Friday, June 29, 2012

Could the Number-Needed-to-Treat (NNT) Empower Health Care Consumers?

Here's an example of how information is
presented on
I've been thinking about the  Number-Needed-to-Treat  (NNT) lately. Dr. Tuckson mentioned it at the Modernizing Healthcare event I attended. Edward Tufte talked about it in a course on presenting data and information that I attended. And, then it came up again in one of the books I'm reading, The Creative Destruction of Medicine, where I learned of

Here's the basic idea as described on the site. "The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person. The concept is statistical, but intuitive, for we know that not everyone is helped by a medicine or intervention — some benefit, some are harmed, and some are unaffected. The NNT tells us how many of each." 

One of our goals is to "Help ASHA staff to be health-conscious consumers." I'd like to empower staff to have conversations with their physicians to better understand the likelihood that they will be helped, or harmed, or unaffected, by a given medication or procedure. Could educating staff about NNT help us achieve this goal? 

Thursday, June 28, 2012

My #SHRM12 Reading List

I've always come home from the SHRM conference with a stack of new books to read and this year was no exception. (They're just on my Kindle and Audible now.) I'm already part way through The Checklist Manifesto: How to Get Things Right. I'd heard about the success of using checklists in hospital settings, but didn't realize the stories came from this book. I'm so glad Teresa Amabile mentioned it during the masters series on Monday. 

Wednesday, June 27, 2012

The Best of #SHRM12

I attended the annual SHRM conference for 16 years in a row. In 2009, our budget was tight at ASHA and I didn't go. The next couple of years, I identified other learning opportunities, but this year I found myself missing SHRM, so here I am at my 17th annual SHRM conference in Atlanta. The conference is pretty much the same as I remember -- lots of interesting sessions to choose from, ridiculously long lines for the restroom, even more ridiculously long lines to get a cup of coffee, and ten minutes in the exhibit hall sends me into sensory overload. The tools are a little better though. I have my iPad and use Notetaker HD to take notes during the sessions. When someone mentions a book I'm interested in, I have it downloaded to my Kindle in less than a minute. (Well, not really less than a minute -- my 3G is about as fast as dial up in the convention center.) Sorry Jenny and Vince -- I do still appreciate the SHRM Store. And, of course, I love connecting with my SHRM friends. 

SHRM is really pushing social media and Twitter, but I haven't been able to get the #SHRM12 tweets to load when I'm in the convention center at all. Of course, I don't blame SHRM for the network being overwhelmed with traffic. Guess that just shows you what avid social media users SHRM folks are. The Hive was a fun idea. The Hive was set up to help attendees receive "actionable guidance from leading social experts, your peers and SHRM about how you can leverage social media to engage employees, attract talent and build your brand." I'll be taking that idea back to ASHA. Maybe something similar would be appreciated by our members. 

I've used Corkulous to compile my "Best of SHRM12 Notes." It's been a fun tool to capture what I want to do and share when I get back to the office. 

ASHA's annual conference will be in Atlanta this year too, so I'm all primed and ready to work to make the experience as good for our members as it was for me. 

Wednesday, June 20, 2012

Our Health Care Data Integration Challenge

I used my favorite new iPad app, Corkulous, to illustrate the data integration challenge I'm trying to tackle. If you have experience with this or with Viverae, InforMed or Allegeant and you're willing to talk with me, please let me know. 

Thanks for introducing me to Corkulous Terry!

Wednesday, June 13, 2012

Dr. Tuckson's Recommended Reading on Modernizing Health Care

Being a bookworm, I decided this part of Dr. Tuckson's presentation deserved a post of its' own. 

Tuesday, June 12, 2012

Modernizing Health Care

I had the good fortune to be invited to participate in a panel discussion on modernizing health care this morning that was sponsored by the Washington Business Journal and UnitedHealthcare. Dr. Reed Tuckson delivered the keynote address. He's a compelling speaker and I want to share some of what I took away.

From The Economist May 3, 2011
Dr. Tuckson shared a graph similar to this. I've seen it before, but always find it shocking. We spend more per capita than any other country on health care yet it doesn't correspond to an increase in life expectancy. Even more shocking, he shared that the U.S. is ranked 43rd in the world in children surviving their first year of life.

Tobacco is still our number one killer. He said 17.3% of people still smoke. 90% of all smokers are hooked by the time they're 18 years old. I didn't find that shocking, but then he told us a little about how the tobacco industry markets to teens -- pink cigarettes, nicotine strips that dissolve on your tongue like Listerine breath freshener, packs designed to look like a bottle of perfume. (I think this deserves a post of its' own in the near future.)

Some other interesting statistics that he shared:
  • 27.5% of Americans are obese. If the current trend continues, 43% of the U.S. populations will be obese by 2018. 
  • 55% of adults report getting no vigorous activity. 32% get no activity at all. 
  • 50% of high cost claimants used lest than $5,000 in care the year before. 

He talked a bit about sensor based data -- digital smart band aids and apps with devices to monitor and track blood pressure. And, he showed us some of the apps UHC has developed. 

He placed a lot of emphasis on evidence based medicine. Another scary statistic, 50% of the time health care is not consistent with science. He shared that there is no correlation between the quality of care and the cost of care. UHC is putting a lot of effort into identifying quality care and steering their insureds to quality providers. He mentioned that UHC is seeing a trend toward businesses requesting smaller, high quality networks. 

Dr. Tuckson talked about how they're working to integrate data and use it to help people make personally appropriate medical decisions. I've been spending a lot of time thinking about data integration lately. Right now UHC has all of our claims and RX data. Lifework Strategies has a lot of biometric data on our staff. But, none of it is in a form I can use. I described what I want to be able to do in response to one of the questions posed to the panel. I want to be able to have one of our partners send a letter to all of our plan participants taking a proton pump inhibitor. In that letter, I want to explain that proton pump inhibitors can effect the absorption of calcium and lead to osteoporosis. Then, I'd like to invite people to a bone density screening we are hosting in the office. There, we can provide additional information to participants and maybe even partner with a supplier like The Vitamin Shoppe to give people coupons for supplements. This is one way I can imagine delivering actionable health care information to help our staff become more health-conscious consumers. (This is one of our goals.)

At one point in his presentation, Dr. Tuckson said, "Trust is key." This couldn't be more true. If I do what I'd like, I expect a small number of folks to be put off, but I believe the majority would be glad to receive the information. We've built our wellness program slowly over many years and I think most staff know we truly care about their health and well-being. 

Dr. Tuckson recommended a number of books to the audience. As a bookworm, I decided this deserved a post of its' own. So, stay tuned. 

I'm grateful to have been included in today's discussion. I enjoyed meeting the other panelists -- Janet Stypula from Orbital Sciences Corporation and John Miller from the MidAtlantic Business Group on Health. Alex Orfinger, the Publisher of the Washington Business Journal, did a nice job of moderating the panel.

We're Not Spending our Money on Wellness

This infograph clearly conveys one of the things that keeps me up at night. I saw this first on Fran Melmed's blog. It was orginally in the Washington Post last Wednesday. There is some debate going on about where the evidence to support the infograph came from, but I still think it's worth sharing. 

If we were to increase our spending on wellness, what should we spend it on? According to this article in the NY Times, not physicals.  

The debate on the Incidental Economist blog -- More about that “what makes us healthy” infographic

Thursday, June 7, 2012

Our Wellness Program Goals

Last month, I posted a draft of our wellness program goals and asked for feedback. Our Wellness Advisory Team and members of the CoHealth Workplace Wellness Community were particularly generous with their time and provided valuable feedback. I've incorporated what I learned below.

  1. Reduce the overall percentage of drug costs to treat health conditions that can be reversed through non-pharmaceutical means. 
  2. Increase the number of staff and their family members completing preventive screenings recommended in Healthy People 2020.
  3. Support staff in their efforts to quit smoking and lose weight.  
  4. Reduce sick days taken by staff. 
  5. Help ASHA staff to be health-conscious consumers. 
  6. Make active living an easier path for ASHA employees. 
  7. Enhance the sense of camaraderie and teamwork among ASHA staff. 
Subject to change as we continue to learn, of course. We're now focusing on our measures and identifying evidence-based behavioral solutions that have been shown to work long-term. 

Thanks to everyone who contributed!

Friday, June 1, 2012

I Think My Vitamix is Making Me Stupid

I used to know that broccoli and chocolate don't go together.

During our Trip to St. Thomas campaign last year, one of my colleagues, Mike Cannon, purchased a Vitamix and embarked on a smoothie adventure. He was beyond enthusiastic about the health virtues of his vitamin packed smoothies. He convinced another colleague, Taniza, and our insurance broker, Mark, to invest in a Vitamix. When my husband recently started talking about getting one, I got onboard and went to Mike for advice.

From: Janet McNichol
Sent: Sunday, April 29, 2012 10:11 PM
To: Mike Cannon
Subject: Smoothies

Is there an easy way to pull up the recipes on your website? Patrick is talking about getting a vitamix and I want to show him some of what you've made.

From: Mike Cannon
Sent: Monday, April 30, 2012 12:18 PM
To: Janet McNichol
Subject: RE: Smoothies

Cool--I highly recommend the 5200 model or the Super 5200. You can get to recipes on the blog by going to the Blog tab and then scrolling down to the Change Your Life in 30 Days carousel. That has about 22 recipes on there (tried to get to 30, but ran out of time). My site has a code where he can get free shipping if he buys one--saves about 25-40 bucks, depending on the model.

From: Janet McNichol
Sent: Friday, May 04, 2012 9:25 PM
To: Mike Cannon
Subject: vitamix

Patrick just ordered a vitamix for us through your link ;-)

From: Mike Cannon
Sent: Sunday, May 06, 2012 8:46 PM
To: Janet McNichol
Subject: RE: vitamix

Hot damn! That's awesome--thanks! You will love it.

From: Janet McNichol
Sent: Friday, May 11, 2012 5:05 PM
To: Mike Cannon

Guess what came today?

From: Janet McNichol
Sent: Tuesday, May 22, 2012 3:11 PM
To: Mike Cannon
Subject: vitamix

I saw this on Pinterest and I’m making it for breakfast tomorrow morning. Really hoping it’s true that you can make broccoli taste like chocolate!

Healthy Chocolate Cherry Bomb

1/4 cup raw, unsalted walnuts (an optional extra step is to soak them in water overnight and rinse them well before using)
2 cups filtered water
1 cup frozen cherries (organic, if possible)
2 cups frozen broccoli florets
1 frozen banana
1 tablespoon cacao powder
1 teaspoon chia seeds
1 tablespoon flax meal
2 large dates, pitted
splash of vanilla extract

Make homemade walnut milk by blending the walnuts and the water in a high-speed blender for one minute. Next, add frozen fruit and remaining ingredients and blend on high until smooth. Serve cold with cacao nibs sprinkled on top.

From: Mike Cannon
Sent: Tuesday, May 22, 2012 3:27 PM
To: Janet McNichol
Subject: RE: vitamix

I’ll be curious to hear how that turns out. I was just thinking about how cauliflower would taste in a smoothie, and broccoli is definitely something I need to add to my diet as well.

I am about to bust into the smoothie I brought today. Want to try some? It’s mega kale and spinach, masked delightfully by apple and berries. Also has chia seeds, maca, wheat grass, kelp noodles, a nanner, and some juices.

I chatted with Tanizia on my way to see Mike. Tanizia gave me some good advice. I was telling her how much I like the Dr. Robek's smoothie from Robeks and that I had duplicated it pretty well. She suggested I make that and then add some greens. 

Mike's smoothie was delicious and refreshingly chilled in his Klean Kanteen. I went back to my desk and ordered two Klean Kanteens.

Undeterred, however, I still tried the recipe above.

From: Janet McNichol
Sent: Tuesday, May 23, 2012 3:11 PM
To: Mike Cannon; Tanizia Holmes-Cragette
Subject: vitamix

I think the Vitamix is making me stupid. I used to know that broccoli and chocolate didn’t go together.

But, I got right back on the horse (or for those of you who know me, I could say bike)....

From: Janet McNichol
Sent: Tuesday, May 24, 2012 3:11 PM
To: Mike Cannon; Tanizia Holmes-Cragette
Subject: vitamix

Berry/apple/banana/kale/flax seed/chia seed/protein powder/bee pollen/pineapple/orange smoothies chillin' in our new Klean Kanteens for tomorrow.

From: Janet McNichol
Sent: Tuesday, May 29, 2012 3:11 PM
To: Mike Cannon; Tanizia Holmes-Cragette
Subject: vitamix

Getting braver with the greens. I especially like the lemony zing sorrel gives a smoothie.

Next up: I want to try green tea instead of juice and water as the liquid. When tomatoes are in season, I'm looking forward to gazpacho and tomato juice from the Vitamix recipe book. I also want to try the Lemon Lime Basil-ade. Doesn't that sound refreshing?

We might just have to start a smoothie club in the office.