take two important steps to improve their ability to help their patients better manage their diabetes, including reaching out to their entire population between office visits so patients waiting too long to get retested are motivated to have the testing done earlier.

Economists need to reexamine their data linking the employment rate with healthcare coverage. Despite economic reports showing that the recession is over, the percentage of workers with health benefits still remains low, according to a new report by the nonpartisan Employee Benefit Research Institute (EBRI).

Links between the employment rate and health insurance coverage have been documented over the years. Since most workers in the United States get their health coverage through their jobs, a rise or drop in the unemployment rate usually means a corresponding rise or drop in the uninsured rate as well, the report states.

But these facts aren’t holding up against trends that show that nearly half of the population does not have coverage.

We’d like you to examine and respond to our current e-survey on the population health management of dual eligibles. These nine million Americans eligible for both Medicare and Medicaid present unique challenges. Public and private payors are now tailoring care coordination strategies for Medicare-Medicaid beneficiaries that are both geared to their medical, social and functional needs and cost-efficient. Describe your organization’s approach to care coordination of dual eligibles by August 6, 2013 and you will receive a free summary of survey results once it is compiled.

Healthcare Business Week in Review: Depression Management, Value-Based Benefits, Dual Eligibles

July 2nd, 2013 by Cheryl Miller

It takes a village to help those suffering from depression. Even a barber shop.

According to a new study from the RAND Corporation, when community-based support groups such as churches, substance abuse counselors, and yes, even barber shops, offered support to lower-income people suffering from depression, the patients’ mental health improved, their level of physical activity increased, and their hospitalizations decreased.

Researchers targeted lower-income neighborhoods because help is frequently unavailable or hard to find. Many suffering from depression also go undiagnosed; called the “silent monster,” it affects almost one out of five people from all cultural groups at some point in their lives. You can find more details in our story.

It takes a value-based benefits plan, and a disease management program, to help diabetics better control their health.

According to a new study from Truven Health Analytics™ and the Florida Health Care Coalition, patients enrolled in value-based benefit design in conjunction with a disease management program showed higher adherence to both brand and generic oral medications and a higher uptake of insulin over the three-year study period.

The study, Value-Based Design and Prescription Drug Utilization Patterns Among Diabetes Patients, which appears in the May/June issue of The American Journal of Pharmacy Benefits, examined the three-year effect of value-based design and disease management programs on diabetes patients. Value-based insurance design is a medical benefit plan design that reduces patient out-of-patient costs for treatments that are known to be effective, and increases out-of-pocket prices for lower value services.

It takes a combination of factors, including financial hardship and disability or old age to meet the criteria that defines dual eligibles, a population that nears 9 million in the United States.

You can find these facts and more in our new HINfographic, Defining the Dually Eligible: 16 Things to Know for Population Health Management, which illustrates a wealth of metrics on the dual eligibles population. Managing this population successfully is key to keeping healthcare costs low; and the HINfographic lists six keys to successful management of duals, including medication management and patient education.

Lastly, we’d like to ask you to take some time to fill out our third e-survey on Telehealth.

A clear majority of healthcare organizations are using telehealth in clinical and non-clinical settings, according to preliminary results from survey. Your response will be kept strictly confidential and will only be used in the aggregate.

TTYL Craving: Texting Helps Smokers Kick Butts, Healthcare Costs

April 25th, 2013 by Cheryl Miller


Remember the Marlboro Man, who filled black and white TV screens and magazine pages back in the day, always holding a cigarette in his calloused hands?

Initially designed to counter public opinion that filtered cigarettes were for women, he appeared to be the quintessential macho man, unafraid of anything, whether it was errant horses, lawless poachers, or even the front lines of war.

Not surprisingly, the Malboro Man got a makeover of sorts over the years; revealing that he was afraid of something, and that something was chemotherapy. It was one of California’s arsenal of ads they’ve been pummeling the public with for the last few decades. And they’re working; in a recent news story published here, the University of California SF reported that the state’s tobacco reform campaign, while costing California $2.4 billion since 1998, reduced healthcare costs by $134 billion, and reduced the sales of cigarette packs by 6.8 billion, amounting to a loss of $28.5 billion in sales to cigarette companies.

Well, a new ad might appear on the sun-drenched horizon soon, featuring the older, wiser Marlboro Man holding a smart phone instead of a lasso, and reading one of many specially timed texts to help him quit smoking.

Agile Health recently announced Kick Buts 2.0, a major upgrade to their Kick Buts high touch, low cost smoking cessation program. Kick Buts delivers personalized text messages to smokers who need advice, support and encouragement as they try to quit smoking. It sends messages at scheduled intervals over a six-month period to help them develop the knowledge, motivation and behavioral skills necessary to drive sustained behavior change.

It also responds immediately to key words from participants requesting help to overcome cravings, slip-ups or relapse. So, someone can text “Craving” and they will receive a pep talk on how to ride the craving out.

It seems like a perfect way to hook the smokers who are already hooked on their smart phones — in particular, kids who’ve found their way to a cigarette despite the worldwide glut of anti-smoking campaigns. According to our recent survey on mHealth, smart phone apps are the most widely used technology tool today, with text messaging coming in a close second.

“These days I prescribe a lot more apps than medications,” says Dr. Eric Topol, who was profiled on Rock Center with Brian Williams recently, and is author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. He points to the smartphone as a leading breakout tool, with the eventual ability to detect cancer cells circulating in the blood or warn patients of an imminent heart attack or monitor glucose levels through a sensor implanted in the body which, when activated, sends a signal to the patient’s smart phone.

“A ninety-year-old can leave the hospital and be monitored remotely like he’s still in the ER,” says Dr. Topol, and it is this kind of remote technology that could save the healthcare industry millions in prescription drugs and unnecessary tests.

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.

Meet Healthcare Case Manager Lori R. Young – Treating Each Patient Like a Work of Art

March 4th, 2013 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.

Lori R. Young, RN, CCM, Case Manager Mid-America, North Flex Medical Team

HIN: Tell us a little about yourself and your credentials.

(Lori R. Young:) I’ve been a nurse for more than 25 years. I have a current RN license in both Georgia and Florida, and recently obtained my certification in case management, which I enjoy very much. When I began with Aetna about seven years ago, I spent my first four years in disease management. I was one of six core nurses chosen for a large employer customer team. Only six nurses out of the entire disease management team were chosen, so that was quite an honor in itself. I was also the nurse chosen to meet Ron Williams, our CEO at the time. They selected one nurse for him to talk with and see how we do things, and what our workflow was. Meeting Ron and having that experience was a wonderful experience.

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

I have actually been a nurse since I was 15 years old. I started in South Florida as a candy striper in a geriatric home there. I would write letters for patients, hold their hands while they were having their blood pressure done. That is how I began in nursing, solely on a volunteer basis.

Seeing the difference that caring and respect made had a big impact on my life. I’m a very positive person. I’ve been an artist for the past 25 years, and that does play into this. Each piece I do is unique and it’s how I view my patients and my members.

What kind of art do you do?

I use multimedia. I am a gourd artist; gourds are natural products and I do high-speed carving, including a seasonal Santa Claus line. Three or four years ago I did a show for HGTV, I was one of six artists featured, and it was the greatest time. I also create a line of jewelry with my mother; she is in Florida, and we make bracelets for the battered women’s facility there. My mom presents them to people who have nothing. And I also make glass; I turn it into what appears to be stained glass. I created an entire line of these and gave them as gifts to a group of nurses I worked with; each piece had their names carved into the glass.

That’s in my midnight hour. It’s so relaxing to do nursing and case management all day long on a full-time basis and have that time of relief. And I think it actually makes me zero in even further the next day when I go to work.

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

There have been so many it’s hard to pick just one. I assisted a family with two children; I was assigned to be the father’s case manager after he had an acute MI. It was the scariest night of this family’s life, and the mom said it was a night that changed their life around. She wrote a letter to Aetna and dedicated a song to me, She’s an Angel, by Alabama.

I still get tears in my eyes when I feel like my patients are holding my hand over the phone or they bring me into their personal lives and tell me how their grandchildren or their elderly parents are. I believe that is such an important part in what we do.

In brief, can you describe your organization?

I am extremely proud to work for Aetna. It’s a company that has helped build and shape America for over the past 160 years. I respect our leadership in (Aetna CEO Mark) Mr. Bertolini and those who work with him. It was about 1850 or 1853 when Mount Aetna erupted, an 11,000-foot volcano in Sicily that led to the naming of Aetna. To this day I still feel such pride and passion in working with them because I feel they shape America on behalf of our members, the communities they serve, and their endless efforts to give. They’re the first ones there when a tragedy strikes. I just can’t say enough for my company, for our company and its leadership.

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

Privacy is one of the most important concepts, whether you’re in an elevator or whether you are standing with your friend on the corner and talking. We have a very large population of baby boomers and late baby boomers and you just never know who is standing next to you in an office or elsewhere.

People are so unique onto themselves, just like my art pieces – their expectations, their level of knowledge of procedures, techniques, doctors, personalities, the healthcare system itself. There’s so many complexities that each and every person has to absorb; I think proper assessment, and respecting privacy is very important.

I also believe that collaboration between our departments, between our managers, and our higher management is important; that we talk to each other on behalf of our efforts towards each member of patient. What do they need? We can’t be afraid to talk to each other or that it’s going to take too much time.

Lastly, most of us are telephonic, and it is important that our members or my patient knows my sincerity, and the smile on my face. I want to treat every single person like they’re the 8:30 call of the day. I want them to feel that. I don’t want them to think I’m too busy to hear something very important, or that they’re just going to throw something by me and see if anybody cares, and if they get a response. I really do want to be that person that hears them.

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

With the changes coming in healthcare, there’s a great deal of fear among people: fear of the unknown, fear of whether their children, as they get older, will have insurance. Do they even know what a socialized system is? Do they know whether or not this is going to become the system? Aetna wants to be the forerunner. They want to get it right. And they want to get the information correct and get it out to the people as easily and thoroughly as they possibly can. Aetna Navigator is a tool that our members have access to with private ID and password. It’s a very secure site that each year is becoming more and more user friendly. And reaching out on a community level is very important. I believe there is a great need for Aetna to come to the neighborhoods.

Do you see a trend or a path that you have to lock onto for 2013

The trend that I’m seeing is providing an increased knowledge base to our communities and our existing members. Helping them to understand. It’s difficult for most of us that have been in healthcare for 25 and 30 years; it is quite complex. And to do this not only in a multilingual sense — we have a language line that is just sensational – but to provide people with the most accurate, easy to understand information. I’m going to use ‘accurate’ as the first word, because they hear so much from so many sources, and so many of them depend just on the television. My goal would be for Aetna to provide these people with a better understanding of where we’re headed.

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

Being a case manager is multifaceted. It is being able to be the patient’s advocate and assist them and their families with their healthcare benefits, and help them utilize their benefits to the maximum degree.

And the most important thing is, again, to let them hear my voice, to let them know how much I care. This is not just a business transaction. This is their life, their family’s life, and I really care that we do this right.

What is the greatest challenge of case management and how are you working to overcome this challenge?

One of our greatest challenges is patient load. We are a very busy team and no matter how busy, we still assist other teams when needed. No matter how busy I am, when I speak with a person I don’t look at a clock. Our case managers’ time management skills are sensational for everything from technical problems (the biggest thing that can slow us down) to the patient who needs to talk for 90 minutes versus the patient who only needs five minutes. Time management is a great skill that case managers must possess. And, the case manager must maintain a balance: after you finish with that 90 minute member, the next person should feel like they’re the first one of your day. And that’s a fine balance.

What is the single most effective workflow process, tool or form case managers are using today?

The most important tool we have is collaboration. It is the greatest tool that I know of, to collaborate with my peers, medical directors, supervisors, and it all requires excellent time management. If you have spent 10 minutes, or you have clicked three times to reach what you’re after and you’re still not there, reach out. Manage your time. We all get caught up in it sometimes. We want to be successful in our search of that unique thing, but as a team, it’s best to be time efficient and reach out to your peers.

We also have a Wiki, which identifies a complete workflow, and we have our central sites that we go to. Aetna has provided unlimited resources – (PS2) performance tools if we need them – if you have a very difficult case and want to look at that discharge plan and get your flow down just a little bit better, it’s available. It’s there for us.

Finally, continuing education. We’re in a very fast-moving medical world. So what they offer us in continuing education is just phenomenal.

Where did you grow up?

I grew up in Hollywood, Florida. I started my prerequisites at Broward Community College and didn’t know anyone except a cousin in Georgia, but I had always heard Georgia was a beautiful place.

In high school I was the recipient of a junior scholarship. It was out of financial need, and it was for dental hygiene because I had six years as an oral surgical and dental assistant prior to becoming a nurse.

Even though I had received a scholarship, I stood up and I said, “Please give this to someone who is going into dental hygiene, I’ve just decided I’m going to go into nursing and become a nurse.” I gave up the scholarship to someone who could definitely go forth and use it for their dental hygiene career.

Are you married? Do you have children?

I do not have children, but I rented about a thousand of them. I was in pediatrics for 12 years. It was an absolute joy. I did not have children by choice. I am married to my absolutely most adorable best friend.

What is your favorite hobby?

It is my art and being outside. I love to create unique pieces. And Mother Nature is one of my greatest past times. We live on a creek and I just love the hummingbird migration time. I feed the birds, the rabbits, and the deer; we had baby warblers, cardinals and wrens this year. I love watching them making their homes and nest. And then they have the babies right there.

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

Yes, l very much like the David Baldacci series. I just loved the Camel Club (a trilogy). And I was so excited about the new Men in Black movie that came out. But that’s not the one I would recommend. I would recommend Avatar, for its creativity. And I’m an old movie buff. Gunsmoke is one of my favorites.

Any additional comments?

I’m in a place in my career of combining business and medicine. I guess that dreams do come true. I worked very, very hard to get here and I am honored to be with a company like Aetna.

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25 to 31 Million Americans Receive Care Through ACOs

December 11th, 2012 by Cheryl Miller

In just two years, the number of ACOs has swelled across the country, according to a new report from Oliver Wyman. A total of 25 to 31 million U.S. patients currently receive their care through ACOs, and an estimated 45 percent of the population live in regions served by at least one ACO. Researchers weren’t surprised by some of the ACO-intensive areas, namely urban areas like Los Angeles and Boston. But other ACO-rich areas were surprising, findings that support researchers’ claims that ACOs are poised to offer a competitive threat to traditional FFS medicine.

Increasing patient numbers, especially among the uninsured and Medicaid-eligible, has always been a problem for public hospitals, according to a study from the Center for Studying Health System Change (HSC), and will continue to be a problem in light of ongoing health reform. How to continue to service low-income patients without sacrificing care quality? Expanding primary care access and attracting privately insured patients are two of six strategies public hospitals are taking; other strategies are detailed in this issue.

Rising healthcare costs could be contained by an estimated $200 to $600 billion in savings over the next 10 years if care provider payments are reformed, according to a report from UnitedHealth Group’s Center for Health Reform & Modernization. Around half of these savings might apply to Medicare and Medicaid, but even under optimistic assumptions about net savings and speed of adoption, health spending would continue to grow faster than incomes. Researchers maintain that payment reform is not the only answer, and needs to be pursued with other alternatives.

One potential solution for the sadly soaring numbers of cancer patients: oncology-specific EMRs that chart evidence-based treatment plans, according to a clinicians at The Mount Sinai Hospital. These EMRs enable drugs to be prescribed and health records to be exchanged electronically. Quality-related clinical data can also be captured for analysis. A panel convened specifically to study the EMRs’ effectiveness found that nearly 80 percent of people using them felt they increased their day-to-day efficiency and improved the quality of patient care.

And lastly, one aspect of healthcare that needs to be increased: the use of health coaching as a critical tool in population health management. Studies are showing that health coaches help to boost self-management of disease and reduce risk and associated cost across the health continuum. What do you think? Take HIN’s fourth annual Health Coaching survey; results will demonstrate how healthcare organizations use health coaching as well as the financial and clinical outcomes that result. Complete the survey by December 21, 2012 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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

Q&A: Integrated Health Coaching Brightens Total Healthcare Picture of Population

November 21st, 2012 by Jessica Fornarotto

To determine the coachee’s values, the health coach listens to achieve empathy and understanding, which demands that they have a sense of an individual value, says Kelly Merriman, vice president of service delivery at HealthFitness.

Prior to their presentations during a September webinar on Integrated Health Coaching: The Next Generation in Health Behavior Change Management, Merriman and Dr. Dennis Richling, chief medical and wellness officer at HealthFitness, discussed HealthFitness’ transition to a population health management focus, why HealthFitness’ coaches target the chronic disease population and a new coaching tool called appreciative inquiry.

HIN: How has HealthFitness’ shift from a disease management to a population health management focus meshed with the industry’s post-reform models of care, for instance the patient-centered medical home (PCMH) and the accountable care organization (ACO)?

(Dr. Dennis Richling): HealthFitness has had a population health management focus for many years and we see that many of the same principals that we use in our approach are included in ACOs and in medical home models.

Recently, we took a new look at disease management, which traditionally has been a stand-alone service, largely focused on patient self-care issues separate from lifestyle coaching interventions. In our new model, health behaviors across the entire risk continuum are dealt with in a person-centric way, rather than a disease-centered approach. That of course aligns with some of the principles of the post-reform models of care, like the medical home, and even to some degree with ACOs, which are attempting to be responsible for the total healthcare picture of a population.

HIN: In your company’s three-tiered coaching across the continuum approach, where do most of the coaching candidates fall?

(Dr. Dennis Richling): In every population you find different numbers, but in a typical employer, we see that the greatest opportunity for coaching is in those individuals who have behaviors that can lead to chronic disease. A good example of an ideal candidate for our coaching program is a 40-year-old manager working 50 hours a week. His blood pressure isn’t high, his cholesterol is slightly elevated and he’s a little overweight. He doesn’t exercise regularly and while he tries to watch his fats, he isn’t eating the most healthy diet because he hasn’t figured out how to balance his work schedule and his family life, and being 40. He’s also at risk for chronic disease. If he adopts more healthy behaviors, he can avoid developing a chronic disease.

Then there are those who already have a chronic disease like diabetes or coronary artery disease. This is about 10-20 percent of a population, depending on the population we’re looking at. Instead of putting all of them into nurse coaching, like traditional disease management, we determine through claims and a short assessment if the disease is well managed. In our experience, about three-quarters of those with chronic disease are taking their medicines and managing their diseases relatively well, though, they still need help with the underlying lifestyle issues that led to the chronic disease.

Those individuals are matched with an advanced practice coach (APC) who understands their underlying chronic disease issues, but will work with them to achieve goals that they want to work on, like losing weight or exercising regularly. By far the smallest group is those with the newly diagnosed or uncontrolled chronic disease. We match them with nurse coaches who can most effectively work with their self-management approaches, with making sure that they follow their medication and care plans that the physicians have prescribed.

HIN: In tailoring a coaching program to the individual, how does a coach determine the coachee’s values?

(Kelly Merriman): We call it ‘listening until you don’t exist.’ Most people listen to get information or because they enjoy the process of exchanging perspectives. Our coaches listen to achieve empathy and understanding, which demands that they have a sense of an individual value. For example, Michelle is 46 years old and is significantly overweight. And because of her weight, she’s a pre-diabetic. She told her coach that she was ready to make a change. She knew her weight wasn’t only impacting her health, but also her self-esteem. Michelle’s coach listened and learned that she took pride in being a pillar of support for family and friends, that ‘never let them see you sweat’ mentality, which meant she was holding in her fears of being overwhelmed at times.

Imagine if a coach reflected back thoughtfully and said, “I’m hearing, Michelle, that you take pride in caring for others, that you value being competent and having others rely on you for support. And sometimes when things get to be a little too much, you overlook your own health.” Once a coach finds those values, they’ve got something to work with to promote hope and inspiration. It’s what we call motivation.

HIN: Could you provide some details on appreciative inquiry and perhaps describe a scenario in which a coach might employ this tool?

(Kelly Merriman): All too often when people want to change a behavior, they tend to focus on all the negatives. All the attention goes to focusing on what’s broken. That focus can hold a participant back from achieving their goal. Our coaches use appreciative inquiry to focus on the participant’s strengths instead. The appreciative inquiry approach deliberately seeks to discover that person’s exceptionality, through their unique gifts, strengths and qualities. We listen with intent to appreciate who they are during the early coaching interactions and then envision how they want their life to be.

Appreciative inquiry has low resistance as an approach to change because it builds upon the person’s positive core, the things that they already have going for them. It assumes that tapping into their positive experiences and strengths are useful in discovering their intrinsic motivation to change and development. This immediately shows the coach and the participant that they have faith in the ability to make a positive change.

As an example, let’s look at Michelle again. We want to appreciate what she’s got going for her and use that to help her to envision what her future may be. Michelle is overweight, pre-diabetic and feeling overwhelmed. Her coach learned that she’s committed to her health, takes pride in being a pillar of support for her family and friends and is organized and creative. Instead of focusing immediately on fixing what’s broken, that she eats too much between meals and doesn’t exercise enough, her coach focuses on envisioning Michelle’s idea of health, one that honors her strengths and her values. In this case, Michelle’s vision of health may be using her creativity and strengths of purpose to take care of her own self as well as the people she loves. She’ll make healthy choices, will see the results, and have the freedom to live the life she wants.