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June 25, 2009 Volume VI, No. 6

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

Accounting for nearly 70 percent of all U.S. deaths, chronic diseases are the country's leading contributors to healthcare costs and disability. This week's DM Update looks at chronic disease and its effects on productivity in the workplace as well as healthcare IT approaches to managing chronic conditions.

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

This week's DM news:

Table of Contents

  1. Chronic Disease & Productivity
  2. Reducing Infections
  3. Healthcare in the Medical Home
  4. Text Messaging for Chronic Diseases
  5. Healthcare Trends & Studies
  6. LDL Management Improved
  7. Healthcare Trends Mid-2009

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The Effect of Chronic Disease on Productivity

One of the biggest drains on business is the struggle with employee absences due to chronic, uncontrolled disease states. Approximately 20 percent of an employee population is accountable for 80 percent of overall healthcare costs. According to the Journal of Occupational & Environmental Medicine, absenteeism and presenteeism can greatly increase the cost to a business. Studies find a direct link between health risk and productivity loss, and each additional risk factor is associated with a 2.4 percent decrease in productivity. High risk persons (those with as many as five risk factors) may have as much as 12.2 percent increased loss of productivity.

As healthcare costs continue to rise, employers bear the brunt of these high costs and look for ways to improve the health of their employees. Most employers understand the value of endorsing health and prevention initiatives, but stand-alone wellness and education programs are just short-term fixes. More and more employers are realizing that in order to get a handle on these costs, they must address high-risk chronic cases first.

“Disease management is the most important proactive and critical element of managing health risks of a working population,” says J. Melvin Deese, Jr., M.D., chairman of HealthScreen, an independent population health risk management company specializing in clinical/claims based cost risk analysis along with personalized nurse care. HealthScreen works with employers to identify significant risks to assist with appropriate programs and measures for the chronically ill and those in the “at-risk” category, while remaining HIPAA compliant and ensuring confidentiality of employees and their families. The company identifies, stratifies and engages members eligible for enrollment using medical and pharmacy claims data, health risk appraisals and biometric screenings. They then provide proactive nurse care management with incentive models to impact behavioral change that promotes healthier and better managed lifestyles, reducing absenteeism and lost productivity. According to Dr. Deese, implementation of such programs can also decrease turnover and increase morale of the entire workforce as productivity improves.

To learn more about this research, please visit:

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Reducing Infections Among Cancer Patients

The CDC Foundation, CDC and Amgen have launched a three-year campaign to reduce infections among cancer patients. The campaign will provide resources and educational tools to help patients, families and healthcare providers better prevent and manage treatment-related infections. The comprehensive education campaign will include curricula for healthcare professionals on infection control for cancer patients and appropriate antibiotic management to prevent resistance. It will also include an online education program for patients and caregivers.

Healthcare professionals are highly concerned about the impact that infections have on treatment outcomes. According to a new Harris Interactive, Inc. survey of oncologists, infectious disease (ID) specialists and patients, 92 percent of oncologists say it is extremely to very important to prevent infections to achieve successful outcomes in chemotherapy patients. Physicians are also concerned about emerging antibiotic resistance in this population, with 96 percent of ID specialists and 79 percent of oncologists reporting an increase in antibiotic-resistant infections in cancer patients over the past five years.

"We know that patients who acquire drug-resistant infections have more severe illness and higher risk of death," says Arjun Srinivasan, M.D., a medical epidemiologist in the Division of Healthcare Quality Promotion at CDC. "Programs to improve infection control in cancer patients, whose immune systems may be compromised by chemotherapy, will aid in saving the lives of these high-risk patients."

To learn more about this research, please visit:

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Primary & Behavioral Healthcare in the Medical Home

Individuals with severe and persistent mental illnesses are likely to die 20 years earlier than people without such conditions, says Liz Reardon, president of Reardon Consulting and a member of the National Council for Community Behavioral Healthcare (NCCBH) Integration Consulting Team. Putting the right medical home services in place for adults with chronic mental illness can help to reduce this disparity, suggests Reardon, explaining why the earliest medical homes for children with complex health needs are great models for behavioral healthcare organizations.

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Text Messaging Interventions

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Randall Williams, M.D., F.A.C.C., CEO of Pharos Innovations.

Question: What techniques or interventions have you used or observed in other health plans that successfully worked with text messaging? Does this work best for notifications about refills for example, or can text messaging work for preventive health reminders as well?

Response: Text messaging is a great vehicle if that’s how a particular member or patient would like to communicate. The challenge is that many individuals in older demographics — where chronic disease is more prevalent — are not facile in text messaging. Opportunities will continue to evolve as technology evolves and as our population — who has grown up with that technology as part of their day-to-day life — continue to age into the categories where more of these chronic conditions are prevalent. But since the target of our interventions has been chronic disease, few individuals are opting to receive reminders or communication at this point via text.

For more information on health IT in care management, please visit:

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Medical Home Monitor tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

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Waging War on Cost of Chronic Disease

Chronic conditions — such as asthma, heart disease and diabetes — affect approximately 30 percent of the population, or more than 90 million Americans. Seven of every 10 deaths are attributed to chronic disease. According to the Alliance for Health Reform, while a healthy person’s medical expenses average around $1,000 per year, a chronically ill person spends between $6,000 and $16,000. The medical costs associated with chronic conditions account for 75 percent of total healthcare expenditures. This white paper discusses the prevalence of chronic diseases and outlines key elements necessary in a successful DM program.

To download this complimentary white paper, please visit:

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Management of LDL Improved Over Last Decade Reform

Patients at risk for coronary heart disease are taking heed and lowering their low-density lipoprotein (LDL) cholesterol levels, say researchers from the University of California San Francisco (UCSF). More than 70 percent of patients have an LDL cholesterol within target levels, nearly double the percentage in the late 90s, David D. Waters, M.D., of UCSF and colleagues reported online in Circulation: Journal of the American Heart Association.

"Although there is room for improvement, particularly in very high-risk patients, these results indicate that lipid-lowering therapy is being applied much more successfully than it was a decade ago," Dr. Waters said.

Many trials have demonstrated that lowering LDL, predominantly with the use of statins, lowers cardiovascular risk. Guidelines have recommended that very high-risk patients achieve a target of less than 70 mg/dL. To assess how much LDL control has changed over a 10-year period, researchers compared results from their Lipid Treatment Assessment Project 2 (L-TAP 2), a survey of about 10,000 patients from nine countries who were on cholesterol management between September 2006 and April 2007 with results from the original L-TAP, conducted in 1996 to 1997.

The researchers found that, overall, the number of patients successfully reaching their risk-appropriate LDL goals rose from 38 percent in the 1996 to 1997 study to 73 percent in the 2006 to 2007 study. Among high-risk patients, 67 percent reached their target, compared with 18 percent of high-risk patients in the first study. Some predictors of successful LDL control included lipid-lowering therapy, being in the lower risk group and male sex.

To learn more about this research, please visit:

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Healthcare Trends Mid-2009

Suffering from project overload due to frozen resources? Adjusting decision-making, pricing, marketing and more to compensate for reduced revenues in a depressed economic climate? You are not alone. To learn how your healthcare colleagues are responding to the current economic and legislative environments, take HIN's Survey of the Month on Healthcare Trends in 2009: Mid-Year Adjustment by June 30. Nearly 50 healthcare organizations have responded so far. 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:

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