Holiday Care

A friend sent me a note about this forum posting at HIStalk recently. It’s about an interesting new foundation called Doctors in Peril. Here’s the original text:

Hi,

My name is Jim Edison and I work part time for a private, non-profit foundation called www.doctorsinperil.org. The foundation was started after a personal loss of the founder and its mission statement is to assist doctors in obtaining refunds from electronic medical records manufacturers for products that do not work as advertised. The EHR industry is new and many companies are taking advantage of doctor’s natural trust and naitivite. We do not take any money for our services.

We will investigate a complaint filed with us and if there is merit to the complaint, we will use the threat of public exposure to help the doctor or clinic obtain a refund. We also have a legal war chest and a law firm on retainer that may be used for class action lawsuits against companies that ignore our requests or who have a history of widespread abuse.

I am looking for the best way to tell doctors about our service, so please refer me to other popular sites that might allow us to post this announcement. Please feel free to visit our site and register if you have a complaint.

We have recently updated our site with two new sections titled, "Unscrupulous Practices By EMR Companies" and "ADVICE ON PROTECTING YOUR IT INVESTMENT". They can be found here & here.

Thank you,

James Edison

Jim — I applaud your efforts and felt I should publish your request on my blog as well. If any of my physician readers have already used this service or find the new site and organization useful please do drop us a comment here.

“Say No to Drugs Vaccines”?

According to a recent article in the NY Times, a growing number of parents in California (and 19 other states including Ohio and Texas) are opting to not vaccinate their children against some diseases such as measles, mumps and rubella. Taking advantage of state exemptions to laws that require school-aged children to be vaccinated, some parents are not vaccinating their children in fear that such vaccines are linked to autism, a growing epidemic among children today.

While these parents may be protecting their children from what they feel is the bigger problem, they are also exposing others in the community to these potentially deadly diseases. Children too young to receive the vaccinations are at risk, as well as those who have had their shots, as not all vaccinations are 100 percent effective.

???The very success of immunizations has turned out to be an Achilles??? heel,??? said Dr. Mark Sawyer, a pediatrician and infectious disease specialist at Rady Children???s Hospital in San Diego. ???Most of these parents have never seen measles, and don???t realize it could be a bad disease so they turn their concerns to unfounded risks. They do not perceive risk of the disease but perceive risk of the vaccine.???

Some “exemptster” parents are intentionally exposing their children these diseases by sending them to “parties” to contract specific diseases so they develop natural immunities to them.

The Consumer-Purchaser Disclosure Project today announced a national agreement with leading physician groups and health insurers on principles to guide how health plans measure doctors??? performance and report the information to consumers.

The Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs creates a national set of principles to guide measuring and reporting to consumers about doctors??? performance. According to the Consumer-Purchaser Disclosure Project, the accord is an important step toward patient-centered health reform that gives patients reliable information that will lead to better care and help them make informed choices. Where embraced, the Patient Charter will ensure both consumers and physicians will be able to understand, trust and contribute to how health plans rate doctors??? performance.

Consumer, employer and labor groups endorsing the charter include AARP, AFL-CIO, the Leapfrog Group, the National Business Coalition on Health, the National Partnership for Women and Families and Pacific Business Group on Health. Physician groups that support the accord include: the American College of Physicians, the American Academy of Family Physicians, the American Medical Association, the American College of Cardiology and the American College of Surgeons. Supporting insurers include the America???s Health Insurance Plans, Aetna, Cigna, UnitedHealthcare and WellPoint. The agreement was spearheaded by the Consumer-Purchaser Disclosure Project, a group of leading consumer, labor and employer organizations that works to ensure that all Americans have access to publicly reported healthcare performance information.

The Consumer-Purchaser Disclosure Project is an initiative that is improving healthcare quality and affordability by advancing public reporting of provider performance information so it can be used for improvement, consumer choice, and as part of payment reform. The Project is a collaboration of leading national and local mployer, consumer, and labor organizations whose shared vision is for Americans to be able to select hospitals, physicians, and reatments based on nationally standardized measures for clinical quality, consumer experience, equity, and efficiency. The project is funded by the Robert Wood Johnson Foundation along with support from participating organizations.

This week a national survey reported that gas prices surged nearly 7 cents over the past two weeks to reach an all-time inflation-adjusted high of $3.26 per gallon of self-serve regular. The Lundberg Survey found that average prices in Newark, New Jersey, were the nation’s lowest at $3.03 per gallon, while drivers in San Francisco, California, where the average price was $3.66, paid the most. While we are all a little more conservative in our gas consumption these days, home health caregivers don’t always have that option. This week’s Healthcare Business Weekly Update reports on a request from the Pennsylvania Homecare Association to increase Medicaid reimbursement to $100 per home visit for skilled services. The organization says it spent an additional $6.7 million in 2007 to help cover rising gas costs.

With March rapidly coming to an end, it is important to note that April marks Parkinson’s disease (PD) Awareness Month. Many organizations are holding walks and other events to spread the word and raise awareness for the disease. This week’s Disease Management Update also sheds some light on PD, including new research involving therapeutic cloning that has been used to treat mice wth PD, and a gene linked to development of PD in those with family history of the disease.

This video from the Healthcare Intelligence Network explains how two pilots in the patient-centered medical home for patients with diabetes resulted in improved clinical outcomes and compliance in the two populations and saved millions of dollars in health costs. This model holds promise for patients with heart disease, asthma and other chronic diseases.

YouTube, Yahoo, MySpace, Metacafe, Google, Revver and DailyMotion

The Healthcare Intelligence Network would like to congratulate Danielle Butin, whose enthusiastic presentations on health coaching and developing confidence and self-management skills for the chronically ill have been favorites here at HIN. Over the last year, Butin has found another way to make a difference in disease management, this time on a global scale. Appalled by the lack of medical supplies she learned about during a 2007 trip to Tanzania, she has launched a donation-based clearinghouse of medical supplies to benefit the medically needy in Africa.

The initiative, called the Afya Foundation, procures and ships vital supplies necessary to support medical and surgical initiatives worldwide, with a primary focus on Africa. Supplies are donated and gathered from hospitals, surgical centers and corporations. According to its Web site, the organization’s goal is to “serve as a donation-based clearinghouse for the international health community.”

A story about Ms. Butin and the AFYA Foundation was featured on the front page of yesterday’s New York Times:

Ms. Butin, who calls her new project Afya Foundation of America ??? afya is Swahili for health ??? doesn???t believe in wasting supplies. She doesn???t believe in wasting time, either. In the time it takes her to get from the first floor of a hospital to the 17th, she???ll grill a nurse on the elevator about how to tell the difference between an operating room table and a heavy-duty stretcher (the table is heavier). If she???s waiting for a Jamba Juice at Whole Foods, she???ll ask the store manager if the market would donate cooking supplies for the kitchens of overseas hospitals in need (yes, she eventually heard from the Union Square store). It???s a straightforward system, really: She asks, and usually, people say yes.

Ms. Butin embraces this out-of-the-box (and into the 40-foot Haiti-bound container stuffed with medical supplies) initiative with the same zeal that categorized her presentations to our audiences on health coaching over the last few years.

During a 2005 audio conference on health coaching for disease management, Butin said:

The concept of health coaching begins with the philosophy that we are teaching people how to fish. We are not fixing their diabetes; we are not testing their glucose; we are not going to take care of everyone. Rather, we are going to teach the tools and tricks an individual needs to develop confidence in a new language or new script in life and move forward.

She continued:

To build a health coaching program for this population, where the primary focus is developing confidence in managing one???s health, the first requirement for health plans and providers is to think ???out-of-the-box” because if we expect people to learn by doing, we must train them on the same philosophy.

This “learn by doing” philosophy is grounded in her background in occupational therapy. When the former healthcare executive’s organization was charged with writing a self-management course book, Butin and her staff spent eight hours in a bookstore reading “every medical book geared toward self-management for an older adult population that we could find.”

And in a later conference about identifying high-risk populations to decrease the likelihood of hospital readmissions, Butin said:

About 22 to 24 percent of our new enrollees actually scored at high risk for malnutrition. In response — and I have to emphasize that it is pointless to screen if you don???t have a program or solid intervention to back up what you???re going to do — we created a nutrition benefit.

HIN wishes Ms. Butin the best of luck with this new venture. While much of the AFYA’s Web site is still under construction, the organization can be reached at:

http://www.afyafoundation.org

216 Lake Street,
Yonkers, NY 10701
United States

Telephone: + 1 914-207-1008
FAX: + 1 914-207-1005
E-mail: [email protected]

Case managers for Community Care Plan of Eastern North Carolina give new meaning to the term “accessibility.” These case managers participate in Community Care’s medical home pilot for Medicaid patients with diabetes. Roberta Burgess, nurse case manager for the program, describes how case managers educate patients about their condition and prepare them for doctor’s visits:

“We build an ongoing relationship with the family. So many times people have been in their medical home for 20 years, they’ve been going forever and ever and that’s a good thing. We provide excellent education; we do this also in the practice. We also make telephone calls, we send out population management letters, information about community support groups, information about diabetes health fairs, different kinds of medicine. We go in their home and actually teach one on one. We find out what they know, what they don’t know, and where can we impact and help them grow. We teach them how to take care of their diabetes on a level that they can do it. As far as care coordination and case management strategies, we also do assessments. A lot of times they’re done at the doctor’s office, but we will often have a time where we can go in and do them in their home as well. And as care coordinators, as case managers, we contact that diabetic on a regular basis. And in my case, we contact our diabetics, the ones that are on our case ID, maybe every 2 or 3 months, just to talk to them and find out, ???How are you doing? Are you getting your medicine? Is anything going on? Have you had a cold? Did you get your flu shot? Any sores? Have you had your feet checked???? Just general conversation. When we call, they’re ready to talk, so a lot of times any time a new problem comes up we can go ahead and have it addressed, make an appointment and get them in and get them seen. And that’s a part of being accessible.”

The award-winning program, which saved North Carolina taxpayers $231 million in 2005 and 2006, develops diabetic resource tools for providers and has launched a diabetes education program that maximizes self-care behavior. This involves providing diabetes education and training to the client in their home.

According to the Journal of the American Medical Association (JAMA), cardiac arrest experienced outside a hospital setting is becoming a major health concern and chances of survival are slim for the more than 250,000 Americans who experience it each year. This week’s update features new out-of-hospital treatment that is increasing cardiac arrest survival, as well as a study from Brigham and Women’s Hospital on predicting one’s risk of cardiovascular disease (CVD).

Actively involving your patients in managing their own healthcare is essential to consumer empowerment. With the help of Chief Medical Officer Dr. Harlan Levine, OptumHealth Care Solutions provides innovative, integrated solutions that supports the best clinical and financial outcomes for both consumers and clients. OptumHealth designs its programs to educate, empower and activate individuals to become better healthcare consumers by helping them identify their healthcare needs, their treatment options and the best physician and facility for their situation based on their preferences and unique needs.

But how does OptumHealth and other such organizations that promote consumer empowerment differ from traditional disease management programs that have been in existence for decades? According to Dr. Levine, OptumHealth’s treatments are “something different.”

“This program is about informed decision making. By engaging the consumer earlier in the decision making and by giving them relevant information that’s highly personalized and delivered in a caring and expert manner, we’re able to bring greater value to the consumer,” explains Dr. Levine. “And because we recognize that everybody’s different and at a different stage in their level of understanding when they receive a diagnosis, we know that in order to bring the most value we need to meet that individual where they are in terms of their own health literacy. We then educate them on their condition and specifically on their stage of their condition by providing information, tools and resources, delivered in consumer-friendly manner, to help them make the best decisions for themselves. By focusing on where they are, both in the decision making process and on the specifics of their condition, we make the communication more relevant to the consumer.”

Moreover, Dr. Levine comments that empowerment does not mean making decisions for the consumers, but to motivate them to engage in positive behaviors, empower them to actively seek and utilize healthcare information, so they truly own and are accountable for their own healthcare decisions.

Also presenting with Dr. Levine was Dr. Stephen Rosenberg, senior vice president of outcomes research with ActiveHealth, a company that promotes evidence-based medicine in the belief that closing gaps in care can prevent avoidable adverse events, which would result in less hospitalizations, less emergency room visits, and ultimately less money spent. Dr. Rosenberg cites health literacy as an important component of consumer empowerment.

“[Health literacy] has to be handled in almost all member communication by pitching written and oral communication to a level that’s reasonable and that’s understandable by the great majority of patients, but that is not so low that it’s condescending in any way and making sure to avoid jargon,” advises Dr. Rosenberg. “It’s a difficult balance to reach,” he notes.