Sunday, September 21, 2014

How to Be the CEO of Your Health

Rources for Empowered Patients

Last week, we had the good fortune of having Dr. Michelle Gourdine come talk to the ASHA staff. She delivered a presentation titled You're the Boss: How to be the CEO of Your Health. Dr. Gourdine is a physician and CEO of Michelle Gourdine and Associates. She is a Clinical Assistant Professor in the Departments of Epidemiology and Preventive Medicine and Pediatrics at the University of Maryland School of Medicine, and a Senior Associate in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. She served as Deputy Secretary for Public Health Services for the Maryland Department of Health and Mental Hygiene (DHMH) from 2005 - 2008. So, she knows both the medical and policy sides of health care. She is a nationally-sought-after speaker and author of the book, Reclaiming Our Health:  A Guide to African American Wellness. We have a few copies in HR if you're interested in checking it out.


She began by showing us slides that demonstrate how we spend too much on healthcare in the US and get results that pale in comparison to other countries. (The one to the left was my favorite.) She pointed out that chronic disease is driving a lot of our spending and that there is an inverse relationship to what we spend to improve our health and what really makes us healthier. She stressed that 90% of Type 2 diabetes, 80% of heart disease and 60% of all cancers can be prevented by basic healthy lifestyle choices. People manage their health through day-to-day decisions. She suggested we start by asking ourselves these questions.



She shared some practical approaches for accomplishing each and added a 5.1 How well am I managing my stress? She also mentioned the importance getting 7 to 9 hours of sleep each night. You can see her recommendations by flipping through the slide show below. I also recommend reading Eat, Move, Sleep by Tom Rath. It's full of compelling reasons to do all of the above and practical tips that will improve your health.

Dr. Gourdine moved on with tips to help us get the most out of relationship with our doctors. She recommended that we ask these five questions any time a doctor recommends that we take a medication or have a test or procedure.



She explained when seeking a second opinion is valuable and outlined which screenings she recommends. It seems these recommendations are changing all the time and I was grateful that she outlined everything clearly. She cautioned against chasing test results rather than treating a patient and cited The $50,000 Physical that was in JAMA last June as a cautionary tale. 

Here are her screening recommendations:
  • Blood pressure check every 2 years…more frequent if high 
  • Cholesterol test every 5 years 
  • Diabetes test every 3 years 
  • Colonoscopy every 10 years starting at age 50 
  • Dental exam and cleaning yearly 
  • Eye exam every 1 to 3 years 
  • Height, weight, BMI every year or 2 
  • Flu shot yearly 
  • Tetanus booster every 10 years 
  • Prostate cancer screening and PSA -- Discuss with provider starting at age 50…age 45 if African American 
  • Annual lung cancer screening (low dose CT scan) for smokers 55 – 80 with: 30 pack year smoking history AND currently smoke or have quit within past 15 years
  • Mammogram every 2 years starting at age 50
  • Pap smear (and HPV) -- Every 3 years starting at age 21 and every 5 years starting at age 40
She also shared 5 resources for empowered patients:
  1. choosingwisely.org
  2. costhelper.com
  3. mayoclinic.com
  4. webmd.com
  5. nlm.nih.gov
Again, I recommend flipping through the presentation and don't forget to mark your calendar for October 16 at 1:00 when Dr. Gourdine will be back. She'll be talking to us about where to seek care. 




Thursday, September 4, 2014

How Much Does a Screening Colonoscopy Really Cost?

Screening colonoscopies are included in the preventive care benefits mandated by the ACA and they're supposed to be covered without any patient cost-sharing, but are they really free?


You turn 50 and before the candles on your cake have stopped smoking your loved ones start talking to you about getting a colonoscopy. My husband, Patrick, finally gave in and scheduled his last month. I read that one of the reasons people don't get a screening colonoscopy when they turn 50 is the hassle of dealing with the insurance coverage, so I figured I'd write about his experience. I didn't expect it to cost us anything because screening colonoscopies are included in the preventive care benefits mandated by the ACA and they're supposed to be covered without any patient cost-sharing. I was surprised when that wasn't quite how it played out. Here's a breakdown of the bills. (We have ASHA's high-deductible plan, Choice Plus with HSA.)




When the ACA first required health plans to cover preventive services, consumers encountered problems when a polyp was discovered during the procedure. The doctor would, of course, remove the polyp, but even if it was benign, they would no longer bill the procedure as preventive. The government came out with a clarification that included treatment being done at the same time or "integral to the procedure" and specifically cited removal of a polyp, so this shouldn't be an issue for you. Just confirm that the provider will be billing the procedure with a preventive care code. 


Unfortunately, that's as far as the government's clarification went and I've run into a surprising interpretation from UHC. They are saying the initial consultation with the gastroenterologist and the prep kit are NOT integral to the procedure. Therefore, the services are subject to the deductible or the copays dictated by your plan. (Baffling, I know. I'll continue to look into it.)

Another common problem is winding up with a anesthesiologist that is out-of-network. This happened to Patrick, but the claims were reprocessed with one phone call to UHC. After that was done, I called the anesthesiologists office and, without my even making the request, they told me they'd written off the balance. In some instances, you may have to write a letter of appeal. ASHA staff can contact Health Advocate and they will write the appeal for you.

All in all, the screening cost us $209 and the money ASHA contributed to our HSA ($2,000) more than covered it. I compared notes with a colleague that has our Choice Plus PPO. She paid a $15 copay for the office visit and $25 for the prep kit for a grand total of $40. 

I'm a bit of a skeptic when it comes to some screenings, but it is widely believed that preventive colonoscopies detect and prevent colorectal cancer. Colorectal cancer is the second leading cause of cancer death in the U.S. and the third most common cancer in men and women. Gastroenterologists actually remove precancerous polyps and small cancers during a screening colonoscopy. The number of deaths from colon cancer could be reduced if more people were screened. Listen to your loved ones and set aside the money whether it's $40 or $200 to take care of yourself.



Related reading:

Wednesday, July 30, 2014

Highlights from the World Congress on Employee Well-Being #WCEWB14

  1. The World Congress hosted the Employee Well Bootcamp for HR, Benefits and Wellness Professionals in Boston on July 23-24, 2014. When I attend events like this, I like to create a list of books, articles and resources that are mentioned and share what I compile.

    Susan Tufts from L.L. Bean kicked the conference off right with Health and Well-Being -- Build a Business Case for Your Employee Wellness Program.
  2. Susan shared a compelling slide that showed how their smoking rates decreased as they became a smoke-free environment. I've often thought that employer have the potential to have the same sort of impact on other health and wellness factors like diet and exercise as we have had on smoking in the U.S.
  3. Looking back at my notes from #wcewb14. Susan Tufts from @llbean shared this compelling slide. http://t.co/r3MdzwuWEe
    Looking back at my notes from #wcewb14. Susan Tufts from @LLBean shared this compelling slide. pic.twitter.com/r3MdzwuWEe
  4. Fitness room utilization tripled @LLBean when they upgraded equipment & refreshed the fitness rooms. #WCEWB14
  5. Susan talked about how they used health risk assessments. Some years they conducted biometric screenings and some years they had people self-report the information. The data showed that people know their weight (although they take a pretty optimistic view of it), but they don't know their blood-pressure, cholesterol level, or A1c. I've been moving away from screenings, but the data Susan shared caused me to pause and think about it again. 
  6. Self-reported health risk data shows people know their weight (although they're optimistic), but not BP, cholesterol & A1c.#WCEWB14
  7. Michael D. Parkinson, MD from the UPMC Healthplan was up next with Think Populations, See Individuals -- Lessons Learned and How to Apply Them. 
  8. Think "tribes" not "populations". Main reason wellness programs don't work - groups of employees don't think they apply to them.#WCEWB14
  9. "Insurance changes everything" and not for the good. #WCEWB14
  10. "If you don't have an HSA, get there fast." #WCEWB14
  11. I'm no fan of health risk assessments. My experience has been that they don't tell me anything I don't already know about our population. I do think we could do something meaningful with the 5 questions that Dr. Parkinson said matter though. Can you say "yes" to all 5?
  12. Can you say "yes" to all 5? Forget about HRAs. This is what matters. #WCEWB14 http://t.co/8gxjQ5z2DD
    Can you say "yes" to all 5? Forget about HRAs. This is what matters. #WCEWB14pic.twitter.com/8gxjQ5z2DD
  13. I'll be dusting off the post I started on how screening colonscopies are billed after hearing this tidbit. 
  14. Free isn't free enough for preventive care. People get aggravated with billing errors & skip next time. Dbl down on communication.#wcewb14
  15. He fed my fear of cholesterol lowering medications with his comments.
  16. Talking about combating "McLipitor" syndrome. People think they can eat whatever they want if they take cholesterol lowing meds.#WCEWB14
  17. Nature vs Nurture -- arrow goes both ways & faster than we realized. Epigenetics - hugely transformational. #WCEWB14
  18. Align incentives -- make the right thing the easy thing. #WCEWB14
  19. He mentioned Connected and Blue Zones which are two of my favorite books and suggested we read about developing NASA's program.
  20. Then he wrapped it up with this gem.
  21. The reason it "runs" in your family is that no one "runs" in your family! Quote of the day from Dr. Mike Parkinson #wcewb14 #run
  22. Next up was a Employer Case Study from Keurig Green Mountain -- Develop the Right Formula to Create a Culture of Total Well-Being that Supports Business Success, Performance Growth and Sustainability -- presented by Deb Borton and Deanna Merola from Keurig and Colleen M. Reilly from Total Well-Being.
  23. 5 best practices in communicating wellness - #1 keep it simple #2 be creative #3 the scan test #4 use reminders #5 build a brand#WCEWB14
  24. Amanda Goltz from Aetna, Marty Jaramillo from Yingo Yango, and Brain Jones from Castlight Health presented Implement Innovative and Disruptive Approaches to Health Fitness and Productivity in the Workplace.

    They discussed an Aetna study on the impact of incentives. 
  25. And mentioned a number of things worth looking into. 
  26. Great discussion at #employer well-being boot camp #WCEWB14on health care/wellness vendors must use open source API. Must share data.
  27. Zipongo - Healthy Recipe Recommendations and Savings by Zipongo, Inc. #WCEWB14  https://appsto.re/us/KcbRA.i 
  28. HelloWallet by HelloWallet another potentially disruptive technology #WCEWB14  https://appsto.re/us/RMdKC.i 
  29. Barbara Linton from Baystate Health presented Baystate Health Takes Innovative Steps to Win the Weight Loss Battle. They broadened their definition of wellness using the 5 Gallup factors to help increase participation from 35% to their target of 50%.
  30. The improved quality of life stories are often more compelling than the data. #WCEWB14
  31. After the lunch break, Andrew Gold from Pitney Bowes launched into Identify Employee Population Demographics to Implement Need-Based and Focused Health Initiatives. You can learn about what they're doing on their website pbprojectliving.com.
  32. Everything @andrewgold14 is doing ;-) -- Pitney Bowes Project: Living  https://www.pbprojectliving.com/home  #wcewb14
  33. Pitney Bowes uses Yammer & Facebook. @Andrewgold914 Says always use a calendar invite when you schedule something.#WCEWB14
  34. Pitney Bowes is having a lot of success using Yammer. We tried it for awhile at ASHA, but engagement died out as soon as some senior executes logged in. Unfortunately they created accounts that people could see, but never engaged in the discussion. I think this made people feel like they were checking-up on them. Anyway, it's nice to hear it is working well in other environments.
  35. He also showed us a cool deck of cards that they crated to reinforce a back pain prevent program they held. 
  36. Love the "we got your back" deck of cards to reinforce back pain prevention program at Pitney Bowes @Andrewgold914 #WCEWB14
  37. Gary Earl stepped up to the podium next to present Create Wellness Engagement and Communication Strategies that Deliver Messages that Resonate and Motivate. Gary actually served as the master of ceremonies for the whole conference and did a stellar job. 
  38. Amazing job by Gary Earl hosting World Congress Employee boot camp . #WCEWB14 #anthem
  39. He talked about his experience working at Caesars in Vegas. 
  40. Casino managers know how to engage people. We can learn something from them. #WCEWB14
  41. Even the carpet selection drives desired behavior in casinos. If only we applied that knowledge to create healthy workplaces.#WCEWB14
  42. Don't just look at an individual's behavior. Look at the culture that they live in. Built environment matters! #WCEWB14
  43. Value the employee's voice. Create a safe environment to invite people to build your programs with you. #WCEWB14
  44. On-site chiropractor and physical therapy. Created 6+ touch point to transition people to behavioralist and wellness coaches.#WCEWB14
  45. $3.18 pepd allowed Caesars to send home healthy food with employees. #WCEWB14
  46. I never thought about looking to casinos to learn about engaging people, but Gary has me wanting to go to casino engagement school. Seriously, where do those folks learn the tricks of their trade?
  47. Claire Santarelli presented Learn How the Massachusetts Department of Public Health Implements Statewide Approaches to Prevention and Wellness. She shared two resources that I want to take a look at.
  48. Use this for evidence-based 7-step process for developing an infrastructure of wellness in your workplace #wcewb14 http://www.mass.gov/eohhs/docs/dph/mass-in-motion/worksite-wellness-toolkit.pdf 
  49. Next up was another case study from Bon Secours -- Say What? How the Right Game Plan Doubled Program Engagement. It was presented by Meghan Melvin from Bon Secours, Anne Marie Ludovici-Connolly from AMLC Consulting and Keith McMullin from Health Diagnostic Laboratory
  50. Day Two began with Jeremy Nobel from the Northeast Business Group on Health presenting Employers and Coalitions -- Catalysts for Change in Health Care. I just joined theMid-Atlantic Business Group on Health here and I've already met some interesting folks. 
  51. 55% of individuals in US obtain health insurance through employers. #WCEWB14
  52. Most of health care is regional. Coalitions can act as a convener to bring people together and think about the future together.#WCEWB14
  53. He also mentioned the Choosing Wisely campaign that I'm a big fan of. I particularly like the piece -- 5 Questions to Ask Your Doctor
  54. Good resources for employers -- Choosing Wisely | An Initiative of the ABIM Foundation #wcewb14  http://www.choosingwisely.org/ 
  55. I was up next to share an ASHA case study -- Use Your Organization's Size and Unique Culture to Positively Impact Your Employees' Well-Being. Here are some of the resources I mentioned.
  56. I also talked about using Airbo to share information with our staff and invited people to use the Healthcare Savvy board I created.
  57. inside workplace wellness: more about our Mediterranean Diet Challenge #wcewb14  http://www.insideworkplacewellness.com/p/30-day-challenge.html 
  58. And with a nod to @carolharnett a #fail story on inside workplace wellness: Wellness Program #Fail #wcewb14 http://www.insideworkplacewellness.com/2013/05/fail.html 
  59. inside workplace wellness take on a must read: 9 Lessons for Longevity from The Blue Zones by @BlueZones #wcewb14 http://www.insideworkplacewellness.com/2010/09/9-lessons-for-longevity-from-blue-zones.html 
  60. How Safe Are the Hospitals We Use? Using @LeapfrogGroup info to educate our staff.  http://bit.ly/1np1rVQ 
  61. You can learn a lot more about my work at Inside Workplace Wellness. And thanks to Haiku Deck for providing a prize pack for me to give away. 
  62. Lola Chriss from Texas Instruments presented Use Wellness Program Data to Build the Most Appropriate and Cost-Effective Worksite Clinics for Your Organization. 
  63. You can't consider the employee without considering the impact of the employee's family/dependents. #WCEWB14
  64. Nationally more than 15% of large employers offer on-site health clinics. Many expand to include primary care. #WCEWB14
  65. And for the conference finale, Brett Powell from American Institute for Preventive Medicine shared an interesting presentation on generational differences -- Engage the Most Diverse Workforce in History.
  66. Millennials and the World of Work: The Impact of Obesity on Health and Productivity #wcewb14 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868992/ 
  67. He wrapped things up by sharing the fun piano stairs video. If you haven't seen it, take a minute to watch. 
  68. Piano stairs - TheFunTheory.com - Rolighetsteorin.se
  69. There you have it. My first Storify post. It was an interesting two days. I do wish more folks had been tweeting though. It's always interesting to see what captures people's attention. Especially when we're all listening to the same presentations.