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June 11, 2009 Volume VI, No. 4

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

This week's DM Update picks up where last week's left off, featuring part two of Melanie Matthews' coverage from the National Medicare Readmissions Summit and the 2009 Medicaid Congress. In this issue, Matthews talks toolkits as she provides insight on what is needed for for health reform. And in our newest feature "Ounce of Prevention," find out which five basic preventive services can save over 100,000 lives a year.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Cutting Costs with Diabetes Screenings
  2. Healthcare Reform Toolkit
  3. Improving Engagement Rates
  4. Increasing Patient Engagement in DM
  5. Healthcare Trends
  6. 5 Prevention Basics
  7. Healthcare Trends Mid-2009

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Please send comments, questions and replies to lgreene@hin.com.

Publisher:
Melanie Matthews, mmatthews@hin.com

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Routine Diabetes Screenings Could Cut Healthcare Costs

Screening adults for diabetes could result in significant cost savings for healthcare systems compared to the costs of not screening individuals at all. Researchers at Emory University screened 1,259 adults who had never been diagnosed with diabetes. The volunteer participants underwent four screening tests, including random plasma and capillary glucose and a 50g oral glucose challenge test (without a prior fast, at different times of the day) with plasma and capillary glucose measured one hour after the glucose drink. All participants also had a definitive 75g oral glucose tolerance test (OGTT) performed in the morning after an overnight fast.

The researchers found that 24 percent of the adults screened had either diabetes or prediabetes. In addition, they concluded that costs for screening and three years of treatment with metformin, or change in lifestyle for individuals found to have prediabetes or previously unrecognized diabetes, would be lower than costs for not screening. Projected health system costs for diabetes screening and management over a three-year period ranged from about $180,000 to $186,000 — all lower than costs for no screening, which totaled about $206,000.

To learn more about this research, please visit:
http://whsc.emory.edu/home/news/releases/2009/06/routine-diabetes-screening.html

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Health Reform Toolkit Needs Focus on Health Management and Prevention

The toolkit needed for healthcare reform is more broad-based than containing costs and improving quality, says Kenneth Thorpe, executive director for the Partnership to Fight Chronic Disease. Thorpe is also a Robert W. Woodruff professor and chair of the Department of Health Policy & Management at Rollins School of Public Health, Emory University.

Reform efforts must also include population health management, health prevention and care coordination, Thorpe said during a panel discussion in conjunction with last week's National Medicare Readmissions Summit and the 2009 Medicaid Congress.

“Getting to the Value Quadrant of Healthcare Reform,” sponsored by Pharos Innovations, highlighted several care management programs achieving positive returns, as well as the role of care coordination in health reform...

To read the rest of this story, please visit:
http://blog.hin.com/?p=489

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Improving Engagement Rates in Behavior Change Programs

Daily contact with participants in self-care health monitoring programs is one way healthcare organizations can improve patient engagement rates, explains Pharos Innovations CEO Dr. Randall Williams. In his work with Medicaid beneficiaries with chronic illnesses, he has observed that participants identified for health improvement programs are very receptive to daily contact and highly engaged in the process.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#80

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Increasing Patient Engagement, Activation in DM

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Ariel Linden, Dr.P.H., M.S., president of Linden Consulting Group.

Question: Can you describe some strategies for increasing levels of patient engagement and patient activation in the DM process?

Response: There is a tremendous existing body of literature that talks about behavioral changes, using motivational interviewing to change to make people more self-efficacious in managing their own diseases. But the literature on patient activation is substantial, and it appears to be consistent. For example, if an individual has read about the developments in hospital reimbursement, he or she knows that MedPAC came out with recommendations that hospitals do not get reimbursed for readmission within 30 days for things that are avoidable, nosocomial infections that occurred during admission. The writing on the wall is that readmissions for congestive heart failure (CHF) and other chronic illnesses will probably not be reimbursable in future iterations. Imagine you’re a hospital and you’re trying to avoid a 30-day readmission because you’re not going to get reimbursed for it. The patient is about ready to be discharged from the hospital, but they have low activatiion. It’s likely that you’re going to give them discharge plans that tell them that they need four different medications, 12 different times a day and they have to do all these other things as well. In this case, the patient is looking at you with a blank stare. Focusing this patient before they leave the hospital with a motivational interviewing technique or a very strong intervention to prepare them — whether they get discharged home or to another area — to help them follow the treatment plan, know what to take and when, who to contact if they’re not feeling well or if they don’t understand it, that is already moving them toward improving their activation. This specific instance will likely keep them out of the hospital and keep them from being readmitted in the next 30 days.

For more information on the role of DM in the healthcare continuum, please visit:
http://store.hin.com/product.asp?itemid=3904

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U.S. Could Save 100,000 Lives a Year with 5 Basic Preventive Services

As Congress tackles health reform, a new public education campaign notes that more than 100,000 lives could be saved every year by investing in five basic preventive services: aspirin counseling, tobacco cessation counseling, adult influenza immunization, colorectal screening and breast cancer screening. An estimated 45,000 deaths would be prevented each year if people who could benefit were advised by their doctors to take a daily dose of aspirin to prevent heart disease and 42,000 lives that could be saved a year if doctors offered tobacco cessation counseling.

A number of obstacles — including lack of coverage as well as co-pay and deductible requirements — currently discourage doctors from providing these services and also discourage many patients from obtaining them, according to Robert Gould, Ph.D., president of Partnership for Prevention and a behavioral scientist who was an architect of the highly successful “truth” anti-tobacco marketing campaign. “As a result, these services are under-utilized, needlessly placing people at risk.”

Partnership for Prevention is urging Congress to provide coverage for high-value preventive services in all federal health plans, to encourage it in all private plans and to remove deductibles and copays. Dr. Gould notes that three of the five services — aspirin counseling, tobacco cessation counseling and adult flu immunization — actually save money, while the other two services are highly cost-effective.

To learn more about this research, please visit:
http://www.prevent.org/images/stories/2009/100k%20lives%20press%20release%20_2_.pdf .

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Healthcare Trends Mid-2009

Healthcare organizations are recalibrating business plans and priorities mid-year in response to the recession, pending healthcare reform efforts, federal stimulus funds for health IT and state Medicaid programs and rising unemployment. Find out how other healthcare organizations are reacting to the current financial, legislative and reimbursement environment by completing HIN's Survey of the Month on Healthcare Trends in 2009: Mid-Year Adjustment by June 30. You’ll get a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/...

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