Another example of how an educated patient reduces healthcare

Posted on June 9, 2011 by Janet Sameh

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

Traveling Jan (or why I have been invisible for the last few weeks)

Posted on May 27, 2011 by Janet Sameh

In the last month or so I have been to:

Philadelphia for the CBI Conference on Patient Adherence

Las Vegas for the Armada (specialty pharma purchasing organization) Summit

London and Frankfurt (for our MBA program’s global healthcare studies class)

I have also finished 2 final papers for class, and walked for my graduation ceremony (even though I have 10 weeks left of class).

With all of this healthcare related traveling it has been amazing the common themes that keep coming up in conversations. In the US we are struggling with access, in UK and Germany, the conversation is about what the government will approve reimbursement for. Payors in all 3 countries are all struggling with growing demand and their impact on budgets whether it is private insurance companies (US), sickness funds (GER) or the government (UK, US – Medicare, Medicaid, VA- or the few German uninsured). In the US, the FDA looks at safety, in Germany they have implemented rules that require new treatments be evaluated not only for safety and efficacy but also for cost effectiveness against existing treatments. The UK is looking to make hospitals more efficient and financially accountable. And everywhere we went the greatest conversation revolved around chronic disease management especially Type 2 Diabetes.

What I found most interesting is that the organizations we met with (both public and private) wanted to learn from us as much as we wanted to learn from them. While there are many improvements needed in our system, there are pro’s and con’s to the other models we looked at. In both Germany and the UK the cost for healthcare are much lower than the US, but with reasons that could not be duplicated here. In the UK they have a single payor with a government panel (NICE) that decides what will or will not be covered. If patients want treatments not approved by NICE, they need private insurance or pay out of pocket. In Germany, like the US, the majority of the healthcare costs are covered by sickness funds that are funded by a combination of employer/employee contributions. An employer can decide which of the many sickness funds will cover their employees, however all of the funds are NON-PROFIT, as opposed to the US where they are under pressure to create value for their shareholders. And while physicians overseas do not have the malpractice insurance premiums or med school debt that our physicians have in the US, they make far less than their US counterparts. While all of these concepts work (with grumbling) within the context of their systems, I do not see either the insurance lobby or politicians, or providers allowing them to translate over here.

So what is the answer to our spiraling costs? The one easy answer is we have to get off the reactive fee for service model and look proactively at patient health. We have started down that path with the concept of ACO’s and bundeled payment models, and as painful as it is to change, we have to continue. As much as many of the players do not want to give up their autonomy, the only way we can look at keep costs down is to incentivize wellness and change the mindset from fixing what is wrong with the patient, to having the patient be a partner in improving their own health and outcomes. Yes, there are upfront costs to changing the model, and with shrinking reimbursements, most providers are having a hard time covering current expenses let alone fund future improvements. They will need help (hello pharma, government and insurance companies….). But with no disrespect to other systems, we can not import what they do and expect it to work over here. They have been in place long enough to be integrated into their culture. We need to develop one. that we can afford, that integrates with ours.

ACHE Congress 2011 – A Different Perspective

Posted on March 27, 2011 by Janet Sameh

Due to a generous grant from the Thorek Foundation, I and several others of my peers from our MBA program in Health Care Managementhad the privilege of attending this year’s ACHE Congress. Since I was on the student track, I did not have the opportunity to attend all of the events, but some of the presentations I listened to included:

Amir Kaissi (Trinity University) and Dan Q Linn (Geisinger Careworks) spoke about hospital owned and affiliated retail clinics.
Kathy Young, Mary Ellen Griffin and Sandra Herman from St.Joseph’s – Kokomo IN shared their experiences in turning a community hospital around.
Tadd Pullin and Glenn Fosdick – showed how the branding and marketing efforts of Nebraska Medical Center impacted their growth and had true ROI.
Virginia Richardson (Institute for Leadership in Medicine) spoke on social media for patient engagement.
Eric Topol, (Scripps Translational Science Institute) spoke about technologies that will impact the future of medicine including social media (keeps popping up!), telemedicine, and genomics.

In the spirit of full disclosure I have to state that I am not a hospital administrator (nor do I play one on TV). My insights (or naiveté) come from being in the business world for the last 25+ years, a world that operates far differently than healthcare, especially hospitals. My perspective is far different than most attendees but to me there were some signals that the stewards of our healthcare institutions better start paying attention to.

First the dominant conference theme:

Changes in reimbursement – I am starting with this as it is most pressing issue and I want to get it on the table and move on. Do more with less is the mantra and organizations that are creative with their physician alignments and transparent to their staff and their community will be in the best position to weather the next few years. Got it – ‘nuff said.

Now what should be in the mix but is not:

Healthcare is going direct to consumer, not the other way around. Whether it is retail clinics, social media, or smartphone apps, hospitals and health systems will need to employ the tools that engage the patients on their own turf. Patients increasingly are turning to the internet for health information, engaging in conversations about their conditions (and your brand) in common social medial platforms like Facebook, You Tube and Twitter, and as well as online health websites, hospital rating sites, and patient communities. Health technologies are dropping in price allowing patients to do at home what was formally the province of hospitals like monitoring their sleep or home based genomic testing. Several health systems have recognized this shift and are starting to align with this new movement by employing robust social media strategies, creating affiliated retail clinics, and exploring ways to integrate consumer health technologies into their protocols. Many have not, and if they don’t start soon, they will not meet patient expectations and lose market share (Kodak anyone?).
Employees are an untapped resource and your best marketers. If you develop a culture of engagement with your employees they will return the favor tenfold. St. Joseph credits its UM2M (You matter to me) campaign as a strong contributor to their being named one of the best places to work in Indiana four years in a row. Nebraska Medical Center concentrates on sustaining and growing internal brand evangelists and has an internal hire referral rate of 44%. Employees wear their work gear proudly contributing to $1ML revenue from a branded retail store. Both hospitals credit their internal reputation as a key contributor to their strong external market share.

Several organizations already understand the many drivers in their community’s behavior and are using a creative mix of solutions to contribute to their system health and stability. As we move towards integrated care, the influence of individual physicians to bring new patients to a hospital or health system will diminish. Geisinger, St. Joseph’s and Nebraska Medical Center are far different organizations, but each has created their own strategies to differenciate themselves, using the contributions that of ease of access, internal reputation, and/or telling your story where consumers are actively seeking information, bring. Others would be wise to look to their (or other’s) examples. Missing trends can be deadly. Just ask WANG Labs.

Two Sides of the Same Coin

Posted on March 9, 2011 by Janet Sameh

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

Models are Out there to Reduce Costs. They Just Have to be Funded.

Posted on March 8, 2011 by Janet Sameh

Health Affairs this morning released their March issue which is devoted to innovations in healthcare delivery. There were a total of 15 different programs mentioned, grouped around the following areas:

Providing Care to Seniors
Treating Children with Asthma
Caring for Vulnerable Populations
Coordinating Care
Providing Patient-Centered Care
Delivering End-of-Life Care

I could do a blog post on each program, but what is more striking is the common solutions that showed up in many of the programs. One theme seen over and over again was the use of multidisciplinary teams to oversee and coordinate care in hospitals, nursing facilities or at home. Multidisciplinary not meaning a primary care and specialist treating a patient, but using resources like, behavior health specialists, pharmacists and others who bring to the patient care a broader base of knowledge. Another commonality was how many different programs employed social workers, patient advocates, care managers and the like to have ongoing relationships with the patients outside of the care facilities. These relationships support compliance and identify health issues that are gestating before they get to a crisis state. A third theme was making it easy for the patients to receive care. Smart use of same day appointments, group appointments and mini-clinics gave patients opportunities to receive cost effective and timely care.

All of these programs fit outside how healthcare is currently provisioned. All of them are far less expensive than ourcurrent system hospital centric fee for service models. None of them use state of the art

technologies, or new facilities. (Click here to see a Concord (NH) Monitor article about how new facilities do not always translate to improved care ).

These programs need to be funded. And it needs to be done in a way that makes sense to the organizations that provide them. Primary care is the lynch pin to the success of all of these programs. And it is still seen as the very poor step child in our current provisioning model.

The sooner CMS and the other payors support and encourage these types of programs, the faster we can impact the success of our nation’s health.

For an overview of the Health Affairs issue click here

Intervention is the Best Prevention

Posted on January 26, 2011 by Janet Sameh

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.

Here’s a novel thought, lets tie reimbursement to effectiveness!

Posted on December 1, 2010 by Janet Sameh

Most of the conversation regarding changing the reimbursement model has been tied to organizational efficiencies (bundled payments and ACO’s), there has been very little discussion of tying reimbursement to therapy effectiveness. In an October Health Affairs article Steven Pearson, president of the Institute for Clinical and Economic Review and Peter Bach, an associate attending physician at Memorial Sloan-Kettering Cancer Center, state the case for using reimbursement as a carrot to incentivize providers to use therapies that show “superior” outcomes. The authors propose a 3 year baseline to evaluate whether a therapy deserves increased payment.

According to a WSJ blog posting about the study,

They use intensity-modulated radiation therapy, which was rolled out in the early 2000s, as an example. Medicare’s reimbursement for the treatment was set at about $42,000 for prostate cancer treatment, compared to $10,000 for an older form of radiation — though there were no gold-standard studies comparing the risks and benefits of the two procedures. Hospitals bought the spiffy new equipment … and Medicare spent an estimated $1.5 billion more on prostate cancer treatment, the authors write.

If that reimbursement rate had been guaranteed only for three years before being revisited, there’d have been an “incentive for manufacturers and clinicians to perform the research needed to evaluate the clinical performance of the new therapy in comparison to the standard three-dimensional treatment,” the authors write

While comparative effectiveness has been vilified as stifling creativity, it may also have the effect of changing the game. By awarding innovation via increased payments, it throws a challenge to suppliers (pharmaceutical companies in particular) to come up with new solutions that are innovative instead of the low hanging fruit of slight variations to extend patents.

However we are talking Medicare here, so don’t hold your breath…..

PS. As a follow-up to the blog posting the lead author wrote,

As the lead author, I hope you will permit me to make one early comment. The title of the blog asks whether cost-effectiveness should be considered in coverage decisions at Medicare. That is exactly NOT what we are proposing. Our idea is not to ask whether something is or isn’t cost-effective, or whether something passes an arbitrary threshold of cost-effectiveness and therefore merits coverage. Instead, we think it would make more sense for Medicare (and by extension other insurers) to make a judgment about the comparative CLINICAL effectiveness of a new service in determing how much to pay for it — AFTER the insurer has already decided to cover the new service according to the process and standards they use now. Setting payment in this way would avoid many of our current problems associated with a “cost-plus” reimbursement system that all too often pays 2-5 times as much for new services without any solid evidence that they work better than what we can already do for patients. No payment system is perfect, but we hope ours might provide a model for how Medicare can shift towards a future when the real question isn’t a “yes/no” coverage decision but a “yes, and…” payment decision

Patching the Boat

Fixing the USS Healthcare

Another example of how an educated patient reduces healthcare

Traveling Jan (or why I have been invisible for the last few weeks)

ACHE Congress 2011 – A Different Perspective

Two Sides of the Same Coin

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:

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,

Later on in the article:

Models are Out there to Reduce Costs. They Just Have to be Funded.

Intervention is the Best Prevention

Here’s a novel thought, lets tie reimbursement to effectiveness!