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December 16, 2010 Volume VII, No. 23

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue provides a look at the increase in workplace clinics, the many benefits such clinics can offer employers and their staff, and five keys to clinic success. Also, find out which condition dropped from third to fourth place in leading causes of death, and the link between biological diversity of ovarian cancer and screenings.

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

This week's DM news:

Table of Contents

  1. 5 Keys to Workplace Clinic Success
  2. Stroke Fourth Leading Cause of Death
  3. Nurse Advice Line
  4. Employee Health Program Obstacles
  5. Top HRA Incentives
  6. 2010 Health & Wellness Incentives
  7. Ovarian Cancer Screening
  8. Reducing Hospital Readmissions in 2010

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Increase in Workplace Clinics Benefits Employers in Cost and Productivity

Interest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services, according to a new study by the Center for Studying Health System Change (HSC). Employers view workplace clinics as a tool to contain medical costs, boost productivity and enhance their reputations as employers of choice, according to the study.

Many experts interviewed for the study said most workplace clinics try to achieve a “trusted clinician” primary care model that offers much shorter appointment and in-office wait times and much longer clinician-patient encounters. Experts said that longer clinic visits allow the clinician — sometimes but not always a physician — to listen to patients, diagnose their conditions and discuss different treatment options with them. In addition, the clinician has time to screen for other problems unrelated to the immediate visit. Estimates of clinic prevalence vary, with some recent employer surveys indicating that more than one-third of large employers offer onsite or near-site clinics, while another survey reported one-fifth of large employers doing so. According to HSC’s 2007 Health Tracking Household Survey, 8 percent of American families had at least one family member who had ever used a workplace clinic, and 4 percent had a family member who had used a clinic in the past year.

The availability of simple, routine care at work can be a valued perk for employees, but most experts observed that clinics’ direct cost-saving potential for employers is limited, if it exists at all. Instead, experts noted that what generates savings for employers is the ability to change practice patterns, such as drug prescribing, ordering of tests and procedures, and specialist referrals, along with the potential for early diagnosis and treatment to avoid emergency department visits, hospitalizations and other costly downstream complications. Based on a literature review and more than 35 interviews between February and July 2010 with workplace clinic industry experts and representatives of benefits consulting firms, clinic vendors and employers sponsoring onsite clinics, common themes emerged:

  • The trusted clinician model of wellness/primary care delivery hinges on having the right staff. One of the most promising aspects of workplace clinics is their potential to transform the delivery of wellness, disease management and primary care by developing a relationship between a patient and a trusted clinician. Through longer, more frequent face-to-face encounters, this approach emphasizes holistic rather than acute, episodic care but depends on finding and retaining clinic staff with the right skills and qualities.
  • Whoever runs the clinic, sustained employer engagement is critical to success. Most employers outsource clinics to vendors, but experts noted that no successful clinic is completely a turnkey operation. Senior company leaders need to provide active, visible support at start-up and remain engaged throughout the life of a clinic. Achieving the appropriate balance between too much and too little corporate involvement is a challenge.
  • Gaining employee trust is key to clinic acceptance. When clinics are first introduced, employees may be mistrustful of employer motivations, concerned about personal data confidentiality and skeptical about quality of care. Employers need to expect these concerns, communicate clearly and honestly about how the clinic fits into the company’s core business strategies and demonstrate convincing evidence of patient privacy protections. Employers also need to be patient in allowing employee trust to be built through first-hand personal experience and recommendations from early clinic users.
  • Investing in the appropriate scope and scale of clinic services is challenging but essential. At start-up, some employers take such a cautious and incremental approach that the clinic makes little impact on care delivery or cost containment. Other employers take a no-expenses-spared approach, building state-of-the-art facilities with comprehensive ancillary services — an approach that might pay off in reputation and brand but makes it difficult to recoup direct medical costs.
  • Employers should be realistic about return on investment (ROI ) and recognize that measurement poses challenges. Employers should not expect clinics to be a quick fix for high health costs, because savings from population health improvement take time, even in the most effective programs. There are many challenges in accurately capturing ROI, and because workplace clinics are often implemented in conjunction with other benefit changes, isolating the impact of clinics on employer cost trends may not be possible. And, while well-designed, well-implemented clinics may prove to be wise, financially viable investments for employers, the magnitude of savings is unlikely to make clinics “game changers” in bending the cost curve substantially overall.
To learn more about this research, please visit:

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Stroke Drops to Fourth Leading Cause of Death in 2008

Stroke is now the fourth leading cause of death in the United States, down from the third place ranking it has held for decades, according to preliminary 2008 death statistics released by CDC's National Center for Health Statistics. While deaths from stroke and several other chronic diseases are down, deaths due to chronic lower respiratory disease increased in 2008.

There were 133,750 deaths from stroke in 2008. Age-adjusted death rates from stroke declined 3.8 percent between 2007 and 2008. Meantime, there were 141,075 deaths from chronic lower respiratory disease and the death rate increased by 7.8 percent. Some of the increase in deaths may be due to a modification made by the World Health Organization in the way deaths from chronic lower respiratory diseases are classified and coded. The National Center for Health Statistics will conduct a thorough analysis on this change and its effect on the chronic lower respiratory disease category before the final 2008 deaths data are released.

It was also found that life expectancy at birth dropped slightly to 77.8 years from 77.9 years in 2007. Life expectancy was down by one-tenth of a year (a little over a month) for both men and women. However, black males had a record high life expectancy in 2008 of 70.2 years — up from 70 years in 2007. The life expectancy gap between the white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007. The data are based on 99 percent of death certificates reported to NCHS through the National Vital Statistics System from all 50 states, the District of Columbia and U.S. territories. Other findings include:
  • Heart disease and cancer, the two leading causes of death, still accounted for nearly half (48 percent) of all deaths in 2008.
  • In addition to stroke, mortality rates declined significantly for five of the other 15 leading causes of death: accidents/unintentional injuries (3.5 percent), homicide (3.3 percent), diabetes (3.1 percent), heart disease (2.2 percent) and cancer (1.6 percent).
  • In addition to chronic lower respiratory disease, death rates increased significantly in 2008 for Alzheimer's disease (7.5 percent), influenza and pneumonia (4.9 percent), high blood pressure (4.1 percent), suicide (2.7 percent) and kidney disease (2.1 percent).
  • The preliminary infant mortality rate for 2008 was 6.59 infant deaths per 1,000 live births, a 2.4 percent decline from the 2007 rate of 6.77 and an all-time record low. Birth defects were the leading cause of infant death in 2008, followed by disorders related to preterm birth and low birth weight. Sudden infant death syndrome (SIDS) was the third leading cause of infant death in the United States.
  • Overall, there were 2,473,018 deaths in the United States in 2008, according to the preliminary deaths report — 49,306 more deaths than the 2007 total.
  • The age-adjusted death rate for the U.S. population fell to 758.7 deaths per 100,000 in 2008 compared to the 2007 rate of 760.2.
To learn more about this research, please visit:

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Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization

More than a third of healthcare organizations have launched nurse advice lines to reduce avoidable ER use and direct patients to the most appropriate care venue, according to a July 2010 survey by the Healthcare Intelligence Network. The staffing and operation of Optima Health's nurse advice line is influenced by many factors, explains Patricia Curtis, director of operations, clinical care services for Optima Health. Curtis describes the distinct responsibilities of the LPNs and RNs who staff the advice line as well as the diverse needs of the member populations who call the advice line.

To listen to this complimentary HIN podcast, please visit:

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Overcoming Employee Health Program Implementation Obstacles

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Gregg Lehman, PhD, president and CEO of Health Fitness Corporation, and David Sensibaugh, director of Integrated Health at Eastman Chemical Company.

Question: Once the decision has been made to implement a health change program in the workplace, what were the biggest roadblocks and how were they overcome?

Response: (David Sensibaugh) The biggest implementation challenge was that we had had an entitlement mentality of benefits — that is, people feeling that things are free, and we don’t have to do anything. All of the sudden we’re introducing some expectation. While there’s still choice, some people view that as forcing them to complete an HRA. It is all part of the journey — what can we do to help condition people to earn their trust and to understand what’s important? We show them how healthcare costs were increasing dramatically — how many millions of dollars we’re spending each year — and that was not acceptable for our company. For the survival of our company, we set the business case, which is most critical first and foremost. Then we make them understand why HRAs were important. We have people who are very healthy, people who are very sick and everywhere in between. We’re going to provide services, tools and resources throughout that whole continuum, but you have the responsibility to access and take advantage of those tools and resources.

People also need to overcome that fear that if they complete an HRA they will be penalized. By using an external partner, that provides that sense of anonymity. There was a small subset of our population who were already familiar with that organization, and so there was a degree of trust. We have about 7,000 people in our headquarters and we have a number of different divisions. They’re like small companies, having anywhere from 400 to 1,100 people. Each of those organizations has its own grassroots wellness team made up of peer employees and leadership. That’s a way to help disseminate information, explain why we’re doing this, and also to defuse some of the trust issues.

(Gregg Lehman) Employee confidentiality is a big issue; it’s the Big Brother mentality. Employees want to know what we are going to give back to the employer. When we worked directly with the employee participants in the program, they’re assured that their individual information — whether it’s the information from a biometric screen, an HRA, the goal achievement through a health coaching program or an intervention program — is only shared back to the employer in the aggregate, never by individual employee.

For more information on employee health programs, please visit:

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What Are the Top HRA Incentives?

Health risk assessments (HRAs) are a key tool in the delivery of health promotion and disease management. We wanted to find out the top incentives offered to individuals who complete an HRA.

Click here to view the chart.

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2010 Benchmarks in Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate. This executive summary captures responses of 139 healthcare organizations to HIN's second annual Health and Wellness Incentives Use e-survey administered in February 2010 on the focus, utilization and impact of health and wellness incentives, from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives.

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Biological Diversity of Ovarian Cancer Lessens Value of Screening

Cancer prevention experts have long been frustrated by the lack of a meaningful way to screen women for ovarian cancer. It is a relatively rare disease that often progresses with few symptoms until it is too late for potentially curative treatments, and elevated values of the most commonly used biomarker used in screening, CA125, are also related to other disorders. Scientists at the Duke Cancer Institute say that incorporating the latest information about the biological diversity of ovarian cancer appears to lessen the potential value of screening even further.

Until recently, ovarian cancer has been regarded as a single disease. But studies at Duke and elsewhere have shown that it has at least two distinct subtypes: a slow-growing, indolent form, which takes months to years to move into an advanced stage, and a more aggressive variety driven by key gene mutations that gallops through stages I and II in about half that time.

Researchers used information in the Surveillance, Epidemiology, and End Results (SEER) database to create a decision model for screening for ovarian cancer. The SEER database, maintained by the National Institutes of Health, includes information on cancer incidence, prevalence and survival in over a quarter of the U.S. population and breaks out ovarian cancer by type. They then validated the model using early data from a real-life study, the U.K. Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), a large, randomized trial that is using CA125 values and ultrasound to screen a general population of post-menopausal women for ovarian cancer.

In conceptualizing ovarian cancer as a single disease, the model predicted that screening women over the age of 50 in the United States could potentially lower cancer deaths by about 15 percent. But incorporating the two subtype concept, the model predicted deaths would fall by only 11 percent. Researchers said that it makes sense: Screening is more likely to pick up a greater number of slow-growing, as opposed to fast-growing tumors, because indolent cancers remain in a more treatable early stage almost twice as long as their more virulent counterparts. “Catching and successfully treating the slower-growing cancers isn’t going to do as much to reduce deaths from ovarian cancer as much as catching the more lethal tumors would do," according to the researchers.

To learn more about this research, please visit:

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Reducing Hospital Readmissions in 2010

Spurred on by incentives from public and private payors, healthcare organizations are working hard to reduce avoidable rehospitalizations, especially among Medicare patients. Describe your organization's efforts to reduce hospital readmissions by taking HIN's second annual Reducing Hospital Readmissions Benchmark Survey. Respond by December 31 and receive an e-summary of the results once the survey is completed.

To participate in this survey and receive its results, please visit:

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