2007-11-30 00:00:00

Health Plan Uses Secret Healthcare Shoppers in Emergency Room Management

Many healthcare organizations monitor patient satisfaction as part of their overall quality improvement initiatives. As part of an initiative to divert non-essential ER cases to primary care, Wellpoint utilized secret shoppers to evaluate consumers’ experience at its network physician offices and identify ways to improve access. In a recent audio conference on redirecting non-urgent ER cases to more appropriate healthcare settings, Dr. Karen Amstutz, Wellpoint’s regional vice president and medical director of state-sponsored business, described how it went:

We wanted to look at what our members experience when they try to access care appropriately through our physician offices. We began with a secret shopper program to physician offices, which revealed that one of our offices were dropping phone calls and patients were unable to complete a call successfully through to the office. The staff was also directing patients to the ER when the primary care doctor was not available or the clinic was too busy to offer an appointment. Finally, we identified that often the staff didn???t triage our members and ask them questions about what was going on to help them decide how urgent the visit was ??? whether it was the same day or could be handled the next day.

Based on these findings, we made recommendations to our providers about scheduling appointments and about walk-in hours. … Part of the reason that our providers were willing to accept our interventions is that there???s a very close relationship between our network education representatives and our provider offices. So when we went back to them with secret-shopper information, we already had a very good longstanding relationship on which to say, ???Here???s what we???re seeing. Can we talk about how we might work together and help you solve these problems which will help us and our members????

This was just part of Wellpoint’s approach, which reaped some great reductions in ER visits and hospital admissions per member. It also focused a lot of attention on educating its members about self-care—knowing when to head to the ER and when a visit to the primary doctor should suffice. Extended hours (with special reimbursement codes), nurse triage lines and hospital-health plan collaborations helped, too.

Filed under: — @ 2007-11-30 00:00:00
2007-11-29 00:00:00

Disease Management Update: Healthy Diets

You know what they say ??? you are what you eat. And what you eat can have a great impact on your health. This week’s DM Update discusses some recent studies that show diets rich in some ingredients can help reduce the risk and stunt the growth of certain types of cancer. Visit HIN’s blog to read about some problems that diet can create.

Filed under: — @ 2007-11-29 00:00:00
2007-11-28 00:00:00

Antidotes to Expensive Medication

Attention consumers, providers, pharmacies and health coaches: MedFriendly Blog suggests alternate avenues for obtaining prescribed medication when cost, lack of insurance or other financial obstacles get in the way. Pass these suggestions on to patients, clients and friends who find themselves in this situation.

Filed under: — @ 2007-11-28 00:00:00
2007-11-28 00:00:00

C-Suite Support is Key for Corporate Health

Participation in wellness programs and initiatives at the executive level can yield great results, according to Gregg Lehman, president and CEO of HealthFitness, a provider of integrated health and fitness management services for employees and individuals.

However, levels of C-suite involvement can vary greatly, ranging from verbal encouragement and support (via newsletters, emails, videos, and general letters of support for programs), to recognizing employees working to improve their health status, to executives becoming active participants in health management programs and sharing their success stories.

In a recent interview with HIN, Lehman cited some valuable techniques that are effective ??? and essential ??? in obtaining optimal wellness program success and creating a corporate culture of health. His list includes:

  • Generating corporate mission and vision statements that support employee health and well-being;
  • Encouraging workers to participate through financial incentives and easy access to programs while at work;
  • Incorporating an integrated approach to managing employee health programs, aligning previously segmented functions like HRA, workers comp, risk management, long-term disability, occupational health and DM programs;
  • Conducting an annual assessment of baseline health through an HRA and biometrics screenings;
  • Engaging employees and encouraging employee input (i.e. creating a committee or task force);
  • Offering fitness programs, prevention programs, etc., and
  • Enforcing no-smoking policies, offering healthy food choices in the cafeteria, and addressing other environmental factors.

Reducing risk factors of chronic diseases in the workforce is one of the best long-term investments CEOs and CFOs can make, says Lehman.

Filed under: — @ 2007-11-28 00:00:00
2007-11-26 00:00:00

Week in Review: Measuring Up in 2008

As we see it, 2008 will largely be about measuring up. In response to expected quality and performance initiatives, doctors, hospitals, health plans and just about anyone involved in health and wellness will have to validate their effectiveness to both consumers and payers. This week’s Worth Repeating shows how data mining can turn up surprising trends in health coach effectiveness (for example, whether former smokers make better coaches) and coaching ROI. In New York, the state and physicians hope a joint analysis of “near-misses” today will help reduce tomorrow’s hospital errors. And in What’s New at HIN, an audio interview with HealthFitness President and CEO Gregg Lehman yields a blueprint for constructing a corporate culture of health — and the very measurable benefits that can accompany this attitude shift.

How well does your organization measure up in MRSA education and prevention? Just a few days remain to take HIN’s monthly e-survey on this subject and receive a complimentary e-summary of the results.

Filed under: — @ 2007-11-26 00:00:00
2007-11-21 00:00:00

Connecting with Medically Underserved Populations

Locating, making contact with and staying connected to members of medically underserved populations is a challenge for many organizations that administer disease management (DM) programs. Challenges include working with outdated addresses and phone numbers and the generally transient nature of such populations. HIN’s non-scientific online survey in September 2007 yielded some out-of-the-box ideas from 67 healthcare organizations ??? including hospitals, physician organizations and health plans ??? on how they deal with hard-to-reach clients. Here are just a few suggestions excerpted from the complimentary white paper of survey results, Making Contact:
How Healthcare Organizations Locate and Communicate with Hard-to-Reach Clients:

  • Provide home outreach.
  • Get updated demographics while patient is still in the hospital.
  • Offer incentives for attendance or participation.
  • Develop distribution lists from programs and events that patients have participated in.
  • Offer work site initiatives and collaboration.
  • Put stickers on the member ID cards instructing them to call a number to update information.
  • Connect every visit with personal benefit so the patient has something to gain from each contact.
  • Rely on vendors to supply us updated/improved data.

Please share any successes your organization has had in this area.

Filed under: — @ 2007-11-21 00:00:00
2007-11-20 00:00:00

Proper Mattress Can Improve Sleep Comfort, Reduce Pain, Says American Chiropractic Association

A??good night???s sleep is an essential part of a healthy lifestyle; however, an estimated 70 million Americans complain of sleeplessness. This October, during National Chiropractic Month, the American Chiropractic Association (ACA) is offering advice to help consumers select comfortable mattresses and pillows that can help limit unnecessary back and neck pain.

???Americans spend one-third of their lives sleeping, so it makes sense to invest in a sleep set that can improve your comfort and overall health,??? says Scott Bautch, DC, DACBOH, spokesperson for the American Chiropractic Association. ???Many people don???t realize the reason for their neck or back pain is literally right underneath them???it???s their mattress and pillow.???

A 2006 study published in the Journal of Chiropractic Medicine showed that sleeping on a new mattress can significantly reduce stiffness and back pain.?? Researchers found that study participants reported immediate and sustained benefits after sleeping on a new mattress. This was especially true of participants who entered the study with back pain complaints, as they reported a 63 percent improvement in back discomfort with a new mattress.

When it comes time to purchase a new mattress, the ACA recommends the following:

Shop for Support
Look for a mattress that provides uniform support from head to toe; if there are gaps between your body and the mattress (such as at the waist), you???re not getting the full support you need.?? Mattresses can be too firm; pay close attention to uncomfortable pressure on prominent body features such as the shoulders, hips and low back.

Shop for Comfort
When mattress shopping, give each option a good trial run before you buy; lie down on a mattress for a minimum of five to 10 minutes to get a good idea of its comfort level. If you cannot find a comfortable position, you probably have the wrong mattress.

Shop for Size
Does the bed provide enough room for both you — and your sleeping partner if you have one — to stretch and roll over??? The ideal mattress will also minimize the transfer of movement from one sleeping partner to the other, which means one person shouldn???t feel motion as the other leaves the bed.

Generally, a mattress should be replaced every 5 to 8 years to ensure proper support and comfort. Be aware that life???s changes can signal the need for a new mattress as well. For example, people who have lost or gained a considerable amount of weight, those who have a medical condition which has changed the way they sleep, or even those who???ve changed partners may need to consider a new mattress.

Pillows important, too
After investing in a quality mattress, don???t forget to choose an equally supportive pillow, advises ACA spokesperson Steven Conway, DC, DACBOH, Esq.?? ???People will spend thousands of dollars on a mattress and then skimp on a pillow that doesn???t support their head and neck properly,??? he observes.

When selecting a new pillow, ACA recommends selecting one with ergonomically-designed features, which will enhance comfort and limit pain.?? Look for pillows that are:

  • Designed to keep the spine in natural alignment. When lying on your side, your head and neck should remain level with your mid and lower spine. When lying on your back, your head and neck should remain level with your upper back and spine.?? Avoid pillows that are so thick or thin that they angle your head and neck away from your body.
  • Designed to support different sleep positions, including side sleeper or back sleeper. (It???s best never to sleep on your stomach, as it???s the most back unfriendly sleeping position.)
  • Hypoallergenic.

There is no such thing as a universal fit when it comes to pillows, Dr. Conway notes. ???Find a pillow that is consistent with the shape and size of your body. If you find yourself sleeping on your side with one hand propped under your pillow, that???s a clue that you???re not getting the support you need from that pillow,??? he explains.

If you continue to experience pain and discomfort at night or have difficulty falling asleep, visit your doctor of chiropractic. Doctors of chiropractic are trained to treat spinal problems that can interfere with a restful night???s sleep. They can also offer nutritional and ergonomic advice that can help improve the quality of your sleep. To find a chiropractor near you, view ACA???s searchable member database.

The American Chiropractic Association is the nation???s leading chiropractic organization representing more than 16,000 doctors of chiropractic and their patients.

Filed under: — @ 2007-11-20 00:00:00
2007-11-19 00:00:00

Week in Review: When Caregivers Are Homebound

Healthcare in general and long-term care in particular are emerging as particularly volatile issues in the 2008 presidential election. More than 70 percent of respondents to a survey mentioned in this week’s news say they’re not prepared to handle either their own long-term care needs or those of a loved one. In a related story, caregivers are in desperate need of support programs and education. A new white paper issued this week reveals how your organizational peers are caring for the caregivers. Program innovation and ingenuity are called for when caregivers are frequently unwilling or unable to leave their charges alone to attend your program.

Filed under: — @ 2007-11-19 00:00:00
2007-11-19 00:00:00

NY Times Magazine: Conspicuous (Healthcare) Consumers vs. the Categorically Needy

Did anyone notice how yesterday’s New York Times Magazine juxtaposed two of the greatest problems facing the healthcare industry and the U.S. population as a whole — the country’s rampant obesity problem and the 47 million uninsured Americans?

In The Stomach-Surgery Conundrum, Freakanomics authors Stephen J. Dubmer and Steven D. Leavitt ponder the rationale of thousands of obese Americans opting for expensive bariatric surgery despite the physical and psychological complications and replacement addictions that may result.

There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn???t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn???t this what progress is all about?

On the other hand, why is such a drastic measure called for? It???s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that???s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that ???the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn???t changed in that time.???

So the cause is, essentially, that people eat too much; and the cure is, essentially, to eat less. But bariatric surgery seems to fit in nicely with the tenor of our times. Consider, for instance, the game shows we watch. The old model was ???Jeopardy!,??? which required a player to beat her opponents to the buzzer and then pluck just the right sliver of trivial knowledge from her vast cerebral storage network. The current model is ???Deal or No Deal,??? which requires no talent whatsoever beyond the ability to randomly pick a number on a briefcase.

In stark contrast in the same issue are emotive photos accompanying the article “Patients Without Borders” by Sara Corbett. The article/photo essay describes the efforts of Remote Area Medical (RAM) — a corps of volunteer dentists, doctors, nurses, hygienists and X-ray technicians. Normally deployed to thirld world nations, they are spending increasing amounts of time tending to the uninsured in this country.

The setting for the article was a three-day period this summer when RAM treated more than 2,500 patients who had lined up for care beginning at 3 a.m. Working in animal stalls and makeshift tents on a fairgrounds in Appalachia, Virginia, the corps had to turn away several hundred more from this medically underserved population.

Imagine the good that might result if future candidates for bariatric surgery modified eating behaviors and rerouted some of those billions toward the uninsured population. Then perhaps we’d all sleep better. (That, by the way, was the subject of a third article in the NY Times Magazine.)

Filed under: — @ 2007-11-19 00:00:00
2007-11-14 00:00:00

4 Steps to Child Seat Safety

1. For the best possible protection keep infants in the back seat, in rear-facing child safety seats, as long as possible up to the height or weight limit of the particular seat. At a minimum, keep infants rear-facing until a minimum of age 1 and at least 20 pounds.

2. When children outgrow their rear-facing seats (at a minimum age 1 and at least 20 pounds) they should ride in forward-facing child safety seats, in the back seat, until they reach the upper weight or height limit of the particular seat (usually around age 4 and 40 pounds).

3. Once children outgrow their forward-facing seats (usually around age 4 and 40 pounds), they should ride in booster seats, in the back seat, until the vehicle seat belts fit properly. Seat belts fit properly when the lap belt lays across the upper thighs and the shoulder belt fits across the chest (usually at age 8 or when they are 4???9??? tall).

4. When children outgrow their booster seats, (usually at age8 or when they are 4???9??? tall) they can use the adult seat belt in the back seat, if it fits properly (lap belt lays across the upper thighs and the shoulder belt fits across the chest).

Filed under: — @ 2007-11-14 00:00:00
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