Consumer-driven health plans, workplace wellness, a rising demand for provider quality data, Medicare Part D implementation and the threat of an influenza pandemic were just some of the issues demanding the attention of the healthcare industry in 2006. Which of these topics will continue to consume the healthcare executive, and which new challenges await the industry in 2007?In "Healthcare Trends & Forecasts in 2007: Performance Expectations for the Healthcare Industry," a special report based on a September 2006 audio conference sponsored by the Healthcare Intelligence Network (HIN), Peter Kongstvedt, M.D., F.A.C.P., shares his assessment of current and emerging trends that will impact the healthcare industry in 2007. Dr. Kongstvedt is a partner in the Health/Managed Care Consulting Services Practice at Accenture.This special report, "Healthcare Trends & Forecasts in 2007: Performance Expectations for the Healthcare Industry," also examines the responses of more than 150 healthcare organizations to a September 2006 online survey on the current and future state of the healthcare industry.Table of Contents * The State of the Healthcare Industry: Looking Back and Planning Ahead o Defining Present and Future Drivers of Healthcare Costs o Renewing the Focus on Wellness o Care Management's Emphasis On Modifiable Chronic Conditions o The Link Between Evidence-Based Medicine and Pay for Performance o Factoring In Administration Costs a Given o Integrating Disparate Functions into the Equation o The Effect of the Decreasing Commercial Lives Pool o Organic Growth Ideas: Grow Core Business, Launch New Niche Products o Suggestions for Expanding Ancillary Products o Inorganic Growth Considerations: Mergers & Acquisitions Lead to Market Consolidation o Implications of Current and Emerging Trends o Giving Consumers Data While Respecting Privacy o Regional Health Information Organizations o Electronic Health Records o The Impact of the Uninsured * HIN Survey Results: Industry Growth, Optimism Tempered by Budget, Staffing and Regulatory Constraints o Renewed Focus on Wellness Is Boon for DM Vendors o Health Plans Holding Steady o Uncompensated Care, the Uninsured Top Hospitals Concerns o Physicians Cautiously Optimistic o How Employers, Industry Service Providers Fared o New Ventures in 2006 * Q&A: Ask the Experts o The Effect of Measuring Patient Satisfaction o The Importance of the Second Sale" o On the State of Primary Care o Moving Toward Horizontally Integrated Disease Management o Extending Coverage for Dependents through Age 30 o Addressing the Problem of the Uninsured o Harnessing the Power of Health Risk Assessments * For More Information * Glossary * About the Author
One of the greatest roadblocks to effective disease management is getting patients to comply with doctors'' orders. By using a combination of technology and psychology, healthcare providers, health plan administrators and employers can work to modify patients'' behaviors to optimize disease management outcomes. But to be successful, these programs require active patient engagement that emphasizes self-care, self-monitoring, and self-education. In short, programs that empower and motivate members to participate in their own healthcare. But how do you get patients to invest in themselves? In this special report, "Modifying Patients'' Behaviors to Optimize Disease Management Outcomes," based on two recent audio conferences, expert speakers described results-oriented strategies that healthcare organizations can use to bring about the appropriate attitude and behavior adjustment in patients. You''ll hear from Richard Citrin, Vice President of Health and Productivity at Corphealth Inc., Gregg Lehman, President and CEO, Gordian Health Solutions, Michael Montijo, MD, MPH, FACP, Senior Vice President, Government Relations at American Healthways, Fred Navarro, President and Founder, PATH Institute, Scott Smith, MD, Vice President and Chief Medical Officer, First Health and Sean Sullivan, President and CEO, Institute for Health and Productivity Management on theories, application and results of behavior modification and patient engagement strategies. This report is based on the July 28, 2004 audio conference "The Role of Behavior Modification in Disease Management: How You Can Maximize your Program''s Effectiveness" and the November 3, 2004 audio conference "Patient Engagement Strategies in Disease Management" during which Citrin, Lehman, Montijo, Navarro, Smith and Sullivan described which strategies healthcare organizations are using to modify behaviors to increase the effectiveness of disease management programs and strategies that are most successful at engaging members in disease management programs. You''ll get details on: -Effective tools for behavior modification; -Using technology to impact behaviors; -Getting physicians on board with disease management programs to help effectiveness of programs; -Recruiting patients into disease management programs; -Patient profiles that indicate a willingness to change; and -The real story on incentives. Table of Contents Health and Productivity Management Go Hand in Hand -Payoffs of Preventative Maintenance -Managing Health, Disease and Disability -Average Hours Lost Per Week From Health Problems -Modifying Physician Behavior -Work Limitations Questionnaireй Sample ItemsMaximizing the Effectiveness of a Behavior Modification Program -Changing the Emphasis to Prevention -The Burden of Chronic Illness in America -Population Risk Statistics -Empowering the Patient -Increasing a Health Coachs Credibility Quotient -Healthcare Consumerism on the Rise -Measuring the Value of IncentivesPatient Profiles Indicate Readiness to Engage in Healthy Behavior -Archetype Profiles -Identifying Archetypes -High-Risk Archetypes -Focus of Disease Management Interventions -Gauging Propensity to Learn -Gauging Likelihood to Engage in Healthy Behaviors -Health Priorities and Their Relationship to DM Fitness -The Power of PersuasionStrategies to Engage Patients in Disease Management Programs -Enrollment vs. Engagement -Mailings as Marketing Tools -Cold Calls vs. Clinical Calls -Program Accountability -Best Time of Day for Engagement -Engagement Maintenance -Incentives and OutcomesThe Payoff of Proactive Patient Engagement Strategies -First Healthо Care Support Program -Maximizing Consumer Engagement -Effectiveness of High-Touch ApproachBehavior Modification: Theories and Practice -Health Perception Theory: Brenda Lyon -Phases of the Change Experience -Health Belief Theory: Irwin Rosenstock -Planned Behavior Theory: Icek Ajzen -Studying Effect of Opt-Out vs. Opt-In Approaches -Scaring Off Members with Fear AppealsQ&A: Ask the Experts -Recommended Timeframes for Follow-Up -Transplant Patient Retention Issues -Calculating and Evaluating ROI -The Media and Disease Management -Determining Optimal Case Loads -Role of In-House Medical Directors -Coaching the Health Coach -Grading Effective Educational Materials -Behavior Modification for Specific Diseases -Rating Physician Behavior -Participant Challenges as Motivators -Management Support for Prevention Programs -Assessing Readiness to Change
Thirteenth in HIN's Disease Management Dimensions series! The greatest roadblock to effective disease management programs is often the patients themselves. In the spirit of consumer-driven healthcare, health plans and providers are asking patients and members to accept responsibility for behaviors that impact their health. Disease management efforts and health coaches target individuals with unhealthy habits, but frequently encounter resistance. In "Narrowing the Health Perception Gap: Coaching to Change Behavior and Raise Self-Efficacy," a 35-page special report based on a July 2005 audio conference sponsored by the Healthcare Intelligence Network (HIN), HIN's contributing authors delve into the field of behavior modification and suggest techniques health coaches and disease management specialists can employ to motivate clients and patients to adopt healthy lifestyles. In this special report, Dr. Rick Botelho, professor of family medicine, URMC Family Medicine Center, Dr. Richard Citrin, vice president, integrated care management, Corphealth Inc. and Michael Thompson, principal with PricewaterhouseCoopers, shed light on theoretical models, industry trends and personalized approaches as keys to sustain lasting behavioral change. Note: Receive additional savings on this resource when you order it as part of the three-volume "Health Coach Collection," a related item shown below. Table of Contents Moving Toward Holistic Health -Population Health Management -Organizational Learning and Lifestyle Change An All-Encompassing Field -Theories of Behavior Modification -A Multi-Dimensional Approach -Strategies That Work Vision for the Future -Expanding the Possibilities -The Old-New Paradigm -The Uncertainty Principle -A Lifelong Learning Process -Motivational Practice and the Six Steps -Putting Principles into Practice -Sustaining Health Behavior Change Q&A: Ask the Experts -Getting Members to Call Back -Empowering the Patient -Stepping it Up -Addictive Case Management -Trends in Weight Management -Participants Take the Floor Glossary For More Information About the Authors
Providing a comprehensive overview of the current and future uses of Artificial Intelligence in healthcare, this Advanced Introduction discusses the issues surrounding the implementation, governance, impacts and risks of utilising AI in health organizations. Analysing AI technologies in healthcare and their impacts on patient care, medical devices, pharmaceuticals, population health, and healthcare operations, it advises healthcare executives on how to effectively leverage AI to advance their strategies to support digital transformation.
-A powerful component of a health plans disease management toolkit is the Health Risk Assessment (HRA), which evaluates the populations health status and targets actionable programs to address identified risks. Implementing effective HRAs and mining the resulting data is a strategic means of harnessing healthcare costs and promoting consumer awareness. -In this special report, Mining Health Risk Assessments for Richer ROI and Results, HINs expert panelists explore the progressive evolution of HRAs. Gregg Lehman, PhD, president and chief executive officer, Gordian Health Solutions, Marlene Sigwalt, RN, MSPH, clinical consultant, Innovation Center, Humana, Inc., and Yan Zhang, research scientist, Humana, Inc. provide procedures, objectives, predictive capacities, consumer engagement strategies and results of these tactical questionnaires to identify risk before it becomes reality. -Youll also get case studies on the HRA programs at HealthAtoZ, Blue Shield of California and Aetna. -You'll get details on: -Evolutions in the HRA market; Risk stratification in the HRA; Ideas to incent HRA participation; Strategies for engaging physicians in the HRA effort; Case study of HRA implementation; Anatomy of Humana's in-house HRA development effort; Using HRAs to probe productivity; How an incentives program at Blue Shield of California cut claims cost in its first year; and Stratifying your population to identify next years high-risk population.-Table of Contents -HIN Survey Finds HRAs First Line of Defense in Population Health Management -Evolutions in the HRA Market -The Market Position -HRA Evolution -The Gordian HRA Model -Selective Branching Critical -Sample Online Questionnaire -HRAs as a Screening Tool -Risk Stratification in the HRA -Sample Health Risk Profile -Creating HRA Profiles -ROI in Population Health Management Strategies -DM Programs Yield Greatest ROI -Measuring Outcomes -The Human Condition -Lifestyle Incentive Programs -Ideas to Incent HRA Participation -Getting Physicians Involved -Healthcare Faces a Chronic Challenge -Chronic Care: The Burden of Illness-Same Time, Next Year: HRAs Help Rescue Risk Pool Drifters -Fine-Tuning the Message from the C-Suite-Getting What You Pay For: Cash Incentives Cut Claims Cost in First Year -Sample Questions from Blue Shield of California's HRA -Lessons Learned-On the Horizon: Using HRAs to Probe Productivity -Voluntary HRAs and Tempered Use of Incentives Is Best Strategy-Humanas Home-Grown HRAs: Anatomy of In-House Development -Humanas Health Management Strategy -HRA Application Architecture -HRA Process Flow -Sample HRA Results Screen -A Sample Population Rates the HRA -Going Forward -A Look at Satisfaction Ratings-Q&A: Ask the Experts -Dissecting the ROI -Keeping It Simple -Multiple Populations and the HRA -Determining Appropriate Interventions -Age-Related Concerns -Promoting Physician Engagement -Data Sharing and Application -The Movement to Standard Practice -Individual Impacts in PHM Analysis -The Role of Health Coaches -Member Qualification for Intervention -Match Case-Control Groups-Glossary -For More Information -About the Authors
Just teaching patients not to call their doctor at 4:30 on a Friday afternoon can reduce unnecessary emergency department (ED) utilization, a trend that is sapping the resources of EDs around the nation. According to the National Center for Health Statistics, 55 percent of the 90 million visits to EDs in the United States in 1996 were unnecessary. In healthcare dollars, that means that 40.5 million people paid up to three times as much for routine care at the ED as they would have paid at a physician?s office. Teaching timely access to outpatient care is just one tactic covered in this special report, which is based on an October 2006 audio conference sponsored by the Healthcare Intelligence Network (HIN). For Emergency Use Only: Curbing Unnecessary Emergency Room Use Through Education, Accountability and Physician Engagement provides a blueprint for health plans, hospitals and providers desiring to address and reduce unnecessary ED utilization in their populations. In this 35-page special report, Roberta Burgess, clinical case manager, Community Care Plan of Eastern Carolina, and Gerald Kiplinger, vice president and executive director of the Georgia Enhanced Care program for APS Healthcare, detail how to target and reduce unnecessary and inappropriate ED use. You'll get details on initiatives and interventions for decreasing non-urgent ED use, mining data to target high-utilization, high-cost individuals, implementing an ED case management program, communicating proper ED use to targeted populations and enlisting physicians' support in care redirection and appropriate ED use. Table of Contents Redirecting Care to Appropriate Settings -Types of Care and the Costs of Chronic Illness -Opportunities to Redirect Care to Appropriate Settings -The Role of Referral Agencies and Support Services -Increasing PCP Access To Reduce Emergency Care Visits -Call Centers Serve Multiple Purposes -ED Reductions a Side Effect of Healthy Together! DM Program Goodbye Emergency Room, Hello Primary Medical Care -Defining an Emergency -Profiles of Serial Users and Frequent Fliers -Benefits of Partnerships with Community Organizations, Providers -Communication Via Toolkits, Outreach and Self-Management -Mining Reports to Target High-Utilization, High-Cost Individuals -Case Management That Meets the Client in Their Environment -Motivating Physicians to Help -Removing the Stigma of Case Management -Making All Players Accountable Q&A: Ask the Experts -Determining When Screenings are Billable -ED vs. Urgent Care Facilities -The Advent of ?Minute Clinics? in Retail Space -Case Manager Work Schedules and Case Loads -Models for ED ?At-the-Door? Screening -Making the Case for Urgent Care Centers -Redirecting Patients to Lower Levels of Care -Costs for Running the ?Healthy Together? Program -Dissecting Diabetes Results in ?Healthy Together? Effort -Enlisting Providers? Support for ED Redirection Efforts -Referral Turnaround Times -Responsibilities of the ED Case Manager -Monitoring ED Visits Related to Drug Interactions -Statewide DM and CM Efforts -Future ED Redirection Initiatives -Benchmarks for ED Utilization by Population -Analyzing ED Visits by Type of Coverage -Investigating FQHC-Hospital ED Partnerships Glossary For More Information About the Author
To deflect the cost of chronic care, the scope of healthcare has broadened to embrace prevention. Using a variety of tools and methodologies, more healthcare organizations are striving to pinpoint that population poised for or in the midst of a health crisis and then attempting to slow or prevent complications. This special report, Health Risk Stratification: Targeted Tools and Methodologies to Prevent Illness and Improve Health, profiles the efforts of two organizations who have successfully identified high-risk members and patients and aligned appropriate interventions.In separate case studies, Health Risk Stratification: Targeted Tools and Methodologies to Prevent Illness and Improve Health chronicles the paths of two healthcare organizations seeking to identify health risk factors in their respective populations and develop policies and outreach to put these individuals on the road to better health. With a special focus on the challenges of connecting with Medicaid enrollees, this 38-page special report highlights the essential role of the health risk assessment (HRA) tool in pinpointing the health status of employees and health plan members.This 40-page report is based on contributions from Thomas Ferraro, business development director with Mayo Clinic Health Management Resources, and Penelope Kokkinides, national vice president of disease management with AmeriChoice, a United Healthcare Company, who presented at a HIN audio conference in August 2006.PLUS this report contains a detailed analysis of the more than 200 responses to HIN's 2005 online survey on the use of HRAs by health plans, employers and healthcare providers.You'll get details on: * Identifying health risk factors in populations and mapping risks to interventions; * The special challenges of engaging the Medicaid population; * Post-HRA interventions to promote health; * The incentive debate -- whether carrots or sticks motivate individuals to participate; * Collecting, analyzing, integrating and storing HRA data; * Interacting with HRA and disease management vendors; * The impact of HRAs on more than 200 healthcare organizations who use them -- employers, health plans and providers; * and much more. Table of Contents * Strategies for Identifying and Referring the Appropriate Service and Intervention o Four Key Drivers of Participation o Matching Risk Factors to Interventions o The Role of Campaigns o The Coaching Continuum * Utilizing Health Risk Assessment Data to Target and Identify Members at High Risk for Chronic Disease o Additional Challenges of the Medicaid Population o The HRA Process at AmeriChoice o Time Constraints and Frequency of HRAs o Internal HRAs Yield the Best Results o Identifying Unnecessary Emergency Room Utilization o The HRA Engagement Process o Targeting, Stratifying and Referring Members o Vendor Interactions o Key Program Factors * HIN Online Survey Results: How the Healthcare Industry Identifies Risk Before It Becomes Reality o A Tool for All Trades o Incentives Boost Participation o Mining Data for ROI o Lessons Learned o Moving Forward * Q&A: Ask the Experts o Storage Formats for HRA Data o Analyzing Higher Response Rates for Home-Grown HRAs o Coach Contact Frequency and Caseloads o Integrating HRAs with Other Data o Optimal Length for an HRA Questionnaire o The Effect of the Medium on the HRA o Reducing Inappropriate ER Utilization o Acquiring NCQA Certification o Carrots or Sticks: Incentives That Get Results * Glossary * For More Information * About the Authors
One of the primary goals of the Health Insurance Portability and Accountability Act (HIPAA) was to simplify administrative processes in the healthcare industry by requiring the use of standardized electronic transmission of administrative and financial information. The regulations requiring adoption of specific security and privacy standards apply to all healthcare providers, health plans and healthcare clearinghouses who transmit and store health information electronically. Covered entities must have sufficient protections in place to ensure the security and confidentiality of patients health records during storage and transmission. In HIPAA Security Auditing: How To Create a Consistent, Repeatable and Documented Program, a special report from the Healthcare Intelligence Network, youll get a step-by-step guide to developing, implementing and refining a HIPAA security auditing program. Youll get advice from two leading industry experts, Chris Apgar, CISSP, Principal, Apgar & Associates and Mikel Lynch, Director of Corporate Compliance for University of Missouri Health Care on the key components of an audit program to ensure HIPAA security compliance by the April 2005 deadline. This report is based on the September 21, 2004 audio conference on HIPAA Security Auditing, during which successful approaches for security audits were discussed. Youll get: -17 crucial elements to consider for project management and implementation; -details on how to overcome compliance challenges; -how the 50% rule applies in auditing -how to position audits as a management tool -an in-depth case study of the University of Missouri Health Care auditing program -an 18-point checklist for implementing an audit program -how to audit your audit program -auditing and technical safeguardsTable of Contents Why Audit? -Rules and Regulations -Protected PaperworkBuilding an Audit Program -Audit Program ConstructionAudit Programs Project Management -Project Management and Program Implementation -Legacy Systems -Keep It Coming-Authority and Responsibility Overcoming Challenges to Compliance -Compliance Challenges -The 50% Rule -Self-Funded Plans -Word of Warning Audits As a Management Tool -Auditing Is a Tool That...CASE STUDY: Three-Dimensional Auditing -Random Audits -Targeted Audits -Universe for Targeted Audits -Targeted Auditing and Staffing -Performance Report CardImplementation Considerations -Points to ConsiderSecurity Issues -Controls and CostsPrivacy Issues -Faxed PHI -Patient QuestionsAuditing Your Audit Program -Reasonableness Test -Point to Note Technology Considerations -Funnel Vision -Strong PasswordsTechnical Safeguards -System Down -Network Monitoring Access Considerations -Access IssuesThe Clock Is Ticking Final Comments
Web technology is touted as the antidote to a multitude of healthcare woes: rising consumer dissatisfaction, increasing consumerism and ever-escalating healthcare costs. But for consumers to embrace e-health tools, health plans and employers must entice them with a healthy mix of autonomy and handholding. In this special report, "e-Health Initiatives: Driving Behavior Change and Fostering Consumerism," a panel of experts discusses state-of-the-art healthcare e-tools, strategies for engaging members to use them and the impact e-tools can have on consumer-driven plans. You'll hear from Kim Bellard, Vice President of eMarketing, Highmark Inc., and Erin Lenox, Associate, Hilb, Rogal and Hobbs, on strategies for harnessing the power of e-tools that enable consumers to collaborate in their own healthcare design. This 37-page report is based on the January 19, 2005 audio conference "Using Web Technologies in Consumer-Driven Healthcare" during which Bellard and Lenox described how healthcare organizations are utilizing the web in consumer-driven healthcare plans. You'll get details on: -The role of web applications in consumer-driven healthcare; -Evolving trends in consumerism; -Web tools that can assist consumers in behavior change; -The 10 key technological components of a healthcare web site; and -The e-health options from Highmark Inc. Table of Contents Using Web Technologies in Consumer-Driven Healthcare -Moving Toward Consumerism -Key Technological Components -Going from High-Tech to High-Touch -Evaluating the Credibility of Web-based Health Information -Examples of Online Tools -The Future of e-Health Initiatives -Build, Buy or Partner -Evolving TrendsIn Electronic World, Informed Consumers Drive Marketplace -Highmarks Consumer-Centered Strategies -Breadth and Depth of Information Critical -Website Health Centers Target Specific Demographics -Provider Profiles Encourage Comparisons, Choices -Informing Consumers Health Plan Choices -Increased Choice Improves Customer Satisfaction -Diverse Approaches Serve Diverse Needs -Spending, Savings Accounts on RiseQ&A: Ask the Experts -Strategy for Developing Web-based Tools -Rating Online Tools -BlueChoice Growth Predictions -Front-end Administration vs. Back-end Ease -Integrating with Pharmacy Benefits -Making the Move to e-Visits -Determining ROI -HIPAA's Impact on Web Self-Service Applications -Recommended e-Tools for Employers -Comparing Provider Pricing
Consumer healthcare toolkits are critical to drive behavior change and empower consumers. Healthcare toolkits encourage consumer advocacy through interactive approaches. By teaching self-awarenesss and skills to reliably assess personal health, toolkits promote responsible treatment decisions. In this special report, "Healthcare Toolkits: Empowering Consumers Through Education," HIN's panel of experts described the ways healthcare organizations can capitalize on today's consumer-driven healthcare environment by using healthcare toolkits to promote awareness and generate positive returns on investment by helping consumers help themselves. You'll hear from Erin Lenox, associate, Hilb Rogal & Hobbs, Tracy J. Mungeam, managing consultant, Hilb Rogal & Hobbs, and John Mills, director, product development, HIP Health Plans, on how the movement toward consumerism is driving the adoption of healthcare toolkits and how organizations are benefitting from the implementation of various toolkits. This 40-page report is based on the June 15, 2005 audio conference "Consumer Health Toolkits: Providing the Right Tools at the Right Time to Empower Consumers" during which Lenox, Mungeam and Mills described the types of toolkits that healthcare organizations are using, their organizations' initiatives and program results. You'll get details on: Which toolkit development -- inhouse or outsourced -- experts prefer for their organization; How to educate employees on consumer-driven healthcare; How a multi-faceted approach to educating consumers can have multiple advantages; Driving adoption -- six ways to promote consumer awareness; and How healthcare toolkits will be evolving in the future. Table of Contents Consumer-Driven Healthcare: The Fundamentals The Movement Toward Consumerism Crunching the Numbers Some Statistics on Healthcare Costs Expanding the Role of Employers Driving Behavior Change The Basics of Consumer Health Toolkits Web-based Toolkit: myuhc.com Consumer Health Toolkits Overview Cost/Quality Data from a Toolkit A Look at a Live Nurse Line Toolkit Use in Disease Management Tookit Content and Outsourcing Recent Innovations in e-Health Cost Savings Tied to Members' Behavior Change Accepted Methods of Measuring Toolkit ROIConsumer Health Toolkits: Supply and Demand Multi-faceted Approaches, Multiple Advantages Sample Healthcare Cost Calculator Consumer Empowerment Driving Adoption Driving Adoption of Health Toolkits Results, Returns and Customer ResponseQ&A: Ask the Experts Employee Education In-house vs. Outsourced Toolkit Development A Big Job For Small Companies Frequently Used Tools Trends in Utilization Site-Secure Tools Improving HRAs Impact of Cost Transparency Risk Assessments and HIPAA Regulations Reaching the Technologically Challenged Educated Patients and Their Physician Provider Education Engaging Extrinsic Interest In-house Incentives Getting Member Feedback Driving Adoption of Consumer Health Toolkits
With 60 percent of adult Medicaid enrollees afflicted with a chronic or disabling condition (most commonly diabetes, hypertension, asthma, psychoses and chronic depression), and nearly half this group suffering from a second condition, this population is in critical need of a healthy dose of disease management (DM), healthcare industry experts say. The number of DM programs serving Medicaid populations continues to rise as states look to these programs to control Medicaid cost increases.In this special report, "The Medicaid Population: Making a Difference with Disease Management," based on a recent audio conference, expert speakers delve into Medicaid concerns ranging from eligibility and patient engagement to marketing strategies and provider connections as they explain how DM programs can integrate and improve care for those in need.You'll hear from Jerry Kiplinger, executive director, APS Healthcare and Herb Schultz, vice president, government account management, McKesson Health Solutions, on how to serve the unique needs of the Medicaid population in disease management programs.This 46-page report is based on the January 25, 2006 audio conference "Serving the Needs of the Medicaid Population in Disease Management Programs" during which Kiplinger and Schultz provided an inside look at their organizations' Medicaid disease management programs.You'll get details on: * Addressing the challenges of patient enrollment; * Identifying eligible beneficiaries; * Working with public health entities; * Maximizing existing resources; and * Promoting patient engagement.Table of Contents * Case Study: APS Healthcare Advocates Total Health Management o A Multi-Faceted Approach o Care Coordination and Staff Support o A Patient-Centered Program o Overcoming the Obstacles o Creating a Workable System o Influence of Politics o Characteristics of the Medicaid Population o Optimizing Community Outlets * Case Study: Disease Management Making a Difference at McKesson Health Solutions o The Foundation for Effective Programs o Maximizing Existing Resources o Medicaid Models in the States o Serving DM Needs of Medicaid Populations o Interruptions in Medicaid Eligibility o Clinical Indicators in DM Cases o Trends, Outcomes and Solutions * Q&A: Ask the Experts o Expediting the Process o More Members Log On o Determining Eligibility o Medical Homes Promote Continuity of Care o Strategies for Patient Engagement o Developing the Care Plan o The Coach-Client Relationship o Producing and Distributing Provider Toolkits o Seeking Out Specialists o Setting Some Standards o Keeping a Consistent Program o The Reality of Internet Use o The Low-Down on Physician Engagement o Targeting the Aged Population o The Technical Side o Staff Ratios by Program o Marketing Expenses o Using the Nurse Advice Line o Expanding Treatment to Children o Continuing Medical Education o Assessing ROI o Population Parameters o Choosing a Provider Champion o Provider-to-Population Ratios o Assessing Program Progress * Glossary * For More Information * About the Authors
The growth and market adoption of consumer-driven healthcare continues to drive health plans and employers to develop more widespread member and employee health improvement initiatives. Workplace Wellness Case Studies: Tactics To Promote Health and Reduce Risk looks at whats working in health plan wellness and health promotion programsaward-winning and unique efforts, best practices, ROI, and lessons learned. Starting with case studies of health improvement innovations in place at three national health plans, this report then delves into two parallel tactics that are gaining ground among employers: pitting departments against each other in a friendly competition for the healthiest workers and rewarding employees for healthy lifestyle choices. Both the game plan for healthy workplace competition and a profusion of winning ideas for incentives are profiled here. Youll get case studies from some of the pioneers in wellness programming, including American Cast Iron Pipe Company, Excellus Blue Cross Blue Shield, Health Alliance Plan, HealthPartners, Meridian Health System, Texas Health Resources and Washoe County School District. You''ll get details on: Analyzing the outcomes for a program run by Highmark to reverse heart disease; Formatting a wellness team; Designing incentives to increase wellness program participation; Evaluating the payback on wellness programs; Targeting your marketing to multiple audiences; Using health coaches in wellness programs; and Ensuring your wellness program''s compliance with HIPAA.Table of Contents Winning Ideas in Health Plan Wellness and Health Improvement Programs *Case Study: HealthPartners Tackles Risk Factors with "A Call to Change" Anatomy of a Phone Line Program Curriculum Structure Improving Health Step by Step Program Evaluation*Case Study: Health Alliance Plan Goes On-Site to Impact Employee Health Work Site Health Promotion Program Coping With Flu Season Walking for Better Health Purchasers'' Demand for Health Promotion Surges Sharing Best Practices in Work site Wellness Forum "iStrive for Better Health" Program Employer Partner Provides $75 Reward for HRA Completion*Case Study: Mandatory HRAs and Wellness Interventions Reap Rewards for Highmark Blue Cross Blue Shield Employers Division Organization Choosing Interventions Embedding a Healthy Philosophy Into the Product Line HRAs Mandatory for Highmark Employees Outcomes*Healthy Competition: Taking the Team Approach to Wellness The Benefits of Teaming Up at Work Planning and Implementation Incentives Reduce Risk Selling the Program and Making it Work Setting the Price of Participation Real Team Competitions An Optimistic Outlook*Case Study: Meridian Health System Promotes a Healthy and Productive Workforce Changing the Employer Culture "Fit to Win" Weight Loss Program a 12-Week Effort Keep Programs Simple and Entertaining*Case Study: Washoe County School District Gets Good Grades in Health Promotion The Purpose of Wellness Programs: A Deeper Look Programs and Process Generate Progress Reading to Lose Weight, Improve Mental Health The Payback on Wellness Programs Some Encouraging Results*Case Study: Excellus Blue Cross Blue Shield Steps Up Web-Based Wellness Efforts Targeting Marketing to Multiple Audiences Free Step Up Program Open to Members and Non-Members Alike Putting Together a Healthy Competition Measuring Activity, Results and AwarenessIncentives for Healthy Lifestyles Designing Incentives to Boost Outcomes Behavior''s Role in Health Status Incentives Influence Behavior, Corporate Culture Refining Requirements A Bona Fide Wellness Program The Challenges of Sustaining Participation Incentive Programs Behind-the-Scenes A Promising Prognosis*Case Study: ACIPCO Incentives Stimulate Gains in Productivity, Compliance and Safety The Building Blocks of Success Approach to Wellness at ACIPCO Important Indicators Incentive Insight from Experience*Case Study: Onus on THR Employees to "Be Healthy" A Unique Role Strategic Goals and Measurements THR''s Long-Term Strategy Program Vision Impacting the Bottom Line Looking Ahead*Q&A: Ask the Experts More Medical Behavior Integration Incentives for HRA Participation Making HRA Completion Mandatory The Legal Ramifications of Incentives Assessing Readiness for Telephonic Coaching Who''s Online Counseling for Occupational Traumatic Stress Role of Communications in Engaging Employees Employers Reaction to Workplace Wellness Engaging the Workforce Implications of the Selection Process Program Development and Decision-Making Getting on Board with Healthy Competition Programs Looking Ahead Most Effective Communications Tools Getting Participants to Track Their Progress Opening Programs to Non-Members Incentive Program Time Frame Sustaining Motivation Calculating Improvement in Complex Measures Self-Reported Behavior Change Software for Health Screenings Getting into the Wellness Game Employee Coverage Reporting ROI*Glossary *For More Information *About the Authors
Thirteenth in HIN's Disease Management Dimensions series! The greatest roadblock to effective disease management programs is often the patients themselves. In the spirit of consumer-driven healthcare, health plans and providers are asking patients and members to accept responsibility for behaviors that impact their health. Disease management efforts and health coaches target individuals with unhealthy habits, but frequently encounter resistance. In "Narrowing the Health Perception Gap: Coaching to Change Behavior and Raise Self-Efficacy," a 35-page special report based on a July 2005 audio conference sponsored by the Healthcare Intelligence Network (HIN), HIN's contributing authors delve into the field of behavior modification and suggest techniques health coaches and disease management specialists can employ to motivate clients and patients to adopt healthy lifestyles. In this special report, Dr. Rick Botelho, professor of family medicine, URMC Family Medicine Center, Dr. Richard Citrin, vice president, integrated care management, Corphealth Inc. and Michael Thompson, principal with PricewaterhouseCoopers, shed light on theoretical models, industry trends and personalized approaches as keys to sustain lasting behavioral change. Note: Receive additional savings on this resource when you order it as part of the three-volume "Health Coach Collection," a related item shown below. Table of Contents Moving Toward Holistic Health -Population Health Management -Organizational Learning and Lifestyle Change An All-Encompassing Field -Theories of Behavior Modification -A Multi-Dimensional Approach -Strategies That Work Vision for the Future -Expanding the Possibilities -The Old-New Paradigm -The Uncertainty Principle -A Lifelong Learning Process -Motivational Practice and the Six Steps -Putting Principles into Practice -Sustaining Health Behavior Change Q&A: Ask the Experts -Getting Members to Call Back -Empowering the Patient -Stepping it Up -Addictive Case Management -Trends in Weight Management -Participants Take the Floor Glossary For More Information About the Authors
Just teaching patients not to call their doctor at 4:30 on a Friday afternoon can reduce unnecessary emergency department (ED) utilization, a trend that is sapping the resources of EDs around the nation. According to the National Center for Health Statistics, 55 percent of the 90 million visits to EDs in the United States in 1996 were unnecessary. In healthcare dollars, that means that 40.5 million people paid up to three times as much for routine care at the ED as they would have paid at a physicians office. Teaching timely access to outpatient care is just one tactic covered in this special report, which is based on an October 2006 audio conference sponsored by the Healthcare Intelligence Network (HIN). For Emergency Use Only: Curbing Unnecessary Emergency Room Use Through Education, Accountability and Physician Engagement provides a blueprint for health plans, hospitals and providers desiring to address and reduce unnecessary ED utilization in their populations. In this 35-page special report, Roberta Burgess, clinical case manager, Community Care Plan of Eastern Carolina, and Gerald Kiplinger, vice president and executive director of the Georgia Enhanced Care program for APS Healthcare, detail how to target and reduce unnecessary and inappropriate ED use. You'll get details on initiatives and interventions for decreasing non-urgent ED use, mining data to target high-utilization, high-cost individuals, implementing an ED case management program, communicating proper ED use to targeted populations and enlisting physicians' support in care redirection and appropriate ED use. Table of Contents Redirecting Care to Appropriate Settings -Types of Care and the Costs of Chronic Illness -Opportunities to Redirect Care to Appropriate Settings -The Role of Referral Agencies and Support Services -Increasing PCP Access To Reduce Emergency Care Visits -Call Centers Serve Multiple Purposes -ED Reductions a Side Effect of Healthy Together! DM Program Goodbye Emergency Room, Hello Primary Medical Care -Defining an Emergency -Profiles of Serial Users and Frequent Fliers -Benefits of Partnerships with Community Organizations, Providers -Communication Via Toolkits, Outreach and Self-Management -Mining Reports to Target High-Utilization, High-Cost Individuals -Case Management That Meets the Client in Their Environment -Motivating Physicians to Help -Removing the Stigma of Case Management -Making All Players Accountable Q&A: Ask the Experts -Determining When Screenings are Billable -ED vs. Urgent Care Facilities -The Advent of Minute Clinics in Retail Space -Case Manager Work Schedules and Case Loads -Models for ED At-the-Door Screening -Making the Case for Urgent Care Centers -Redirecting Patients to Lower Levels of Care -Costs for Running the Healthy Together Program -Dissecting Diabetes Results in Healthy Together Effort -Enlisting Providers Support for ED Redirection Efforts -Referral Turnaround Times -Responsibilities of the ED Case Manager -Monitoring ED Visits Related to Drug Interactions -Statewide DM and CM Efforts -Future ED Redirection Initiatives -Benchmarks for ED Utilization by Population -Analyzing ED Visits by Type of Coverage -Investigating FQHC-Hospital ED Partnerships Glossary For More Information About the Author
With disease management a hedge against escalating healthcare costs, the health coach is a key player on the team of professionals encouraging health plan members to take charge of their health. Structuring health coaching programs to improve disease management outcomes was the theme of a March 2005 audio conference sponsored by the Healthcare Intelligence Network (HIN). In this special report, "The Role of Health Coaches in Disease and Care Management," HIN's panel of experts described how health plans and disease management companies can best utilize health coaches, who encourage members to participate in a personalized plan that complements a physicians prescribed treatment. You'll hear from Danielle Butin, director of health services at Oxford Health Plans, a United Healthcare company, Kerry Little, senior health coach with Duke University Medical Center and Roger Reed, executive vice president, chief health officer at Gordian Health Solutions on how their organizations have structured their health coaching programs to improve disease management outcomes. This 35-page report is based on the March 23, 2005 audio conference "The Role of Health Coaches in Disease and Care Management," during which Butin, Little and Reed described their health coaching programs and the impact the programs have had on patient outcomes. You'll get details on: -motivating and training health coaches; -health coach responsibilities; -keeping members in health coaching programs; -coaching diverse populations; and -coaching for specific diseases. Table of Contents The Health Coachs Role in Disease and Care Management -Health Coaching and Self-Management in Managed Care -Motivating Health Coaches -Training Health Coaches -Self-Confidence Breeds Self-Efficacy -Transitions-in-Care Coaching Program -Living with Diabetes Self-Management Program -Reducing Chronic Pain Self-Management Program -Options for Living Self-Management Program -Telephonic Coaching for Emphysema PatientsUsing New Models to Transform Healthcare -Coaching a Culturally Diverse Population -Health Coach Responsibilities -Motivational Techniques for Health Coaches -Health Coach Toolkit -Keeping Participants in a Coaching Program -Involving Family in the Coaching Experience -Measuring the Impact of Effective Coaching -10 Tips for Motivating MembersThe Value of Health Coaching to Employers -Gordians Health Coach Model -Components of a Typical 12-Month Intervention -Printed Support Materials -Key Components of the Coaching Call -Health Coach Characteristics -Gordians Health Coach Training -Monitoring Health Coaches Interactions -Health Coach Quality Control ChecklistQ&A: Ask the Experts -Health Coaches vs. Case Managers -Typical Health Coach Schedule and Caseloads -Average Length of Coaching Call -ROI on Coaching Mid-Range Patients -Staffing Ratios in Coaching Scenarios -Cost Structure for Health Coaching -Engaging Participants for Program Duration
A provider-patient language barrier can undermine the quality and accessibility of healthcare for that patient. But cultural misunderstandings can have more subtle consequences. This special report, "Cultural Competency in Healthcare: Translating Differences Into Improved Quality and Access," details educational and communication strategies for leveraging cultural differences to improve the quality and accessibility of healthcare. Representatives from two healthcare organizations detail how their diversity programs are addressing the needs of culturally diverse populations. Also included are first-hand experiences from some of the respondents to HINs recent online survey of cultural diversity efforts in the healthcare industry. You'll hear from Elsa Batica, cross-cultural health development and training manager, Children's Hospital and Clinic (Minneapolis) and Loretta Estes, coordinator, cultural and linguistics services, Passport Health Plan on the development and implementation of the cultural diversity programs at their organizations. This report is based on the May 18, 2005 audio conference "Cultural Diversity in Healthcare: Addressing Differences to Overcome Barriers" during which Batica and Estes provided in-depth details on their respective programs. You'll get details on: -Building an organizational cultural competence environment; -Creating orientation and ongoing training for staff members on cultural sensitivity; and -Addressing the challenges of a multicultural society. Table of Contents Building Organizational Cultural Competence -Developing Relationships with Community Organizations -Top Management Makes Diversity a Priority -Identifying Culturally Competent Knowledge, Skills and Attitudes -Culturally Responsive Employees from Day One -Addressing Language BarriersAssessing Cultural Competency -Cultural and Linguistic Competency in Healthcare -Job Description: Cultural and Linguistic Services Coordinator -Provider Education and Support -Translating Educational Materials -Passport Health Plans Associate Training -Internet-based Staff Training -Cultural and Linguistic Services for Members -Technology and Cultural Competency ToolsAddressing the Challenges of a Multicultural Society -Striving for Diversity -Looking Ahead -Advice from the FieldQ&A: Ask the Experts -Merits of Monthly Celebrations -Recommended Reading Levels for Translated Materials -Population Participation in Program Development -Interpreter Reimbursement and Information -Coping with Conflict -Training, Testing and Toolkits -Becoming a Certified Cultural Diversity Trainer -Educating Vendors -Toolkit Training -Combating Cultural Competence Cop-Outs -Tools and TestsGlossary -For More Information
A leading cause of illness, disability and death among healthcare consumers, chronic disease claims a disproportionate share of costs for the elderly and generates a heavy financial burden on the nation as a whole. Now more than ever, health plans and providers are seeking strategies to balance the healthcare equation. Medicare disease management (DM) programs have emerged to even the odds, and have already demonstrated positive impacts on patients health status and spending.This special report, "Medicare Disease Management: Tactics to Improve Health, Education and Independence in an Aging Population," highlights challenges and opportunities in working with the Medicare population, strategies to close gaps in care, and steps for sustaining system change and improved outcomes within senior care communities.Report contributors Blake Andersen, president, Chronic Care Group, Health Sciences Institute, Pamela Fromelt, vice president of government programs, LifeMasters Inc. and Dr. Randall Krakauer, national medical director, retiree markets, Aetna, provide inside details on how disease management programs can serve the needs of Medicare beneficiaries with chronic conditions to improve their health status, while reducing spending on these conditions.This 41-page report is based on a spring 2006 audio conference, "Medicare Disease Management: Identifying and Engaging the Elderly Population To Improve Chronic Health Status."Table of Contents * Analysis: Demography, Geography and Risk o Bridging Gaps Across Care Settings o The Real Question: Does It Work? o Barriers to Quality Improvement o Applying Lessons Learned * Case Study: LifeMasters Braces for Aging Baby Boomer Impact on Health System o Inside LifeMasters Medicare Programs o A Laundry List of Challenges o Advantages of Working with the Medicare Population o Key Strategies for Success * Case Study: Aetna Identifies Disparities in Senior Care o A Model for Development o Characteristics of the Medicare Population o Creating an Inclusive Program o An In-Depth Look at Medicare Health Support o Staff Ratios for Medicare Populations o Early Results Pave Road to the Future * Q&A: Ask the Experts o Identifying Risk in the Medicare Population o Predictive Modeling Techniques o Strategies for Enrollment and Engagement o The Cost of Medicare DM o Assessment Tools & Techniques o Meeting Consumer Demand * Glossary * For More Information * About the Authors
The healthcare industry?s call for quality service is coming from all sides. Health plans, employers, consumers and even the federal government are leaning on healthcare providers to document the quality of the care they provide. The Centers for Medicaid & Medicare Services (CMS) is now asking for even more reporting. Physicians can now voluntarily self-report adherence to certain evidence-based quality measures to CMS. Given the benefit of confidential feedback, physicians are encouraged to open their practices to performance improvement and apply lessons learned on their own terms.In this special report, "CMS Physician Voluntary Reporting Program: Weighing the Benefits of Participation," based on a recent audio conference, expert speakers explore the role of CMS? Physician Voluntary Reporting Program (PVRP) in the context of healthcare?s pay-for-performance environment. Highlighting industry trends and directions, they tap into their own experiences to explain how physician groups can use this and other programs to enhance their organization's performance and improve patient outcomes while still preserving the bottom line.You'll hear from Julie Baker, director, healthcare advisory practice, PricewaterhouseCoopers and Robert Fortini, clinical operations manager, Community Care Physicians on the factors driving quality improvement, strategies for success in pay-for-performance programs and how Community Care Physicians is building quality reporting into its practice for P4P programs, including the voluntary CMS program.This 45-page report is based on the January 26, 2006 audio conference "CMS' New Voluntary Physician Pay-for-Performance Program: Identifying the Opportunities" during which Baker and Fortini provided an inside look at pay-for-performance programs along with why and how Community Care Physicians is participating in CMS' new program.You'll get details on: * Today's P4P environment; * Highlights of CMS' Physician Voluntary Reporting Program; * Applying lessons learned from CMS' Hospital Premiere P4P Program; * The benefits of participation in PVRP; * How physicians can build a solid P4P program; and * How Community Care Physicians overcame the obstacles to P4P participation. Table of Contents * The Demand for Performance Improvement o Introducing Pay for Performance o An Industry Trend Takes Hold o CMS Program Applies Lessons Learned o Defining Quality, Standardizing Measures o Identifying the Opportunities o Acknowledging the Challenges o P4P Becoming a Dominant Industry Force o Tapping into the Trend o Hospital Providers React to Changing Market Dynamics o Selling the Product o Moving Toward National Accreditation o Making Incentives Matter o Getting Ahead: Strategies for Success * Case Study: Community Care Physicians Presents the Participant Perspective o Building a Solid Program o Defining Your Own Parameters o Effect of Visit Frequency on HgA1C Levels o Taking the Next Step o A Systematic Approach to Disease Management o Targeting High-Risk Populations o Overcoming the Obstacles o A Commitment to Performance Improvement o Coping with Data Collection o Finding New Routes to Enhancement o A Challenging Endeavor o Electronic Medical Records: Friend or Foe? * Q&A: Ask the Experts o Keeping Up with Reports o Bridges to Excellence Eligibility o Taking and Reporting HgA1C and LDL Levels o Clarifying Data Collection o Submitting the Data o Facilitating Communication * Glossary * For More Information * About the Authors
Pay for Performance (P4P), the burgeoning movement in the healthcare industry to align financial incentives with improved results, is touted as a means of improving healthcare quality without increasing costs. Health plans are now devising metrics for tying millions of dollars in physician bonus incentives to healthcare quality outcomes. In this special report, "Pay for Performance: Raising the Bar on Quality, Efficiency and Results," based on two recent audio conferences, a panel of experts shared their experiences: healthcare consultants analyzed the results of national studies on the reach of P4P programs among U.S.-based health plans and sketched out a timeline for future developments, while three organizations described their ongoing efforts to build cohesive P4P programs. You''ll hear from Geoffrey B. Baker, President, Med-Vantage, Inc.; Dr. Nicholas Bonvicino, Senior Medical Director, Clinical Network Management, Horizon-Blue Cross Blue Shield of New Jersey; Paul Keckley, Executive Director, The Center for Evidence-Based Medicine at Vanderbilt University Medical Center; Dr. Milton Schwarz, Regional Medical Director, Aetna US Healthcare; and Mark Xistris, Director of Provider Relations & Health Information, The Alliance on theories, application and results of pay for performance programs. This report is based on the June 10, 2004 audio conference "Pay for Performance: Improving Clinical and Financial Outcomes" and the September 8, 2004 audio conference "Pay for Performance Measures: Lessons from the Early Adopters" during which Baker, Bonvicino, Keckley, Schwarz and Xistris described the P4P landscape today, the impact of evidence-based medicine on P4P, an employer coalitions experience, how Horizon Blue Cross Blue Shield of New Jersey has revamped their quality improvement program and the fundamentals, metrics and payment details of the Aetna P4P program in California. You''ll get details on: -Trends in P4P; -Getting physician buy-in; -Components of a successful program; -Transitioning P4P programs to an open access environment; -Overcoming the common obstacles to P4P; -Steps in the process of building a performance-based reimbursement (PBR) program; and -What other purchasers are doing. Table of Contents National Update on Pay for Performance -2004 Survey Identifies Five Significant Trends -Ideal Program Scores High on Efficiency and Quality -Medicaid, Self-Insured Jump on P4P Bandwagon -2004 Survey: Participation by Provider Type -Early ROI Evident as Most Markets Enter Phase 2 -Scorecards Show Consumers Quality, Efficiency and Service Grades -Outside Factors Cloud ROI -Early Provider Involvement Boosts Success Rate -Top Ten P4P PitfallsThe Impact of Evidence-Based Medicine on P4P -Defining Evidence-Based Medicine -Common Misconceptions about EBM -Lags in Learning Times Decrease -The EBM Challenge: Timeliness -Media Sways Consumers Interaction with Providers -The Role of Third Parties -Future of Plan Market Consolidation, Consumerism and Competition -Linking Pharmaceutical Costs and P4P -Health Plans and P4P -Emerging Focus of P4P ProgramsPerformance-Based Reimbursement: One Coalitions Experience -Enlisting AHRQ Support for Research -Measuring the Measures -Relating Quality Improvements to Healthcare Costs -Re-admission, Infection Rates Under MicroscopeCrafting a P4P Program California-Style -Key Features of California Effort -Inclusion of Administrative Data Saves Costs, Forces IT Card -Data Collection Overview -Developing a Statistically Viable ScorecardIn Face of Provider Pushback, Horizon Rewards Performance and Efficiency -Program Goals -Quality Scorecards Provide Actionable Information -Catastrophic Detail Report (Horizon BCBS-NJ) -Per Member Per Month Performance of P4P -Evaluating Program Results -Level II Group Financial Results: 2002 PMPM Payout -Success Factors and Future Plans -Fostering Providers Compliance with NIH GuidelinesQ&A: Ask the Experts -Suggestions for Measuring Small Populations -Current Efforts Just the Beginning -Using Financial Incentives to Modify Physician Behavior -Evaluating Risk Adjustment Software -Factoring Provider Interactions in Care Episodes -Weighing the Advantages of Tiered Networks -The Impact of Malpractice on P4P Programs -Formulating a Collaborative Approach to Chronic Disease -Determining Payout Frequency -Data Sources for Advanced Measurements -Measuring the Success of P4P in California -Applying ROI Methodology to P4P Programs -Finding a Champion to Back a P4P Effort -Linking Consumer-Directed Healthcare to P4P -Looking Ahead to P4P in 2005 -Motivating Physicians to Embrace IT -Replicating the Success of the California Endeavor
Patients' health behaviors often contribute to the onset of their diseases, and their continued behavior can either help or hinder their progress. Healthcare providers need motivational strategies that respect the individual's state of mind but result in behavior changes that improve the patient's outcomes. In this special report, "Motivating Resistant Patients: Influencing Behaviors to Improve Outcomes," HIN's panel of experts described how their organizations meet the challenges of motivating patients who are resistant to change. You'll hear from Rick Botelho, MD, professor of family medicine at the University of Rochester Family Medicine Center, Richard Citrin, PhD, vice president of EAP solutions at UPMC Health Plan and former vice president of Integrated Care Management, Corphealth Inc. and Barbara Rutkowski, EdD, medical manager, St. Marys Managed Care Services on the strategies that their organizations have developed to meet these challenges. This 40-page report is based on the February 2, 2005 audio conference "Beyond Giving Information & Advice: Motivating Resistant Patients" during which Botelho, Citrin and Rutkowski described their organizations' initiatives and program results. You'll get details on: -A stepped approach to behavior change; -Strategies that get through to resistant patients; -Sustaining participation; -Tips for engaging patients; and -Involving patients in change.Table of Contents What It Means to Change -The Benefits Continuum -The Risk Continuum -Understanding Patient Resistance -Metaphors to Motivate Practitioners -A Model for Continuing Professional Development -Dissecting the PARE Improvement Cycle -A Stepped Approach to Micro-skills Development: Defining -Motivational Practices and Skills -Motivational Principles -Clarifying Issues About ChangeIntegrated Disease Management: A User-Friendly Model Targeting Resistant Patients -SMART Strategies That Get Through to Resistant Individuals -Valuing Individual Patient Perspective -What We've Learned About Individual Patient Perspective -Setting SMART Goals -Adding Predictive Modeling to the Mix -Components of Healthy Lives Plan -Program Builds on Population Model Management Process -Improved Outcomes in Diabetes -Ideas to Sustain Participation -DM Program Stratification by Age -Healthy Lives Member Survey Results 2004 -Member Survey Finds Overall Satisfaction, Improved OutcomesBeyond Giving Advice: Motivating Resistant Patients -Six-month Mean/Median Costs for High-Risk Coached Group -Predictability Results -Reaping Savings in Healthcare Costs, Leaps in Patient Satisfaction -Member Health Perception Driving Force for Change -Four Key Questions to Determine Change Potential -Tips for Engaging Patients -Involving Patients in ChangeQ&A: Ask the Experts -Engaging Identified Plan Members -Motivating Metaphors -Breaking Down Patients' Resistance -Approaches for Larger Populations -Customized Solutions for Chronic Ilnesses -Health Coach Training -How Behaviorists Communicate with PCPs -Recognizing Readiness to Change -When an Employer Mandates HRAs
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