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Cincinnati Pioneers “Health Coaching” Program in Partnership with Kroger

by LAS

The City of Cincinnati partnered with Kroger and Anthem Blue Cross Blue Shield of Ohio to run a pilot program for 600 employees and retirees. The programs offer “health coaches” in Heart Healthy Coaching and Diabetes Coaching for some amazing results.

The enrollees were compared to a control group and saw statistically significant results. Enrollees were better at adhering to medications, and blood pressure dropped 4 percent. Kroger's clinical development manager stated that just a 2 percent drop in BP can mean a 10 percent drop in stroke deaths.

Emergency room visits dropped 40 percent with the group in the Heart Health program, compared to the general population. Participants in the Diabetes Coaching program saw an astonishing 90 percent drop in cardiovascular-related ER visits.

Those who did not participate in the program saw total cardiovascular medical costs triple, compared to a drop of 11 percent for the enrollees.

A carrot was held out to participants in the form of deep discounts on their medications as long as they were active in the coaching program. Co-pays were waived.

The first visit with a coach typically lasted an hour, when the patient declared what their goals were, and the coach started to guide them through the kinds of decisions they were making.

Many times, an enrollee would meet with a dietician who would walk the participant through the grocery aisle and help her decode food labels so she could make smarter choices. Sometimes the pharmacist is the coach for someone who has several medications or has questions or concerns.

As of 2012, Kroger was exploring whether it could expand the program to other chronic conditions such as asthma or chronic obstructive pulmonary disease. Kroger rolled out the program to all 17 of its Cincinnati-area stores. Meantime, the City of Cincinnati is looking for other claims and pharmacy data that could show whether the program is succeeding or not, and by how much. 

Telemedicine Cutting Costs of Health-care While Improving Outcomes

by LAS

The innovation of offering telemedicine – where patients contact their doctors by phone, email or online – is not only helping shave the cost of health-care but is also helping patients manage ongoing health problems more successfully.

Employers and insurers are both hopeful that telemedicine will potentially keep more patients out of the emergency rooms who do not need that level of care.

Often patients go the ER because they have no other options, either they have no insurance or no local urgent care clinic or the clinic is closed at that hour that they need it. So telemedicine is really offering a medical advice service that is on-call 24/7.

It may shock you to learn that in 2009, there were 136 MILLION emergency room visits, and that at least 20 percent (and by some measures as much as three-quarters of them) could have been properly treated either in a clinic by their primary-care provider or in an urgent care facility. Given that the average ER visit costs at least $1,400, channeling those visits into other options has a high priority.

The good news is that telemedicine is getting rave reviews from users, never mind the insurers. Upwards of 90 percent of patients who used telemedicine gave it a positive approval rating.

One such telemedicine provider is STAT Doctors in the Scottsdale, Arizona area. Scottsdale began offering the telemedicine option and began seeing benefits: lower costs of course, but also decreased absenteeism.

Many employers offer call-a-nurse services as part of their healthcare plan. If more employees took advantage of that service, maybe a true form of telemedicine with access to physician consultations would be deployed.

Looking ahead, applications designed for wireless home-based health care services and advice is expected to grow from a $304 million-dollar market to $4.4 BILLION by the end of this year. 

Four Medical Tests for Women Over 50; Four Medical Tests for Men Over 50

by LAS

Dr. Oz has been promoting the value of four basic medical tests for men and women age 50 and over to catch the most serious health problems early.

FOR MEN--

1- A PSA test. Recommended on an annual basis for men age 50 and over. You might get the test at age 50 just for a baseline reading, but Dr. Oz still feels that annual testing provides essential information for your healthcare provider.

2- Colonoscopy. Colon cancer is the third most common cancer in men.

3- Hearing test. Going to the audiologist is recommended especially for men, who more often work with power tools, jackhammers, or in noisy environments. Hearing loss affects about a third of adults over age 65, and almost half of all men over 75. Tinnitus (ringing in the ears) is also a reason to see your doctor.

4- Not a single medical test, but a head-to-toe skin check to catch changes in moles or other abnormalities that can signal skin cancer.

FOR WOMEN--

1- Bone Scan-- Osteoporosis can lead to bone fractures particularly in women past menopause. If you are identified as having a bone-thinning disease, you may elect to take bisphosphonates to curb further bone loss. Other approaches such as weight-bearing exercises or dietary changes can also fend off further bone loss.

2- Colonoscopy-- Colon Cancer kills more women than ovarian, uterine and cervical cancer combined. Testing can start at age 50, though you only need to take it once every decade.

3- Mammogram-- A baseline test is suggested at age 40, then annual tests after age 50. Your doctor may want annual tests earlier than that if you have had any family history of breast cancer.

4- Pap Smear Test-- Annual testing is suggested for most women of any age. You could elect to drop this test after age 65, though, since one's risk drops off greatly after that if you have had mostly clean screenings.

Smokers Cost Employers $12K More Per Year (each) than Non-smokers

by LAS

Studies show that each smoker costs a company an average of $12,000 a year more than non-smokers. Inspired by a California study that showed every dollar spent by the state on smoking-cessation programs saved $18 in health care costs – more employers are moving to start smoke-free policies or tobacco-cessation programs in the workplace.

Employers do have to skirt some smokers' rights laws in a few states to avoid discrimination lawsuits if they become too invasive.

In just 29 states, the employers are limited to prohibiting smoking in the workplace, and states may prohibit smoking in public places. They have what is called “lifestyle laws” that protect workers. Employers may not take smoking into account regarding promotions, hiring or firing.

These laws, one must admit, are pretty toothless. It is difficult to prove that an employer violated the law because they know enough to provide some other, innocuous reason for not hiring or promoting someone.

Some of the state laws are even weaker. The Virginia law apply only to state employees. Three states – Minnesota, Illinois, and Montana – protect smokers rights but allow employers to charge higher premiums for the smokers. Three states – Tennessee, Louisiana, and Colorado – apply their protection of smokers to future hires, not current employees (when the law was passed).

Smokers who try to quit generally have to make many attempts before it sticks. Statistically, it takes seven attempts for a smoker to quit smoking. So keeping trying, you never know what approach will finally help you reach your goal.

More Than Two-thirds of ER Visits Avoidable, Says Study

by LAS

A recent study by Truven Health Analytics found that 72 percent of emergency room visits were avoidable, and could have been safely treated by a primary care provider. Truven drew upon a database of 24 million patients.

Healthcare situations were broken down into four categories of urgency. Category One is Non-emergent; medical care was not required within 12 hours.

Category Two is Emergent – Primary-Care Treatable; medical care was required within 12 hours but could have safely been delivered in a primary care setting (that is, in a clinic office).

Category Three is Emergent, (preventable or avoidable); this means that the patient needed medical care within 12 hours, for could have been prevented with effective office visits. An example of the latter would be someone who had diabetes or high-blood pressure who was not taking their medication as advised, and suddenly had a sudden event such as a stroke.

Category Four is Emergent (not preventable or avoidable); these are the kinds of events that people normally associate with an ER visit – a child falls out of a tree, someone is a victim of a car accident or shooting, someone is hit by a softball in a game, a homeowner falls off the roof, etc.

Some events were split between two categories, such as “abdominal pain, unspecified site” since there is a 33 percent chance of it being a serious problem requiring emergency treatment and a 67 percent chance of being something that could be looked at in your doctor's office.

The good news that only 6 percent of patients had an event that could have been prevented with proper primary care. That suggests that people are taking existing conditions seriously, taking their medicine, and making sensible lifestyle decisions.

Almost half (42 percent) could have been acceptably treated by their primary care provider. No reason was floated for why patients did not go to their physicians. Possibly they felt they could not get into a treatment room in a timely fashion.

One quarter had serious conditions but did not require treatment within 12 hours. Presumably they could have gotten into their primary care provider within that time, or gone to an urgent care center.

When broken down by age, it was shocking to see that three-quarters of the visits by children age four and under were of a nature that should have been seen in a primary care setting. Whether the parents had health-care coverage for minors was not addressed in this report. But still, these health events should have been seen in a primary care setting by a pediatrician who was familiar with the child's background.

Steering patients to the proper non-ER setting would by itself create huge cost savings for not only insurers but the patients, who presumably would have come up with much larger copays for an ER visit. 

Gee, Does Medical Tourism Mean I Can Go To Appleton???

by LAS

I ran across a mention that a hip replacement costs only about $27,000 in Appleton, Wisconsin, while it can cost as much as $126,000 in a major metro area such as Houston, Texas. Why the disparity?

Obviously wide variations in income levels between major metro areas and smaller towns are a big factor. But also the fact that the hospital has to pay much higher property taxes and other expenses in a big city is another major factor. It may also have to buy another lot to build a parking structure on for patients and visitors, while the small town has free street parking.

The small town hospital might also sacrifice some frills, too.