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Archive for June, 2007



Blogs and the News from China

by Fred Fortin

While this may be a little off-topic, it really has a lot to do with how we get information on what is happening in China including what’s going on in health care. Rebecca Mackinnon, an Assistant Professor at the University of Hong Kong’s Journalism and Media Studies Centre, recently completed a revealing study titled “Blogs and China Correspondence: How Foreign Correspondents Covering China Use Blogs.” (You can download a full .pdf copy from her own blog.)

Mackinnon worked her way up from the very bottom of CNN’s Beijing bureau, ended up as CNN’s Beijing correspondent and Bureau Chief from 1998-2001. After that she moved on to be Tokyo Bureau Chief. She then served as a Research Fellow at Harvard Law School’s Berkman Center for Internet and Society and also co-founded Global Voices Online - an award-winning international citizens media community.

Mackinnon conducted a survey of foreign correspondents who cover China. The responses showed that blogs have become an important part of the media diet for foreign correspondents who cover China. Some of her findings include:

  • 90 percent of those interviewed follow blogs, and answered “yes” to the question: “For the purposes of work, do you or your staff ever read blogs written from or about China – either in Chinese or another language?”.
  • Most respondents find blogs useful for story ideas and information - In fact they find blogs significantly more useful than CCTV (Television network of the People’s Republic of China), CNN, BBC (radio & TV), overseas forums, BBS & chat rooms, or Chinese radio.
  • Most find blogs useful to spot emerging stories and as a general source of story ideas.
  • ESWN (EastSouthWestNorth) and Danwei appear to be substantially more important to correspondents than other English-language China-focused blogs.

As China opens up, the ongoing need for ‘bridge blogs’ that help reduce the ‘lost in translation’ distortion is increasing. With the world starting to focus its attention on China’s domestic and international development, these blogs are becoming a risky but welcomed addition to helping us get as close to the ground as we can. The ‘new media’ (like the World Health Care Blog) can also make a big difference in this ongoing struggle for mutual understanding and cooperation when it comes to health care as well.



China’s New Minister of Health

by Fred Fortin

In the wake of news about bad seafood, tainted toothpaste, fake drugs and lead-painted toys, China announced the appointment of a new health minister and only the second non-Party member to be named to a ministerial post since the 1970s. No reason was given for the change.

Chen Zhu

China’s official media said that China’s top legislature on Friday approved the cabinet nomination of Chen Zhu as the country’s new health minister. He is described as a Paris-trained scientist replacing 63-year-old Gao Qiang, who was assigned to the Health Ministry after former Health Minister Zhang Wenkang was sacked over the SARS crisis in 2003. Chen’s appointment is officially seen as a demonstration of both the Communist Party and the central government’s commitment to open up top jobs to non-party members and non-politically affiliated people. Former Minister Gao will serve as secretary of the ministry’s leading Party members’ group and vice minister, according to the document submitted by the State Council to the Standing Committee of National People’s Congress.

According to the news report, Chen obtained a master’s degree in medical science from Shanghai Second Medical University in 1981. He received his doctorate from the Institute of Hematology of Hospital Saint-Louis, connected to University Paris VII, in 1989. He was also involved in post-doctoral programs in the French institute. Chen won international acclaim for his achievements in the clinical and molecular study of the treatment of acute promyelocytic leukemia. He is an academician with the Chinese Academy of Sciences, the French Academy of Sciences and the United States National Academy of Sciences.

Richard McGregor writing for the The Financial Times sees the appointment somewhat differently.

“. . . the manner of Mr Chen’s appointment underlined the limits of his real powers, even as a minister – in theory, the top job in the health bureaucracy. In a puzzling move, Gao Qiang, the present minister, was retained both as a vice-minister and as the secretary of the ministry’s Communist party committee, meaning he will continue to outrank the minister. Not being a party member, Mr Chen will be ineligible to attend the ministry’s party meetings, creating a potentially awkward relationship with other officials. Lacking party status and networks, he will also struggle to impose his own agenda on the ministry.”

Whatever the political terms of his appointment, Chen will have a demanding job and one that deserves the support of the world health community. How he will affect the government’s efforts in health care reform remains to be seen, but at the very least he should be on the radar screen of health policy makers given the enormous challenges he will be facing.



Competition or Continuity in Medical Care?

by Scott MacStravic

In the latest salvo of organized medicine in its war with retail clinics staffed by non-physicians, the American Medical Association has called for a probe of pharmacy-based health clinics, asking both state and federal agencies to investigate possible conflicts of interest involved. Apparently, members of the association felt there is an inherent conflict of interest when pharmacies or superstores that contain pharmacies host clinics whose providers write prescriptions. More people than should may have their prescriptions filled at the host pharmacy.

This is a strange argument, in light of the huge number of physicians’ practices located in “medical buildings” that also host pharmacies, often smaller and higher-priced ones than is the case for those that host health clinics. But it was apparently promoted by alleged reports of clinic operators having financial incentives based on the numbers of prescriptions they write and have filled at host stores. [S. Reinberg “AMA Wants Probe of Pharmacy-Based Health Clinics” WashingtonPost.com June 26, 2007]

Given the medical profession’s advocacy of “evidence-based medicine”, it might be better if the AMA had presented evidence of such conflicts of interest before calling for a national investigation of all such clinics. Given the profit motive that motivates all businesses, and scandals over pharmaceutical firms being swayed by their own interests over those of patients, the potential for abuse is clearly present. But where is the evidence that it is happening, as contrasted to “allegations”?

A spokesperson for Walgreens, the large pharmacy chain that hosts Take Care Clinics staffed by nurse practitioners in some of its locations, denied any conflict of interest. The Convenient Care Association, the trade group for such clinics noted that their growth reflects the desire of patients for access to high-quality, affordable care. It expressed surprise that the AMA has taken such a position, since many physicians and hospitals already have working relationships with this new model of care.

The AMA also wants to eliminate the financial advantage that such clinics have by forcing insurers to charge the same co-pay for patients, whether than obtain care in a retail health clinic or a physician’s office. While this is argued as merely a way to “level the playing field”, it may be seen by both patients and payers as simply a way to deprive consumers of a more cost-effective option.

Of course the comparability of retail clinics has already been attacked by some state medical societies, including Texas. Concerns were expressed that nurse practitioners and physicians assistants that staff such clinics could easily miss health problems other than those that prompt visits, and that they present an automatic risk because of the discontinuity of care created by patients’ using retail clinics for some problems, and personal physicians for others.

This continuity disadvantage, as well as much of the risk of failing to recognize other conditions that may be present, could both be significantly reduced if physician practices widely adopted electronic medical records, as have most retail health clinics, for example. Yet less than 20% of physician practices have EMRs, despite their widespread advocacy as valuable, if not essential elements of good medical care and practice operation. [B. Bysinger “Healthcare Crisis: EMR Non-Acceptance in the U.S.” Health Leaders News Features June 27, 2007 (www.healthleadersmedia.com)]

It seems most likely that more could be accomplished — for the good of patients and society as a whole, to say nothing of third-party payors who like the lower costs of retail clinics compared to both physicians’ offices and ERs – if organized medicine tried to work with retail clinics rather than against them. Considering the current battle over competition between physician-owned freestanding ambulatory surgery centers and specialty hospitals, where physicians favor competing with general hospitals over cooperating with them, it is clear that physicians, in general, favor competition over regulation.

It is true, as the old saying goes that “What’s sauce for the goose is sauce for the gander”, then perhaps medicine should accept the inevitability of competing ways to deliver health care, especially given widespread reports of physician shortages. A system in which all providers of health care cooperate to achieve the levels of access, quality, convenience, and outcomes for health care that most agree we should strive for would seem better than one looking more like dogs fighting over a bone.



Low Adoption of Electronic Medical Records: Hidden Reasons?

by Scott MacStravic

Adopting and particularly sharing EMRs have been major features of most expert suggestions for health care reform. Despite their availability for two decades, their adoption in the US is well behind most European countries, as well as China, Japan, Australia and Russia, at less than 20% compared to 50-90% and more elsewhere. Whatever the benefits of EMRs, to patients, payors, and the country as a whole, we are only slowly and somewhat reluctantly gaining them.

Among the reasons suggested for the slow adoption rate is the sorry state of third-party and consumer payments to providers, compared to the high costs of EMR adoption. A related charge is that our “cottage industry” providers do not seek improvements in quality and productivity for their sakes alone, but look first at what it will do for individual practitioners, personally, financially, and immediately. And most EMR benefits take a while to reach their full potential.

Small medical practices tend to be the slowest in adopting EMRs, probably because the cost of adoption, compared to the benefits, tend to be highest when there are few physicians to share them. Physicians have little or no education or training in the business of medicine, so are often unfamiliar even with the basic tenets of what makes for good business and profits, where dentists, for example, are well versed in such matters.

In addition to the internal advantages of EMRs to provider organizations, and to the patients they serve, there are supposed to be significant, potentially life-saving advantages to patients in making EMR data available to other providers. Enabling ERs, or providers not familiar with patients, for example, to access patient histories rather than repeat tests or make best guesses about diagnosis and treatment based on presenting signs and symptoms alone, is likely to save lives, improve quality, and save money.

Suggestions for increasing and speeding up adoption have included payors, including governments, offering incentives to reduce the financial burden of EMR systems, including higher payment levels ror providers that adopt and use them appropriately. Medical societies and schools could promote the use of EMRs, and include training in their use in medical schools and residency training. Malpractice insurance carriers could reduce premiums for physicians who have EMR systems. [B. Bysinger “Healthcare Crisis: EMR Non-Acceptance in the U.S.” Health Leaders News Features June 27, 2007 (www.healthleadersmedia.com)]

But there are other reasons for resisting the adoption and sharing of EMRs, not being addressed by suggestions for improving both. There are both marketing and legal disadvantages to having EMRs and sharing access to them. Medical records are one of the more significant “switching costs” that face patients who might consider changing physicians, or using a physician unfamiliar with their medical histories. If large numbers of competing providers had access to patients’ medical records, needing only the patients’ permission, their regular physician would lose this advantage and barrier to patients’ use of other providers.

For example, the American Medical Association has recently called for a probe of retail clinics owned by retail pharmacies and stores with pharmacy services. Among the many concerns expressed by physicians has been the lack of continuity of care when patients seek care at such clinics. If these clinics could easily and quickly access patients’ past histories by permitted access to EMRs, including EMRs that patients, themselves, may have on file with other providers, the continuity argument would become largely moot.

Given the marketing advantages already owned by retail clinics – prompt appointments, with any waits tempered by offering opportunities to do other shopping, rather than reading old magazines; low out-of-pocket costs, sometimes no cost when employers or insurers cover them in order to promote use of cheaper sources – eliminating most of the continuity disadvantage could take even more volume and revenue away from physician practices. If practices had operational and interoperative EMRs, could they resist sharing information with other providers when patients request it?

The legal liability disadvantage, which may be far greater than any potential premium reduction from malpractice insurers, lies with the threat that has always existed relative to accessible knowledge for providers. If they have access to the information, they can be sued if they fail to access it and apply it to any particular case, relative to either diagnosis or treatment.

Suggestions have made, for example, that it would be helpful if physicians cooperated actively in promoting patient compliance with taking medications and making recommended. Currently, employers, insurers, and pharmaceutical firms all engage in such promotion, and given the trust and reliance most patients put in their own personal physicians, they are powerful allies to have in such efforts. But if physicians have access to such knowledge, they might be sued for not using it to remind patients and achieve the level of compliance needed to control the chronic condition in question, or the level of cure of an acute condition that compliance would enable.

Any legal requirement, or the malpractice risk that would arise if lawyers could simply make a case for physicians and other providers being accountable for knowing what is contained in accessible EMRS, would tend to dissuade or at least cause concern among providers relative to their adoption. Providers would then be expected to access the entire patient record contained in EMRs, and be liable if they failed to respond to warnings, risks of interactions, allergies, etc. that were contained therein.

Even if accessing EMRs for every patient seen would only add a few minutes to each visit, it would mean reducing the number of visits per day a physician could manage within the hours each sets aside for the purpose. This would reduce the daily and annual revenue each physician could generate with the same investment of time. Given the growing desire of physicians to lead a normal life outside work, and enjoy a comfortable return on their major investments in becoming physicians, even a few minutes more per patient visit would probably be seen as too much. And having access to patient histories via shared EMRs might even increase malpractice liability compared to physicians that lack such access.

There are probably ways to overcome these disadvantages and risks of EMRs, or to counter them by advantages other than those already included in healthcare reform proposals. But until and unless the concerns of physicians are fully identified and addressed, including the marketing and legal risks cited here, it may be a long time before EMRs are adopted by even the majority of providers.



Healthy Communities and Health Communities

by Scott MacStravic

Healthy Communities

The idea of healthy communities has been around for decades, with a number of successful and not-so-successful examples of new communities planned for their healthy impact on residents still in existence. Celebration City, Florida is one of the classic examples, with close involvement by the Florida Hospital system from the outset, along with the Disney Corporation, and many ideas implemented to protect and improve residents’ health, including walking paths and nature trails, fitness centers and golf.

Another form of “healthy community” is the residential health vacation, which may last from a few days to a week or as long as a month. These are offered as ways for people to get a running start on health improvement, or a refresher for those who have been on a health quest for some time. The Duke Integrative Medical Center in Durham, NC offers a number of such community options. The Greenbrier Clinic in West Virginia offers a shorter version of such a community, with a one-day clinic assessment and consultation built into vacation stays or weekends.

The Miraval Resort in Tucson, Arizona offers similar vacations in a number of four-day stays. Canyon Ranch, with locations in Lenox, Massachusetts and Tucson offers three-to-seven day health vacations in a luxury resort setting, with prices in the range of $1000 per day. Executive Resorts of Denver offers multiple health-focused vacation locations all under an annual membership fee for the wealthy.

Perhaps the most thorough example of healthy community residential facilities are being created through Canyon Ranch Residences, in Miami Beach, FL, and Tucson, AZ, with others opening in Maryland and Massachusetts. These are intended to be true “healthy communities”, with all the facilities and staff available onsite to enable residents to continue their personal health improvement and protection efforts on a daily basis. The entire community is designed to facilitate and promote healthier lives, and includes tele-monitoring arrangements for tracking progress by Ranch staff.

Health Communities

Health communities are a more recent development, and involve “virtual communities” of people who share an interest in coping with specific health challenges, such as managing chronic diseases, controlling risk conditions, reversing risk behaviors, or generally improving wellness and fitness. These communities are often part of Health Management (HM) programs, aimed at populations who share the same employer or insurer, as well as challenge.

The idea behind these communities is that people at various stages of their HM quests can learn a lot from each other, including ideas on how to overcome barriers they have found, and confidence in overcoming them when they learn many others have. These communities do not depend on people being in the same place, as is the case with healthy communities, though they can include the equivalent of local “buddies” who provide support via face contact.

Revolution Health, Steve Case’s movement to reform healthcare includes a wide range of health communities via “Premium Memberships costing $129 per year that include advice on healthy living, selecting providers, managing health expenses, for example, as well as a personal online health record. Vetted information on ten different healthy living topics, as well as a comprehensive range of chronic conditions, along with medications are available to members. Special 6-week programs are also available for living better, longer, and becoming smoke-free.

Marketing Healthy and Health Communities

Both kinds of communities require marketing efforts to reach, attract and retain prospects. Healthy communities require a greater effort because of the high cost and high-involvement decision involved. Health communities generally cost little or nothing, but still must be advertised to create awareness of and interest in their existence. The health experiences of both kinds of communities need the same kind of attention to “customer experience management” as any other product or service being marketed, with an emphasis on the long-term health and life quality outcomes possible and being achieved through community participation.

Both kinds of communities can gain a great deal of market impact through social networking, viral and buzz marketing, in addition to more traditional seller-controlled communications. Marketing the communities, as well as marketing the healthier behaviors each community promotes will be a long-term process, and focused on the outcomes that members have achieved and can achieve in the future, in addition to the enjoyment of participation experiences.

In most cases, healthy communities are for the affluent to rich among us, while health communities are accessible to almost everyone. Even when they are not sponsored by employers, insurers or governments, their use of online communications enables them to operate at low cost, and charges to consumers for participation tend to be modest. This may be part of the bifurcation of our health system, into one for the affluent/wealthy, such as “concierge” medicine and “VIP” suites in hospitals, executive health, etc. and the other for the vast majority who cannot afford them. But at least there are a growing range of opportunities for people to get help in managing their own health.



AMA and other physician insights

by Tony Chen

If you hadn’t noticed all the press releases from the AMA, they’ve had a busy week at their annual House of Delegates meeting. A few highlights:
- While there was pressure to ban retail clinics outright, they settled on demanding state/federal investigations & regulations to ensure quality and real patient choice (in filling prescriptions). Scott MacStravic takes the view that physicians should spend their time collaborating with these clinics for more referrals, instead of condemning them. When you put all self-interests and politics aside, this really gets to the age-old healthcare triangle of quality, cost, and access - you can never have all 3. In our microwave economy, I believe market demand is growing fastest for access, giving these clinics a lot of market traction.
- AMA delegates were also very wary of pay-for-performance and want to ensure P4P trials don’t come “at the expense of physicians.” You can read their press release here, but essentially physicians want to be confident that agreed-upon metrics are meaningful and drive the right kind of quality improvement.
- Among other highlights, the AMA established principles for health courts, adopted policies to promote healthier food (e.g. fast-food/chain restaurant nutritional labeling), and stopped short of calling heavy video gaming an addiction.

Beyond AMA news, a new study showed that some physicians “self-disclose” too much, often wasting precious time or distracting from the patient conversation. Lonely? Building trust and rapport with the patient? Tired and loss of focus? Comforting the patient by sharing a common problem? Whatever the reason, the researchers were surprised at how often the disclosure seemed to be more about the physician rather than the patient. If physicians cut out a bit of the unnecessary chatter, maybe they would have time to ask if the patient wants to be called on a first name basis or not.



“Globalization Needs a Soul”

by Fred Fortin

Thanks to Salon’s Andrew Leonard I’ve been following some blog commentary on recent statements by Pope Benedict XVI on globalization. The Pope argues, not surprisingly, that while globalization has benefited many millions of people, it has also led to growing inequities in the world that are fueling significant unrest. Other principles that need to guide the economy are justice and charity, the Pope explained. He calls for a globalization “characterized by solidarity and without marginalization of people”, values, which, together with sound economic policies, he says, could go a long way in finding solutions to the ethical challenges in a globalized world.

Leonard who besides generating a discussion on whether socialism was the favored economic system of the Catholic Church opined:

“. . . any way you slice it, the pope’s basic analysis is, well, pretty infallible. Globalization has created opportunities for hundreds of millions of people to escape poverty, and it has contributed to widening gaps between rich and poor in both the developed and the developing world. Addressing that contradiction requires that societies make value-laden choices. The pope believes in the sacrament of Jesus Christ. Others might settle for universal healthcare and wage insurance. Either way, globalization needs a soul.”



Interview with medical tourism author Jeff Schult

by David Williams

Jeff Schult,  author of medical tourism book Beauty from Afar: A Medical Tourist’s Guide to Affordable and Quality Cosmetic Care Outside the U.S., began writing the book when he journeyed to Costa Rica for major dental work. What started out as a magazine article turned into a full length book once he got to Costa Rica and learned the extent of the medical travel phenomenon. As the name implies, Beauty from Afar focuses mainly on cosmetic and dental procedures. However, he does delve into some of the more “serious” treatments as well. The afterword of the book is written by Curtis Schroeder, CEO of Bumrungrad International in Thailand.

You can listen to the interview at MedTripInfo.



“Cha-Ching” is the sound of children’s hospitals turf wars

by Gary Schwitzer

In the Minneapolis-St. Paul hospital marketplace, there are some interesting expansion efforts underway. It’s not unlike what has been seen with hospital expansion in many other markets, but this story seems to have some peculiar oddities, and, although the latest round of hospital announcements made news in both local metropolitan newspapers this week, the real meat of some of the important issues at play have not drawn a great deal of attention. Issues such as:

1. How many children’s hospitals does one community or one region need?
2. Where is the public policy “voice” in the decision-making to allow competing hospitals to expand?

This week Children’s Hospitals and Clinics of Minnesota announced a $300 million plan to renew and expand its hospitals in Minneapolis and St. Paul. Earlier this year, the University of Minnesota Children’s Hospital announced plans for a new $175 million facility on its Fairview campus. These facilities are only about a long Justin Morneau home run away from each other. The St. Paul Pioneer Press reported :

“The announcement is a bittersweet reminder, though, that the Children’s, Fairview and Allina systems couldn’t consolidate their pediatric care into a single powerhouse hospital.

“Everybody made a good faith effort to try and make that work,” said Alan Goldbloom, Children’s president and chief executive officer. “In the end, the financial complexities just could not be overcome.”

Some health policy officials believe the separate Children’s and Fairview projects will create costly redundancies in care. Leaders of both hospitals repeatedly have indicated they would be better off with combined hospitals, so it will be interesting to learn if the public now embraces separate projects, said David Durenberger of the National Institute of Health Policy at the University of St. Thomas.

“One wonders why the community would invest upwards of $500 million without achieving the ‘national center of excellence’ it may be more eager to support,” he said.

The Minneapolis Star Tribune reported:

“Competition for young patients is growing. In addition to the University’s planned expansion at Fairview Riverside, the Mayo Clinic just opened its $15 million T. Denny Sanford Pediatric Outpatient Center. South Dakotan Sanford also gave $16 million to Sioux Valley Hospitals in Sioux Falls, S.D., for the Sanford Children’s Hospital. …

Peter Gove, co-chair of a Citizen’s League committee that looked at medical facilities’ decision making last year, said the current system for determining where and when hospitals and other medical centers get built is done without input from those who pay for it: Consumers.

“The system remains supplier driven, and the public policy role is limited,” Gove said.

There’s been far more coverage locally of separate stadium plans for the Twins pro baseball team and for the Vikings pro football team and for the University of Minnesota football team. But this is about health care, now representing 16 percent of the gross domestic product. It’s hard to understand why journalists haven’t made this a bigger issue in the Twin Cities. So it’s easy to see why consumers aren’t engaged in the discussion. And it’s easy to see how the spending and the expansion will go on.



Insurers Moving More into Health & Productivity Management

by Scott MacStravic

Commercial insurers devoted their initial investments in managing health, rather than just paying for sickness care, primarily in disease management.  Since roughly three-quarters of sickness care costs come from chronic disease, this makes sense when insurers aim for significant positive return on their investment (ROI), and as soon as possible.  For the same reason, most of the federal government’s investments have also been in disease management demonstrations.

But there are signs that commercial insurers, at least, are developing both a broader view of the problem of controlling sickness care costs, and a broader range of solutions to this challenge.  They are extending the scope of their investments to include the full range of health management (HM), including general wellness/fitness promotion, risk behavior and condition reduction, as well as disease management.  And they are offering a wide range of interventions, not merely the usual problem-specific interventions.

For example, Blue Cross and Blue Shield of Kansas City offers its “A Healthier You” initiative to almost 60 employers in its market.  The program includes onsite health fairs which assess employee health and identify problems, plus customized behavior change programs, such as smoking cessation and weight management.  Aetna offers a Healthy Living incentive/reward credit card that functions like retail loyalty cards, offering points that can be redeemed for rewards based on employees’ purchases of health promoting services and products.  [T. Worth “Insurers Remedy High Costs with Preventive Measures” Kansas City Business Journal June 15, 2007 (kansascity.bizjournals.com)]

The Blue Care Network’s “Healthy Blue Living Wellness” benefit plan is one of a number of new health insurance products that are being offered that emphasize wellness, rather than merely coverage for sickness care.  Blue Cross Blue Shield of Michigan has gained over 200 employer groups since initiating this product last October.  The program combines incentives to employees and support from their employers and primary physicians to commit to and achieve better health.  Employees can earn lower out-of-pocket healthcare expenditures, while their employers gain an average of roughly 10% savings over HMO products. [“Blue Care Network’s Healthy Blue Living Wellness Product Sees Surge in Enrollment” Blue Care Network Newsroom June 25, 2007 (www.miben.com)]

Some insurers, including both Aetna and CIGNA offer their own HM programs on a fee basis to employers, including those who are not even customers for their insurance products.  This not only generates added revenue, it also gives the insurers a cost-saving center business link with employers, in contrast to the cost-center of hospital/medical insurance benefits.  Humana recently began offering health coaches to employers, for example. [“Humana Launches Integrated Health-and-Wellness Program for Health Plan Members” BusinessWire.com June 6, 2007]

Health Net of California announced its new offering of a combination of traditional HMO coverage with a preventive/wellness emphasis as part of a new consumer-directed health plan, called the “Optimizer HMO with a Health Reimbursement Arrangement spending account.  It rewards healthy behaviors by employees, including a $100 reward for completing a health risk assessment (HRA) , and another $100 for using a health coach. [“Health Net of California Redefines Consumer-Directed Health Plans” Health Net News Release June 7, 2007 (investor.health.net)]

Wellpoint, the largest insurer in the US has created a web-based program to promote employees’ participation in its WebMD HRA, including a Spanish version.  Feedback from the HRA includes customized analysis of individuals’ risks and advice on managing them, along with access to resources for information and support.  It also offers a resource center for physicians to help them deal with the cultural and language diversity of patients they manage in markets serves by Wellpoint. [“Wellpoint Launches New Innovative Tools for Members and Health Care Professionals” Wellpoint News Article June 6, 2007 (phx.corporate-ir.net)]

CIGNA has gone beyond merely managing employee health in traditional ways. It has launched a new identity theft prevention and recovery program for employees, with 24/7/365 access to services and support.  Studies have indicated that people who are victims of identify theft spend an average of 175 hours, or roughly five weeks over a two year period trying to restore their financial integrity.  Much of this time is spent while people are at work, and their worry about the problem can impair their productivity and performance at work even when they are not devoting time to fixing the problem.  [“New CIGNA Program Helps ID Theft Victims Recover Identity; Helps Employers Avoid Lost Productivity” CIGNA Newsroom June 27, 2007 (cigna.mediaroom.com)]

The combination of employer and insurer collaboration in HM programs is likely to increase employee participation and response, and thereby increase the value that employers gain from HM investments.  When providers are also included, the “critical mass” achieved may prove even more successful, compared to any one HM provider by itself.  Employers generally prefer to outsource HM initiatives, given laws and regulations on the privacy and confidentiality of employee health information.  And insurers gain a stronger foundation for a continuing, long-term relationship with employer clients, rather than one based simply on annual premium levels.

Providers, including any primary physicians or hospitals that are willing and able to join the HM movement can also share in the benefits.  Employee participation in HM initiatives, for example, have been shown to improve dramatically when a trusted physician recommends such participation. [“Workplace Disease Management Program Participation Boosted Three-Fold by Patient Contact with Trusted On-site Clinician” i-Trax/CHD Meridian Feb 22, 2007 (www.i-trax.com)]  Provider support of HM participation may reduce the need for employee incentives, for example, and thereby save money for employers, and increase the chances for and amount of ROI on their investments.

As the number of stakeholders involved in HM efforts increases, the chances of success are likely to increase as well.  Lack of support by providers, for example, is usually a major handicap to HM participation and success.  By getting employers and insurers on the same page, along with employees and providers, the probability and extent of employee participation, health management and financial success are likely to be significantly greater than any effort that lacks one or more of these key stakeholders.  The increased involvement of insurers that is happening already will give us a chance to find out if this is the case.

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