Better health begins with better understanding
Industry experts discuss disease management solutions.
By Phil Colpas, Editor, March 2013
As the U.S. healthcare model changes from rewarding for quantity to rewarding for quality, disease management is projected to be one of the fastest-growing segments in the industry, with healthcare IT vendors scrambling for a piece of the proverbial pie.
They really have their work cut out for them.
According to a National Assessment of Adult Literacy survey, two in five American adults have difficulty processing health information and services needed to make appropriate health decisions. That’s an estimated 90 million people, and those with poor health literacy also are more likely to have a chronic disease and less likely to get the healthcare they need.
The survey goes on to state that 75 percent of Americans who reported having a long-term illness had limited health literacy and knew less about their conditions or how to handle symptoms. The need for awareness and adherence to health literacy principles has become a public health concern, estimated to cost the U.S. economy in the range of $106 billion to $238 billion annually, according to the survey.
“The widespread but often unrecognized public health challenge of health literacy serves as both a warning and a call to action,” says Jack Harris, M.D., vice president of Eli Lilly and Company’s U.S. medical division. “Overcoming health disparities is a transformational and important journey. At Lilly we are working to develop communication and health education that connects with patients in a way that’s meaningful and understandable.”
If a chronic disease sufferer doesn’t understand his or her diagnosis or treatment plan, it’s easy to see how that lack of information could lead to recurring hospital readmittances for the same condition. As vendors, hospitals and physician practices formulate their disease management plans, health literacy should be top of mind.
James B. McGee, M.D., co-founder, Decision Simulation
Improved decision making can help prevent readmissions
Last year, more than 2,000 hospitals were financially penalized by the Centers for Medicare and Medicaid Services (CMS) for excessive readmissions. Many of these readmissions were related to recurring or escalating chronic conditions, such as diabetes or congestive heart failure.
Until now, healthcare has focused primarily on responding to immediate problems. New care models, however, require clinical decisions that focus on long-term patient outcomes. This shift is a significant transformation and requires new approaches to challenges, such as reducing readmissions.
Some chronic-condition readmissions are the result of patient behavior; others are the result of decisions by care teams. To address these issues, healthcare systems should consider training programs to enhance decision making. Web-based clinical simulation platforms offer one proven approach.
For care teams, clinical simulations sharpen decision making in a safe environment, through deliberate practice. They ensure providers understand how to apply the correct protocols, in the right situations and with the right patients, to manage chronic illness. Simulations provide immediate, individualized feedback that demonstrates the impact of both correct and incorrect care decisions.
Simulations can also help providers clearly outline to patients the importance of treatment plan adherence. Customized case scenarios can illustrate the consequences of non-adherence, including negative effects on quality of life. Through proper education and training, providers can ensure that patients are better prepared for managing chronic disease.
Although simulation training for care teams and patients cannot prevent all readmissions, it is an important component of any program. Simulations that leverage adaptive learning can benefit broad groups of learners, cost-effectively allowing them to quickly reach competency. Leveraging Web-based clinical simulations can help hospitals avoid short-term financial penalties, while improving long-term outcomes and quality of care.
Julie Cheitlin Cherry, RN, MSN, director of clinical services, Intel-GE Care Innovations
Look to remote care-management technology as a future standard of care
As hospitals face the daunting task of caring for our aging population amidst new readmission penalties from CMS, being able to drive behavior change among patients and facilitate efficient, proactive care is essential to maintain positive margins. People 65 and older with multiple chronic conditions are 100 times more likely to have preventable hospitalizations than someone without chronic conditions, and that population is growing at record rates. Providing care at home is one way to address this need; it can be achieved efficiently using a remote care-management (RCM) program that increases an individual’s interaction with health information and healthcare professionals at home.
Using RCM technology, healthcare professionals can monitor patients’ vital signs, connect with patients through videoconferencing, send educational materials to patients and proactively teach patients how to manage their own conditions. Studies demonstrate that care models delivered by a clinician and facilitated by RCM technology may drive appropriate utilization of healthcare resources, reduce costly ER visits, improve self-management behaviors and keep people out of the hospital.
Recently, St. Vincent Health, Indiana’s largest healthcare employer, implemented a model of care using an RCM program to deliver care into the home setting. The program incorporated technology, clinical protocols and educational materials to better manage patients with CHF and COPD. In less than two years, preliminary results show St. Vincent reduced readmissions to 5 percent – a 75 percent reduction compared to the control group (20 percent) and national average (20 percent).
Reaching patients when they are outside the hospital should be a priority, and models of care using technology to reach into the home offer a cost-effective way to improve care and possibly reduce readmission rates.
Tom McGuinness, CEO, PatientPoint
Managing chronic disease and population health
As the number of Americans with chronic disease continues to rise, disease management and population health management have become big challenges for physicians. But are annual doctor visits, mobile disease-management apps or other wellness tools alone sufficient to improve outcomes and drive down costs associated with chronic disease?
An effective disease-management program needs to be multi-faceted, engaging patients beyond the office visit. Maintaining an ongoing, interactive patient-physician relationship before, during and between care visits is important to address patients on an individual level, identify actionable steps and ensure adherence to treatment plans. During the days of paper patient records and snail-mail appointment reminders, this might have been difficult to achieve. However, hospitals and physician practices today have begun to realize the true potential of technology in changing the way both physicians and patients approach disease management. They have started to use patient education tools, care coordination technology and secure online/mobile messaging to better engage and monitor patients throughout their entire care process.
Reducing chronic disease and associated healthcare costs is also about preventive care – educating patients to create positive change in health behaviors and managing health risks to avert compounding problems or adding to current ones. This has become essential as the industry moves toward quality initiatives and value-based care, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). From preventive screenings and patient education to appointment reminders and treatment adherence programs, the common thread to effective disease management and population health improvement is engaging patients in their own care from beginning to end.
Richard Bedrosian, Ph.D., director of behavioral health and solutions development, Wellness & Prevention, a Johnson & Johnson company
Cognitive-behavior therapy helps manage insomnia
Insomnia is estimated to affect almost a third of all adults and is attributable to costs of more than $100 billion a year in the United States.
The growing role of the Internet in patient self-management provides a unique opportunity to address insomnia through Web-based cognitive-behavior therapy (CBT) interventions, which can be efficiently and inexpensively deployed to millions of people.
CBT for insomnia translates well into an interactive format, where patients can track their sleep patterns and behaviors online; the program can offer suggestions based on data entered.
Digital health-coaching programs based on CBT protocols for insomnia are designed to help users learn more effective sleep habits and relaxation techniques, change negative sleep thoughts, create a stable sleep pattern, make lifestyle changes to improve sleep and reduce daytime stress.
Users have reported an average of 30 minutes more sleep per night, improvements in overall sleep quality, greater confidence in ability to manage insomnia, less difficulty falling asleep, increased ability to stay asleep and reduced anxiety and fatigue.
Web-based interventions can effectively be deployed in conjunction with an online health-risk assessment (HRA), which can be used as a basis for recruiting employees into specific self-management programs, such as those for insomnia.
The proven effectiveness and affordability of Web-based programs can help address a gap in services to reduce insomnia’s impact on health and productivity, providing a substantial return on investment to health plans and employers. HMT
Tags: Disease Management