Disease Management Update
Volume III, No. 46
March 8, 2007

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Table of Contents

  1. Common Jaw Pain Eased by Supplemental Therapy
  2. Disease Management Q&A: Legal Concerns over Outcome-based Incentives in Wellness Initiatives
  3. HealthSounds Podcast: Integrating Health Coaching into a Comprehensive Health Management Effort
  4. Naps May Reduce Coronary Mortality
  5. Healthcare Trends in 2007: Hoping to Build on 2006 Growth

1. Common Jaw Pain Eased by Supplemental Therapy

A new supplemental therapy that teaches pain coping and biofeedback skills can reduce pain, the potential for chronic pain and healthcare costs for millions of Americans suffering from a common jaw disorder, according to researchers at the University of Texas (UT) Southwestern Medical Center.

Researchers conducted a trial to evaluate early biopsychosocial intervention, which aims to help people at risk of developing chronic pain due to temporomandibular disorder (TMD). All trial participants received standard dental care, but only half received an additional intervention teaching a combination of coping techniques and tips on controlling stress-related bodily functions.

The results show that those who received the intervention had significantly lower levels of pain and fewer doctor visits. Participants in the intervention group also spent less money on treatment than those with no intervention. Standard care for TMD, such as medication, physical therapy and surgery, can be expensive.

In search of a low-cost supplement, researchers in this study combined two separately effective teaching techniques — pain-coping and biofeedback skills — into early biopsychosocial intervention. The six-week intervention teaches patients about the body's reaction to stress and relaxation training in everyday settings. Instruction also is given on biofeedback to teach a person to control functions generally considered involuntary.

To learn more about this trial, please visit:

2. Disease Management Q&A: Legal Concerns over Outcome-based Incentives in Wellness Initiatives

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Lynette Phillips, director of population health support for Healthways.

Question: I have checked with legal firms who have communicated that outcome-based incentives are a very sensitive area. Although I believe these incentives are a good recommendation, are there legal difficulties?

Response: A wellness program can be tied to financial incentives as long as it provides a reasonable period of time for improvement, promotes good health and gives a reasonable alternative standard. For example, with providing an incentive for improving a health risk assessment score — since a chronic patient may not be able to improve their score significantly — a reasonable alternative might be a physician's compliance letter that would also meet the criteria for the incentive. The process is confidential; although the employer receives a list of employees to receive financial incentives, we are the only ones who know how that person qualified. Therefore, it's HIPAA-compliant.

For more details on using risk assessments to determine appropriate interventions and incentives for improvement, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Integrating Health Coaching into a Comprehensive Health Management Effort

In this week's Disease Management podcast, Dr. Susan Butterworth, director of health services at Oregon Health & Science University, explains the elements of motivational interviewing training, certification, requirements and benefits. She also describes how to help patients prepare for coaching and then recognize when they are ready for self-management. Additionally, Roger Reed, executive vice president for marketing operations at Gordian Health Solutions, describes the quality checks built into his organization's coaching initiatives, the immediacy of cash incentives in effecting behavior change, and the value of the "accountability factor" in health coaching.

To listen to this complimentary HIN podcast, please visit:

4. Naps May Reduce Coronary Mortality

Midday napping may reduce coronary mortality by about one third among men and women, according to research from the Harvard School of Public Health and the University of Athens Medical School in Greece appearing in the Archives of Internal Medicine.

Researchers looked at 23,681 individuals who, at the beginning of the study, had no history of coronary heart disease, stroke or cancer. The study participants were followed for an average of 6.3 years.

The results showed that people who napped at least three times per week for an average of at least 30 minutes, had a 37 percent lower coronary mortality than those not doing so. Occasional nappers showed a statistically non-significant 12 percent reduction in coronary mortality. The apparent protective effect of midday napping was particularly strong among working men and weaker among those not working, mainly retirees. Among working women, there were too few deaths to allow inferences.

The authors believe that an afternoon nap in a healthy individual may act as a stress-releasing process, since there is considerable evidence that stress has both short- and long-term adverse effects on incidence of and mortality from coronary heart disease. The fact that the association was more evident among working men compared to retirees apparently reflects the different stress levels these subgroups have to cope with.

To learn more about their research, please visit:

5. Healthcare Trends in 2007: Hoping to Build on 2006 Growth

Some pundits are of the mind that healthcare has been in crisis for the last 25 years. Most recently, the threatened demise of primary care, spiraling healthcare costs, physician and staffing shortages and reimbursement woes have been getting a lot of ink, virtual and otherwise. But depending on the industry segment you talk to, the situation may not be as dire as reported. In particular, as the industry focus on disease management (DM) widens to embrace wellness and lifestyle management, DM companies are reaping the benefits. This was evident in the responses to a recent online survey conducted by the Healthcare Intelligence Network (HIN) — every DM company said the last 12 months reflected an improvement in business.

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