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July 8, 2010 Volume VII, No. 1

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to a Kaiser Permanente study, which is featured in this week's issue, telehealth is playing a positive role in colon cancer screening rates — increasing these rates by 30 percent. The economy is also playing a role in cancer care, and Geisinger Health System's ProvenCare Model will now be applied for treatment of lung cancer patients.

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

This week's DM news:

Table of Contents

  1. Cancer Patients & the Economy
  2. Lung Cancer & Geisinger's ProvenCare Model
  3. Emerging Role of Nurse Practitioners
  4. Educating Patients on Care Transitions
  5. Incentivized Health Improvement Activities
  6. Telehealth Benchmarks
  7. Colon Cancer Screenings & Telehealth
  8. Reducing Avoidable ER Visits

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

Publisher:
Melanie Matthews, mmatthews@hin.com

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Cancer Patients Struggling to Afford Care in Troubled Economy

A new poll illustrates the difficulty that cancer patients, survivors and their families face in affording needed healthcare, underscoring the need to strongly implement the Affordable Care Act so that it works for cancer patients. The national non-partisan poll of families affected by cancer finds that nearly half of cancer patients and survivors under age 65 have had difficulty paying for healthcare costs such as health insurance premiums, co-pays and prescription drugs in the past two years, and that one-third of those currently in active cancer treatment have put off some type of healthcare in the past year.

The survey, conducted for the American Cancer Society Cancer Action Network (ACS CAN), found that one in three cancer patients or survivors under the age of 65 has been uninsured at some point since diagnosis, and nearly one in five families affected by cancer lost their insurance because a family member lost their job or their employer dropped coverage for reasons unrelated to the cancer diagnosis. Research by the American Cancer Society has shown that lack of access to care can lead to later stage diagnoses, and that people with private insurance have better chances of surviving cancer than people who are uninsured. Giving all Americans access to quality healthcare is critical to defeating cancer, which kills an estimated 565,000 people each year.

While cancer patients, survivors and their loved ones are acutely aware of the gaps in the broken healthcare system, they are far less familiar with many of the provisions in the new law that will directly benefit them. The survey found that seven in 10 people with cancer or living with someone with cancer do not know that new insurance plans will be required to provide free cancer screenings, and 55 percent do not know that lifetime benefit limits will be banned. More than half of respondents were not aware that prescription drug costs will be reduced in Medicare with the phase-out of the Part D "doughnut hole," and nearly two-thirds were unaware that the law creates a high-risk pool for uninsured people with a pre-existing condition. Once they discovered that the law covers these and other provisions, no fewer than eight in 10 poll respondents supported each one.

ACS CAN continues to be the leading voice of patients and is actively working to ensure that the law is applied as strongly as possible for cancer patients, survivors and their loved ones. To that end, ACS CAN has specific implementation priorities that are critical to meaningful improvements in the healthcare system for people with cancer, which include the high-risk pool, state health benefit exchanges, prevention and Medicaid. The survey found that 89 percent of families affected by cancer feel investment in research to find better ways to prevent, detect and treat cancer should be a top national priority and nearly two-thirds of respondents say they are more likely to re-elect an elected official who advocated for more cancer research and prevention programs.

To learn more about this research, please visit:
http://pressroom.cancer.org/index.php?s=43&item=251

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Pilot Study Expands Geisinger Health System's ProvenCare Model for Lung Cancer Patients

A national pilot study that will promote evidence-based evaluation and treatment standards for patients with resectable non-small cell lung cancer (NSCLC) was launched by the Commission on Cancer (CoC) of the American College of Surgeons. The Commission on Cancer National Pilot Study for the ProvenCareģ Lung Cancer Collaborative is based on the success of the Geisinger Health Systemís ProvenCare model, which has significantly increased adherence to evidence-based standards, improved clinical outcomes and engaged patients as participants in their own care when applied to acute care episodes associated with other disease sites. The study plans to accrue a population of 1,000 patients and run for a minimum of 12 months.

This groundbreaking study marks the first time that Geisingerís ProvenCare model has been applied to a population of patients undergoing lung resection for NSCLC. It promotes a specific care pathway of 38 standard elements that will be followed from patientsí preoperative to postoperative care by treatment teams at six CoC-accredited institutions. Treatment team members at each participating institution commit to providing all 38 of the established care pathway steps to ensure that patients receive the highest standard of care. Institutions must also provide resources for a collaborative Web-based data entry process and data abstraction capabilities.

Patients in the study lend their participation to the process by making a commitment to communicate with the members of their surgical team (that is, when they donít understand something or when asked about current medications), getting their family or loved ones involved in their treatment plan and completing important care steps outlined to them by their healthcare providers. Patient engagement is an important element of Geisingerís ProvenCare as research studies have shown that patients have better results when they participate in their own medical care.

To learn more about this research, please visit:
http://www.facs.org/news/cocpilot0710.html

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The Emerging Role of Nurse Practitioners in Expanding Access, Enhancing Revenue

Nurse practitioners constitute a workforce already grounded in patient-centered care, explains Linda Lindeke, Ph.D., an RN and a nurse practitioner herself since 1978. Lindeke, who is also associate professor for the School of Nursing and Department of Pediatrics and director of Graduate Studies for the School of Nursing at the University of Minnesota, describes the demographics where a nurse practitioner's contributions might need clarification, explains why there's not much mention of the medical home in nursing literature and assesses the impact of the Affordable Care Act's $15 million allocation to fund 10 nurse practitioner-led clinics that will provide primary care services to the medically underserved.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#121

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Educating Geisinger Patients on Role in Care Transitions

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Janet Tomcavage, R.N., M.S.N., vice president of health services for Geisinger Health Plan, and Doreen Salek, B.S., R.N., C.C.S./C.P.C., director of business operations of health services for Geisinger Health Plan.

Question: What types of patient education programs does Geisinger use to help with the patientís role in the transition of care?

Response: (Janet Tomcavage) Thereís a fair amount of patient engagement and family engagement. I re-emphasize the family engagement because particularly with our seniors, we need to get the family more engaged. From an education perspective, we create an action plan with every patient in case management. That action plan provides the management tools that the patient or the family needs to be aware of. If they have diabetes, asthma or chronic lung disease, the plan describes the self-management steps that they need to take to manage their disease. If theyíre not checking their blood sugar, they need to understand why and how. If they donít understand the role of weighing themselves every day for heart failure (HF), we spend a fair amount of time one-on-one with the case manager and the patients and/or family, educating around that. Another core component of education is medications — understanding what and why, how much and when to take them. We educate, educate and educate because we have found that it takes several times before patients get it.

(Doreen Salek) We learned very quickly in our pilots that the teachback method for education wasnít being utilized. The teachback method is important to make sure that the patient understands those three or four important things about the problem or reason for the hospitalization — whether that was HF, diabetes or wound care following surgery. The method ensures that they left clearly understanding, not just reading back their discharge instructions, but having that teachback moment and finding those teachable moments. With our telemonitoring and Interactive Voice Response (IVR) programs, when someone alerts on a question and that nurse is doing the follow-up, those have proven to be those follow-up teachable moments. If youíre alerting because youíve gained two pounds in a day and we talk to you, and youíve eaten three sausages and a hot dog, thatís that teachable moment.

To learn more about patient engagement in care transitions and telehealth, please visit:
http://store.hin.com/product.asp?itemid=3946

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

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Top 9 Incentivized Health Improvement Activities

Paying for participation in health and wellness programs? Financial and benefits-based incentives are offered for a host of health improvement initiatives. We wanted to see which health and wellness activities most often rewarded its participants with incentives.

Click here to view the chart.

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2009 Telehealth Benchmarks — Wired for Access and Efficiency

How are healthcare organizations utilizing telehealth and telemedicine? How prevalent is remote monitoring, and which medical conditions are most often monitored? How has telehealth impacted levels of healthcare access, efficiency, cost and patient compliance? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Telehealth e-survey. This executive summary of responses from 134 healthcare organizations identifies emerging trends in the use of telehealth and telemedicine and offers a glimpse into a healthcare future where no patient is left behind because of a lack of access.

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

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Automated Telephone Reminders Increase Colon Cancer Screenings

Simple, automated telephone reminders can increase colon cancer screening rates by 30 percent, according to a Kaiser Permanente Center for Health Research study funded by the National Cancer Institute. The study — which is the first to examine whether automated calls can increase screening for colon cancer — involved nearly 6,000 Kaiser Permanente members in Oregon and Washington who were overdue for screening. Half received up to three reminder calls stressing the importance of screening and offering them an at-home kit to detect blood in the stool. Within six months, 22.5 percent of people who received reminder calls ordered and completed a stool card test, compared to only 16 percent of those who did not receive reminder calls.

In this study, people aged 51 to 80 received calls because they had not had a colonoscopy in the last 10 years, a flexible sigmoidoscopy or barium enema in the last five years, a Fecal Occult Blood Test (FOBT) — a non-invasive test to detect blood in the stool — in the past 12 months or a clinician referral for an FOBT or barium enema within the last three months. The automated calls in English and Spanish lasted about one minute. Members were told about the importance of screening, and were asked to press a number on their phone if they wanted to order a free at-home kit. If the person did not order and complete the test within six weeks they received a second call, and if they didnít respond in another six weeks, they received a third call. People in the control group — who were of similar age, sex, BMI and race — did not receive automated calls, but may have received reminders from their primary care physician (PCP).

According to researchers, ďThis study shows that simple, automated calls motivate more people to be screened, which means that more cancers will be detected at an early stage when lives can still be saved.Ē Because the study was a success, Kaiser Permanente in Oregon and in Washington is now using the automated phone calls to remind all members who are overdue for colon cancer screening. Colon cancer is the second leading cause of cancer death in the United States, claiming more than 52,000 lives a year. The U.S. Preventive Services Task Force urges Americans to start screening at age 50, unless they are at high risk, in which case they should be screened earlier.

Other studies have found live phone calls very effective in boosting cancer screening rates, but because those calls require hiring extra people, they are cost-prohibitive for many healthcare organizations. Other research found that reminder postcards can boost screening rates, but automated phone calls are less expensive than postcards because the cost per call decreases as the number of calls increases. An automated call system could be implemented easily by public and private healthcare systems, especially those with fewer resources, according to researchers.

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

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Reducing Avoidable Emergency Room Visits

Inappropriate and preventable use of the hospital emergency department is a nationwide problem and a serious drain on healthcare resources. Many healthcare organizations have launched programs to reduce avoidable use of the hospital ER. Complete this month's survey on reducing unnecessary emergency room visits by July 31, 2010 and we will e-mail you a copy of the compiled survey results in August.

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

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