Monday, July 25, 2011

7 Trends in Healthcare

While attending UnitedHealthcare's Customer Forum, I made note of some trends that were discussed. Here are seven that I think will have significant impact in the near future. 
Targeted Analytics = Targeted Solutions
  1. Shift toward bundled payment structures like Accountable Care Organizations (ACOs) and integrated delivery systems. Payment structures that focus on value. Value being a combination of quality and affordability.  
  2. Focus on primary care and care coordination. UHC is introducing a plan based on a gatekeeper model in FL. They said they've had requests from customers for it. (Yep, everything old is new again.) I'm still worried about shortages of primary care physicians. Maybe the focus on care coordination will help this issue bubble to the surface nationwide. 
  3. Integrating data to perform predictive modeling -- Targeted Analytics = Targeted Solutions. (I wish this extended to the data customers maintain with wellness providers and other partners, but I think UHC is overwhelmed with integrating all of their own data right now.)
  4. Reaching out to people identified through predictive modeling to minimize avoidable costs by putting personally appropriate interventions in place. UHC focuses on this with their nurseline
  5. Steering insureds to preferred providers and centers of excellence for complex medical conditions. Definitely a win-win proposition. 
  6. Reverse innovation -- This is the term used in the Harvard Business Review article, How GE is Disrupting Itself. It refers to developing products for emerging markets and then distributing them globally. (The opposite of how things have traditionally been done -- developing products for their home market and then adapting them for other markets around the world.) Two product examples, a $1,000 handheld electrocardiogram device and a portable, PC-based ultrasound machine that sells for $15,000. A conventional ultrasound machine was selling for $100,000 and up. These new products have the potential to replace much more expensive technology that is being used in the US. And, it could make tests that are now performed in radiology centers available in doctor's offices. 
  7. Making information accessible through mobile devices. Asusannah fox at Pew’s Internet & American Life Project said, “Information has become portable, personalized and participatory. Once someone has a mobile device, they’re more likely to use the internet to gather information, share what they find and create new content.” UHC had DocGPS to locate network providers when we started working with them. In March, they introduced It allows you to see specific information about your plan; view, fax and email an image of your card; and check recent claims. Then, in April, they introduced OptumizeMe which has a social, gaming focus. Mobile health was the topic of this #co_health tweet chat I participated in recently and a good source of additional information. 

    Friday, July 22, 2011

    St. Thomas Entries -- Rediscovering the love of sports & There's a hole inside of me

    I'm enjoying the diversity of the entries in our St. Thomas program and have permission to share these with you. 
    • One of my colleagues was an athlete growing up, but became a spectator as a mom. Her goal was to rediscover her love of sports and to have more fun. She tried tennis, golf, stand up paddling and trapeze. Next on her list is fencing. Check out this impressive stunt...

    • There's a hole inside of me -- Another colleague used this song to capture the intent of her journey to use creative expression rather than food to fulfill herself. You'll enjoy her blog. She's embarked on what she thinks might be a life-long journey.
    Stay tuned... We plan to announce the winner the week of August 7th.

    Thanks again to our very generous and supportive insurance broker, Mark Sager, for giving us the trip to use as a prize for our wellness program. 

    Tuesday, July 19, 2011

    St. Thomas Entries -- The World Congress of Puddings & Living with RSD: what comes next?

    I laughed, I cried and, I'm totally relieved that I have nothing to do with choosing a winner. The entries for the trip to St. Thomas came in all shapes and sizes today -- a really lovely scrapbook, typed journals, videos and blogs. The one thing they seem to have in common -- the participants already had it in the back of their minds that they wanted to make a change when we announced the contest. The contest turned out to be the right prompt at the right time. (That's one of the things incentives can be good for -- breaking inertia.) 

    I counted 11 entries today. We started with 31 participants. Some dropped out and some decided, that although meaningful, their journeys were just too personal to share. Here's a sampling of what I read last night. 
    • The World Congress of Puddings -- It's sometimes a stretch for me to follow this colleagues wit and quirky sense of humor. The transformation has been stunning though. One day we're discussing the quality of the robes at Johns Hopkins University Hospital, the next a 173 mile ride along the C&O Canal. Behold the power of the smoothie! You'll love this journey and it's guaranteed to make you laugh.
    • Living with RSD: what comes next? -- One of my colleagues started a blog about living with RSD. Reading it made me cry out of frustration. I can totally relate to her need to exercise and her desire to wear cute shoes. I think you'll appreciate her idea of creating a "body budget" when your physical energy is an exhaustible resource just like your bank account. 
    Both these folks plan to continue blogging and I look forward to following their journeys.

    Stay tuned... (I'll be sharing more entries if they're conducive to being shared this way and I have the participants' permission.)

    Thanks again to our very generous and supportive insurance broker, Mark Sager, for giving us the trip to use as a prize for our wellness program. 

    Monday, July 18, 2011

    Debunking Food Labels

    Foraging for a Healthy and Sustainable Meal

    We're planning a bi-annual Green Living event at work. This has me thinking more than usual about what the various food labels mean. I've been trying to create a hierarchy in my mind to inform my purchasing. It's not as simple as it sounds. (I've talked about that before -- 8 Things You Can Do to Combat the Supermarket Paralysis Caused by Thoughtful Eating.)

    The best solution I heard was on a #assnchat Twitter Chat. We were discussing uses for QR codes and @mgallizzi suggested farmers could put them on egg cartons. The link could take you to a webcam where you could see the chickens happily pecking around a shaded farm yard. In the meantime, here's what you can glean from the labels on food.

    • Antibiotic-Free: No antibiotics were administered to the animal during its lifetime, neither to treat nor prevent disease.
    • Cage-Free: A cage-free hen is not necessarily a free hen running around a pasture. Often, cage-free hens are in crowded barns, with little or no access to the outdoors. They often have their beaks cut off in a practice called “debeaking,” because it cuts down on the amount of injuries when they fight each other. They may still be pumped with antibiotics and hormones. In Food Inc., they showed chickens that were "cage-free," but had received growth hormones that caused their breasts to grow so large that their legs couldn't support their weight. 
    • Free-Range or Free-Roaming: U.S. Department of Agriculture definition of these terms in its entirety: "Producers must demonstrate to the Agency that the poultry has been allowed access to the outside." In other words, there has to be a door, and it has to be open at least part of the time. The USDA has not defined the amount, duration or quality of outdoor access. Free-range chickens are typically debeaked, just like the caged kind. 
    • Certified Humane: The birds are uncaged inside barns or warehouses but may be kept indoors at all times. They must be able to perform natural behaviors such as nesting, perching, and dust bathing. There are requirements for stocking density and number of perches and nesting boxes. Forced molting through starvation is prohibited, but beak cutting is allowed. Compliance is verified through third-party auditing. Certified Humane is a program of Humane Farm Animal Care.
    • Grain-Fed: Animals raised on a grain diet which might have supplements in it.
    • Grass-Fed or Pasture-Raised: Animals that graze on pasture, eating grasses and no other supplements. There have been studies that show that grass-fed animals are healthier to eat. Compared with commercial products, they offer you more "good" fats, and fewer "bad" fats. They are richer in antioxidants; including vitamins E, beta-carotene, and vitamin C. Furthermore, they do not contain traces of added hormones, antibiotics or other drugs.
    • Organic: Birds are uncaged inside barns or warehouses, and are required to have outdoor access, but the amount, duration, and quality of outdoor access is undefined. They are fed an organic, all-vegetarian diet free of antibiotics and pesticides, as required by the U.S. Department of Agriculture's National Organic Program. Beak cutting and forced molting through starvation are permitted. Compliance is verified through third-party auditing. Obtaining the certification is expensive. Some small farms practice organic farming, but do not have the certification. 
    • Natural: A product containing no artificial ingredient or added color and is only minimally processed. Minimal processing means that the product was processed in a manner that does not fundamentally alter the product. The label must include a statement explaining the meaning of the term natural (such as "no artificial ingredients; minimally processed").
    • No Added Hormones: I've read that hormones are not allowed in raising hogs or poultry.Therefore, the claim "no hormones added" cannot be used on the labels of pork or poultry unless it is followed by a statement that says "Federal regulations prohibit the use of hormones." The term "no hormones administered" may be approved for use on the label of beef products. Honestly, I'm confused by this given what I saw in Food Inc. Wasn't it hormones that were given to the chickens that caused them to grow so unnaturally that their legs couldn't support their weight?
    • Vegetarian-Fed: Cattle and poultry that have not been fed any animal by-products, supplements or additives, which are commonly used in factory farm situations. This label does not have significant relevance to the animals' living conditions.
    I'm sure there's much more that could be said about these and other labels, so please chime in. And, if someone can explain the whole added hormone thing to me that would be great. 
    For my family, I just placed my first South Mountain Creamery order for dairy and meat. The products are not organic, but they seem to be trying to do things right and milk just tastes better from an old fashioned glass jar.

    Monday, July 11, 2011

    Healthy Mind Healthy Body = Zero

    When I was at the UHC Customer Forum, they gave us each a report with some employee engagement metrics. We did reasonably well on the adoption of with 75.32% participation, but not so well on the measure of Healthy Mind Health Body subscribers with a big fat zero. Hmmm, I wonder if that could be because I haven't told anyone about it?

    Healthy Mind Healthy Body is a unique health and wellness newsletter because subscribers can personalize the content by choosing topics of interest. It's an interesting, easy to read publication and it's free. To subscribe:
    • Go to:
    • Select UnitedHealthCare and enter your email address
    • Enter our group ID number (It's on your card.)
    • Choose how you want to receive the newsletter -- monthly by email and/or seasonal print issues
    • Choose the topics of interest to you
    • Watch for an email from uhcenews and click through the link to confirm your subscription (If you do not receive it right away, check your junk email folder.)
    Honestly, I had not told anyone about this newsletter because I didn't know it existed. I discovered a lot of new things during the customer forum and I'm sure there is still more for me to uncover. UHC has 25 different websites. I was overwhelmed by the number at first, but then I started to think of UHCs offerings like our flexible work options. We have flextime, telecommuting, compressed work weeks, flexplace etc... You can't avail yourself of all the arrangements simultaneously. People need to pick and choose what fits best. And, that's what I need to do with UHC. Try to familiarize myself with what they offer and share what seems most meaningful for us.

    Tuesday, July 5, 2011

    Staff Survey Feedback Related to Health and Wellness

    We recently conducted a staff survey that included some open ended questions about our benefits. Like most folks, I honed in on the negative feedback and I'm looking for opportunities to address the concerns people raised. It was the impetus for my recent post about our vision benefits and a response to a question about the cost of our fitness program in our weekly staff e-newsletter. Then, I got to thinking that this blog gives me a platform for being very direct. So, here's what I heard and what I wish people understood.
    • Choice of UnitedHealthCare (UHC) - We didn't choose UHC because the coverage was cheaper. Guardian is no longer in the health insurance business, so we had to find a new carrier. We went through a very structured decision making process to identify the carrier that would best meet ASHA's needs. I shared details of the selection process in this post
    • Prescription drug coverageFor many years, we had a very liberal pharmacy benefit -- no insurance companies offer plans with a 90 day supply of maintenance medications via retail or mail order pharmacy for one copay currently. This year we moved our insurance to UHC and many of us have found the pharmacy benefit more restrictive and more costly. I talked about it and shared some tips on how to save money on prescription drugs in this post. 
    • Vision coverage - I appreciate hearing feedback about our new vision coverage with UHC. I've learned that UHC focuses on getting large box stores in their network and ASHA staff tend to favor seeing individual practitioners, so this coverage might not be the best fit for us. Please continue to share your experience and we'll consider making a change for 2012. More details here
    • Fitness class cost - Study after study shows that healthy work environments benefit an organization’s productivity and bottom line.  Workplace wellness programs that address lifestyle changes and promote health demonstrate clear returns on investment. The American Journal of Health Promotion estimates that employers can realize a return as high as $4 for every $1 invested in their employees’ well-being. I just heard a recent SHRM study showed an even higher return of $6 for every dollar spent. In reality, a very small percentage of the money ASHA spends on healthcare is allocated toward wellness and an even smaller portion to our on-site fitness program. The staff that participate in the classes defray a lot of the cost. And, we all benefit when our population is healthy because it keeps all of our healthcare costs down. (56 staff members or 22% of the staff are currently taking at least one class per week.) This article in yesterday's Washington Post, Corporate fitness programs survive hard times talks about the trends and ROI of workplace wellness.
    • St. Thomas trip - ASHA did not pay for the trip to St. Thomas. It was a gift from our very generous broker, Mark Sager. You can learn more about it here
    • My time - I'm passionate about health and wellness and I spend a lot of my personal time reading, writing, planning and networking about it. I guess from the outside it looks disproportionate and frankly it is. I definitely don't spend my free time reading up on unemployment hearings, responding to subpoenas and such... I know it sounds a bit pollyannaish, but I really do care about my colleagues at ASHA and that's a huge motivator for me. On a related front, I enjoy many of the fitness classes, but they're not designed for my personal benefit. Many are the result of requests from staff. For example, Diane Paul suggested our new TRX class. Personally, my focus is on training for my first triathlon right now.
    There was some positive feedback too. For example, this comment, "Excellent benefits: health insurance, wellness program, disability, annual and sick leave, flextime, flexplace, telecommuting, paying for professional development, computer loan program. The exercise program is one of the best benefits and I think it's contributed to my overall better health and appreciation for work and life. It's great that ASHA supplements the classes. Keep it going!" It's feedback like this that does keep me going.