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Medicine, Exercise and the Importance of Patient Adherence

July 18, 2014
12:41 pm

(This month, the Healthcare Leadership Council sponsored a Capitol Hill briefing on the importance of patient adherence in improving the quality and cost-effectiveness of healthcare.  The briefing featured expert perspectives from inVentiv Health, Novartis, SCAN Health Plan and Walgreens.  We were pleased to see commentary about this briefing on the “Be Active Your Way” blog sponsored by the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health promotion.  The blog post is reprinted below.)

On Monday, July 14th, the Healthcare Leadership Council hosted an excellent briefing on non-adherence to medication, highlighting the fact that 1 out of 3 patients never fill their prescriptions, and nearly 3 out of 4 Americans don’t take their medications as directed.

The panelists discussed innovative strategies for improving adherence, such as targeted and timely communication. Each strategy was based on the reality that a one-size-fits-all approach to communication is both inefficient and ineffective. Clearly, the digital age is creating medical providers with new opportunities for engaging patients and tracking their adherence, but there are no simple solutions for getting folks to take their medicine.

The problem of non-adherence to medication raises an uncomfortable question for physical activity advocates.

If 1/3 of patients are signaling that a visit to the pharmacy is a barrier too high to overcome, and 75% are finding it too difficult to take medication properly, how many patients can we reasonably expect to fill an exercise prescription that typically requires 150 minutes/week of exertion?

Although evidence suggests that patients are more likely to exercise if their doctors prescribe exercise, we suspect very few patients will stick to an exercise program unless medical offices and physical activity providers (e.g. health clubs, personal trainers, community centers) adopt engagement strategies similar to those being implemented by the pharmaceutical industry for medication adherence.

At Novartis, for example, a comprehensive study of patients revealed 4 clusters of patients, each with a distinct set of compliance barriers: “Strugglers,” who seem overwhelmed by the medical condition and necessary medications; “Skeptics,” who view medication as a last resort; “A-Students,” who are fully engaged with their health care and likely to adhere to their prescription; and “Independents” who are likely to adhere but not be consumed with their health issues.

Understanding the four clusters helps Novartis create targeted adherence plans for each patient. The plans include customized messaging, 6 months of support, 3 or 4 email and text messages per week, an interactive website, real-time messaging support, and more.

Can this level of engagement be accomplished by a fitness center? Absolutely. And I know there are some pioneering clubs already on this path and achieving great results. But effective engagement does not happen overnight. It clearly requires an investment of time and resources, both of which are in short supply at most fitness centers.

So let’s make sure we support the great work of the Exercise Is Medicine initiative and champions of the “exercise prescription” movement like Dr. Eddie Phillips and Dr. Bob Sallis, by making sure that fitness facilities are prepared to help patients adhere to those prescriptions.

What do others think? How can we help patients adhere to exercise prescriptions? Do you work at a fitness center with a great member orientation program? Perhaps you work for a software company developing tracking systems for medical fitness providers? We’d love to hear from you.

Our Veterans Deserve Better

January 31, 2014
1:45 pm

Last year, the book “Best Care Anywhere:  Why VA Health Care Would Work Better for Everyone” entered its third printing.  The book tells of a Veterans Administration healthcare system that, according to the author, is far superior to the private sector in both quality care delivery and cost containment.  The message delivered in this book, in fact, became something of a core liberal talking point during health reform debates – that the wonders of single-payer, government-run healthcare can be seen on full display at the VA.

This week, CNN is painting a different picture of the VA system, reporting that at least 19 veterans have died as a result of delays in receiving routine diagnostic exams such as colonoscopies and endoscopies.  This follows an earlier CNN report that as many as 7,000 veterans in just two states alone – South Carolina and Georgia — are on a backlog list to receive these fundamental diagnostic screenings.

And, as the cable network points out, not a single person has been dismissed or demoted as a result of this substandard care, and the VA is consistently ignoring congressional committee requests for explanations and accountability.  One has to agree with Rep. John Barrow (D-GA) who said, “We have a duty to make sure the veterans who serve get the best health care possible.  And it is very obvious that, for too long and for too many folks, that hasn’t happened.”

This is not to say that the VA doesn’t carry out some aspects of healthcare very well.  The institution has, for example, been among the early adopters in demonstrating the effective use and value of electronic medical records.

But in terms of the argument that all of American healthcare should emulate this type of bureaucratically-run system, it’s been made clear this week that several thousand service men and women have reason to disagree with that thesis.  For too many who have dedicated their lives to serving their country, the concept of getting the right care at the right time isn’t happening.  That’s simply unacceptable.

Healthcare Leaders Meet the Press

January 07, 2014
12:28 pm

Let’s give credit to “Meet the Press” for choosing to address healthcare in its January 5 installment by turning to actual health industry leaders instead of the usual Washington, D.C. talking heads.

Cleveland Clinic CEO Toby Cosgrove and Mayo Clinic CEO John Noseworthy, both physicians as well as hospital executives, joined host David Gregory to discuss the implementation of the Affordable Care Act and, just as importantly, other healthcare issues that deserve more attention than they generally receive in the media.

Both Dr. Cosgrove and Dr. Noseworthy, for example, emphasized the importance of improving a Medicare program that is headed toward insolvency, saying that this a key to addressing healthcare costs.  To quote Dr. Noseworthy, “The long-term sustainability of Medicare is something no one has taken on yet.  The nation has to have the courage to step up to the looming insolvency of Medicare.”

And Dr. Cosgrove also emphasized the critical role of wellness and disease prevention in achieving health system sustainability.  Mentioning the cost ramifications of the growing obesity epidemic in the United States, he said, “We need to have incentives for individuals to take care of themselves, and that’s not a big enough part of the new law as it should be.”

Dr. Noseworthy and Dr. Cosgrove are both members of the Healthcare Leadership Council.

You can see the video of their Meet the Press appearance here.  Articles about their comments can be found here and here.

The Truth About Wellness

December 22, 2013
10:31 pm

Posting a summary of the remarks offered by one of its recent featured speakers, the secretary-treasurer of the National Union of Healthcare Workers, the National Press Club headlined its synopsis with “Union Official Debunks Workplace Wellness Programs.”

The problem with that headline is simply, well, he really didn’t.

John Borsos’s Press Club remarks could be boiled down to these points:

•    There is no evidence workplace wellness programs improve health or save money.
•    Wellness incentives are unfair to those who don’t choose to try to achieve them.
•    Wellness programs are an invasion of personal privacy.
•    What America really needs is a single-payer healthcare system.

What America actually needs is a discussion about wellness and disease prevention that relies more on facts than hyperbole.  Employers throughout the country have, in fact, developed firm evidence that wellness initiatives are bringing greater health to employees and reducing healthcare costs.  You can find specific metrics on many of these successes in a compendium we have published, The Future Is Here.

On the topic of how to make wellness programs work in the workplace setting, I urge you to read the post by Colin Watts of Weight Watchers below.  He offers an insightful discussion on the relative efficacy of carrots versus sticks in these programs.

And, as to privacy, as Kaiser Permanente, CVS Caremark and others have pointed out ad nauseum, wellness profiles of employees are collected and viewed in the aggregate.  Individual privacy is constantly respected and protected.

The fact is, we are facing a significant, disturbing escalation in chronic illnesses like diabetes, heart disease and pulmonary illness that will affect both the health and finances of the U.S. population, not to mention the sustainability of our healthcare system.  We need bold action to address this growing problem, and that action cannot exclude the eight or more hours each day that millions of Americans spend at their workplace.

Guest Post: What Drives Engagement in Workplace Wellness Programs — Carrots or Sticks?

December 18, 2013
2:24 pm

(The following post was authored by Colin Watts, President of Weight Watchers Health Solutions.  Weight Watchers is a member of the Healthcare Leadership Council.)

In our conversations with employers, we’re often asked: What works better when it comes to employee wellness programs – penalties or incentives? In other words, should we use a carrot, a stick or some combination? It’s a great question and one we’re studying closely through our research.  One interesting example is a program Weight Watchers is supporting for the Oregon Educators Benefit Board (OEBB) and Oregon Public Employees’ Benefit Board (PEBB), which provide health insurance coverage to state teachers and public employees.

In 2009, obesity-related ailments were driving health care costs for the State of Oregon public employees and educators to the tune of nearly $1.6 billion. At the same time, in partnership with OEBB and PEBB’s health plan providers (Providence, Kaiser Permanente and ModaHealth,) Weight Watchers – both meetings and online tools – was offered to all of OEBB and PEBB’s covered lives.   If a participating member attended 75 percent of their Weight Watchers meetings, the cost was completely covered.

That year, PEBB decided to introduce financial incentives into their benefit design, which included completion of a confidential health risk assessment (HRA) and participation in at least two resulting action steps, which could include a weight management program.

During the first year of the program, they charged employees a penalty of $17.50 per month if they failed to take a baseline health risk assessment and follow through with lifestyle recommendations. That first year, 70 percent of employees completed their assessment and took action.

The following year, in 2010, the penalty was switched to a $17.50 per month reward for participation and a $100 higher deductible per person for those not participating. This action resulted in a 7 point increase in the percentage of employees completing the wellness recommendations and action steps.

This example would suggest that both penalties and rewards impact employee participation. That said, it would also indicate that rewards lead to better participation than penalties. While participation is highly linked to outcomes in several weight management studies, it has not been rigorously evaluated with the inclusion of a mandatory penalties/rewards program.

While not definitive, the results in Oregon are promising. Between 2009 and 2012, a time when rates of obesity were increasing among the State’s general population, obesity rates decreased among state employees and educators from 28 percent to 22 percent. Given the PEBB experience, OEBB started a similar program in 2013.

“These results show that a well-designed wellness program coupled with financial incentives that prompt and reward healthy behaviors can work,” said Joan M. Kapowich, administrator at PEBB. “Setting up programs that help employees succeed in changing their habits and rewarding them for doing so was really key for us. It has demonstrated success in reducing our cost trends and improving the health status of our members.”