Disease Management

Primary Care: Are You Busy Or Effective (or Both)?

May of 2018 we turned on dashboards on the Value of Care for a group of 400 providers. On the dashboard the scale of 0 – 100, a 70 was considered “good value,” below this there were significant opportunity for higher value care. The average score for our providers was 35.

Within hours the phones began to ring – “my care is better than this,” “my dashboard is wrong,” “your data is incomplete” – the general sentiment was “I am making a bigger difference that you are saying I am.”

Let’s look at the facts – they were busy – usually filling their schedule to 80+%, moving through the day giving 100% to each person sitting before them. At the end of the day going home feeling tired but sure of their contribution to their patients. They must be high quality, effective, and their patients are benefiting based on days, months, and years of committed work.

So why the relatively low scores? We set up teams to investigate. The ability to click down to a member level allowed the providers to see what was going on with their patients. Were the patient really theirs or not? An examination revealed YES! Then why weren’t their blood pressure, cholesterol, asthma, blood sugars, immunizations, and screenings not at goal?

Barbara was supposed to come back in but never did, Bob travels all the time, Suzie stopped taking her meds, but never communicated it, John’s son got ill and he missed his appointment and never came back in…. The list of reasons went on and on. But the reality did not change – we were confusing being busy with meeting the needs of our patients. Often, we were not seeing the patients that needed us the most.

This lead to new systems, new ways of proactive (and automated) outreach. Soon the right patients were in the right practice at the right time. Quality took a jump up. Providers knew they were doing the best thing for all of their patients, not just the ones in front of them.

Busy was now productive and we were adding years to the lives and life to the years of those we served!

Is your practice busy, effective, or both?

Missed The Window? It Is Not Too Late

By DrScott – Posted on December 19, 2013 on www.compassphs.com

In the first three Seven Numbers posts the natural history of the most important conditions to your healthcare spend were shared. But what do you do if you have missed the primary prevention window? Is it too late to control costs? So let’s say that the disease has appeared in the body – diabetes, heart disease, or cancer. It is not too late.

With cancer, for example, one cell becomes two, then four, eight, sixteen, thirty-two, and so forth. But the cells are localized, contained in one small area. They could easily be removed by a short procedure. It is not until literally hundreds of thousands of cells have appeared that the ability to completely cure the cancer is lost for many of the common cancers. Again, it is estimated that 3 to 5 years go by during which we could act and literally save our own lives. Which cancers could be diagnosed early?

  • Breast cancer (detected with breast exam, mammography, and breast MRI),
  • Colon cancer (detected with colonoscopy, occult blood testing and exam),
  • Cervical cancer (detected with an exam and pap smear),
  • Endometrial cancer (detected with a history, exam and a simple test) and
  • Skin cancer (detected with history, exam, and a simple biopsy).

For heart disease, diabetes, or hypertension, blood sugar and blood pressure gradually rise. Fat gets deposited in our arteries (LDL cholesterol for example) and begins to accumulate. No untreatable “end organ damage” in our heart, brain, kidneys, or other organs has occurred (if they had the employee would have had a heart attack, stroke, or kidney failure). With proper treatment these complications can be prevented or delayed for decades. But the window to act is closing.

How does your company make sure this occurs? Why don’t we and our employees act? Why do the majority of us allow these changes to occur in our bodies without acting? In the next Seven Numbers Blog we will explore the answer to this question.

The Five to Fifteen Year Window to Reduce Healthcare Costs & to Save Lives

By DrScott – Posted on December 12, 2013 on www.compassphs.com

In the first installment of the Seven Number Series, we understand how three of your biggest expenses are slowly (and effectively) attacking your company. The key to stopping this epidemic? Acting early – preventing pre-disease from moving to disease. During this phase, which lasts 5 to 15 years, our bodies have the ability to undo or delay any long term damage. If we stop the lifestyle and habits, our bodies will heal the damage – return to normal functioning, and even repair body tissues that are beginning to fail (diabetes & heart disease) or grow abnormally (cancer). Perhaps the best example of pre-disease that can be reversed is metabolic syndrome.

Metabolic syndrome is defined as the appearance of any three of these five numbers on an employee’s biometrics:

1. A waist circumference of 35 inches for women, 40 inches for men

2. Triglycerides (a lab test for blood fat) of over 150 mg/dl

3. A reduction in good – HDL cholesterol to <50 in women, < 40 in men

4. A blood sugar of >100 mg/dl

5. A blood pressure of >130/85

What do you do when you know these numbers? Simple, set up programs and activities to get them down. Everything from participating in 5K walks and bike rides, changing food out in the vending machines and your café, bring in targeted programs, and so forth. These actions should be part of your health benefits design and included based on their effectiveness.

Equally important to these efforts is activating and empowering employees to get more involved in understanding, monitoring and managing their health. Focus on what really matters – getting these Seven Numbers to goal. Putting incentives and penalties in place over a series of years is vital to actually decreasing illness, disability, and costs. Having a foundation to communicate with your employees, to empower them, is necessary for success. Please feel free to request a copy of The Seven Numbers book.

Follow my blog posts and I will give examples of companies that are doing these types of changes today with outstanding results.

Proactive Providers Save Lives and Money

By DrScott – Posted on November 26, 2013 on www.compassphs.com

In my private practice in the 1990s, I often would see patients for 7 to 15 minutes, three times a year, trying to inspire them and direct them in management of high cholesterol, diabetes, high blood pressure, and other medical conditions. One particular patient I remember was a mechanic working at a large defense contractor. He had diabetes, high cholesterol, and an at-risk blood pressure. Every year he would come in for his physical because it was required by his employer. I would test his blood and consistently find that his cholesterol and other numbers were not well managed. We talked about how important it was to treat these conditions. I would offer additional medications and teach him to improve his lifestyle. He always assured me that he “felt fine” and didn’t think there was anything significantly wrong. A year later nothing changed and he continued down the same path.

Then one year, he came in with a form from his employer and asked me to fill in his numbers to then send back to his employer. Upon completing the form and handing it back to him, he said he had a new incentive program at work and was rewarded if his numbers met the goal. I asked him if he was willing to take additional medications and he said he would do “whatever it takes”. Low and behold, he saw a dietician, took additional medicine, and got his numbers to goal. Upon receiving the reward from his employer, he and his wife used that money to take a trip in their RV to the Pacific Northwest.

This continued for the next several years with him maintaining and managing his numbers to goal because his employer would reward him for his behavior. After he retired he was no longer incentivized, lost focus on his numbers, and had a significant heart attack several years later. I believe we prevented this for years through his engagement.

It was through interactions like this that it became clear to me that seeing a patient for 7 to 15 minutes, three times a year was only a portion of the solution. Having a partnership with employers that encourage and support employees engaging in proactive healthcare was equally important. Through this partnership, employees would win significantly.

How Regularly Are You Exercising? 2014 May Be The Time To Start

To stay up to date on the latest information I listen to the Massachusetts Medical Society Journal Watch.  They say medical knowledge doubles every 9 months these days so it is important to stay on it! 

I thought you might enjoy this summary on exercise;

Robust midlife cardiovascular fitness is associated with lower heart related disease, but what about death? To answer that question, researchers evaluated the associations between fitness and several chronic conditions (namely, ischemic heart disease, congestive heart failure, stroke, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, Alzheimer disease, and lung or colon cancer) in older patients by linking a preventive medicine registry to Medicare data. Nearly 20,000 patients got full baseline fitness and medical evaluations and were stratified into five groups based on their fitness level (the patients’ average age at study entry was 49; most were men). A good number of the patients had relatively favorable cardiovascular risk profiles at study entry. Findings appear in the September 24 Archives of Internal Medicine (http://viajwat.ch/WhxcCO).

During a median follow-up of 26 years, the patients who were most physically fit had about half of the prevalence of chronic conditions than did those who were least physically fit. In adjusted analyses, each Met (metabolic equivalent) increase in baseline fitness was associated with a roughly 6% reduction in risk for developing a chronic condition.

Although these results on midlife cardiovascular fitness being a predictor of healthy aging are not surprising, they add another motivation for encouraging midlife fitness: This approach can lower the risk for frailty and comorbidities while improving quality of life for older people. 

Here is to aerobic exercise at least every 48 hours in 2014!  Happy New Year.  SC

It’s time to rethink the way we eat

One of the joys of my life is teaching Weight Loss The Jabez Way at local churches. The first line of the Prayer of Jabez is “And Jabez Cried out to the God of Israel” 1 Chronicles verse 4:10. Note, he didn’t ask, request, suggest or inquire – he CRIED OUT! When have you cried out in your life? When you are desperate, frustrated beyond belief, or hopeless? What are you willing to do at this point? To try something new?

With our weight if we knew how to fix it we would.. So the fact we are struggling means we need to be open to a new way, we don’t know what to do, and it is time to change and be a learner (as opposed to a knower).

Here is a must read article that suggests that what we have taught in the past may not work for everyone, and in fact may be harmful. Please take a moment to read it at: http://io9.com/5979523/why-you-should-starve-yourself-a-little-bit-each-day ” Starve Yourself!>

The Next Generation of Value Based Medicine: Corporate Population Health Management™ – Part 1

Working with corporations and providers to create Value Based Care. Read more at the Open Health Market Blog: The Next Generation of Value Based Medicine: Corporate Population Health Management™ – Part 1.