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A New Approach To Care: Health Incentives In The Affordable Care Act (Guest Post)

Preventative Care is a key aspect of the Affordable Care Act that stands to benefit millions of Americans, in ways that you might not expect.

The term describes an array of services, programs, and incentives that are funded by the government in order to make people healthier. Contrary to what you might think, however, the funds are not limited to impacting care on the individual level.

Rather, the reforms will include everything from building public health centers to creating bike lanes and walking paths. Not to mention, free immunizations for individuals and families.

It’s important for consumers to understand what these changes could mean for them, in every respect. With this thought in mind, let’s explore the ways in which individuals, families, and communities will be impacted by these new reforms.

Individual and Family Health

Individuals and families will benefit tremendously from a host of preventative services that will be offered free of charge by insurance providers, regardless of pre-existing conditions.

Offered services will include: Breast cancer screenings, wellness checkups, domestic violence screenings, contraception, and breast-feeding supplies. Immunizations, counseling services, and depression screenings will also be made available as a result of the new legislation.

For many Americas, this change will mean first time access to potentially life-saving services that work in turn to promote further wellness among individuals, families, local and regional communities.

Public Health and Prevention

Without funding, reforms are simply laws on the books that don’t have any real-world import.

In 2010, The Prevention and Public Health Fund was created in order to ensure that care actually gets to the people who need it, through the development of programs that mobilize entire communities toward the goal of better health.

The fund’s initial budget has been compromised since 2010, but local governments have already received an estimated $290 million to put towards the development of healthy eating programs that are aimed at some of our nation’s deadliest health issues, such as child obesity and diabetes. Funding has also been put to work through infrastructure development to create sidewalks and bike paths, in an effort to encourage daily exercise.

Although the Prevention and Public Health Fund has met some opposition from congressional republicans, the potential for positive impact is clear.

Smoker’s Penalty: Two Sides Of The Same Coin

The Affordable Care Act takes a bold stance on smoking.

The Smoker’s Penalty, as it’s come to be known, has to do specifically with plans offered in the state health insurance marketplaces, which will open for business this October.

Under the ACA, insurance providers are allowed to charge smokers up to 50% more for their coverage than non-smokers, due to the associated health risks.

However a recent, highly publicized computer error has delayed this possibility. This is due to the fact that the computational system in place cannot differentiate between price inputs for smokers of differing ages. The glitch may take up to a year to fix.

Although this may seem like good news to smokers, no one knows how insurance companies will respond to the penalty issue come October.

Some view the smoker’s penalty as discriminatory, while others see the benefit in a hard-nosed incentive to get people to quit.

The good news is that the ACA will provide access to quitting services and products at no charge to consumers, and you can’t be denied coverage for having been a smoker.

All of these incentives, controversial or otherwise, are clear indicators of a much needed change in government thinking. Healthcare reform is doing more to help Americans avoid potential problems altogether. Let’s hope this is just the beginning.

Michael Cahill is the Editor of the Vista Health Solutions Blog. He writes about the health care system, health insurance industry and the Affordable Care Act. Follow him on Twitter @VistaHealth and @VistaHealthMike 

Guest Post: The Reality Of Health Insurance Exchanges

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The legislation has passed and the legal challenges are, for all intents and purposes, exhausted. It’s time for American businesses and individuals to start dealing with the reality that the Patient Protection and Affordable Care Act, also known as ObamaCare, is now the law of the land.

Health Insurance Exchanges

One of the most important provisions of the PPACA created state and federal health insurance exchanges, online marketplaces that will offer people and businesses the opportunity to shop for health insurance plans on the Internet and choose the plan and premiums that fit their needs. They will be able to start buying insurance on Oct. 1, 2013, but the plans won’t go into effect until Jan. 1, 2014. And, if all goes according to White House predictions, the exchanges will help individuals and small businesses shop for insurance coverage and get a better deal than they’ve been able to garner in the past.

In fact, the federal government will subsidize health insurance premiums for many Americans. For instance, Washington will pay for part of your premiums if your annual income is between $15,302 and $46,021 for an individual and from $31,155 to $93,700 for a family of four. Those who earn less than $15,302 probably qualify for Medicaid, which is not available through the health insurance exchanges. At the same time, if you currently have high-end coverage, holding on to it may cost you big time in the form of taxes.

Depending on your point of view, the health insurance exchanges will either fuel competition among insurance companies and increase the size of the insurance pool, which will in turn make insurance more affordable and more accessible, or the exchanges will burden American taxpayers and the country’s economy as a whole with ever-increasing health care costs.

Financial Sense

If you own a business, you’ll have to decide what makes more financial sense: providing your employees with some type of health insurance plan or letting them purchase their own insurance through the newly-established health insurance exchanges.

Businesses and individuals will be able to buy one of three levels of health insurance from the exchanges. The most expensive plans will have lower deductibles, while those insured under the least expensive plans will have higher out-of-pocket costs. Deductibles will be no more than $5,950 a year for individuals and $11,900 for families. According to the White House, an estimated 23 million Americans will buy their health insurance through the exchanges.

Health Plans Will Cover…

All plans sold under the health insurance exchanges will cover:

  • Emergency services;
  • Hospitalization;
  • Maternity and newborn care;
  • Mental health and substance abuse services, including behavioral health treatment;
  • Prescription drugs;
  • Rehabilitative services and devices;
  • Preventive and wellness services, as well as chronic disease management;
  • Pediatric services, including oral and vision care.

Probably the most controversial parts of the PPACA are provisions that (1) prohibit insurance companies from denying coverage based on pre-existing conditions, and (2) permit individuals to get around the rule that they must have health insurance by paying a fine that is less costly than the insurance itself. This could mean that some people will pay the fine ñ a tax, actually, according to the Supreme Court ñ until they get sick, at which point, they will buy health insurance.

In the past, insurance companies have refused to pay for necessary health care because of pre-existing conditions. According to a study by the House Committee on Energy and Commerce, between 2007 and 2009, the nation’s four largest insurers ñ Aetna, Humana, UnitedHealth Group and WellPoint ñ rejected 212,800 claims for this reason. This will no longer be an option for insurers.

In addition, the PPACA will get rid of lifetime and annual limits on plans purchased through health insurance exchanges. This will eliminate the possibility of financial ruin for individuals ñ and the employers who insure them ñ with long-term and unusually expensive medical issues.

Who Will Run The Exchanges?

The states now have until Feb. 15, 2013 to decide whether they will set up their own health insurance exchanges. Unsure of the ultimate cost of doing so, many states have chosen to let the federal government handle that job.

As of the end of 2012, 18 states, mostly in the far West and the Northeast, had chosen to establish their own health insurance exchanges. Twenty-five states, many of them in the South and the Midwest, had decided to let the federal government operate the exchanges, while another seven states had opted for a partnership with Washington.

Regardless of who is operating the health insurance exchange in your state, the way you purchase insurance is going to change. You probably won’t know for sure who the winners and losers will be in the new world of health care until all the provisions of the Patient Protection and Affordable Care Act are implemented.

How will these new rules affect you and your family? Do you see the centralization as a good thing or a bad thing?

This post was provided by John Egan is managing editor of Insurance Quotes, a popular insurance website that provides online services to consumers seeking Auto Insurance knowledge and savings on their car insurance policies.

PHM Is The New Black Post At CCA Blog With Diabetes Examples

This is a partial copy (teaser) of a guest blog I did on the Care Continuum Alliance blog earlier this week.

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With all the talk about Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), the adoption curve for the Care Continuum Alliance (CCA) model for Population Health Management (PHM) should move beyond the innovators in 2013 and begin to “Cross the Chasm.” I believe there are several preconditions that would set the stage for this to occur, for instance:

  1. Technology advances leading to the “Big Data” focus;
  2. The changing paradigm from fee-for-service to outcomes-based care;
  3. The realization of the role of the consumer led by the e-Patient movement, the idea of the Quantified Self, and the focus of large healthcare enterprises on being consumer centric; and
  4. The budget crisis that is driving employers and other payers to embrace PHM, wellness, and other initiatives that impact cost and productivity.

Of course, most companies are still in the infancy of designing systems to address this coordinated care model, which does not view the patient as a claim, but longitudinally aggregates demographical, psychosocial and claims data.  Additionally, training staff using Motivational Interviewing and integrating external staff into the virtual care team in partnership with the provider will continue to evolve as do our care delivery models.

To read more especially the diabetes examples that I shared, please click over to their blog.  Thanks.

 

Guest Post: Is It Too Late To Avoid The Flu?

By Paula Spencer Scott, Caring.com Senior Editor

The 2012-13 flu season is shaping up to be one of the worst in years. If you or your loved ones haven’t succumbed yet, these steps can help you stay healthy. And if someone does get sick, many of the same steps can prevent a wider spread of infection.

Get a flu shot. No, it’s not too late. This year’s shot only offers 62 percent effectiveness, according to Thomas Frieden, director of the Centers for Disease Control and Prevention. But it’s still considered the number-one prevention tool.

Give the flu shot time to kick in. It can take one to two weeks for a flu shot to offer protection (see: How Long Does It Take for a Flu Shot to Offer Protection? for more information on flu shot protection). So don’t expect instant immunity.

Keep vulnerable loved ones away from crowds. Given how widespread the flu already is, we’re all courting trouble by hanging out in crowded public places like shopping malls. But those who should especially keep away include the very young, the frail old, and those with health conditions that weaken the immune system or who are using treatments that can affect the immune system, such as.

Keep suspicious visitors away from vulnerable loved ones. If you live with someone with a chronic illness or who is a frail older adult, be a good gatekeeper. If a guest has a cough, a runny nose, or is complaining about being under the weather, don’t endure a visit. Invite him or her back at a better (healthier) time.

Stay home if you’re feeling under the weather. Best to avoid crowds, including the workplace, when your immune system is low. And in case your symptoms mean you’re coming down with something, you can avoid infecting others.

Wash hands often. Pretend you’re obsessive-compulsive and do it all day long. Be sure to wash hands (with soap and water or hand sanitizer) after touching doorknobs.

Become a clean freak. Stock up on cleaning supplies. You may use them more if you have them handy right in each bathroom and the kitchen. Wipe down surfaces often. Bring portable wipes to work so you can keep your keyboard and any shared spaces cleaner, too.

Try a face mask. It’s not clear they’re super-effective, but in a situation where some people are sick, they can provide an added barrier between a frail older adult and the flu.

Stay well hydrated. Keeping nasal passages moist helps them resist germs. Drinking lots of water and using nasal saline sprays helps — especially when flying, as aircraft cabin air is dry.

Get at-risk groups to the doctor at the earliest symptoms. Very young children and the very old should get swift treatment, says the CDC. Medicines such as Tamiflu work best within the first 48 hours.

About the Author

Paula Spencer Scott is senior editor at Caring.com, the leading online destination for caregivers seeking information and support as they care for aging parents, spouses, and other loved ones. Paula is a 2011 MetLife Foundation Journalists in Aging fellow and writes extensively about health and caregiving. You may also want to see Paula’s article 7 Ways to Have Fun While Fighting Cold and Flu.

Guest Post: How Nursing Can Help Reduce Healthcare Costs

Yes, the election has come and gone. No doubt we’re still suffering from the latent effects of election-fatigue, buzzwords still echoing in our heads like bad nightmares; stimulus packages, fiscal cliffs, economic malaise, and the ever-popular budget cuts. But the super-sensitive topic at the crux of our current political polarization is undoubtedly, one of healthcare. It’s hard not to get caught up in all the political hoopla in regards to current policies versus proposed plans and how we seem unable to find that magic bullet to rescue us from this healthcare maelstrom instead of dooming us further into the partisan abyss.

It has been estimated that between 2012-2022, Medicare spending will skyrocket through the current $550 billion to the astronomical tune of $1.064 trillion (that’s trillion with a ‘T’). Medicaid will likely double from $253 billion to $592 billion. Additional costs created by expenditures and subsidies for mandatory healthcare will rise from $25 billion to $181 billion. Where will all this money come from?

To counter rising healthcare costs, the burden will be shouldered by all Americans. But don’t start crying that the sky is falling just yet; there is a remedy that would not only benefit our healthcare needs and reduce costs, but also maintain that all-important mark of quality. How? Let’s take a look at how nursing can be the ultimate solution to remedy our economic woes as well help improve our overall good health.

  • Nurse Practitioner: One of the fastest rising fields of healthcare, Nurse Practitioners (NPs) can receive their training and certification four-five times quicker than a physician. The costs of educating an NP is far less than the cost of putting a medical student through medical school and with quicker training that means seeing more patients earlier and subsequently shorter waiting lines and getting in and out of the doctor’s office and on your way to better health in a much more efficient manner. Nearly 96% of all Nurse Practitioners can write prescriptions and according to healthcare studies, patients ranked them as high as they would their primary doctor.
  • Traveling Nurses: If you can earn your nursing degree, than a host of numerous healthcare opportunities will arise for you. Among them are temporary jobs with flexible schedules, some such assignments include nursing jobs all over our country as well as overseas. Here in the states such a program is called, “Nurse-Family Partnership”. This provides a visiting nurse to make house calls for lower income families that might not have the opportunity otherwise to have high quality healthcare provided for them.
  • Silver Boom: In the next twenty years, the elderly population will not only increase due to aging baby boomers but because of better diagnoses and preventative care, we are ALL living longer and more productive lives. According to the Center for Healthcare Workforce Studies*, by the year 2050 the number of older adults will increase from 12.5% to 20% of the United States population (this is among the population of those 65 years and older).

At the end of the day, healthcare will continue to grow as our population follows along this similar trend. Having nurses filling in those costly gaps will pay off down the road with better care, quicker appointment availability and lower overall costs. And in a climate of ever-changing political landscapes, to have one sector not only reducing costs but composed of those continually seeking higher quality standards would be hard to argue against.

*”The Impact of the Aging Population in the Healthcare Workforce in the United States Summary of Key Findings” – Center for Healthcare Workforce Studies, School of Public Healthy, University at Albany.

Kathryn Norcutt has been an active member of the health care community for over 20 years. During her time as a nurse, she has helped people from all walks of life and ages. Now, Kathryn leads a much less hectic life and devotes most of her free time to writing for RNnetwork, a site specializing in travel nursing jobs.

Guest Post: I’m Ready To Lose Weight!

Guest Blogger Lynn Gieger is a contributor to Everyday Health and its calorie counter and fitness tools.
The signs were all there, but until the doctor commented, “You’re overweight and your weight is negatively impacting your health,” it was no longer easy or healthy to ignore the too-tight belt, too-small jeans, and the steering wheel poking into the stomach.

Now what are you going to do about it?

Ignore the hype of the hundreds of weight loss programs that promise effortless weight loss. If it was that easy, you wouldn’t be in this shape right now, would you?

To truly take charge of your weight and health, start by giving yourself some time to think about why weight loss is important to you. What will be different in your life when you lose weight? Look at the health implications: decreased cholesterol, lower blood pressure, reduced risk of type 2 diabetes, less pressure on your knees and hips. Also think about personal reasons why weight loss is important to you: do you want to get on the floor and play with your grandchildren, go hiking with your kids, dancing with your spouse, or just look smashing? List all of the reasons how losing weight will improve your life to increase your motivation to make changes.

The National Weight Control Registry, established in 1994, tracks over 10,000 people who lost an average of 66 pounds and kept it off for 5.5 years. The NWCR research identifies 3 key steps to lose weight and keep it off:

1. Keep a journal detailing what, when and how much you eat. 78% of the NWCR participants report eating breakfast every day, and the majority decreased both calorie and fat intake to lose unwanted pounds. Use your journal to identify specific places to make changes, such as using lower fat salad dressing, choosing water instead of a high-calorie sweetened beverage, and swapping fruit for chips at snack time. Need help figuring out where to make changes? Find a weight management specialist with the knowledge and skills to streamline your food choices and encourage you to make lasting changes in your eating habits.

2. Keep track of daily exercise. 90% of NWCR participants exercise for an average of one hour each day. Create a habit of daily exercise to burn calories and improve your fitness – plus give you something else to do besides eat. Find a certified fitness expert to get you started or ask at your local gym.

3. Decrease the number of hours of non-work screen time (TV, video games, movies, computer). NWCR recommends less than 10 hours of screen time per week. If Sunday at your house means 6 hours of TV football, change your weekly screen-time habits and guess what – you just found time for exercise!

If you’re stuck and can’t figure out how to get started losing weight, work with a certified wellness coach to help you set realistic goals and hold you accountable.

Avoid a weight loss/gain rollercoaster by clearly identifying why weight loss is important to you and focus on the long-term. It doesn’t matter if it takes you 6 months or 6 years to reach your weight goal: the key is changing your habits so you stay at a healthy weight.

And the next time you see the doctor, think of this comment, “Wow, you’re looking great!”

Guest Post: Home Health Aides

Home Health Aides: the Unsung Heroes of Healthcare

It takes a special type of person to succeed in the field of home care. Home health aides’ commitment to their patients really does make them the unsung heroes of the healthcare field. Often times, after patients are discharged, they recall the names of their home health aides and write them letters of gratitude.

Home health aides assist patients during very vulnerable times. Hospice home health aides, for example, provide comfort to patients near the ends of their lives.

A home health aide is sometimes the only person a patient sees on a given day. Therefore, aides go beyond providing much needed medical help; they also provide compassion and an emotional connection. They might be the only person to whom a patient expresses their emotions and thoughts. They’re typically a patient’s housekeeper, caretaker, and compassionate listener.

These compassionate care givers work on the front lines of healthcare to assist seniors, people with disabilities, people recovering from illnesses, and others unable to take care of themselves. Home health aides help their clients with daily activities such as grooming, hygiene, and eating. They give clients their medication and also perform tasks such as dressing wounds, changing bandages, and applying topical medications.

Home health aides also clean their client’s home, do their laundry, and changes their linens. They plan nutritious meals and shop for and prepare the food. They also run errands for their clients and provide much needed time off for family caregivers.

Testimonials

Here are a few excerpts from letters written by actual patients in which they express their thanks for their home health aides:

“Just a note to thank you for the time you spent with my sister and me. You were very helpful and your sensitive manner put us at ease so that we could understand and deal with mother better at such an emotional time. You folks who work with ill people are very special and I for one thank you for being that way.”

“I want to thank you for sending Dolores as my homemaker. She does a great job; she sees what needs to be done and does it! This is so helpful to me. She’s very pleasant to have around.”

“Thank you so much for your promptness in responding to my need. I must say, Ellen was excellent. She was so warm and kind. I responded favorably to her at once. She worked hard and seemed to fit my rhythm so well. I had been quite shocked by my recent experience and was feeling quite low. Her spirit and enthusiasm had such a positive effect on me. I think she is a gem and I am so grateful to have had her come into my life and care for me.”

(Source: Metropolitan Home Health Services, Inc.)

Home health aides make a huge difference in the lives of their patients and their family members. However, according to the Bureau of Labor Statistics, the median annual salary of home health aides is only $20,610. It’s no question that these unsung heroes who play a vital role in improving the quality of life of their patients deserve a whole lot more!

Brian Jenkins writes about the home health aide career field, as well as other careers in allied health, for the Riley Guide.

Guest Post: Treat Your Health Like Your Finances

I am a big believer that we need to change our approach to how individuals manage their health. After a dinner with a financial planner friend of mine, it got me thinking what if we helped individuals plan for a long healthy life the same way we help them plan their careers or their finances. We have whole industries dedicated to helping people make smarter investment decisions for their retirement and job choices for their careers, but when it comes to our health we are rarely proactive.

According to Morgan Stanley, 90% of Americans think financial planning is important. Why? Three of the top reasons people undertake financial planning include:

  • Making sure your money will last during retirement or rolling over a retirement plan
  • Being prepared for a financial crisis such as a serious illness
  • Caring for aging parents or a disabled child

The common thread through all of these reasons is personal health. Whether concerned directly about illness, both our own and that of our loved ones, or about our ability to enjoy our retirement to its fullest, personal health is a key component of a well-planned retirement.

The reality is life expectancy has increased dramatically. We may live 30 years in retirement. I would argue the quality of that retirement is even more dependent upon our health than our finances. Yet no one hires a “personal health coach” or creates a “personal health plan.”

It is about time we stop neglecting our future health. You can take control of your future health by developing a personal health plan. These simple steps can help you get started:

Step 1: Conduct a Personal Health Audit. Before you can build a plan you need to understand your base-line. You can’t map directions to your destination until you know where you are. When you meet with a financial planner the first thing they want to know is how much money you have saved for retirement. Your personal health plan is the same way. Do you suffer from any chronic illness? What is your height & weight? How much exercise to you get? What are your eating habits? Do you have any family history of disease? What type of pain do you suffer from? How is your mental health your relationship with your spouse and children? Capture everything and identify areas that need attention or improvement.

Step 2: Define Success. What does a healthy future look like? The second question a financial planner will ask you is how much monthly income will you need in retirement to live the lifestyle you want? The same is true for health. When do you plan on retiring? What hobbies do you have that you would like to pursue? Do you plan on having grandchildren? How will bad or good health impact all of these plans? Does your family history require you to focus on preventing cancer or heart disease or Alzheimer’s? The ability to visualize your health in the future both good health and your health if you let yourself go is a strong motivator for change. A point of note: Thinking about health 30 or 40 years into the future can be very abstract; I suggest breaking down your definition of success into annual targets is more manageable and motivating.

Step 3: Know your Personal Health Indicators of PHIs. By this point in the process you should have a sense of what measurements are most critical to your health. Develop a method for capturing your PHIs on a regularly basis. For some like weight you might update your PHI daily, weekly or monthly. For others like a PSA level for men at risk for prostate cancer, you might update it annually. I detail some of the more common PHIs here: http://www.billpaquin.com/do-you-know-your-phis/.

Step 4: Engage your Health Partners. Now that you have completed your audit, defined success and developed your most important PHIs it’s time for you to engage all of the people in your life who help you manage your health. This will include your family, your physician or other healthcare professionals; maybe you have a nutritionist, acupuncturist or other complimentary practitioner that you frequent. Inform them of your personal health plan and get their feedback and buy in. The more people who are on your side the greater the likelihood of success and the more people that know your health, the greater the likelihood you will have a plan that fits you and your goals.

Step 5: Build and implement your Plan. Building the right plan takes an understanding of what you learned in steps 1-4. By way of example, if you have a family history of colon cancer, you need to understand what behaviors help reduce your chances of getting this cancer, what preventative screening you should be getting and when you should be getting them. All of our plans should include a path to maintaining an ideal Body Mass Index that includes some form of daily exercise and nutrition plan, but we are all unique and will have plans specific to our health situations and desired goals. I do think it’s important to understand that no one is perfect 100% of the time, if you deviate from your plan for a day, week or even month, you are only one day from starting again.

Step 6: Review & Measure your progress. You can’t manage what you can’t measure. At some pre-planned interval you should step back and take stock of your progress. Use your annual physical or dental cleaning as a reminder to sit down and review your health plan. Personally I like to review different elements weekly or monthly, but find what works for you and stick with it. Like the stock market, it won’t be a straight line, but as long as the trend continues up over time you will be alright.

No one is responsible for your health but you. We all need to take a proactive approach to our health. Developing a personal health plan is a great way to insure you live a long, healthy and happy life.

About the Author

Bill Paquin is the Chief Executive Officer at Vertical Health, a publisher focused on improving patient care associated with back pain and endocrine disorders such as diabetes. He is a husband, father and writer who is passionate about and supports the creative destruction of our current healthcare system.

RWJF Guest Post: Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

Guest Post by Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation.  A nurse practitioner whose work has focused on improving health care quality and safety through health professional collaboration, her work at the Foundation addresses: faculty recruitment and education to increase the capacity of nursing programs; developing collaborative partnerships to address local nursing issues; creating the next generation of academic nurse leaders; and building senior executive leaders in nursing. She also is senior editor for the Foundation’s quarterly publication, Charting Nursing’s Future.  (full bio here)

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs.

Some health care institutions are gearing up for the challenge.

  • In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
  • In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.

Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care.

Such efforts are already under way at a number of institutions.

  • Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
  • In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
     
  • The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
     
  • In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditoriums and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.

Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

Sign up to receive future Charting Nursing’s Future policy briefs by email at www.rwjf.org/goto/cnf.

 

 

Guest Post: The Strong Connection Between Education and Health Outcomes

Is there a correlation between education and health? Studies do in fact indicate that there is a positive relationship between advanced education levels and health outcomes. This association has been well-documented in many countries and for many different metrics of health.

Jobs that require a particular level of education typically provide better access to quality healthcare. Studies indicate that unemployment rates are highest for people without a high school diploma. Additionally, evidence indicates that the unemployed population experiences worse health and higher mortality rates than the employed population.

Other studies have shown that more education can reduce a woman’s risk of depression and obesity. Of course, there are health benefits for men as well: educated men tend to drink less and have less of a chance of dying young.

Multi-Generation Implications

Education has some positive multi-generational implications, as a mother’s level of education is correlated with the health of her children. The parents’ education level affects their kids’ health directly because of resources available to the kids and also indirectly because of the quality of schools their kids attend.

Emotional Health Benefits

Evidence shows that more education means a greater sense of personal control. Individuals who view themselves as having a high degree of personal control report a better health status. These folks are at lower risk for physical ailments and chronic diseases. Also, more education improves an individual’s self-perception of their social status, which also predicts a higher self-reported health status.

Health Literacy

Studies show that only three percent of college graduates have below average health literacy skills. On the other hand, fifteen percent of high school graduates and forty-nine percent of adults who don’t have a high school diploma have health literacy skills that are below average. Reports indicate, not surprisingly, that adults with less than average health literacy are more likely to be considered unhealthy.

Education and Health Report

The authors of the Education and Health Report, David M. Cutler of Harvard University and Adriana Lleras-Muney of Princeton University, find a clear connection between education and health. This connection cannot be completely explained by factors such as the labor market, income, or family background indicators. Health and education have a complicated relationship.

The report shows that for some health outcomes, including obesity and functional limitations, the impact of education appears to be even more positive after people have obtained education beyond a high school diploma. The relationship between health and education seems to be the same for men and women across most outcomes; however, there are a few exceptions.

Race, Education, and Health

Studies show there are few racial differences regarding the impact education has on health. For outcomes that do show differences between Caucasians and Blacks, such as being in fair or poor health, Caucasians tend to experience more positive health benefits from more education when compared to Blacks with the same level of education.

Literacy and Health

Low literacy is associated with adverse health outcomes and negative effects on the health of the population. Additionally, poor literacy skills often contribute to a poor understanding of spoken or written medical advice.

Ten studies showed a positive, significant relationship between literacy level and the participants’ knowledge of the following health issues:

  • Contraception
  • Smoking
  • Hypertension
  • Human immunodeficiency virus (HIV)
  • Asthma
  • Diabetes
  • Postoperative care

Clearly, there is a positive connection between education and health. A better educated society leads to better overall health and lower healthcare costs.

Useful Resources

Brian Jenkins writes about a variety of career and college topics for BrainTrack.

Guest Post: Sports Drinks for Kids: A Do or a Don’t?

Joy Paley is a guest blogger for An Apple a Day and a writer on online nursing classes for the Guide to Health Education.

Sports drinks have been getting a ton of bad press lately. Google the subject, and you’ll find a myriad of newspaper articles and blog posts “exposing” sports drinks for what they are—water with sugar and a little artificial coloring. But it’s no surprise that sports drinks have sugar in them; that’s something that’s never been hidden. The real question is, will that extra sugar be bad for your kid? Well, as most things, it depends.

Dental Health: One mark against sports drinks like Gatorade is that they can be bad for your teeth, if you drink them often enough. They all are relatively acidic, which can lead to enamel degradation. Juice and soda are acidic too, though, so it’s not like sports drinks are special in that regard.

Performance: The literature review of the effectiveness of sports drinks on preventing dehydration and increasing performance is mixed. In most respects, water and sports drinks perform equally well. After working out however, kids who have had the sports drink have been shown to have a higher body weight—meaning they lost less fluids during their workout. This is one potential benefit of choosing a sports drink over water.

Calories: Sports drinks are generally full of high-fructose corn syrup, providing many sugary calories to whoever drinks them. For example, 20 ounces of Gatorade Performance has 122 calories! That’s less than 20 ounces of soda, but it’s still nothing to sneeze at.

And, many studies have correlated a higher intake of sugary beverages, like soda and sports drinks, to higher body mass index and worse diet in children. It makes sense right? If a kid is drinking soda all the time, they’re consuming more calories, and drinking less of the beverages that are actually beneficial, like milk or 100% juice; greater intake of those beverages correlated to an adequate intake of calcium, vitamin C, vitamin A, and magnesium.  

In Moderation: If you look at all the scientific studies I mentioned above, you might want to make a knee jerk reaction and pull that sports drink right out of your kid’s hands. Those studies aren’t about your specific child or family, however, and it’s important to realize how your particular situation could come into play here.

If you live in a house where kids rarely have soda or other sugary drinks, letting them have a Gatorade at sports practice isn’t going to make them obese. If your kid is already guzzling soda at home, then adding a sports drink isn’t going to help—but sports drinks are only one thing that should be on your list of dietary worries.

What you do want to avoid is having your kid think that sports drinks are somehow “healthy,” when the truth is that they’re not. And, you don’t want a situation where your kid drinks sports drinks in place of water, because they think the sports drink will somehow make them feel better. However, as long as the drinks are had in moderation, like being consumed only at a specific activity like sports practice, they aren’t going to make your kid unhealthy.

Other Possible Beverages: I would caution parents to avoid replacing regularly sugared sports drinks with lower-calorie artificially sweetened ones. The trouble with these? In studies, greater intake of diet soda has been linked to higher BMI. Why? People rationalize that they are consuming less calories, so they “make up” for it by eating more.

Instead, try creating your own fruit-infused water. Cut up strawberries, cucumbers, and apple slices, and let them sit overnight in a pitcher of water. The result is delicious and low-calorie. Or, pick up a low-sugar 100% fruit juice from the store.

The Bottom Line: If your kid eats a healthy diet and avoids most sugary beverages, letting them have a Gatorade at their practice or game isn’t going to hurt. Just don’t let sugary sports-drinks replace water in regular day to day activities.

Guest Post: Addressing the Correlation Btwn Health Literacy & Mortality In the Elderly

Medication and health management strategies are integral parts of patient care, but if those who need medical help can’t understand their instructions perfectly, the right procedures are lost on them. Health literacy is a growing concern, and it refers to one’s ability to read, process, and implement directions related to personal health care. Both the context of health-related communication and the skill level of health care providers are strong factors in health literacy, but it ultimately describes the comprehension abilities of someone on the receiving end of health care. In a study conducted by Dr. David Baker, MPH, and a team of researchers, it was found that inadequate health literacy contributes significantly to mortality rates among the elderly.

Health Literacy and Mortality Findings

Baker and his team administered a shortened version of the Test of Functional Health Literacy in Adults to a pre-screened cohort of 3,260 Medicare managed-care enrollees. They then collected their data and categorized it into three sections: adequate, marginal, and inadequate health literacy. These results were then compared to all-cause and cause-specific mortality data from the National Death Index, 1997-2003. Although the category of elderly patients with adequate health literacy accounted for the majority of the cohort at 2,094 individuals, their mortality rate averaged only 18.9%. The group with marginal health literacy, which included 366 individuals, averaged a mortality rate of 28.7%, and the group with inadequate health literacy at 800 had a 39.4% mortality rate. Baker and his team found that the number of years of school completed by the subjects was barely associated with mortality, leaving reading and comprehension abilities as the main indicators in determining health literacy. A general lack of health-related knowledge, the ability to apply it, and wide variety of other “pathways” characterized those individuals with inadequate health literacy.

Ways to Address and Manage Health Literacy

According to health.gov, a page dedicated to the activities of the U.S. Department of Health and Human Services and other Federal departments and agencies, there are many ways to develop and deliver health information while maintaining awareness of health literacy. For example, information should be appropriate for the user audience and easy to use. It’s also important to speak clearly and listen carefully when communicating health-related information. The following are some strategies that may help pharmacists, doctors, and other health care professionals communicate information clearly to non-professionals and patients.

  • Be sure to identify a specific audience before you draft any health-related communication. Consider demographics, behavior, age, culture, communication capacities, and attitude, choosing materials and messages that address your audience’s characteristics.
  • Evaluate your communication by conducting usability testing. Test users before and after your information is delivered to see how much of it they can understand and repeat back to you.
  • Limit the number of messages you communicate at one time and use plain language that focuses on action. You can include pictures to help demonstrate important steps.
  • Improve the usability of information online. Make sure that patients know how to access the details of what you’re explaining by going to a specific webpage.  Be sure to use large font and uniform navigation to prevent confusion.
  • Ask open-ended questions and ask that your patients repeat the information back to you. You can also request that they act out a medication regimen in front of you before they have to do it on their own.

Baker, David W. et al. “Health Literacy and Mortality Among Elderly Persons.” Archives of Internal Medicine 167.14 (2007): 1503-1509.

Guest Blogger: Alexis Bonari is a freelance writer and blog junkie. She is currently a resident blogger at  First in Education, researching online college degrees. In her spare time, she enjoys square-foot gardening, swimming, and avoiding her laptop.

Guest Post: Why Pharmacy Technicians Must Be Certified

I get lots of press releases or opportunities to speak with people sent to me. Ashley sent me a request to post an entry on my blog. I gave her a topic that I thought would be interesting, and she followed up with a story. Here it is.

We’ve all seen and interacted with pharmacy technicians more than a few times; they’re the people in the drug store who fill out your prescription and work behind the scenes at the pharmacy. Because certification is not a necessity in a few states, some pharmacy technicians are able to gain employment based on their experience or willingness to learn quickly on the job. They work under a licensed pharmacist and are not allowed to advise patients regarding their medication or any other aspect.

But more often than not, they do interact with patients and offer solicited advice and answer any question they’re asked. It’s no big deal as far as the patient is concerned, unless of course, something goes drastically wrong. If there’s a mix-up with the drugs or if a dispute arises as to the nature of advice given (the patient may misunderstand what the technician says, disregard any words of caution given, or just be careless in following instructions), then the fat is in the fire. And if the pharmacy technician in question is not certified, the problem magnifies exponentially.

Pharmacy technicians must be certified because although experience does count, it is more valuable when built up on the foundation of education and the certification process which teaches them the right way to do things. Certified pharmacy techs have an advantage in that they are aware of the legal ramifications of their job and are able to act accordingly when it comes to dealing with patients in the absence (or presence) of a licensed pharmacist. Also, if anything goes wrong and a patient sues the pharmacy, certification helps to prove the credibility of the technician and holds more water in a court of law. Also, in some states, even though certification is not really necessary to work as a pharmacy tech, there must be one certified technician on duty in the absence of a licensed pharmacist.

Although there are only a few states that require pharmacy technicians to be certified, others will be soon following suit because employers are increasingly looking to hire only techs that are certified and because it’s easier to standardize the quality of patient care provided at pharmacies when all the employees are certified by an accrediting board. As of now, Louisiana, Wyoming, Utah, Virginia, New Mexico and Texas require pharmacy techs to be satisfied. Illinois and Florida will soon pass requirements for certification within the next year. And Kansas, Georgia, Maine, North Carolina and Tennessee require the presence of at least one certified technician if there are more than three or four pharmacy techs at work.

To become a certified pharmacy technician in the USA, you must have a high school diploma, GED or a foreign equivalent, and clear the examination administered online by the Institute of Certification of Pharmacy Technicians (ICPT) or the Pharmacy Technician Certification Board (PTCB). The ICPT offers the ExCPT exam while the PTCB allows you to take the Pharmacy Technician Certification Exam (PTCE), the only pharmacy tech exam endorsed by the American Pharmacists Association.

You must complete 20 hours of continuing education every two years to keep your pharmacy technician certification status, and at least one of those hours must be in pharmacy law. Also, you are disqualified from certification if you have any felony or drug-related convictions or are under any restrictions from your State Board of Pharmacy.

By-line:

This article is contributed by Ashley M. Jones, who regularly writes on the subject of Online Pharmacy Technician Certification. She invites your questions, comments at her email address: ashleym.jones643@gmail.com.


Guest Post: Health Researchers Obtain Grants for Video Game Study

12 US research groups were awarded grants this week in order to conduct studies on how interactive video games affect players’ health. There has been a lot of press lately for Nintendo Wii and its many health benefits. It seems that the Wii isn’t the only gaming system to influence a person’s lifestyle choices where health is concerned. Of course, not all games are having a positive influence.

Grants totaling up to $200,000 were given to each research team, all of which are connected with a major US university. The generous donations come from Robert Wood Johnson Foundation (RWJF), a private foundation that is dedicated to improving the health of all Americans.

In regards to the grants, RWJF program officer Chinwe Onyekere stated:

We have been actively working in this area since 2004. Over this time, we have heard repeatedly that there is a need for stronger evidence that games can improve health and healthcare and support the growing realization that games can make a real difference in public healthcare in the United States.

Our vision is that in the coming years we will have a thriving marketplace of well designed, compelling interactive games that draw on this evidence base to become highly engaging and effective tools for improving the health and healthcare of Americans.

The 12 teams are currently working on projects that focus on different age groups and behaviors. Maine Medical Center, for example, was awarded a grant for its study, “Family-Based Exergaming with Dance Dance Revolution (DDR)”. The aforementioned game, DDR, is extremely popular with children and young adults. It involves moving on a small, portable dance floor while a video with instructions plays on the screen.

Research grants were dispersed by RWJF in order to study things like “the potential of physical activity video games to serve as innovative, cost-effective ways to help people recover motor skills after experiencing a stroke” or “health impacts of online mobile mini-games for people with type 2 diabetes.” Another group of 12 research grants will be awarded next year.

By-line: Heather Johnson is a regular commentator on the subject of CNA Classes Online. She welcomes your feedback and potential job inquiries at heatherjohnson2323 at gmail dot com.

Guest: 5 Ways an iPhone Can Improve Doctor-Patient Relationships

I feel lucky to have people want to post on my blog. Susan Jacobs is a part-time teacher and regular reader. She is also a regular contributor for NOEDb, a site for learning about and selecting an online nursing degree program. Susan invites your comments and freelancing job inquiries at her email address susan.jacobs45@gmail.com .

Ever since Apple announced that third party companies are developing medical applications for the iPhone, predictions on how this will impact the medical industry have run wild. Indeed, the possibilities are endless when doctors have so much information in the palm of their hands.

  1. Easy Drug Reference – One of the biggest names in medical iPhone applications is Epocrates. This company has developed a massive, free online drug reference guide. When prescribing medication, a doctor can quickly double-check any concerns about side effects, drug interactions and more. Also, it is possible that a situation may arise where a patient doesn’t know the name of the medication they are on; only what the pill looks like. Epocrates’ drug reference has a search feature based on a medication’s appearance.
  2. Access to Health Records – More and more patients are allowing their health records to be stored online. With an iPhone, doctors can quickly access a new patient’s health records, should they not be physically available on site. This could be more than convenient; it could save lives.
  3. Quick Second Opinions – How better to serve a patient’s needs than by getting instant advice from another doctor, perhaps a specialist? For instance, a general physician could take a picture of a patient’s skin condition, email it to a dermatologist, and get a quick second opinion. That is just one of the many possibilities available with an iPhone.
  4. Clinical Decision Support – Similar to contacting another doctor, there are applications being designed that offer reliable, clinical decision support. Again, this could improve a doctor’s ability to give a patient the best care possible.
  5. Little Interference – Although physicians could have accessed online information with a personal computer before the advent of the iPhone, this would have certainly interfered with the more intimate communication between doctor and patient when someone’s face is behind a computer. Now, with the aid of a handheld device, the doctor will experience little interruption while seeing a patient.

iphone.jpg

While the iPhone depends on wireless Internet access to take advantage of online applications, this won’t be a problem for doctors in many medical facilities. Hospitals, in particular, are often wired for broadband access and this kind of support is spreading. Communication between offices is also becoming simpler, more reliable and is using less and less paper. (Many medical administrators would be happy to through their fax machine out the window, no doubt.)

The end of the month holds the iPhone Developer Summit in New York City. With more medical applications to possibly be discussed and showcased, even more possibilities will arise. With a vast database of knowledge at a doctor’s fingertips, patients should feel even more secure with the medical treatment they are receiving.

Guest: On Price/Placebo Effect

Frederick Navarro is a research psychologist who, over the past 20 years, has focused his efforts on understanding people and the factors that shape their attention to health and care seeking. He has developed a unique model that approaches health care consumer behavior from a different angle than other models today. Over the past 10 years he has done considerable work with health plans and his findings often fly in the face of conventional thinking. He posted a long comment on my post the other day about Price and Placebo effect that I thought I would post here as a “guest post”.

On the issue of predictable irrationality and perception, what about the situation where a group of people rate their health status much better than another group of people, but the first group generates nearly twice the level of medical claims as the poorer health status group. That’s counter to the current belief that health status drives claims. So, what’s going on?

[His methodology divides people into PATH ( Profiles of Activities and Attitudes Toward Healthcare) Groups as shown below.]

path-groups.jpg

Well, the difference is how each group of people judge when it is time to seek care. When do they say, it is time to go to the doctor? Type 2 people only go to the doctor when problems are serious. They ignore their health and are apathetic towards it. They have health problems, but they just live with them. Type 7 people go to the doctor at the first sign of a problem. They monitor their health and are very proactive about it. If something appears, they seek care for it. These are the types of people it seems the health industry wants to build more of to reduce costs.

In a 1995 study of Kaiser members in Hawaii, the Type 2 members rated their health status 11.9 (SF-12 scale) and Type 7 members rated their health status at 14.3. The Type 2 group had avg claims pmpy of $1,541; the Type 2 group had avg claims pmpy of $2,040. Whoops! The higher health status Type 7’s had nearly twice the claims as the lower health status Type 2.

healthstatus_kaiser.gif

Let’s bring things closer to present time. In 2004/2005 year long study of Cigna members in a DM program the same patterns were there. At the baseline, the Type 2 group reported avg health status of 3.26 (1 to 5 scale) and the Type 7 group reported avg health status of 3.45. Type 7 were higher again! Type 2 avg claims pmpy were $6,176. Type 7 avg claims pmpy were $9,910. Whoops again! After a year, the DM intervention did not change this. At the end of the study, Type 2 people reported health status at 3.3 (a touch better), and the Type 7 people reported health status at 3.54 (a touch better again). The Type 2 group’s claims went down to $4,750 pmpy. That’s over a $1,400 drop. The Type 7 groups claims after 1 year of DM intervention dropped to $9,017 pmpy (almost a $800 drop). The Type 7 higher health status group still had claims that were nearly twice the level of Type 2.

The moral to this story is that the predisposition to seek care is a huge driver of health care costs. In some groups of people it overrides their perception of their health. In the 1995 study and the 2004/2005 study, the reason why the Type 7 people had higher claims is because they came in demanding care. That’s all. And the doctors are happy to see them!

This all harkens back to an earlier blog where you discussed the Dutch study and how preventive care did not lower health care costs. Providers have convinced everybody that the cure to lower health care costs is to encourage more people to become like Type 7 and to make care more accessible and affordable.

Predictable irrationality?

Looks like it to me.

healthstatus_dm_1year.gifhealthstatus_dm_baseline.gif


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