The Community Transformation Grants (CTG) program will support community-level efforts to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes. By promoting healthy lifestyles, especially among population groups experiencing the greatest burden of chronic disease, these grants will help improve health, reduce health disparities, and control health care spending.

Approximately $103 million in prevention funding has been awarded to 61 states and communities serving approximately 120 million Americans. These awards are distributed among state and local government agencies, tribes and territories, and state and local non-profit organizations within 36 states, including seven tribes and one territory. At least 20 percent of grant funds will be directed to rural and frontier areas. {end of first entry}

Steven Woolf and Paula Braverman have a very timely article on the relative contributions of health care vs. social determinants of health and have outlined a comprehensive approach to policy that is worthy of serious attention. Click here to view the article.

Virtually the entire November issue of Health Affairs is devoted to links between community development and health improvement possibilities and challenges. Click here to view the November Issue.

 Evidence-Based Value Analysis

vs.

The Inefficient Containment of Pharmaceutical and Medical Device Costs

Colleen Tallant

  Under the Patient Protection and Affordable Care Act (PPACA), medical arenas are challenged to implement improvements in process flows, safety for patients, and costs.  The reduction of costs will be particularly cumbersome, simply because health care budgets are so intricate.  For example, though they have not yet formally been adopted, Accountable Care Organizations (ACOs) introduce the potential for health care facilities to “share risk,” or pay for the portion of patient accounts that inexplicably cost an exorbitant amount in relation to other patients with similar diagnoses or conditions.  Medicare cuts, as well as the opportunity for payment penalties when readmission rates exceed a justifiable number are other sources of reduced reimbursement.  Financial penalties may also exist for hospitals which exhibit high rates of nosocomial (hospital-acquired) diseases.¹

Pharmaceuticals, as well as medical devices, don’t necessarily work with the idea of “cost savings” in medicine.  I worked as an orthopedic device representative for over two years marketing and selling primarily total joints (shoulders, hips, and knees), in addition to every smaller joint one can think of (finger joints, toe joints, etc.), as well as other bone fixation products like ulnar osteotomies and distal radius plates (for the forearm and wrist, respectively).  I was frequently involved with the hospital device inclusion process and can discuss it in great detail.  I understand the internal political intricacies well.

The structure of device companies is driven primarily by sales, which is divided to compensate corporate positions, in addition to the percentage that goes to Agents, Distributors, Vendors (“Reps”), and their assistants in the operating room (OR), Technical Representatives (“Tech Reps”).  Coupled with the fact that all of these positions- at any level- don’t make money until sales are closed and procedures in the OR are performed, and there are only so many procedures possible in a single day; elevated charges are probably already understandable.

What makes matters worse is elevated prices can also double for “innovation” or “quality,” which is the perception of many.  New research and new equipment will typically cost more, at least initially, to recoup the investment made.  Even though company X’s product may have not cost nearly what company Y’s did to develop, if they service the same ailment or condition and have similar functions, the “market price” will dictate higher costs and company Y will experience greater profits.  From another perspective, larger companies obviously have greater flexibility with pricing because they can afford greater losses than smaller companies just entering the industry.  This puts smaller companies (even though they may offer a superior product) at a disadvantage because their best price may still be considerably higher than that of their wealthy competition.  If price dictates the products that are allowed into facilities for use, there is a significant chance for exclusion of the industry’s best technology.  “Evidence-based value analysis (defined on page 5)” (EBVA) seeks to avoid this outcome by asking stakeholders to convene with the intention to provide health systems with uncompromised technology and patient satisfaction at an acceptable cost¹.  In the past, “formulary (defined on page 4)” and “payment cap (defined on page 4)” models have been used for similar purposes.¹ Outlined, the formulary model approaches medical purchases from a single source, limiting the number of vendors and pricing competition. Benefits from this strategy have included pricing discounts for volume, reduced inventory costs, and improved skill secondary to increased understanding of limited product choices.  In the payment cap model, similar outcomes have been recorded. “Payment caps” are price ceilings for products (separated by function). Although both of these strategies seem logical, the potential limitations for each exceed the benefits. Reductions in product choices may not be satisfactory for physicians, and may not offer superior service to patients.  Although facilities may experience reduced costs, their ability for future negotiations is sacrificed under these plans.

The EVBA approach aims to satisfy the stipulations of health reform in reducing costs while preserving patient satisfaction, quality, and safety.  Improved technology acquisition processes through standardized approaches are one of the expected outcomes.  Other outcomes include standardizing the approach to negotiate prices and the purchasing of health technologies, and improved utilization and value by using evidence-based practices and benchmarking.¹  Some of the results from a 2009 survey of heath care systems found preferred alignment as follows (in order to reduce physician-preference items, or PPI);¹

Standardize PPI: 51%

Formulary model: 46%

Payment-cap model: 45%

Financially, EVBA can improve cost-effectiveness by evaluating the impact new technologies have on the organization.  Before devices are purchased, due diligence should be practiced to learn about the potential return on investment (ROI) and total cost for use.  The involvement and awareness of as many physicians and clinical workers as possible is critical to the success of this strategy.

Though buy-in is essential, a “top-down” approach is still necessary for EVBA to have the greatest impact. Stakeholders who hold positions of decision-making for the organization will need to lead the movement and sustain the changes, ensuring that consistent savings are achieved.  This group may include key physicians, C-suite executives, or other administration.

Modifications to insurance, Medicare and Medicaid reimbursement, and potential penalties for a lack of “quality” expressed to patients are not the only sources of additional revenue for health care systems.  Device industries will also need to have a role in the United States’ overhaul of medical care to achieve the government’s (PPACA) three-part aim of better healthcare, better health and reduced costs.

 Click here to read the entire article

*Please note: you will need to “register” to read this article (i.e. give your name, etc.), however, it is free through this website.

¹Hayes, W. S.  Evidence-Based Value Analysis: Using Scientific Evidence to Drive Quality and Reduce Costs (2012).  Lansdale: Winifred S. Hayes, Inc.  Retrieved from http://www.hayesinc.com/hayes/resource-center/white-papers/evidence-based-value-analysis-using-scientific-evidence-to-drive-quality-and-reduce-costs/

*Please note: you will need to “register” to read this article (i.e. give your name, etc.), however, it is free through this website.

²Saeilo Manufacturing Industries: Medical Devices (2001).  [Image of medical devices].  Retrieved from

http://www.saeilo-smi.com/medical.html

Courtesy of Wiki Images

Surgical Relief for Diabetes Type II Patients

by Colleen Tallant

A March 26^th article of the New England Journal of Medicine (NEJM), in addition to many other international reports, presented weight-loss surgery as the now preferred solution to Diabetes Type II.  For the past two years in Rome, 60 obese patients who have struggled with the maintenance of this metabolic disorder were treated in one of three groups.  The first group was treated traditionally with medication and simultaneous diet and exercise changes.  The second underwent a surgical procedure; Roux-en-Y gastric bypass, which results in a smaller stomach that bypasses part of the small intestine, where most food absorption occurs.  A third group received biliopancreatic diversion surgery, which is a higher-risk procedure than the Roux-en-Y bypass because it removes part of the stomach and attaches the remaining amount to the lower section of the small intestine (Mozes, 2012).  Again, because the small intestine is the primary location for nutrient and mineral intake, one of the largest side effects of this surgical procedure is difficulty with absorption.

All of the patients in the two groups that had surgery were able to stop taking the diabetes medications they were previously prescribed, and a majority experienced full disease remission (Mozes, 2012).  Dr. Francesco Rubino, senior author of the NEJM article and chief of gastrointestinal metabolic surgery and director of the Metabolic and Diabetes Surgery Center at New York-Presbyterian/Weill Cornell in New York City told reporters that we have known for many years that bariatric surgery is helpful in controlling diabetes (Mozes, 2012).  He argued that “what this new study shows is that even when you compare surgery against standard treatment, surgery performs far better in terms of the improvement that you can get in terms of diabetes” (Mozes, 2012).

The Cleveland Clinic has reached similar findings in a 1-year study of 150 patients.  Patients who received surgery had a much higher chance of reducing their blood sugar levels to an acceptable range which enabled them to come off their medication.  40% of surgical patients had increased control of their blood sugar, whereas only 12% of patients who relied on traditional medication therapy saw the same effect (Vastag, 2012).

An understanding of diabetes, its development and the causes of its manifestation is important before supporting a treatment approach.  Diabetes mellitus translates directly in Greek to “to run through” (Pick, 2011).  Normally, when food is consumed cells in our body take glucose (sugar) in by way of insulin.  On the surface of our cells are insulin receptors, ready to accept insulin and bring the glucose in, where it can then be metabolically converted into energy we need for the functions of our bodies.  In the case of diabetes type II, insulin levels are still in the bloodstream as they would be for anyone else, however, cells become resistant to these molecules and glucose in the blood cannot enter cells the way it typically would.  This causes the sugar to remain in the bloodstream, causing blood glucose levels to rise, and subsequently leads to type II diabetes.  The Greek translation fits perfectly; nutrients “run through” our body without the capability of absorption.  Complications can worsen over time; eye problems, kidney damage, nerve damage, and compromised circulation (which can lead to amputations) are all possible outcomes if this disease is uncontrolled (Pick, 2011).

How then, does the surgery correct defective metabolic signaling?  Dr. Loren Wissner Greene, an endocrinologist at NYU Lagone Medical Center in New York City, suggests evidence for changes to hormones (leptin and ghrelin) found in the stomach (Mozes, 2012).  In addition to this, bypassing small to large sections of the small intestine also decreases the amount of digested food that is absorbed, lowering the caloric intake from ingested meals.

Complications from these procedures can include anemia and osteoporosis, as indication that sufficient nutrients are not being absorbed by the digestive tract (Vastag, 2012).  Patients who do not follow dietary recommendations after surgery can also see decreased improvement in their diabetic condition (Mozes, 2012).  We should also recognize that the study only observes patients for a two-year period of time.  Post-surgical complications are possible, and maybe even more likely, after a greater number of years have passed.  The cost of these procedures can also range anywhere from $20,000-$25,000, which is not an especially friendly bill in the economic hardship our country is in.

Some insurance plans will cover the procedure, and others won’t.  If the surgery is deemed “medically necessary” (which varies in definition by state) for example, Medicaid will cover the procedure.  The American Diabetes Association (ADA) only recently accepted the surgery as part of their type II treatment guidelines in 2009.  It is indicated for those who “fail to respond to lifestyle [changes] and medication” (Vastag, 2012).

Although these guidelines are logical; have the surgery if primary attempts at lifestyle modification have failed, the necessary criteria for scheduling the procedure is not quite the same.  Patients who have a Body Mass Index (BMI)of 35 or more (over 30 is considered “obese”) and have been diagnosed with diabetes type II over five years ago are eligible (Mozes, 2012).  The CDC has obesity data posted for the United States in 2008 on their website, showing that 33.9% of adults have a BMI in the “obese” category (CDC, 2012).  This surgery, although a drastic measure, has the potential to benefit over a third of Americans.

Mozes, Alan.  2012.  Weight-Loss Surgeries May Beat Standard Treatments for Diabetes.  HealthDay.  Last accessed March 29, 2012 from http://www.everydayhealth.com/diabetes/0326/weight-loss-surgeries-may-beat-standard-treatments-for-diabetes.aspx.

Pick, Marcelle.  2011.  Insulin Resistance: What women should know about lowering their risk of type II diabetes and metabolic syndrome.  Women to women.  Last accessed March 29, 2012 from http://www.womentowomen.com/insulinresistance/howtopreventtype2diabetes.aspx.

The Centers for Disease Control and Prevention.  2012.  FastStats: Obesity and Overweight (Data are for the U.S.).  Last accessed March 29, 2012 from http://www.cdc.gov/nchs/fastats/overwt.htm.

Vastag, Brian.  2012.  Stomach surgery more effective than medicine for diabetes, studies find.  The Washington Post.  Last accessed March 29, 2012 from http://www.washingtonpost.com/stomach-surgery-more-effective-than-medicine-for-diabetes-studies-find/2012/03/26/gIQAdlvWcS_story.html?wprss=rss_health-science.

Courtesy of Common Images

Job are on the Rise in the Health Care Sector

By Caryn Sever

We live in a time where un-employment in America has hit high levels in the past few years. Whether people are occupying Wall Street, or waiting at line at the unemployment office, the facts are clear: people simply need jobs.

Here is some encouraging news from the job front, according to a recent study from the Bureau of Labor Statistics, employment in the health care sector has increased since February 2012. The health care industry “added 49,000 jobs in February, following a revised increase of 43,300 jobs the previous month”.[1]  Though this report is promising, the BLS report does not indentify whether the 15,000 or so hospital positions were medical professionals, administrative professionals, or IT professionals.

In early March, the Altarum Institute followed up the Bureau of Labor Statistics Economic Situation Summary with a briefing noting that job creation in the Health Care sectors share of the total national employment is at an “all-time high of 10.8 percent” which, according to Altarum is “the highest in at least 20 years”.[2]

According to Altarum[3] employment increases took place in the following areas:

• Hospitals – about 15,000
• Office of physicians – about 9,500
• Outpatient care centers – about 4,000
• Home health care services – about 5,000
• Nursing and residential care facilities – about 5,000
  • Note: “nursing care alone lost 2,000 jobs”[4]

Furthermore, Altarum reports that total private sector health care jobs have grown by 2.6 percent or about 360,000in the past 12 months. It is important to mention that during this same time period, “non-health payroll employment increased by 1,661,000 jobs, or 1.4%”.[5]Altarum’s data is based on a monthly “establishment survey” as well as a “household survey”.

Although it is difficult to find a “con” side of job creation, let’s consider an article published by the New England Journal of Medicine this past October titled: Rethinking Health Care Labor, written by Robert Kocher, M.D. and Nikhil R. Sahni, B.S.  According to the article, improving the health care labor structure can be achieved in three ways: one, “reducing the number of workers, lowering wages, or increasing productivity” two, “reducing current wages or replacing current workers with lower-cost (less skilled or more narrowly skilled) workers who can produce the same output”, and three, a “redesign [of] the care delivery model” which would utilize a “different mix of workers engaging in a much higher value set of activities”.[6] The authors believe that this third option is the most viable and realistic. Dr. Robert Kochner, a George Washington University Graduate, was the former Special Assistant to President Obama for Health Care and Economic Policy (2009 – 2010),

In contrast to the articles take on reducing the number of health care workers, HealthReform.Gov released a fact sheet emphasizing the expected “shortage of approximately 21,000 primary care physicians in 2015” and “without action, experts project a continued primary care shortfall due to the needs of an aging population and a decline in the number of medical students choosing primary care”. [7]

Regardless, the fact remains that the increase in Health Care jobs in over the last 12 months, and specifically in January and February alone, have reached record highs, giving a hopeful outlook for Health Care jobs seekers in America.

Common Image

Americans Benefit when the Affordable Health Care Act Prohibits Lifetime Limitations

By Caryn Sever

My close friend, let’s call him John Doe, has diabetes.  When he was 5 years old he caught a virus called coxsackie which killed his pancreas rendering him unable to manufacture insulin. Throughout the years he maintained a mild control of his disease while on his parents insurance. At 21, John was making a living as a bartender when he went blind due to complications from diabetes. A few years later, his kidneys were functioning at a mere 15% in one and 0% in the other. Clearly John was in need of constant medical care and observation. He was fortunate to receive a kidney from another of our close friends so by 2009 John had 1 functioning kidney and a lifetime of medication to take. A year later he received a pancreatic transplant, more hospital time, medication, and infections. In 2011, John’s functioning kidney was infected with a virus called BK (named for a patient with the initials B.K.). The virus affects transplant patients who use immunosuppressant drugs, becoming a disease known as BK nephropathy and rendering the kidneys non-functioning. Currently John receives dialysis twice a week and is in and out of hospitals with infections and various life threatening situations. Needless to say, John Doe’s medical care is costly.

John’s story is not as uncommon as many may think. “Before health reform, many Americans with serious illnesses such as cancer risked hitting the lifetime limit on the dollar amount their insurance companies would cover for their health care benefits.”[1]  In a similar story posted by the White house Blog titled New Data: The Affordable Care Act in Your State, Des Moines, Iowa native Amy Ward contracted a rare fungal infection after returning from a vacation.  Amy’s health care cost exceeded $1 million dollars within a matter of months. If it wasn’t for the Affordable Care Act, Amy and her family would have never been able to afford her recovery.

In 2009, “nearly 60 percent of employer-sponsored plans and 89 percents of individually purchased coverage” had lifetime limits[2]. An issue brief released on March 5, 2012 by HHS states “the Affordable Care Act prohibits health plans from imposing a lifetime dollar limit on most benefits received by Americans in any health plan renewing on or after September 23, 2010.”[3] According to HHS, this will affect nearly 105 Million Americans, including Amy Ward and hopefully John Doe.

HealthCare.gov released a helpful “fact sheet” about lifetime limits and what that means for the average America.  The information provided details further facts regarding annual limitations as well.

The law restricts and phases out the annual dollar limits that all job-related plans, and individual health insurance plans issued after March 23, 2010, can put on most covered health benefits. Specifically, the law says that none of these plans can set an annual dollar limit lower than:

• $750,000: for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011.
• $1.25 million: for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012.
• $2 million: for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014.

No annual dollar limits are allowed on most covered benefits beginning January 1, 2014. [4]

Please note: that plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not considered “essential.” [5]

In Virginia alone, nearly 817,000 children, 1,036,000 adult males and 1,121,000 adult females for a total of 2,974,000 people, stand to benefit from the prohibition of lifetime limitations on insurance.

For people like John and Amy, these lifetime limits could mean the difference of life or death, it could mean the difference between losing your home due to your out of pocket medical expenses or remaining in your safe and comfortable living space, and it could mean the difference in the quality of care they receive. Prohibiting these lifetime limits will allow patients with chronic and debilitating health issues to continue to receive care throughout their lives, which will, in many cases prolong their life span and quality of life.

Courtesy of the Kaiser Family Foundation

Quality Care for Less Money: Can Regional Success Go National?

(Commentary on the Conference February 15, 2012 at the Kaiser Family Foundation in Washington, D.C.)

Elizabeth I. Flashner, MS, Colleen M. Tallant

                The innovation of health reform, demonstrated through several models across the country, has continued to motivate health care organizations in implementing more effective and cost-saving changes.  On February 15, the Kaiser Family Foundation hosted a meeting of some of the most influential players in the development of reform across the country.  The goal was both to unveil “U.S. Health Care: The Good News”(a documentary made for PBS), and share findings regarding the monumental reform tasks at hand: improve the health of the nation, improve the quality of that health care, while reducing costs.

Dr. Elliot Fisher, Professor of Medicine and Director, Population Health and Policy at Dartmouth Institute for Health Policy and Clinical Practice offered insight into some of the barriers we have faced to successful transitions.  Currently, health reform has the form of an “unseen goal” that is difficult for many to grasp and embrace.  Identifying the information needed to develop a reliable structure as well as access to that data has been an additional challenge for some environments.  Fisher also believes that more organizations need to recognize the urgency for the 3-part aim of reform.

Carol Beasley, Director of Strategic Projects at the Institute for Healthcare Improvement identified three necessary contributors to “change.”  First, organizations of people who have the “will” to create a more efficient health care environment are more effective in achieving that goal and cost-savings.   Secondly, new and innovative ideas must be embraced.  Finally, execution of these ideas is most successful when implemented in an environment which promotes learning between doctors, staff and patients.  Not only alterations to the system, but the means by which measurement of these changes are taken and how often will also be pertinent.  Beasley feels that measuring at six months and one year allow for better correction and longer term success.  She further discussed the example of how Health Partners in Minnesota has developed a comprehensive program for treating patients with diabetes.  The program which is executed with near perfect reliability uses treatment protocols and process measures.  She notes that diabetic patients of Health Partners are seeing results in improved health including a two-thirds reduction in heart attacks, fewer amputations and less loss of eye sight.  Additional information on the results of the Health Partners diabetes program is reported by the website Managed Care in 2009 here.   The health outcomes are examples of how the medical arena is starting to embrace concepts long held in the public health community such as population health, burden of disease, and quality adjusted life years to improve and measure quality in the healthcare they provide.

The Director of the Engelberg Center for Health Care Reform and Chair at the Brookings Institution, Dr. Mark McClellan, agreed with the above speakers and also added comments of his own.  He brought up cost savings options like generic drug substitutions for trade medications used by Medicare Part D.  He also believes that information availability not only for providers and organizations but also for patients will mean better health care. We need to create ways for people to easily identify the cheapest and best health care options for their acute and chronic conditions.  When serving as Director of the Centers for Medicare and Medicaid, (CMS), several physicians explained to Dr. McClellan that they were trying to redesign their practices and clinical services in order to improve the health of the patient population, but ended up practicing medicine in ways which were not incentivized in the Medicare program.  As a result in 2005, CMS created a demonstration project  knows as the Medicare Physician Group Practice, (PGP), Demonstration to allow trials of new payment models to reflect the redesign of the practice and patient care.  The model was the first pay for performance model tried by Medicare care where physician groups were rewarded with a portion of the savings to Medicare derived from the new model of care delivery and organization.  Additional details and outcomes of the demonstration are available from CMS. On August 8, 2011, CMS announced that  all ten original  organizations in the Medicare PGP program are enrolled in a two year extension program.

Sean Cavanaugh, Acting deputy director of Programs and Policy at the Centers for Medicare and Medicaid Innovation, explained the nation’s deficit and budget debate decisions may affect healthcare and the nation’s health as Congress and the president look to Medicare for cost savings.  Mr. Cavanaugh contends fixing the budget through reduced healthcare spending will lead to additional health system problems and poor health outcomes, while redesigning the healthcare system can reduce cost overtime and increase population health status.  While the CMS Center for Innovation has a $10 billion budget, it is important to keep in mind that CMS has an $800 billion budget that they seek to spend wisely.  Programs proven to be effective can be expanded by the Secretary of Health and Human Services.

We look forward to updates on the findings and analysis of the Physician Group Practice demonstration as discussed above and of various demonstration versions of Accountable Care Organizations just getting underway though programs of the Centers for Medicare and Medicaid Innovation .  It’s motivating to see that this country is past the “beginning” of health care reform and strategies are beginning to formulate.

A webcast of the forum can be seen at http://www.kff.org/insurance/trreid_pbs_regional_success.cfm.  U.S. Health Care: The News, the documentary, can be viewed on your local PBS station. Maryland Public Television will air the program on Wednesday February 29, 2012 at 10:00pm and March 1, 2012 2:00 AM.

This is a Common Use Image

Want Affordable Health Care?  Get to the Gym

by Colleen Tallant

                Health Care Reform has been primarily focused on the changes that need to occur within healthcare systems.  The three part aim of increased health care quality, better health and reduction in costs has been a challenge for this country.  The Cleveland Clinic has adopted a different approach that addresses improving the health of Americans, thus reducing their need for the same amount or degree of health care.

The “Healthy Choice” program is available for employees at the Cleveland Clinic who have pre-existing or chronic conditions such as asthma, diabetes, hypertension (high blood pressure), or for those who smoke.  Employees agree to see a physician who helps to create reasonable and attainable health goals. Health insurance premiums then reflect this choice and subsequent outcomes.

If employees choose to join Healthy Choice and they meet their health goals, a significant reward is offered in the form of a 4% reduction in their premium from the previous year.  If employees join and are unable to meet their target goals, they will suffer a 9% increase in the cost of the health care premium (again, with respect to the prior year).  This may seem severe, but it’s considerably better than the price of not joining the program at all; a 21% increase in health insurance cost (1,2,3,4).

Employees who don’t have any conditions which would make them eligible for the program can still avoid the 21% increase by joining the gym.  Through Healthy Choice, a gym membership is free for those who utilize the facility at least 10 times a month.

The CEO of The Cleveland Clinic, Toby Cosgrove, has taken an admirably aggressive approach toward reform.  Instead of putting the weight of health care reform onto the shoulders of physicians, making it the responsibility of healthcare organizations or a problem the government has to carry independently; Cosgrove has shared liability between all of the inter-related parties (1).  Not only have these measures been implemented, “Cleveland Clinic stopped hiring smokers five years ago, as well as launched a healthy food campaign on campuses that eliminated sugary drinks,” further improving the health benefits their employees can gain (1,2,3,4).  If proper resources are provided, as the Cleveland Clinic has done for their employees, aren’t WE responsible for achieving the aim of “better health?”

1. Cheung, K.M.  (2012).  Critics say Cleveland Clinic a ‘big brother’ to employee fitness.  FierceHealthcare.  Retrieved from http://www.fiercehealthcare.com/story/critics-say-cleveland-clinic-big-brother-employee-fitness/2012-02-15?utm_medium=rss&utm_source=rss.

1. Columbus Business First (2012).  Cleveland Clinic employees get fit to avoid premium bump.  Retrieved from http://www.bizjournals.com/columbus/morning_call/2012/02/cleveland-clinic-employees-get-fit-to.html.

1. Glenn, Brandon (2012).  Is Cleveland Clinic a pioneer for telling employees, ‘Get healthy or pay up?’  MedCity News.  Retrieved from http://www.medcitynews.com/2012/02/is-cleveland-clinic-a-pioneer-for-telling-employees-get-healthy-or-pay-up/?edition=hospitals.

1. Theiss, E.  (2012).  Get healthy or pay higher insurance rates, Cleveland Clinic employees are told.  The Plain Dealer.  Retrieved from http://www.cleveland.com/healthfit/index.ssf/2012/02/join_or_pay_more_cleveland_cli.html.

Online Health Care - Courtesty of Wiki Common Images

Using Online Communities to Discuss Health Care and Reform

By Caryn Sever

 Over the last five years, the social networking phenomenon has swept the globe. Users have direct access, in live time to most people who participate in these online communities. It is not surprising then, that many have taken to the web with information and questions about health care, disease, insurance, and reform.

For years people have been scouring the Internet to find communities of like minded individuals. Online message boards and forums were some of the first online communities and social networking avenues. Internet forums were created as early of the 1970s as a virtual bulletin board for people who were beta users and experimenters of the “World Wide Web”. By 1994 web-based Internet forums connected users on topics from gaming to politics and everything in between. Members of these forums were able to post “threads” or messages about a particular subject and respond to the posts. “Lurkers” or those who simply read the posts and responses could generally do so anonymously without signing up to a public forum.[1] Today, the basic structure of social networking is quite similar.

As of 2011, over two billion people across the globe use the Internet with over six million people participating in online message boards or Internet forums,  600 million visitors a month on Twitter and 800 million active users on Facebook. These forums provide a safe, social networking structure to those who are seeking answers or simply reaching out to share ideas, hopes, dreams, and build online friendships. One may ask: where does Health Reform fit into the conversation? For several years, online forums have helped patients seek answers to important health related information, including health insurance coverage, and disease management. These discussions also allow patients, care givers, insurance providers, and policy maker’s direct access to each other.

Dr. Priya Nambisan, an Assistant Professor of Health Informatics and Healthcare Management in George Mason University’s, College of Health and Human Services, Health Administration and Policy, conducted a study in 2011 about social and informational support in online communities. Her article: “Information seeking and social support in online health communities: impact on patients’  perceived empathy”discusses the social, emotional, and informational support of these communities as they communicated through message boards. Dr. Nambisan used a sample group of participants in online communities set up by Health Care Organizations (HCOs).  The objective of the study was to test “the impact of two variables that reflect the functions of online health communities” 1) the informational support and 2) the social support. The research particularly measured the function of homophilous relationships among patients.[1]  Dr. Nambisan describes the concept of perceived empathy as “empathy perceived by patients in an online health community based on their interactions and discourse with other” and believes that is can be “critical to the outcome of online communities”. [2]Among many attributes, these online communities serve two major purposes: as an informational seeking forum or as a social support forum. Nambisan’s study indicated that, between the two, effectiveness of information seeking had a greater impact on patient’s perceived empathy than the social support received from these forums. [3] Given this outcome, Dr. Nambisan’s model proves the need for an online information exchange regarding health care and reform.

 Several bloggers have also addressed this topic in a variety of ways. The Health Care Blog posted a story titled: The slow integration of community into healthcare on January 3, 2012 outlining successful trials of online communities of patients conducted by Geisinger with dLife, Aetna with MindBloom , OneRecovery, and DiabeticConnect an Alliance Health community with the Joslin Diabetes Center . These programs offer innovative, interactive communities for patients. dLife is a free online social community for diabetics that include recipes, forums, and blood sugar management tips. DiabeticConnect provides discussion forums, news, and other helpful information for diabetics. OneRecovery  is a free social media and message board site for an anonymous community to come together and talk about their addiction online.  LifeGame by MindBloom,  is a game designed to track and motivate users to adopt a healthy life style in a fun way. The interface is a life tree the user grows while they track all aspects of their life including: relationships, health, spirituality, etc. and receive motivators such as actions they can take and motivational quotes.

Another writer for The Health Care Blog, David Harlow explains the importance of social media use for hospitals, health care providers, as well as its inclusion in health care reform, in his article Health Care Social Media – How to Engage Online Without Getting Into Trouble, posted on January 3, 2012.  He clearly notes the dangers of social media in the health care world and, in some case how to address them.  As far a health care reform is concerned, Harlow submits that reform itself is “pushing providers into social media”. [5]  The reason: the Meaningful Use regulations that will require providers to adopt electronic health records and make “greater use of personal health record portals”.[6] Furthermore, ACOs will require regular patient engagement which is generally best implemented at this point, through social networking. Harlow’s article is similar to one posted by Daniel Palestrant  on August 22, 2009, titled Can Social Media Save Healthcare Reform. The general consensus is the overwhelming need for direct access; access from providers to patients, providers to and from policy makers and, policy makers and reformers to and from citizens.

In 2009, the White House addressed this need for direct access by developing a website called “Health Insurance Reform Reality Check” as an effort to dispel rumors about Health Care reform. The site features videos of real people talking about real health reform. President Barak Obama believes “Whether or not you have health insurance right now, the reforms we seek will bring stability and security that you don’t have today. This isn’t about politics. This is about people’s lives. This is about people’s businesses. This is about our future.”[7] This site is a demonstration of how social media can be used as a grassroots method to disseminate information about Health Reform.

What is CHPRE Doing?

The Center for Health Policy Research and Ethics believes that it is imperative to participate as active members of the online community. We will do this through a variety of ways. Our website (http://chpre.gmu.edu) is designed specifically for community interaction.
We believe that it is important to establish a dialogue and a connection with real
people as well as policymakers,  providers, and healthcare professionals. CHPRE will launch a video blog featuring Len M. Nichols in February 2012. This blog will address current health care and reform issues in 3 – 5 minute video segments. We will offer the online community a chance to comment and discuss these issues. We will begin a twitter chat, where followers can ask Len M. Nichols and CHPRE staff members about health care and reform in live time. Len is also is the founding Editor-in-Chief of the online Community on Payment Innovation , a joint project of the American College of Cardiology and the American Journal of Managed Care, which provides timely content and aims to foster interactive discussion among clinicians, payers, patients, and policy makers about emerging incentive structures and their implications. CHPRE’s website also features a survey section called Question of the Month which we update monthly where visitors can vote, post comments, and discuss issues on our website. Finally, CHPRE maintains an active Facebook page where students, professionals, and friends can post and discuss online. Through these forms of social networking, and interactive online communication, CHPRE plans to reach out to the public in more viral ways. This will allow more access and discussion across the board.

For more information or links to online community boards, click the below links:

Dr. Nambisan’s Paper

“Information seeking and social support in online health communities: impact on patients’ perceived empathy”

The White House Health Insurance Website

Health Insurance Reform Reality Check

Internet Forums:

HealthBoards: Health Message Boards

PsychForums

Benefits Link Message Boards

There is also a social networking site developed specifically for Employers, insurers, and agent employees called The Employer Health Care Network

This Image is courtesy of Flicker

Continuous Coverage for Low-Income Diabetics?

by Caryn Sever

As a contribution to the continuing debate over whether coverage expansion and seamless coverage is a good idea, the Wall Street Journal Health Blog recently published an article titled “Continuous Insurance Required for Low-Income Diabetics” on January 4, 2012. The article outlines a Kaiser study of over 3000 diabetic patients who received medical care in clinics in Oregon between 2005 and 2007.

The purpose of research was to address the question: “is there some minimum amount of Medicaid coverage that could boost the odds that patients would get the necessary preventative tests and vaccines [that they need]”?

The result of the study: patients with continuous coverage were more apt to receive preventative care than those who were continuously uninsured or even partially insured.

Needless to say, patients who are not receiving preventative care could and would suffer major health consequences, proving the need for continuous coverage.