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October 28, 2010 Volume VII, No. 17

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to the CDC, the prevalence of diabetes in the United States is expected to double or triple by 2050. Learn more about the CDC's research in this week's issue, along with two new recommendations for stroke prevention. And staying with the subject of prevention, learn how Kaiser Permanente's heart disease prevention program is saving lives and reducing costs.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Americans with Diabetes Increases
  2. Stroke Prevention Guidelines
  3. Case Managers in ED
  4. Patient Education Tools
  5. Financial Incentives for Health, Wellness
  6. 2010 Health Coaching Benchmarks
  7. Heart Disease Prevention Program
  8. Healthcare Trends for 2011

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Number of Americans with Diabetes Projected to Double or Triple by 2050

As many as one in three U.S. adults could have diabetes by 2050 if current trends continue, according to a new analysis from the CDC. One in 10 U.S. adults has diabetes now. The prevalence is expected to rise sharply over the next 40 years due to an aging population more likely to develop type 2 diabetes, increases in minority groups that are at high risk for type 2 diabetes, and people with diabetes living longer, according to CDC projections published in the journal Population Health Metrics. Because the study factored in aging, minority populations and lifespan, the projections are higher than previous estimates.

The report predicts that the number of new diabetes cases each year will increase from 8 per 1,000 people in 2008, to 15 per 1,000 in 2050. The report estimates that the number of Americans with diabetes will range from one in three to one in five by 2050. That range reflects differing assumptions about how many people will develop diabetes, and how long they will live after developing the disease.

The projection that one-third of all U.S. adults will have diabetes by 2050 assumes that recent increases in new cases of diabetes will continue and people with diabetes will also live longer, which adds to the total number of people with the disease. Projected increases in U.S. diabetes prevalence also reflect the growth in the disease internationally. An estimated 285 million people worldwide had diabetes in 2010, according to the International Diabetes Federation. The federation predicts as many as 438 million will have diabetes by 2030. Risk factors for type 2 diabetes include older age, obesity, family history, having diabetes while pregnant, a sedentary lifestyle and race/ethnicity. Groups at higher risk for the disease are African-Americans, Hispanics, American Indians/Alaska Natives, and some Asian-Americans and Pacific Islanders. Proper diet and physical activity can reduce the risk of diabetes and help to control the condition in people with diabetes. Effective prevention programs directed at groups at high risk of type 2 diabetes can considerably reduce future increases in diabetes prevalence, but will not eliminate them, the report says.

The CDC and its partners are working on a variety of initiatives to prevent type 2 diabetes and to reduce its complications. The CDC's National Diabetes Prevention Program is designed to bring evidence-based programs for preventing type 2 diabetes to communities. The program supports establishing a network of lifestyle intervention programs for overweight or obese people at high risk of developing type 2 diabetes. These interventions emphasize dietary changes, coping skills and group support to help participants lose 5 to 7 percent of their body weight and get at least 150 minutes per week of moderate physical activity. The program is working with 28 sites across the United States offering group lifestyle interventions with plans to expand to additional sites in the future. The Diabetes Prevention Program clinical trial, led by the National Institutes of Health, has shown that those measures can reduce the risk of developing type 2 diabetes by 58 percent in people at higher risk of the disease.

Diabetes was the seventh leading cause of death in 2007, and is the leading cause of new cases of blindness among adults under age 75, kidney failure, and non-accident/injury leg and foot amputations among adults. People with diagnosed diabetes have medical costs that are more than twice that of those without the disease. The total costs of diabetes are an estimated $174 billion annually, including $116 billion in direct medical costs. About 24 million Americans have diabetes, and one-quarter of them do not know they have it.

To learn more about this research, please visit:
http://www.cdc.gov/media/pressrel/2010/r101022.html

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Treating Metabolic Syndrome, Undergoing Carotid Angioplasty Recommended in Stroke Prevention Guidelines

Treating metabolic syndrome and undergoing carotid angioplasty may prevent recurrent stroke or transient ischemic attack (TIA), according to revised American Heart Association/American Stroke Association guidelines. Last updated in 2006, the evidence-based guidelines for doctors will be published in Stroke: Journal of the American Heart Association.

Nearly a quarter of the 795,000 strokes in America each year happen in someone who has already had a stroke. Ischemic stroke accounts for about 87 percent of all strokes, which are caused by a lack of blood to the brain, resulting in tissue death. TIA occurs when blockage of blood to the brain is only temporary and thus doesn’t cause tissue death. The new guidelines feature several key updates for stroke or TIA survivors, including:

  • The value of screening for metabolic syndrome after stroke is still not clear; however, if it’s diagnosed, patients should receive counseling for lifestyle changes (including diet, exercise and weight loss) and treatments for metabolic syndrome components that are also stroke risk factors, especially high blood pressure and high cholesterol.
  • If a stroke survivor has severe blockage of the carotid artery, angioplasty and stenting may be an alternative to surgery if he or she is at low risk for complications.
  • Excluding patients whose stroke or TIA was caused by a clot from the heart, among those taking an antiplatelet drug to prevent another stroke, either aspirin alone, aspirin combined with dipyridamole or clopidogrel are reasonable options. Therefore, patients and doctors must consider risk factors, cost, tolerance and other characteristics to tailor the appropriate therapy.
  • Stroke or TIA survivors who are diabetic should follow existing guidelines for blood sugar control.
  • All stroke or TIA patients who have carotid artery blockage should aim for optimal medical therapy through a multifaceted approach, including antiplatelet drugs, statin therapy and lifestyle risk factor changes such as blood pressure management.
  • When patients with high stroke risk due to atrial fibrillation (an abnormal heart rhythm) need to temporarily stop taking the anti-clotting drug warfarin, they should receive low molecular weight heparin as bridging therapy to reduce the risk of blood clots.
High blood pressure is the most critical risk factor for recurrent stroke. Doctors should work with patients to find the best drug regimen to suit each individual’s blood pressure control needs, according to Karen Furie, M.D., M.P.H., the director of the Massachusetts General Hospital Stroke Service and an associate professor at Harvard Medical School.

To learn more about this research, please visit:
http://www.newsroom.heart.org/index...

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Embedded Case Managers in the Emergency Department

Organizations should advocate for a case manager in the emergency room, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center. Making the business case for an ED-embedded case manager, Cesta shares key targets for case management intervention in the ED and describes how the ER case manager is positioned to improve patients' transitions in care.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#131

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Optimal Patient Education Tools

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Barbara Wall, J.D., president of Hagen Wall Consulting.

Question: Which patient education tools provide the greatest ROI — disease self-management, wellness, appropriate ER use?

Response: As long as the basis of the information left with the patient — the patient teaching tools — is written at a standard grade level, the materials should be effective. For Medicaid, the grade level is usually at about a sixth grade level, and for a commercial population the reading grade level is junior high school level — about eighth grade level. The most effective use in patient teaching is when there is one-to-one contact between the patient educator and the patient or DM nurse and the patient. There seems to be a much greater degree of engagement in retention and buy-in by the patient when there is interaction on a one-to-one basis in teaching, rather than via educational material in hard copy accessed by the patient alone.

For more information on patient education tools, please visit:
http://store.hin.com/product.asp?itemid=4004

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

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Healthcare Business Weekly Update provides health management executives with in-depth analysis of health business news in DM, HIPAA, e-Health, Reimbursement, Compliance, Coding and much more! Each week the Healthcare Business Weekly Update covers stories in behavioral health, hospital and health system management, healthcare industry/managed care, health law and regulation and long-term care. The Healthcare Business Weekly Update also keeps you informed on the latest publications HIN has to offer.

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Top Financial Incentives for Health & Wellness

Financial and benefits-based incentives are used to promote participation in health and wellness programs. We wanted to see which financial incentives are offered most often.


Click here to view the chart.

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2010 Benchmarks in Health Coaching

This white paper captures the ways in which 161 organizations are implementing health coaching in 2010 — including the top three areas targeted by health coaching — as well as the financial and clinical outcomes that result from this health improvement strategy. These benchmarks are based on organizations' responses to the Healthcare Intelligence Network August 2010 e-survey on health coaching.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerhcbm10.html

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Heart Disease Prevention Program Saves Lives, Reduces Costs

A new study from Kaiser Permanente Colorado is one of the first to show that an intensive population management program that matches heart disease patients to personal nurses and clinical pharmacy specialists not only reduces the risk of death but reduces healthcare costs as well. Researchers examined healthcare expenditures in two populations of patients with heart disease: a group of 628 people enrolled in the Kaiser Permanente Collaborative Cardiac Care Service (CCCS), a population DM program, and 628 matched patients receiving standard care. The goal of the study was to determine if an intensive DM program could provide more value than usual care.

The study found that patients cared for by the CCCS experienced superior health outcomes. As compared to patients receiving usual care, enrollees in the CCCS had better cholesterol control, were more likely to be screened and adhere to important medications like statins, and had far fewer hospitalizations. Overall, CCCS patients had an 89 percent reduction in overall mortality and 88 percent reduction in cardiac mortality compared with patients receiving standard care. When the researchers compared costs, they found that healthcare expenditures for CCCS enrollees were, on average, $60 less each day for an annual average of $21,900 per patient, per year. According to the study’s lead author, Tom Delate, PhD, of Kaiser Permanente Colorado, “The goal of the CCCS is to get patients with heart disease on the right medications and deliver needed screenings and care, so one might expect to see healthcare costs go up with the increased service. However, we found the opposite effect: the CCCS was able to keep patients so healthy that they were more likely to stay out of the hospital. At the end of the day, expenditures from this major cost driver were reduced.”

The researchers calculated total healthcare expenditures by extensively reviewing healthcare utilization claims and electronic health record files. They also attributed an overhead cost to the staff and systems used to administer the population management program. Ultimately, the analysis found that enrollees in the CCCS had lower healthcare expenditures across the board, including the following key areas:

  • Medications: $4 per day, compared to $5 per day.
  • Doctor’s office visits: $7 per day, compared to $8 per day.
  • Hospitalizations: $19 per day, compared to $69 per day.
The goal of the CCCS is to help patients with heart disease receive the evidence-based treatment that has been shown to reduce their risk of another event. The program is unique because the majority of care is delivered over the phone by nurses and clinical pharmacy specialists who work under the direction of a physician.

To learn more about this research, please visit:
http://xnet.kp.org/newscenter/pressreleases/nat/...

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Healthcare Trends for 2011

Following this year's passage of the Patient Protection and Affordable Care Act, the real work of healthcare reform has begun. Learn how more than 50 fellow healthcare companies are preparing for 2011 by completing HIN's sixth annual survey on Healthcare Trends in 2011 by October 31. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/trends2011

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