Featured Articles                                                   October 2010, Vol. III, No. 6
Telephone-based Care Management, Patient Engagement Reduces Admission

A study published in the New England Journal of Medicine shows that a carefully executed telephonic care management program cuts costs. Health Dialog Services Corporation conducted a stratified, randomized study of 174,120 subjects and showed that empowering patients to participate in their treatment decisions generated considerable net savings — $6 per member per month (PMPM). The study assessed the effect of telephone-based care management on medical costs and resource utilization. Subjects were randomly assigned to either a usual-support group or enhanced-support group. After 12 months of intervention:

  • Medical and pharmacy costs per person in the enhanced-support group were $7.96 lower than those in the usual-support group.
  • With the cost of the intervention at less than $2 PMPM, a $6 PMPM net savings was generated.
  • A 10.1 percent reduction in annual hospital admissions accounted for the majority of these savings.

Until now there has been debate about the efficacy of care management support. Studies to date have been largely inconclusive in terms of whether programs truly save money. The Health Dialog intervention was able to generate these results in a large scale, randomized controlled trial because of four critical differences in program design and delivery:

  • Consumer empowerment: The Health Dialog program acts principally by empowering individuals with a wide range of conditions, including chronic conditions, to participate in medical treatment decisions with their doctors. This contrasts with other programs which focus narrowly on one or two disease-specific metrics such as closing a particular care gap.
  • Shared Decision Making® support: The Health Dialog program offers decision support through multimedia decision aids and coaching for key preference-sensitive surgical decisions that can drive costs, such as hip, knee and back surgeries. In this study, inpatient and outpatient surgeries were 9.8 percent lower in the enhanced-support group across six targeted preference-sensitive conditions.
  • Innovations in engagement: Health Dialog was able to engage almost three times as many high potential utilizers of the healthcare system (10.4 percent vs. 3.7 percent) in the enhanced group in part because individuals were scored differently for risk, but also for receptivity to coaching.
  • Unwarranted Variation™ analytics: Health Dialog has developed innovative, tested tools that incorporate research on overuse and underuse of care to identify the most impactable members. These analytic models uniquely incorporate local healthcare system factors and practice patterns, as well as patient receptivity to coaching intervention.

According to the researchers, "Care management interventions have been proposed as one component of remedying runaway healthcare costs. This research proves that supporting patient involvement in the decision-making process through a scalable intervention can be an effective component of a better healthcare system."

Get more information here.

Quotable: What Coaching Is All About

"If information was what participants enrolled in health coaching needed, then we would be the healthiest country in the world. Coaching is more about how we engage people to share with us in such a way that they begin to choose the changes that they will stick with."
                                        — Kate Larsen, Winning LifeStyles, Inc.

Learn more about benchmarks in health coaching.

Teaching Self-Management Skills to Heart Failure Patients Does Not Improve Outcomes

Medical researchers had hoped that teaching patients with heart failure how to improve their adherence to drug prescriptions and lifestyle changes could preserve their health and extend their life, but a new study published in the Journal of the American Medical Association (JAMA) found otherwise. Even with one year of counseling in how to manage their disease, the patients fared no better than if they learned the basics of heart health from simple tip sheets.

Overall, the counseling had no added value. But the data showed that for half of the patients — those falling in the lower income bracket — counseling may have had some benefit.

According to a researcher, “Like any chronic illness, heart failure logically needs the collaboration of a healthcare provider to prescribe therapy and a patient to implement that therapy. To encourage patients’ involvement in their care, we thought that education supplemented by training in self- management skills would help patients actually do what the medical literature prescribes. But our study showed that adding this training made no difference.”

A total of 902 patients diagnosed with mild to moderate heart failure with reduced or preserved systolic function (contraction of the heart) were enrolled in the study between 2001 and 2004 and followed for up to two to three years. The patients were divided into two groups. One group received by mail tip sheets on heart failure management designed for patients by the American Heart Association. The other group received, in addition, training on how to achieve the guidance laid out in the tip sheets about restricting salt, adhering to medication regimens, controlling weight, engaging in moderate physical activity and managing stress. The group training sessions covered such things as self-monitoring and relaxation strategies, as well as eliciting support from family and friends and restructuring their home and work environments — e.g., removing high-sodium canned goods from the home. The sessions involved a problem-solving format that engaged participants in finding their own solutions.

At the start of the study, the average age of participants was 64, about 47 percent female, 40 percent minority and 23 percent with preserved systolic function — representing the kinds of patients typically seen in the clinical setting. Participants were taking an average of 6.8 medications, and 37 percent did not adhere to at least 80 percent of their prescribed heart failure medications. Median sodium intake was 3,338 mg/day, well over the 2,000 mg/day recommended for heart failure patients. Major depressive symptoms were evident in 29 percent of the participants. The researchers found that in terms of time to death or hospitalization due to heart failure problems, the group that received counseling in self-management did no better than the group that received only the educational tip sheets. During approximately 2.6 years of follow-up, there were 163 events (40.1 percent) in the self-management group and 171 (41.2 percent) in the education group. However, the researchers found indication of benefit from counseling in self-management for those with an income of less than $30,000.

According to the researchers, “Our results suggest that self-management counseling may be useful for this important group of the population. They may need special help whether because of poor health habits, poor health literacy, or limited health insurance. But we need to study this issue further to determine whether our results hold up. If the results do hold up, they would suggest that outpatient management of heart failure should be tailored to the economic resources of the patient. The current standard of care does not feature such tailoring and may account for the large disparities in heart failure hospitalization we currently see among disadvantaged subgroups.”

Read the full article here.

Reducing Heart Failure Admissions through Remote Health Monitoring
Remote monitoring of heart failure patients by Henry Ford Health System reduced expected all-cause hospital admissions for enrollees by 36 percent after six months of enrollment and a return of 2.3:1 vs. program costs, according to a September 2009 study. Dr. Randall Williams, CEO of Pharos Innovations, the developer of the Tel-Assurance® remote patient monitoring platform used in Henry Ford's medical home pilot, describes how the daily engagement of Medicaid beneficiaries in self-care health monitoring programs can help healthcare organizations avoid many of the challenges inherent in working with this frequently underserved population. Once participants are identified, they are very receptive to the daily contact, which has resulted in extremely high program engagement rates.

Listen to the podcast here.

New Chart: Benefit-Based Incentives

Incentives for health and wellness activities take many forms. We wanted to see how companies are integrating incentives with health insurance benefits.

Click here to view the chart.

Telephonic Support in Coaching

Question: How does telephonic support affect populations?

Response: Our experience is that any time a human intervenes with a human, the chances of success go up considerably and there are a number of reasons for that. Some of it is science-based. The coach can use appropriate techniques to elicit the best possible responses out of people and get them excited about carrying out the needed efforts. They can also motivate them to stay the course in making appropriate behavior changes, but some of it is also the interpersonal relationship. We always feel more accountable to another human than we do to a Web site, machine or piece of paper that we’re reading. A combination of science and human interaction generates the results.

(John Harris, senior vice president and chief wellness officer of Healthways.)

Learn more about different forms of coaching.

HCH Readers Save 10% on Coaching Resource

Healthcare's Patient Protection and Affordability Act is replete with care delivery reforms — patient-centered medical home, health IT, wellness and prevention — whose effectiveness will largely be driven by the physicians charged with executing the programs. However, building physician buy-in for clinical and financial initiatives is a significant roadblock for healthcare organizations. This special report, Guide to Physician Engagement, deconstructs the physician culture and suggests tactics for converting reluctant physicians into champions for healthcare improvement.

HealthCoach Huddle subscribers should use ordering code HCH to purchase this product at a special price!

Get more information on physician engagement.

Benchmarks in Patient Education: Prevention, Self-Care Top Lessons

How prevalent are patient and member education programs, and which health areas are addressed by these efforts? How are healthcare organizations delivering health education, and who is the primary health educator? What is the chief impact of patient education programs, and how do organizations measure ROI from patient education efforts? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Patient Education and Outreach Benchmarks e-survey. This executive summary of responses from 134 healthcare organizations offers lessons in the value of educating patients and members about disease management and self-care.

Download complimentary white paper here.

Take HIN's e-survey on Healthcare Trends for 2011.

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