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Looking Beyond Hospitals for the New Frontiers of Health Care

August 18, 2009 05:00 PM
by Jill Marcellus
With health care reform threatened by spiraling medical costs, could innovative thinking outside the doctor’s office save money, lives and the reform effort?

Taking Health to the Home: Disease Management Programs

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According to The Boston Globe, a recent study found that between one-third and one-half of patients do not take their medications properly, raising medical costs by as much as $290 billion a year in the U.S. The study, performed by the New England Healthcare Institute, found that the “reasons include cost, unpleasant side effects, confusion about the regimen, forgetfulness, language barriers, and feeling too good to need medicine,” Elizabeth Cooney wrote for The Globe.

The typical eight-minute checkup may not be enough to address these problems. Patient noncompliance—defined as failure, for whatever reason, to follow doctors’ orders—has been driving up costs and readmission rates to hospitals, and its solution might lie in more personal and intrusive care.

Berkshire Medical Center’s nonprofit heart-failure clinic offers one possible model for preventing costly hospital readmissions. In conjunction with the American Heart Association, the center launched a comprehensive attack on heart-failure readmissions, encompassing home visits by nurses and a $55,000 telephone system that monitors released patients’ vitals, according to The Wall Street Journal. Success against heart failure relies heavily on patient behavior, so this model of follow-up care can be strikingly effective. The clinic’s 2008 30-day readmission rate, measuring the percent of patients who return to the hospital within a month after heart-failure treatment, was 18.6 percent, almost six points lower than the national average.

Despite its success at reducing readmissions, the Berkshire Medical program is still a costly model for others to follow. Although insurers cover hospital readmissions, they often do not cover the style of in-home and follow-up care that Berkshire Medical offers, making such programs against hospitals’ financial interests, even though they reduce costs to the health-care system overall. Moreover, since doctors are reimbursed by the number of patients they treat and not by the results of those treatments, there is little incentive for doctors to spend extra time confronting the problems that lead to patient noncompliance.

These concerns have attracted the attention of advocates for government-led reform. President Obama advocates a reimbursement scheme for doctors that hinges on quality of care, and some members of Congress have proposed government funding for follow-up care programs that reduce hospital readmissions.

Rewards for Good Behavior: Workplace Wellness Programs

Behavior-focused measures have also migrated to the workplace, with many firms offering wellness programs that encourage healthy living. Due to the fact that big companies often self-insure, or personally pay for their workers’ health costs, they have an extra incentive to keep their employees healthy. IBM, for example, financially rewards participants in such programs as the company’s physical fitness initiative, and PepsiCo headquarters features an on-site medical department and gym, according to USA Today.

Despite such programs’ long-term savings potential, the grim economy has trimmed many of them from companies’ budgets. Firms have begun to trade carrots for fines, and PepsiCo, for example, charges employees who smoke an extra $600. The Cleveland Clinic stopped hiring smokers altogether and its CEO wishes he could extend the same policy to the obese, according to David Leonhardt of The New York Times.

Leonhardt notes that behavior alone accounts for 40 percent of early deaths. Citing a Health Affairs article that estimated obesity’s annual cost to be $147 billion, he advocates national “collective action” to curb obesity and its toll on the health care system. Japan caused controversy when it launched its own national weight-loss initiative last year, The New York Times reported. Employers and local governments were ordered to measure citizens’ waistlines and institute employee weight-loss targets for certain firms.

Beyond WebMD: Online Medical Intervention

Another frontier of medical innovation is, unsurprisingly, the Internet. U.S. News & World Report uncovered a recent trend of online health interventions for problems ranging from heart failure to alcoholism. American Heart Association spokeswoman Dr. Nieca Goldberg called the initiatives the “wave of the future,” an assessment supported by research of online interventions’ effectiveness, including one study that found that heart patients who participated in an online program were one-third less likely to die than those who did not.

Online interventions can also supplement employer wellness programs. Kaiser Permanente, for example, created a successful wellness system dependent on e-mail reminders of healthy eating and exercise habits. Despite her enthusiasm, Dr. Goldberg warned against immediate adoption of online programs in place of traditional care. Instead, she encourages them as a promising supplement but says they’re not “100 percent there yet.”
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