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December 31, 2009 Volume VI, No. 31

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's DM Update is a "best of" issue, looking back on the most read stories in 2009. Interestingly enough, two of the top stories are prevention stories — one on breast cancer and the other on worksite wellness — indicating the growing emphasis on prevention in disease management. Diabetes care costs was another top story — a big topic of discussion throughout 2009 as data on rising costs of care and diagnostic trends emerged.

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

This week's DM news:

Table of Contents

  1. Preventing Breast Cancer
  2. Diabetes Care Costs in Texas
  3. Desktop Videos Dispense Dose of Wellness
  4. Tracking Program Utilization and Results
  5. Healthcare Trends: Changing Lives with Lifestyle Management
  6. Worksite Wellness and Risk Prevention
  7. Healthcare Case Management

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

Melanie Matthews, mmatthews@hin.com

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Preventing Breast Cancer

The largest review of research into lifestyle and breast cancer ever conducted has confirmed that women can reduce their risk by maintaining a healthy weight, being physically active, drinking less alcohol and breastfeeding their children. The massive American Institute for Cancer Research/World Cancer Research Fund (AICR/WCRF) project looked at the evidence on the links between breast cancer and diet, body weight and physical activity.

“This study represents the clearest picture we have ever had on how lifestyle affects a woman’s risk of breast cancer,” said Martin Wiseman, M.D., medical and scientific adviser for AICR and WCRF. “We are now more certain than ever that by maintaining a healthy weight, being physically active and limiting the amount of alcohol they drink, women can dramatically reduce their risk.”

Because of the link between excess body fat and cancer, AICR recommends aiming to be as lean as possible without becoming underweight. AICR also recommends being physically active for at least 30 minutes every day. If you drink at all, limit consumption to two drinks a day for a man and one for a woman. AICR also recommends that mothers breastfeed exclusively for up to six months and then add other liquids and foods. Evidence is convincing that mothers who breastfeed reduce their risk for breast cancer. There is also probable evidence that children who are breastfed have a lower risk of gaining excess weight as they grow.

“We estimate that almost 40 percent of breast cancer cases in the U.S. &mash; or about 70,000 cases every year &mash; could be prevented by making these straightforward everyday changes,” added Susan Higginbotham, Ph.D., R.D., AICR director of research.

To learn more about this research first reported in September 2009, please visit:

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Diabetes in Texas: Growing Severity of Problem, Higher Cost of Care than National Average

A new report from The Texas Business Group on Health (TBGH) shows that when it comes to the use of evidence-based medical care for Type 2 diabetes patients, such as A1c tests, cholesterol tests and eye exams, Texas continues to rank lower than the national averages. This report includes information for key local markets across the state including Austin, Dallas, El Paso, Fort Worth/Arlington, Houston and San Antonio. Also included are state and national benchmarks that can help providers and employers identify better opportunities to serve the needs of their patients and employees.

In 2008, the number of patients diagnosed with Type 2 diabetes rose sharply across Texas, perhaps suggesting a worsening epidemic, but also greater awareness of diabetes risks and more aggressive diagnosing. The highest increase in prevalence was in El Paso, where 74 percent more individuals were diagnosed with Type 2 diabetes in 2008 than the year before. Other communities that also had relatively large increases in prevalence include Houston (41percent); Austin (34 percent); and Dallas (31 percent).

The cost of treating commercially insured Type 2 diabetes patients in Texas hospitals in 2008, regardless of setting (inpatient, outpatient, emergency room), exceeded the national averages. In fact, inpatient charges were 20 percent higher than the national average of $52,730, and an 11 percent increase over Texas hospitals’ 2007 inpatient charges of $56,765 per Type 2 diabetes patient. Houston had the highest hospital inpatient charges for Type 2 diabetes patients at $62,816 per patient, which is a 13 percent increase over the year before. The lowest cost market was Ft. Worth/Arlington, where Type 2 diabetes inpatient charges were $52,243, which is a surprising 10 percent drop from the year before (2007).

To learn more about this research first reported in September 2009, please visit:

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Wachovia Desktop Videos Dispense Weekly Dose of Wellness

As part of Wachovia's Healthy Connections program, employees with PCs receive a 55-second dose of health and wellness-related information each week that is delivered with the company's daily desktop video news program. The desktop videos launch automatically when users turn on their computers, and are replayed in the company's break rooms, common areas and financial centers throughout the day. These offerings are a core part of Wachovia's wellness culture, says Donna Shenoha, the company's vice president and senior consultant of health and welfare. She adds that the company's new Intranet platform offers social networking options as well as the option to "push out" messaging by targeted areas — either geographically or by employee "affinity groups."

To listen to this complimentary HIN podcast, please visit:

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Tracking Program Utilization and Results

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Eric Berman, medical director and chairman of health policy, Horizon BCBS of NJ.

Question: How are you tracking program utilization and results?

Response: We have invested heavily in our information services department. We look at episodic treatment groups, and we get pharmacy and outpatient laboratory data on each member. We run reports to see the utilization for different disease entities. It would be very hard for somebody to cheat the system if they had a BMI of 35 and claimed they had hypertension, but they never received any medication for that. We would see that from our data warehouse. It's not designed to be an oversight or a "Big Brother" situation. It gives us an idea of the cost of healthcare and utilization and tests effectiveness of these health and education programs. This gives us a handle on the ROI and demonstrates the decreased usage of outpatient labs, surgeries and pharmaceuticals. This hopefully makes our population healthier through complex case management and DM activities.

For more information on cost savings and ROI in DM programs, please visit:

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

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Healthcare Trends & Studies: Changing Lives with Lifestyle Management — Taking the Pulse of Population Health Programs

Numerous healthcare organizations are launching lifestyle management programs for individuals with life-threatening conditions such as diabetes, heart disease and obesity. This executive summary provides details on more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

To download this complimentary white paper, please visit:

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Worksite Wellness Programs Lower Healthcare Costs, Make Employees Healthier

Worksite wellness programs are a proven strategy to prevent the major risk factors for cardiovascular disease — smoking, overweight, obesity, high blood pressure, high cholesterol and diabetes — according to a policy statement published in Circulation: Journal of the American Heart Association.

According to Mercedes Carnethon, Ph.D., an assistant professor in the department of preventive medicine at Northwestern University Feinberg School of Medicine and lead author of the paper, “research shows that companies can save anywhere from $3 to $15 for every $1 spent on health and wellness within 12 to 18 months of implementing a program. Beyond cost savings and increased productivity, visionary employers are realizing the value of an employee’s total health. An effective worksite wellness program can attract exceptional employees, enhance morale and reduce organizational conflict.”

The statement recommends incremental changes to get employees on track, recognizing there is no one-size-fits-all approach to wellness. The paper also outlines keys to a successful worksite wellness program. These include tobacco cessation and prevention, regular physical activity, stress management/reduction, early detection/screening, nutrition education and promotion, and weight management. They also include disease management, cardiovascular disease education including cardiopulmonary resuscitation (CPR) and Automated External Defibrillator (AED) training, and changes in the work environment to encourage healthy behaviors and promote occupational safety and health.

The policy paper was published at the same time that the American Heart Association (AHA) revealed its 2009 list of Start! Fit-Friendly Companies, a program that recognizes employers who create a culture of physical activity and health in the workplace, and provides free walking path kits and online tracking tools for companies that want to get involved. The AHA also champions worksite wellness programs in its healthcare reform efforts.

To learn more about this research first reported in September 2009, please visit:

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Healthcare Case Management

More than 100 healthcare companies have already described how case managers are playing a larger role in the coordination of all phases of patient care, from management of the chronically ill in primary care offices to monitoring hospitalized patients from admission through discharge to overseeing care of residents of long-term care facilities. Complete HIN's Survey of the Month on Healthcare Case Management by January 6, 2010 and receive 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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