Another example of educated patients improving their outcome…

Regular readers of my blog, knows that improved outcomes via patient adherence is an ongoing interest of mine.   Earlier this month, the New York Times had a blogpost about a program at UCSF where nurse educators worked with heart failure patients to reduce readmissions.

How the program worked was very simple.   A coordinator spends at least one hour explaining the patient’s condition to the patient and his or her family, and preparing them to manage the patient’s condition outside the hospital setting.   The coordinator asks questions about the patient’s diet and gives healthy alternatives.  They teach caregivers how look for troubling symptoms, and about the medications the patient is on.   Patients and caregivers develop an ongoing relationship with the program with emails, phone calls and home visits.  There is even coaching on how to interact with other health care providers.

While the program is not cheap, it has a great ROI.   It began with a $575,000 grant and UCSF continues to fund it.   However, since the program began three years ago, the hospital’s heart failure readmission rate has dropped by 30 percent and the hospital estimates the program has saved Medicare at least $1 million a year.

It’s another example of educated patients (and caregivers) improving the quality of their lives, and reducing the burden on our healthcare system. It’s a no brainer, and yet these programs are few and far between.   We need to figure out ways to fund and support more of these programs.   It’s in everyone’s best interest.

 

Another example of how an educated patient reduces healthcare

There was an article in yesterdays WSJ about a strategy to reduce hospital readmissions.  According to the federal Agency for Healthcare Research and Quality, 4.4 million hospital stays are a result of potentially preventable re-admissions.  This additional care adds more than $30 billion a year to the nation’s health-care tab, or $1 of every $10 spent on hospital care.

Until now, there has been little attention given to root causes for re-admits.  Upon examination, researchers are finding that lack of patient understanding of post discharge instructions, are a major contributor to this problem. To counter this, a research group out of Boston University Medical Center has created Project RED (Re-Engineered Discharge), a communications protocol designed to educate patients on next steps once they leave the hospital.  It starts with educating the patient about their diagnosis while they are hospitalized, and walks an institution through eleven steps culminating with a follow-up phone call several days post discharge.

While the concepts in the protocol are not new, the level of detail is.  Project RED has created a virutal patient advocate “Louise”.  Louise’s dialogue changes for each patient based on the information entered into the workstation. Louise aguments the typical discharge protocol, by getting patient confirmation that they understand their instructions. Since Louise is not rushed for time, patients can go at their own pace, and repeat instructions that they do not understand.

While in its infancy, Project RED is showing results. In a pilot run by Health First of Rockledge, Fla from September 2010 to March 2011, readmissions of congestive heart-failure patients in one unit was reduced by 29% compared with such patients in units where the program wasn’t used.  And at Boston University, where the program was created, according to a 2008 study, the program  helped cut readmissions  by 30% in a 2008 study.

This is just another example of how educating and evolving patients in their care, improve outcomes and reduces cost.  Providers should have protocols that ensures patients do not become repeat visitors and that encourages patients to take a larger role in their health.  Tools, like Project RED, which supports treatment compliance, should be utilized wherever possible as their ROI for health systems, and for our nation’s healthcare costs make them well worth the investment.

For more information on Project RED click here

Two Sides of the Same Coin

 

Both from Amednews.com

March 7th – In their Professional section – Top complaint about patients:Falure to follow medical advice.

Part of thearticle talks about  physician frustration with patient non compliance.  (Fair balance- The article also talks about patient frustration with physicians).

 

From the article:

A survey in the February issue of Consumer Reports found that noncompliance with
medical advice and treatment recommendations was doctors’ top complaint about
patients The magazine asked 49,007 subscibers what bothered them most about their doctors, and 660 primary care physicians were asked what bothered them about their patients…. In the new survey, nearly 40% of doctors said patient noncompliance significantly influenced their ability to provide optimal care. 

 

March 9th – In their Buisness section – Humana sweetens its wellness plan with bigger patient rewards

From the article:

Humana’s new wellness program will offer movie tickets, hotel stays, airline flights and other rewards to members who exhibit healthy behavior. Experts say the move is part of an evolution by health plans to make it more valuable for their customers to be well. The wellness program,

HumanaVitality, is a joint venture with South Africa-based Discovery Holdings, which has its own stand-alone Vitality program offering similar rewards.

 

Later on in the article:

Employers and benefit experts continue to experiment to see what kind of rewards promote sustained healthy behavior — daily exercise, healthy eating habits — rather than short-term changes, she said.

The practice has evolved from offering trinkets like T-shirts and key chains to discounts on health insurance premiums and other valuable rewards such as the travel premiums that Vitality offers.

Vitality’s 1.9 million members in 2010 redeemed points for more than 500,000 flights, almost 20,000 hotel stays and 3.5 million movie tickets, according to a news release announcing the deal.

For the article regarding the Consumer Reports survey click here

For the article regarding Humana’s Vitality’s program click here

 

Intervention is the Best Prevention

One of my favorite commentators on healthcare economics is Dr. Atul Gawande, a physician who frequently contributes to the New Yorker. In the a January 17th posting on the New Yorker blog, the blog talks about from Gawande’s article on how to reduce costs for “frequent flyers”, those who are constant consumers of high priced medical services. What is interesting is that the ideas cited did not come from a managed care plans, or ACOs, but rather a small players, looking for how they could improve patient’s well beings.

The first example given was an idea from a single physician, Jeffrey Brenner, who practices in Camden, New Jersey.

From the article:

Brenner’s team, which includes a nurse practitioner and a social worker, make regular home visits and phone calls to check in about new and existing complaints, unfilled prescriptions, and other complications that could land them back in the hospital. They help apply for disability insurance and fill out paperwork for state-run housing where their medication can be overseen. They encourage these super-utilizers to improve their lives with steps like quitting smoking, cooking more, joining Alcoholics Anonymous—even going to church.

Brenner found that his first thirty-six patients saw a forty-per-cent reduction in average monthly hospital and E.R. visits. They also saw a fifty-six-per-cent reduction in average hospital bills—savings that Gawande describes as “revolutionary”

Another example is from an in-house clinic for an Atlantic City hospital. The clinic was designed to provide care for the hospital workers with high medical expenses. Unlike the HMO’s of the past, the patients could receive unlimited access to care. Again the results were surprising. From the article:

Rushika Fernandopulle, who runs the clinic, found that after twelve months the first twelve hundred patients had forty per cent fewer emergency-room visits and hospital admissions and twenty-five per cent fewer surgical procedures. An independent economist who studied these Atlantic City hospital workers found that their costs dropped twenty-five per cent compared to a similar population of high-cost patients in Las Vegas

What is striking about these (and other examples given) is they are simple solutions that are easy to implement. They are not expensive in comparison to the cost savings they provide. And they do not need large infrastructures or systems realignments. They goes back to a common thread of health care reform, focus on outcomes, not transactions.

Click herefor the blog post and the comments that follow.

Change the behavior, Change the outcome

In a The Health Care Blog posting dated 9/26/2010, Joe Flower, a noted healthcare systems expert, looked at three programs that have different methods and viewpoints to see how changing the traditional patient/provider/payer roles and responsibilities can impact results. He found while each program had a different starting point, by influencing patient behavior all three had positive impacts on both patient wellness and cost reduction.

Employer Driven Programs

Because of its’ size, Boeing corporation chooses to self-fund their employee healthcare. As an experiment, the company, and Regent BC/BS who runs the plan, asked employees if they wanted to enroll in a special program. Those who said no were the “control” group; those who said yes were “test” group. The test group was overseen by multi specialty clinician groups that evaluated health risks and set improvement goals. The goals were supported by health improvement plans, coaching, classes, and new meds, anything that would change lifestyle and support compliance. The outcome? From the article…

After 30 months, this “medical home” team model and intensive focus showed results: The experimental group not only showed marked improvement in health metrics, but even counting the cost of all the extra work and attention, its medical costs were 20 percent lower than those of the control group. Twenty percent savings on your “frequent fliers”—that’s a big number.

A similar pilot program was run through the organization HealthMapsRX. HealthMapsRx has a roster of pharmacists that businesses can utilize to be health coaches for their employees, helping patients manage chronic diseases. HealthMapsRX was recently involved in the 10 city diabetes challenge sponsored by Glaxo, Smith, Kline and the American Pharmacists Association. During the program, 30 employers in 10 cities waived co-payments for diabetes medications and supplies if participants met regularly with HealthMapsRx coaches, who helped them track their A1C, blood pressure, and cholesterol, and who also taught patients to manage their disease through exercise, nutrition and other lifestyle changes. Pharmacists communicated with patients physicians after every visit and referred patients to other health care providers for additional care or education as needed. Data from the program showed average total health care costs were reduced annually by $1,079 per patient compared to projected costs if the DTCC had not been implemented.

Insurance Driven Programs

There has been a lot of discussion regarding the impact on Health Savings Plans and Health Reimbursement Arrangements on healthcare costs. CIGNA has a Choice Fund plan that allows consumers to utilize HSA’s and HRA’s. Now one would think that because consumers have “skin in the game” with this type of coverage, they would consume less healthcare. However that is not the case. From the article:

Every year end for several years now, CIGNA has released the results of participation in its Choice Fund consumer-directed health plan (CDHP). In January of this year, for instance, CIGNA reported that employees enrolled in the CIGNA Choice Fund, compared with those enrolled in their more traditional plans, incurred 14 percent lower medical costs. People with specific chronic conditions did even better—15 percent lower for diabetes patients, 21 percent lower for people with joint and back pain and 27 percent lower for people with high blood pressure.

And this is key: The employees did not save money by skipping medical care. People on both types of plans were equally compliant with treatment regimens. The difference in cost seems to spring from better management of the chronic conditions and more careful use of preference-sensitive services.

The business press regularly reports the results as proof that CDHPs lower health care costs and improve employees’ health—but that’s getting the story wrong. The CDHP alone is not what works. What works is using the employees’ “skin in the game” as the basis for a comprehensive program of incentives and massive clinical and information support aimed at behavior change, education, preventive measures and control of chronic syndromes. The programs vary from market to market, even from one employer to another, and often involve contracts with specific health care providers to deal with specific types of problems. Employers pay a small amount extra per year for the extra support, expecting that they will be able to recoup the extra payment in lower costs over time.

So three different programs, three different starting points, similar outcomes. By making patients active participants instead of passive consumers, costs go down, outcomes go up.   With 70-75 % of healthcare costs to be driven by chronic conditions, the model has to change for the US to get greater value for its’ healthcare dollar.  With a bit of creativity, and patient nudges, it can.

To see the post click here.