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Yet Another Meaning of “P” in PHM

by Scott MacStravic

It seems almost as if authors have taken as a wordsmith challenge the creation of new and different meanings for the first word in the initials “PHM”.  The “HM” always means “health management”, but the “P” may stand for any one of the following adjectives:

  •     Performance – when HM is used to improve this among employees
  •     Personal – when HM is provided to self-paying consumers
  •     Personalized – when tailored to individuals vs. one-size-fits-all, or segment-differentiated
  •     Pervasive – when disease management becomes a continuous and deliberately intrusive, constant element in patients’ lives
  •     Population – when it is applied across populations such as insurance plan members or employees
  •     Predictive – when it focuses on altering predictions about individuals’ or populations’ health
  •     Pre-emptive – when it aims to replace sickness with health
  •     Preventive – when it employs primary, secondary or tertiary prevention methods
  •     Proactive – to distinguish it from reactive sickness care
  •     Productivity – when it aims to improve employee performance
  •     Prospective – when it is based on what is foreseen otherwise

This widely varied use of different adjectives to precede “Health Management” is not a serious problem, since the varied meanings are all embraced in what most of us think about and do when thinking about or applying PHM.  On my own part, I file articles under the generic initials “PHM” rather than worrying about what the “P” is said to stand for.  There are more similarities across all the different labels than differences.

And just to add to the list, it occurred to me this morning that there is still another “P” that can apply, though it would involve a number of specific elements that would distinguish it from a number of other PHM examples.  It would be called “Precision Health Management”, and would roughly correspond to “precision marketing” as defined and applied by a research and consulting firm. [“Precision Marketing Solutions” Aberdeen Consulting Group Aug 1, 2006 (www.mycustomerl.com)]

Precision health management would be like precision marketing in that it would rely on predictive modeling and analytics to identify and grade the risks of individual HM prospects, and particularly the different potential value of each to sponsors of PHM, as well as the idiosyncratic personality factors of each relative to selecting the most cost-effective PHM interventions.  Its use in marketing is a sound basis for application to PHM, since both aim to understand, predict, and influence consumer behavior.

Just as marketing is increasingly moving toward customization of relationships, interactions, transactions, and customer experiences in general with customers, so Precision HM would strive for a similar degree and kind of individualized approaches to managing individuals’ and populations’ health.  This would include, for example, choices to consciously avoid “acquiring” some consumers, and even “firing” some already acquired, when their predicted or actual value is less than their predicted or actual costs.

It would include precision choices of communications channels, frequency, and content, involving whatever mix of channels and messages is predicted to be most cost-effective.  It could easily involve the use of the same kinds of software (e.g. SSP and SAS) and contact center strategies currently used in marketing applications designed to improve customer lifetime value (CLV).  It would alter this common set of initials to “PLV” for participant lifetime value, but would otherwise involve similar content and analytic as well as communications technologies.

As with its marketing applications, users of precision HM could choose to adopt internal, on-demand, or outsourced analytic, process, and communications, in whatever mix over time proves most cost-effective.  And as with precision marketing, this approach to PHM would strive for, and should achieve similarly higher levels of ROI for its adopters.  The use of predictive metrics in rules-based application to individuals or segments, where appropriate, should ensure that the value proposition offered and delivered to each individual will optimize the value that both participants and PHM sponsors gain, in both the short and long run.

It is unfortunate that so far, the healthcare industry has been significantly behind the curve in terms of taking advantage of emerging and constantly innovating computer analytics and communications technologies.  Precision HM represents a challenge to all who are or might consider being involved in PHM to ride the “breaking wave” of such innovations in pursuit of the most mutually valuable results possible for all stakeholders concerned.

Medical tourism: What’s new?

by David Williams

Medical tourism continues to be on my mind. I’ve added a variety of items to information site MedTripInfo during the past week. Here are some highlights:


  • Dan Snyder, COO of ParkwayHealth explains why Singapore is lovely and why doctors there may be ambivalent about American patients
  • Milica Bookman, author of Medical Tourism in Developing Countries explains how medical tourism can promote economic growth and help reverse a country’s brain drain –when certain conditions are met
  • Jonathan Edelheit describes how mini-med plans can be enhanced with medical tourism and why he’s founding the Medical Tourism Association


Polls and surveys

How Serious Is Medicare About “Preventable” Sickness Care?

by Scott MacStravic

When I wrote the blog piece posted on Aug 15 about “non-payment for non-performance”, little did I realize how prophetic it was.  In yesterday’s Times appeared an article - “Medicare Says It Won’t Cover Hospital Errors” - announcing that it will no longer treat the costs of preventable errors, injuries and infections that occur in hospitals.  This is expected to save the federal government millions of dollars, while also saving many lives as hospitals have that much more motivation to prevent such errors.

Imagine what could happen if Medicare, Medicaid, commercial insurers and consumers got together and decided not to pay for preventable sickness!  It has been estimated that roughly 75% of all sickness care could have been prevented by effective health management, immunizations, and other forms of proactive health care.  There has long been a category of “avoidable” hospital admissions and treatments, regularly estimated as a large portion of all such treatments, based on best practices in ambulatory care.

This could easily become a “blame game” of course.  Insurers, employers, and governments could blame either consumers for not adhering to healthy behaviors, or complying with medical recommendations and prescriptions, for example.  Or they could penalize providers for not following best practices in managing their patients’ health, or not getting their patients to behave better.

Patients could blame insurers and their employers for not offering proactive health management programs they could enroll in (unless, of course, they did so), or not covering preventive and proactive services (unless they do).  Providers could blame payors for not paying them enough or otherwise supporting them in proactive health care, e.g. not covering the amount of time and effort it takes in terms of “cognitive services” to get patients to behave themselves.  And providers could easily blame their patients for not following their advice, once it has been given.

Payors would clearly have the upper hand in the blame game if they denied all payment for preventable sickness, not merely preventable errors, nosocomial infections, etc.  They have a lot of practice in denying, or certainly dictating lower payment levels when they feel such is appropriate, as Medicare recently did in decreeing that ambulatory surgery centers should only get paid 65% as much as do hospitals for comparable procedures. [”Doc Group Says New ASC Rate Would be ‘Death Blow’” ModernHealthcare.com Aug 20, 2007]

Consumers, when they are payors for some or all the sickness care involved could also exert extreme pressure on providers, by denying them full payment of their charges for sickness care if they deem the sickness something their provider should have prevented.  Providers could be caught somewhere between the impossibility of surviving on payment only for non-preventable sickness, and what they could legally command, or negotiate as their share of the blame for preventable sickness.

Given the widespread number of examples of in-fighting among healthcare stakeholders, there may be some movement toward such a policy and practice combination.  After all, few insurers, employers, consumers, or governments have espoused a sense of responsibility for keeping the current sickness care system alive.  And denying payment, in whole or even in part, for sickness that a given payor deems to be preventable, would threaten the existence of almost all providers.

Wouldn’t it be far better for providers, payors, consumers, etc. to get together and set annual goals for reductions in preventable sickness, involving all of their efforts, with all sharing in accountability for preventable sickness that doesn’t get prevented.  Negotiating the relative share of accountability, in the form of lower payments by payors to providers, would be an interesting process to watch.  On the other hand, if a cooperative approach to common problem solving were tried, where providers and consumers, as well as payors defined and treated preventable sickness as a common problem, that might end up moving the current sickness-focused “healthcare system” in the right direction

Odd Thoughts on Hospital Theory Reloaded

by Fred Fortin

Just a little late night, off beat, philosophical commentary some may find interesting.

Change is So Hard

by Nick Jacobs

As a young man it seemed probable to me that life would become better for everyone. After all, our combined annual budgets in the United States and Europe were enough to make the entire world a better place for everyone.  If we had decided to make it happen, there was enough money for every person to have a home, a car and a job.

Vietnam would be our last war ever.  We would find a substitute for sugar so that we would no longer be overweight.  A replacement for butter, trans fat enhanced margarine, would ease the population away from the epidemic of heart disease, and the cure for cancer as declared by President Nixon, was only a few years away.  Finally, we would have a four day work week and spend quality time with our families.

Thirty years later.  One must wonder just exactly what went wrong?

Daniel E. Koshland Jr in his article the Cha-Cha-Cha Theory of Scientific Discovery describes scientific discoveries as “the steps—some small, some big—on the staircase called progress, which has led to a better life for citizens of the world.”

In its purest sense, Mr. Koshland is absolutely correct in his description.  The problem is that we, as a population, as a species, as a herd, tend to fight change at every level at all times.

In the book “Change or Die” the author, Alan Deutschman, discusses the reality that when cardiologists tell patients with heart disease that they have to “change or die,” nine out of ten fail to switch to healthier lifestyles, 90% of us would knowingly select death rather than change.

Truthfully, when you consider how long we have held onto the outdated, inappropriate practices of the Industrial Revolution, it is fascinating to me that science has evolved at all under the current system, a broken system about which I have written numerous times.

So, we go to the question list:  What can be done to change science?  What can be done to change health care?  What can be done to change man’s inhumanity to man?

Short of a national tragedy, like a pandemic of the avian flu, we continue to embrace old realities that are no longer appropriate.

Collectively, however, we are approaching a major paradigm shift internationally that has been fashioned by the enormous technological advances that our world has been experiencing during the previous decade. Predicated upon the fact that we are now totally and completely tied to each other world wide for the first time in history, this transformation could potentially result in the broadest societal change that the Earth has ever faced.

We are hooked up on multiple levels. From the mountains of Afghanistan to the deserts of Saudi Arabia, from the Arctic to Siberia, our fellow human beings have wireless communication devices that provide contact capacity where it had never existed before.

We now have the ability to commune through the Internet, through cell phones, through Treos and Blackberries with almost anyone anywhere in the world. When teenage kids join each other in chat rooms across continents, nothing goes unchallenged. Regardless if it is the misstatement from leaders, from clergy or from a shock jock, they now have the ability to confirm, verify and validate immediately and completely by tapping some keys or simply calling each other.

This quantity of massive change has resulted in anger, fear and a certain amount of chaos as we struggle to define new pathways in our culture.  All of this is because this connectedness has begun to create new truths and new accountability.

What we have experienced over the past several years has been a reaction to this new world order, a very conservative movement that results from that fact that when life becomes more challenging, we tend to go as far back into our conservative past as we can to find whatever we can attach ourselves to so as to protect our future from change to help us cope with the fear of change.

Let’s hold on for dear life and hope that this potential revolution allows us to change the pursuit of truth through science and to allow our health delivery system to evolve into a useful system more appropriately directed toward chronic illness and prevention.

Adapting Einstein’s Formula to Health Management

by Scott MacStravic

Albert Einstein used the formula E = MC2 to describe the conversion of mass into energy, later demonstrated with the atomic bomb.  A similar formula applies to health management (HM), whether applied to consumers paying for their own services, employees, commercial insurance plan members or government plan beneficiaries.  The difference is that the terms are different:

  •     “E” represents effectiveness/efficiency if HM programs
  •     “M” represents motivation in HM participants
  •     “C1” reflects participants’ capability and confidence, self-efficacy
  •     “C2” reflects participants’ consciousness of how/when to act

While a wide range of interventions have been used to promote HM participant “compliance” or “adherence” to medication and lifestyle regimens, they all can be categorized as aiming to achieve increases in motivation, capability or consciousness.  Many focus on just one of these, some on two, and a few on all three.  But experience has shown that the best results are achieved when all three are affected by HM programs, rather than relying on one or two.

For example, a recent report on a diabetes disease management program, used with significant effect by HealthMedia, Inc. of Ann Arbor, Michigan, identified nine keys to success in promoting diabetes patients’ adherence to medications:

  •     Improving patients’ depression and stress coping skills
  •     Fitting adherence into individual patients’ daily routines
  •     Understanding and addressing each’s adherence barriers
  •     Helping them feel accountable for adherence
  •     Strengthening their relationships with providers
  •     Bolstering their confidence in medications and themselves
  •     Moving them toward intrinsic vs. extrinsic motivations
  •     Focusing on their life quality benefits vs. sponsors’ gains
  •     Understanding and communicating with each as an individual

[K. Wildenhaus “Improving Medication Adherence: The Missing Link to Better Outcomes” HealthMedia.com Aug 16, 2007 (webinar + slides)]

All nine of these essentials deal with one or more of the “MC2” factors.  Improving coping skills, fitting adherence into daily routine, addressing barriers, bolstering their self-confidence – all relate to participants’ capabilities.  Fitting adherence into daily routines, strengthening relationships with providers (physicians, pharmacists, nurse coaches), and dealing with them as individuals — all relate to promoting their consciousness of what and when to act.  And helping them take ownership/accountability, strengthening provider relationships, moving them toward intrinsic motivations, and recognizing their unique personal benefits – all relate to promoting their motivations.

Addressing the changes in or reinforcements of participants’ personal and unique levels of motivation, capability and consciousness required for success is first a helpful basis for planning specific steps in an HM intervention.  It is also a useful focus for evaluating the immediate effects of intervention elements – are there noticeable changes in one or more of these three essentials as each reports them.  Unless one or more of these cognitive/emotional factors are increased, or at least reinforced by HM efforts, there is likely to be little if any effect.

By focusing on all three MC2 factors, HM sponsors can also create a “paper trail” that will enable or reinforce conclusions that their HM interventions are responsible for changes noted in participants’ health status, healthcare, disability and workers compensation insurance expenses, absences, productivity, performance, and overall economic impact.  If changes in one or more of these factors are noted after implementing efforts aimed at changing them, then are linked to changes in behavior, health status, and subsequently in desired economic impacts, sponsors can be much more confident that the HM interventions actually produced the impacts noted than if they only measured the impact per se.

By evaluating the particular impact that HM interventions have on motivation, capability and consciousness, sponsors and providers can also learn which of these three factors make how much difference in achieving necessary enrollment, participation, and completion of each intervention, and to each of the many dimensions of cost savings and performance improvement.  This will enable continuous “tweaking” of the HM interventions, themselves, and improvement of the predictive modeling methods used to identify and target prospects for particular kinds of interventions.

This is equally true with identifying the particular types of motivation, capability and consciousness dimensions, such as the nine examples identified by HealthMedia in its diabetes medication adherence program, that make the most difference to results.  Continuous improvement in our understanding of MC2 factors is needed to increase and maintain positive returns on investment from HM interventions in general, and to this key component of the solution of our healthcare cost crisis.

China Continues to Reveal Details of New Urban Health Insurance Plans

by Fred Fortin

In another speech last week, Vice-Minister of Labor and Social Security Hu Xiaoyi said that by 2010, 240 million non-working urban residents, such as children and students, will benefit from a basic medical insurance scheme now being piloted in 79 cities. From the press report,

” both central and local governments will subsidize the insurance project, and local governments are encouraged to set different contribution rates for adults and children, and families with different income levels. Studies have found that a contribution rate of about 2 percent of the average per capita disposable income would be “appropriate”. . . adding the government aims to have the project cover at least half of the total cost of those insured. The per capita disposable income for urban residents was 7,052 yuan ($940) in the first half of this year, according to the National Bureau of Statistics. If calculated on the formula Hu described, an urban dweller will have to contribute 141 yuan ($18.5) to be covered by the insurance plan.The premiums will be paid by households, instead of individuals, and the government will give subsidies of at least 40 yuan ($5.3) annually to each participant of the insurance program in pilot cities, with more going to families with low-income earners and disabled ones.”

One of the problems you keep finding in current social insurance programs — and in the proposed programs discussed above I believe — is that the collective funding usually offers only a very thin margin of coverage which often fails to pay for even the most modest of illness or injury. This was evident in the accompanying comments by Wang Lin, president of the Chaoyang Charity Association in Beijing, who said that “charity will continue to have a role to play to cover medical bills of the poor, even after the country provides medical insurance for all. For those with serious diseases, donations are very much needed, as a medical insurance plan usually does not foot all the bills.”

Yet an even bigger and more disputatious question will be how authorities will spend these scarce funds, what medical services will get this new financial attention, and how will cost-effectiveness and health outcomes be accounted for. China’s health care delivery system is simply not prepared yet to answer these kinds of questions. The hard work is still very much ahead of us.

Self-Service in Health Care?

by Scott MacStravic

The very idea of people serving themselves instead of relying on professionals in healthcare has been parodied in a TV commercial where a physician in a hospital is advising a patient, in his home, over the phone, to “Make an incision between the fourth and fifth abdominal muscles.”  Clearly, most sickness care requires professional training and experience, and cannot be replicated by consumers in most cases.

On the other hand, “self-care” has long been the objective of 24/7 phone advice lines, offered by insurers, to enable consumers to determine if they could take care of their own or family members’ symptoms or signs in particular cases.  Self-care medical guides have long been published to offer similar advice entirely via self-service reading thereof.  After all, when self-care is appropriate, it is the most convenient and cheapest alternative for patients, as well as saving considerable money for payors.

Self-service is a growing element of chronic disease management, where patients check their own weight, blood pressure, glucose levels, and other clinical metrics that may indicate progress in getting them under control, or a problem that a professional should handle.  Devices that measure such indicators may be directly connected to professionals for review, as well as uploaded into patients’ records or personal web pages to enable both patient and provider to track progress and evaluate treatment.

A growing number of providers are making it possible for patients to make appointments, obtain health information, arrange prescription refills, etc. online, rather than taking the time of office staff.  Enabling patients to self-serve in terms of learning about the risks and benefits of alternative treatments or medications is a way to at least reduce the time professionals might otherwise have to spend educating them, though patient self-education can also end up costing providers time in explaining why something they may ask for, due to direct to consumer advertising or online information they have obtained, is not really the best choice for them.

But the greatest potential for self-service in healthcare may be in what is truly health, rather than sickness care.  The two biggest challenges in proactive health management (PHM) — whether paid for by consumers, employers, insurers or governments – is to make participation in specific interventions and behavior/lifestyle changes required as easy and inexpensive as possible.  Unless they are easy, convenient, fit participants’ work/life patterns, etc. such interventions rarely attract and retain enough participants.  And unless they are inexpensive enough, they will be rejected by potential and current investors therein.

Self-service in PHM is easily the least expensive approach possible, in most cases.  The question is always whether self-service will be effective enough to yield optimal ROI.  Making the costs to sponsors and participants as low as possible is a great way to minimize the cost denominator in ROI ratios.  But it is by no means always the best way to obtain the greatest ROI net gains.  And unfortunately, people differ dramatically in terms of how intensive, what kind, and how expensive efforts must be to get them to make the necessary behavior changes needed for PHM success.

Involving physicians and nurses, as “promoters” of PHM participation, as coaches and motivators of behavior change, and as sources of needed prescription drug support and lab tests or diagnostic scans needed to monitor clinical measures, has proven to improve results.  But it also greatly increase PHM costs, thereby threatening both ROI ratios and amounts.  Moreover, there are many self-service approaches to PHM that cost very little to make available, accessible and acceptable to consumers, in promoting health, preventing or reducing risk behaviors and conditions, or managing chronic conditions.

For example, a recent webinar sponsored by HealthMedia, Inc. of Ann Arbor, Michigan described how automated, self-service-based PHM programs can address a wide range of individual differences, across the spectrum of behavior change motivations and barriers.  Through automated analysis of online surveys that consumers take, behavior change motivation and barriers are identified and measured, with tailored e-mail or mailed communications aimed at individualizing coaching and support, while keeping costs highly affordable.

Compared to information-only efforts, where medications adherence levels averaged 57.7% when the same information is communicated to all participants in the same PHM program.  By contrast, the customized approach has been found to achieve 75.4% adherence, a 28% higher relative level, achieved at minimal added costs.  Even more positive was the fact that high levels of adherence were reached in as little as 30 days of PHM participation, and declined only a bit after its initial success. Participants’ confidence in their medications, perceived importance of adherence, and refill-on-time behavior actually increased from the 30 to 90 to 180 days participation. [K. Wildenhaus “Improve Medication Adherence: The Missing Link to Better Outcomes” HealthMedia.com Aug 16, 2007.

The use of “custom-tailored” communications is growing among most PHM providers, as they recognize the dramatically lower cost potential in automated communications systems and the potential for self-service inputs by participants to enable these systems inexpensively.  In addition to the reduced sickness costs that are typically achieved through better adherence, participants in the program who also reported an improvement in their health because of that adherence were found to yield productivity-cost savings of $1440 on average.

In order to achieve optimal participation in PHM, and thereby optimal economic value for sponsors, participants must also feel they are gaining something worthwhile, in return for the time and effort they must put into improving their health.  In the HealthMedia adherence study, participants reported an average 27% increased confidence in their ability to control their diabetes, a 15% increase in their ability to manage the emotional issues accompanying their condition, 83% reported being better able to communicate with their provider, and almost twice as many reported a good understanding of their condition.

It is certainly unfortunate that most of the negative press that Medicare disease management demonstration projects have received, thanks to the mixed results achieved therein so far, has come from interventions that were very much on the high side in terms of expense, costing literally from ten to one hundred times as much as automated customization systems may cost.  The full potential of self-service by PHM participants, together with automated communications that can be used as often as weekly, even daily when necessary, is yet to be learned, but the signs so far seem promising to say the least.

Healthcare Providers as Health Managers: Clock Issues

by Scott MacStravic

Okay, I admit that had I not begun with an obsessive commitment to “C” issues, the title of this piece would have been “timing” rather than clock issues.  But it is clear that deciding when the ‘clock starts running’ is a key element in health management (HM), for not only providers but all current and potential payors, as well as for consumers.  And generally speaking, nobody seems to start the clock early enough.

The total challenge of health management is to reduce the incidence and prevalence of disease and injury, in order to reduce sickness care costs, productivity and performance impairment, as well as move personal health and employee performance into “better than normal” range.  Different payors have different notions of what is the most important goal, and how best to achieve it, as well as when they should begin.

If it were up to healthcare providers, the time to begin is probably pre-pregnancy in preparing mothers for healthy pregnancies and having healthy babies.  During pregnancy has already been cited as a great point in time to prepare parents for promoting optimal health in their babies after they’re born, from healthy diet to immunizations to child development.[W. Boggs “Better Prenatal Education May Improve Childhood Immunization Rates” Medscape.com Aug 16, 2007]

Preventing childhood obesity is known to be vital for their future health, and preventing metabolic syndrome among children would avoid the fifteen times higher risk of heart disease that this risk condition creates for children. [“Metabolic Syndrome in Kids Ups Adult Heart Risk” Reuters.com Aug 7, 2007]  Teens are among the most susceptible to adopting unhealthy behaviors such as smoking, alcohol and drug abuse, which can condemn them to lifetime addiction.

Insurance plans are increasingly tailoring minimal health insurance coverage for young adults who already see themselves as invulnerable, but if they do not include coverage for risk prevention, at least, they are only adding to the likelihood that when they are older, they will also be sicker.  While capturing them early makes it easier to convert them to more complete and expensive coverage, it could also ensure that they will be more expensive members than is necessary, unless health promotion and risk prevention/reduction are lifetime pursuits.

For younger workers, often with minimal skills and low wages, their employers often deny coverage of health insurance of any kind, and certainly don’t invest in their long-term health.  But when these workers get older, they will likely be expensive risks and performance-impaired due to lack of health management by anyone.  And with older workers, Medicare should worry about what their health will be like when they retire and become eligible for government-paid coverage.

The great disadvantage this country has is the unsystematic plurality of efforts to manage health.  All kinds of different organizations, different providers, payors, and advocacy organizations approach their own narrow segments of the population, their diseases or risks, and their times of life, while there is not even a systematic, lifetime framework upon which they might coordinate their efforts for greater efficiency and effectiveness.  The free market is not capable of doing the job when there is no organized market for lifetime health management.

Clearly, all the stakeholders involved, from insurers to consumers to employers to governments and providers – could get together in an integrated effort to create a health management system.  And until we have the will, shared by enough of these to make enough difference, we can predict that the healthcare crisis will never be solved, and the potential of healthy children, workers, parents, and aging will never be realized.  The clock for health management ticks from even before birth, and continues until death, but we haven’t yet timed our health management efforts accordingly.

As far as I know, not even healthcare providers are organized around, nor do they have a lifetime health management structure to apply to the challenge. But at least they include among them specialists in every phase of the individual life cycle, so may have the best foundation for the job.  But it will take the cooperation of all the other stakeholders to make lifetime health management work, and so far, nobody seems to have even stepped up to the plate to take on the challenge.

Healthcare Providers as Health Managers: Convenience Issues

by Scott MacStravic

Traditional healthcare providers, including hospitals and physician practices have long had an “edifice complex”, expecting patients to come to them for necessary services, to rely on face visits for communications and interactions.  Even today, only a modest proportion of physicians permit online communications with their patients, for example.  Hospitals have relocated or added locations in suburbs rather than the old-fashioned “pill hill” centrality in major cities, but are still losing patients to more conveniently located ambulatory surgery centers and specialty hospitals that established convenient locations earlier.

Convenience of location, hours of availability, and communications is even more important in health management, whether aimed at providers’ own employees or the workforces of employers that are clients for revenue-generating HM programs.  The U.S. Preventive Medicine, Inc. models of “Centers for Preventive Medicine” rely on hospital locations for most of the services they offer, though participating physician “partners” increase the number of locations where patients can obtain services. (www.USPreventiveMedicine.com)

The many hospitals and a few physician practices that offer “executive health” HM programs, which are still the most common example of hospital ventures in this market, almost all offer their major program elements at their own sites, requiring a one-day or longer stay.  While this stay is usually in luxurious surroundings, with “concierge” services to help make it easier for executive and other affluent clients to wend their way through the program, it is still necessary to come to a single location in most cases.  Until recently, most clients had to manage their own lifestyle changes, perhaps with the help of their personal physician back home, though many programs now offer phone coaching follow-up between stays.

By contrast, employers that offer their own HM programs often make them available at the worksite, with a growing number of onsite health clinics that include HM along with traditional occupational health services.  Retail clinics, conveniently located in popular superstores and pharmacies, offer HM services where consumers often shop, and even enable customers to shop while waiting, until a pager notifies them that the provider is available.

HM vendors often offer convenient “kiosks”, where HM participants can have parameters such as weight, body fat and blood pressure checked, in retail stores or worksites, in order to track their progress and qualify for incentive rewards.  Virgin Life Care offers such kiosks (“HealthZone” – www.virginlifecare.com) as does IncentaHealth (www.incentahealth.com).  IncentaHealth also offers daily online coaching for weight loss and fitness improvement.

In the IncentaHealth example, its services are offered mainly through employer-sponsored programs, though it also offers consumer-paid coaching through the New West Physicians in Denver and its Physician Health Coach program.  Participants get physician health recommendations, then IncentaHealth coaching for only $20 per month while they participate.  While these programs are limited to weight management and physical activity, these represent two of the most common health challenges that consumers have.

Whether providers are sponsoring HM programs for their own employees (and dependents, perhaps), for other business clients and their employees, or both – the programs are generally free to participants.  This means that the convenience dimension, i.e. the time and effort required of participants is the major cost to them.  Making it as easy as possible for people to participate, at times and places they find most convenient to participate, with communications channels and timing that fits best into their normal routine, is often the major factor determining the extent of both their participation and success.

Traditional healthcare providers’ insistence on patients coming to their places of business, at limited days and times of access, and communications at providers’ convenience will simply not work in HM, nor can it compete with specialized HM vendors who have already recognized and responded to consumers’ expectations.  Providers wishing to engage as many employees or other consumers as possible, and to promote their continuous and enthusiastic participation, will have to adopt a host of non-traditional convenience tactics in order to compete in the HM market, or achieve optimal results with their own workforce.

As the “new consumerism” increases the power of individuals and their importance in healthcare in general, traditional healthcare providers are already recognizing and responding to increasing consumer demands for greater convenience, even in traditional sickness care.  Providers must be prepared to make even greater improvements in convenience if they hope to achieve optimal results for themselves and their clients in HM, as well.

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