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Healing the Soul of Medicine: The Prescription is an Injection of Humanity

Joseph Marr, MD, is a retired academic physician and pharmaceutical and biotechnology executive. He is the author of the book “Fall From Grace: A Physician’s Retrospective on the Past Fifty Years of Medicine and the Impact of Social Change.” The opinions expressed in this blog post are those of the author.

J. Joseph Marr, MD

J. Joseph Marr, MD

The changes in medical care over the last five decades have been dramatic. Technological and scientific advances have given patients access to a level of medical diagnosis and care previously thought unimaginable.

During this time, Medicare, Medicaid and the Affordable Care Act provided more people with the opportunity to take advantage of that care. Yet, despite all that extraordinary progress, something is missing.

The role of the physician as healer and patient confidant has degenerated to manager of a health care team. The personal interaction of physician and patient has largely disappeared as well.

The problem as I see it is this: The entry of corporate for-profit health care destroyed the soul of medicine. It destroyed the doctor-patient relationship through its demands for brief patient encounters, and most important, it changed the focus of medicine from patient care to quarterly earnings.

The tragedy in the past half century is that the astounding improvements in technology have cost us the human touch. That’s almost completely because of corporate business practices in the health care and insurance industries.

The system is not going to change, but the medical community could improve it by injecting more humanity into the system.

The interaction between a person with a medical problem and the physician who attempts to heal that person is one of the most human and personal of relationships. But it does not lend itself to accounting ledgers, quarterly earnings postings and visits per hour?

There are several ways the medical community can try to make a difference.

  1. Shine a light on misinformation. Physicians can educate the public to counter sometimes misleading information or misunderstandings about medicine or therapeutics. The current trend for some parents not to immunize their children because of unjustified fears is a good example. This would require a conscious change in attitude and a rededication to the physician-patient relationship that once existed. This attitude change would communicate itself quickly to the patient. What was once a brief, impersonal office visit would become more personal, even if still brief.
  2. Create a relationship. Physicians can put that attitude change into practice with an extra question about family, some advice beyond drugs or surgical procedures, and the kinds of human inquiries that we all appreciate but are largely absent from current patient encounters.
  3. Speak up. Most people recognize the high cost of care as a serious problem for the country. Physicians — individually and collectively — must speak out against these costs and advocate measures to mitigate them. A demonstration by the medical profession that it is appalled by the changes in health care as is the general public would go far toward restoring the public trust in physicians.

Fifty years ago, we physicians were accustomed to speaking out against injustice and expressing our opinions openly. When did we become so passive and pliable? Are we as concerned about money and perquisites as those in the corporate suite? Let us hope not and begin to behave accordingly.

Readers: Tell us what you think. Do you agree with Dr. Marr? Let us know your thoughts in the comments section.

 

 

Cultural Competency Key to Positive Health Outcomes

Early in my pharmacy career, a hospital social worker referred to me a deaf patient. He had a reputation for being rude and belligerent to providers. After our first encounter, I was no exception. However, after looking at health care from his perspective – slow communication, unthinking providers, long waits in the clinic – I had an idea.

Joel Zive

Joel Zive

Instead of counseling him with a pad and pencil, I counseled him in front of a computer screen. I made the font larger, and we communicated in this fashion. He was ecstatic! I learned that many deaf people communicate with a device called a Telecommunications Device for the Deaf (TDD), with which they can type responses and often learn to do so rapidly. Because I accounted for his unique point of view and modified my interactions with him accordingly, our relationship changed for the better.

For a provider, cultural competency involves understanding patients’ perceptions of their role in health care. When a provider or prescriber has that insight, significant improvements can occur in therapeutic outcomes. For example, cultural competency can aid providers in preventing drug interactions by determining which complementary and alternative medicines their patients use, as well as help improve patient adherence to prescribed therapies. This is especially important in minority communities, in which the devastating effects of diabetes, hypertension, and other diseases take a disproportionate toll.

Establishing this insight takes time that busy practitioners don’t always have. Fortunately, providers increasingly rely on capable, cost-effective partners: community health workers (CHWs). CHWs work in a variety of settings, including community-based organizations, AIDS service organizations, hospitals, and clinics. They are often of the same ethnicity as many patients and live in the neighborhood; in many cases, CHWs have already developed trusting relationships with patients and may have a better understanding of the nuances of how they expect or want to be treated. CHWs are also in a position to uncover problems that patients are unwilling to share with their physicians and other health care providers.

The positive effects of CHW involvement as provider extenders are well documented. For example, at the Gateway Community Health Center in Texas, CHWs played a valuable role in improving outcomes among people with hypertension and diabetes.

A critical area that can be enhanced by community health workers is complementary medicine. St. John’s Wort is one example of an herbal folk remedy that is sometimes used and endorsed by generations of family members for the treatment of depression, but that many patients may not report to their health care providers. This is significant because St. John’s Wort should not be taken with antiretrovirals. CHWs may be more effective than those ‘wearing white coats’ in learning about use of complementary and alternative medications and, when needed, explaining the dangers of drug interactions with sensitivity and compassion.

Research continues into the benefits of employing CHWs in pharmacies. Four pharmacy school professors at the University of Florida – Folakemi Odedina, Ph.D.; Richard Segal, Ph.D.; David Angaran, MS, FCCP, FASHP and Shannon Pressey – did a pilot project to see whether a CHW paired with a single community pharmacy could uncover medication-related problems that were missed by the pharmacist alone and improve outcomes in hypertension (view this short video for more information). In an interview with Real World Health Care, Dr. Segal said they teamed a CHW with a pharmacist to work cooperatively for 11 months to enroll 30 patients with poorly controlled hypertension (>140/90 mm Hg). The CHW was able to gather information about which patients were using complementary medicines as well as the barriers people were experiencing that affected their adherence to prescribed medicines. Together, the CHW and pharmacist developed a medication action plan that was informed by the added information the CHW was able to collect from patients. While four patients were lost to follow up, the 26 remaining patients showed a significant reduction in systolic blood pressure. The pilot program is being scaled up to involve 30 CHWs with funding from the Department of Health and the CDC. Segal concluded that clinical collaboration between pharmacists and CHWs should also be used for other disease areas.

What other ways can community health workers benefit patients in addition to increasing treatment adherence and decreasing the risk of drug interactions? Share your thoughts in the comments section.

Patient of the Month: Sharon Harris Survives Lupus and Pays It Forward

Sharon Harris remembers February of 2002. She remembers where she was, what she was wearing, and what she was feeling. Most of all, she remembers the day she was diagnosed with lupus.

SharonHarris1

Sharon Harris, lupus awareness advocate and founder of Lupus Detroit

May is Lupus Awareness Month. Lupus is a chronic inflammatory disease that occurs when the body’s immune system is unable to distinguish between foreign illnesses and the body’s own tissue and organs. Inflammation caused by lupus can affect joints, skin, kidneys, blood cells, brain, heart, lungs, and other organs. Although there is no cure for lupus, there are numerous medications that can alleviate its symptoms.

Sharon had just graduated from Florida A&M University in Tallahassee when she received her diagnosis. “I was 22 at the time, fresh out of college,” Sharon said. “You’re taught while you’re growing up to learn your manners, respect your elders, and get a good education. No one tells you about an autoimmune disease that you will have for the rest of your life.”

Nor had anyone told her what having lupus would entail. “I immediately went into battle mode,” she said. “I had graduated from college. I had traveled 1200 miles from my family to make my journalism degree happen, and I was going to fight.”

“But, as soon as I got my fight on, that’s when all the pain started.”

Sharon experienced a flare-up of symptoms. It would be an understatement to say that the rest of that winter was difficult for her. Her hair began to fall out. She suffered from constant fatigue and pain. In the month of February alone, Sharon lost thirty pounds.

After beginning treatment on several different medications, Sharon started feeling better by that summer. One Wednesday during a Bible study, Sharon was asked what she would do if it were her last day on Earth.

“I said I wanted to see the world,” Sharon said. “Because if lupus was going to take me out, then it was going come and find me in Paris on the Eiffel Tower or on a beach in the Virgin Islands.”

By chance, Northwest Airlines (now Delta) had put out an ad to recruit flight attendants. It was a dream job for Sharon. The job provided her with better insurance, and on her off days she could fly to any location on Northwest’s roster. Just as she had hoped, Sharon got a chance to see the world. Amazingly, Sharon started to find that her experience with lupus was helping her have a healthier mindset. “It really made me think of life in a whole different way, and just literally live. Just really get out there and live,” she said.

Sharon eventually moved back to Tallahassee, opening an eyelash parlor and holding down an office job. At that point, she experienced another flare-up. “In October in Tallahassee it is still 100 degrees outside, and I was wearing a wool coat,” Sharon said. “I was so sick.” Sharon packed up and returned to her hometown: Detroit, MI.

Now, too sick to work and without a job, Sharon did not have health insurance. The lupus was attacking her kidneys and the medicine that she was prescribed cost upwards of $3,000 for a month’s supply. Despite pinching pennies to afford her daughter’s medication, Sharon’s mother was willing to refinance her house to save her only child’s life.

That’s when Sharon’s luck shifted. One day, she visited a local lupus organization with the intention of buying a t-shirt, and she ended up walking out with a new job. Her new public relations position did not include benefits but being employed allowed her to purchase health insurance.

Although she had insurance, her share of the payments for her four medications was unaffordable; one of the therapies alone cost more than $1,000 per month. That’s when Sharon found out about the HealthWell Foundation from a Google Alert. HealthWell is a nationwide non-profit providing financial assistance to insured patients who are still struggling to afford the medications they need (and sponsor of this blog).

“Literally, HealthWell saved my life,” Sharon said. “I didn’t have to incur any debt, my mother didn’t have to refinance her house, and HealthWell saved the day.”

SharronHarris2

And Sharon wanted to save the day for others like her. She has become a leading activist for lupus awareness, starting her own advocacy group called Lupus Detroit, which offers lupus patients emergency grants. Sharon points out that there are two colors that are used for lupus awareness, orange and purple. She opted for orange for her organization because the color is “louder” and garners more attention. “Lupus needs all of the attention that it can get,” Sharon said.

Sharon is currently in remission and has been doing well since receiving a grant from HealthWell in 2011 that allowed her to afford her medications. “I was inspired by the work that HealthWell does to help people with their medications,” she said. “I just don’t believe that someone should have to choose between paying for their medication and feeding their children.”

And neither do we, Sharon. Keep up the excellent work.

If you are inspired to help, consider raising awareness during Lupus Awareness Month and showing your support. Here are some suggestions:

  • Make a donation to HealthWell’s SLE Fund in honor of a family member or loved one who is battling lupus.
  • Celebrate World Lupus Day on Saturday, May 10th.
  • Put on Purple on Friday, May 16th and visit The Lupus Foundation of America’s website at www.lupus.org to learn how you can show your support.
  • Find your local Lupus Foundation of America chapter to learn about activities in your area.

Has lupus touched your life? Do you have plans to show support during Lupus Awareness Month? Share your story in the comments section.

Categories: Cost-Savings

KIDS: Providing Children and Families a Voice in Medicine, Research, and Innovation

The active involvement of patients in health care choices, diseases, research, and innovation is an area of recent focus for many public and private entities (e.g., FDA’s Patient-Focused Drug Development initiative).  As an innovative method to engage children, the KIDS (Kids and Families Impacting Disease Through Science) project was launched as an advisory group of children, adolescents, and families focused on understanding, communicating about, and improving medicine, research, and innovation for children. KIDS is a unique collaboration between the American Academy of Pediatrics (AAP) Section on Advances in Therapeutics and Technology (SOATT), local AAP Chapters, children’s hospitals, local schools, and other partners.

The objectives for the KIDS project are as follows:

  • Learn, teach, and advocate for medicine, research, and innovation that improves the health and well-being of children;
  • Engage in the process through projects and consultation activities with hospitals, researchers, and other partners in the public and private sectors;
  • Provide input on research ideas, innovative solutions, unmet pediatric needs, and priorities;
  • Contribute to the design and implementation of clinical studies for children (e.g., assent, monitoring tools, schedules, etc.);
  • Serve as a critical voice for children and families in the medical, research, and innovation processes.

KIDS launched as a pilot program in Connecticut in September 2013 and will be expanding to other states in the US (e.g., Utah, New Jersey). The KIDS Connecticut Team has participated in meetings at Connecticut Children’s Medical Center (Hartford, CT) and Yale-New Haven Children’s Hospital, a Research Summit at Pfizer’s Connecticut Laboratories, and an advisory session with Mr. David Tabatsky, author of Write for Life.

In addition, the team attended the AAP’s Healthy Children Conference & Expo in Chicago in March, at which they staffed an exhibit booth highlighting their work and the importance of research and innovation for children. They also conducted survey-based research by collecting more than 300 responses with a focus on participants’ opinions of the importance of research in their lives and the role of children in research. Three KIDS Team Members delivered an invited Learning Zone presentation for conference attendees discussing the importance of research, the work of the KIDS Team, and the vision for future expansion. Finally, the KIDS interacted with numerous AAP leaders and staff members throughout the weekend. Overall, the KIDS involvement in the conference was a resounding success as each Team Member was articulate and passionate about their work and the importance of medicine and research. Feedback from attendees, exhibitors, and AAP leadership/staff was overwhelmingly positive. The Team will also be attending the Pediatric Academic Societies meeting in Vancouver in early May and will be collaborating with a similar children’s advisory group located in that city.

In addition to a KIDS expansion in the US, SOATT is working with existing young person advisory groups and other partners to develop an international network of children advisors. The children, families, leaders, and partners are very excited about the potential opportunities for these teams and the future network to make a significant impact on the health and well-being of children worldwide.

Do you think it is important for children to be involved in shaping pediatric medical research? Have you had experience with kids getting involved in their health care? What was the outcome? Share your thoughts in the comments section.

If you are interested in participating in this project or would like more information, please contact Charlie Thompson (charles.a.thompson@pfizer.com).

Virtual Health Care: Your Questions Answered by a Telehealth Pioneer

If you follow the latest developments in health care, you may have noticed: telehealth has taken off. Our country is focused on making health care more accessible for Americans, and naturally, telehealth has emerged as a key innovation that can help to make this a reality. It’s an effective way to deliver evidence-based medicine – and it’s something that we as physicians can embrace right now.

Dr. Peter Antall

Dr. Peter Antall

As President and Medical Director of the world’s first telehealth practice, Online Care Group, I’m often asked a handful of common questions about telehealth. Here, I share the most common questions and my answers with Real World Health Care’s readers.

What is telehealth?

To me, telehealth is simple. Telehealth is a live video visit between a doctor and a patient from home or work. This differs from traditional telemedicine, which mainly connected hospital facilities to each other and relied on big, expensive hardware in clinical locations.

With telehealth, the patient can have a video visit with a doctor using every day consumer technologies that are becoming ubiquitous: a smartphone, tablet, or computer. There are other forms of telehealth on the market that use only phone or secure email; however, these visits do not allow for the same level of clinical patient evaluation. I have met with medical boards and associations across the country and found that live video is greatly preferred because it represents the closest interaction comparable to an in-person visit.

Do patients really want to talk to a doctor virtually?

For starters, let me just ask you when was the last time you shopped, banked, booked travel, made a dinner reservation, filed your taxes, or communicated with friends and family online. Chances are – if you’re like many Americans – you’ve done more than one of these things today, probably on your phone or tablet.

While the health care industry has done a great job of supplying information to patients online and has even started to offer patients the opportunity to book appointments online, information and scheduling stop short of what patients want and expect from health care: quality interactions with clinicians. To date, health care ‘transactions’ have only occurred at the intersection of a physical location and the supply of available clinicians. The industry can do better.

Over the last several years, a number of studies have shown that patients are rapidly warming to the concept of interacting with doctors online. Estimates suggest that half to three-quarters of Americans are interested in online consults, and I’d expect this number to grow as more patients have access to telehealth services and as more doctors offer such services to patients.

If you think about the patient experience today, it’s not surprising that most folks respond so positively to the value of telehealth. Consider the national average wait time to see a doctor of 18.5 days, not to mention the excessive wait time in certain urban and rural areas. And once you’re in the doctor’s office, that wait can be long, too, which you know if you’ve ever spent two or three hours in an urgent care clinic or emergency room waiting to be seen. Retail clinics are an option, but these are generally not staffed by a doctor and are often not available outside of normal business hours.

On the other hand, a patient can see a doctor in just a few minutes from their phone or tablet. For example, our wait times at the Online Care Group currently average less than 2.5 minutes, and there’s no appointment or travel required. So it’s not surprising that 97% of patients rate the service “very good” or “excellent”.

How do you examine a patient during a telehealth visit?

Examining a patient through video is different from in-person, though the fundamental rules of medicine still apply. The most important elements of any consultation – online or in-person – is taking a thorough history, asking plenty of questions, and doing a visual examination. Having a video connection with a patient is really important in helping to understand the patient’s overall demeanor and level of discomfort and stress, just as in the exam room. This gives me great insight into the patient’s physical and mental well-being. In terms of a physical exam, I’ve developed protocols to help our doctors guide patients through self-exams in order to provide empirical feedback that’s useful in making certain diagnoses.

One of our main tenets is that doctors must use their own clinical discretion when treating patients online. Our physicians diagnose and treat only when enough data can be ascertained in the video consultation to do so. If not, our physicians triage the patient and refer out for in-person care. That may mean seeing their doctor in-person, going to the emergency room, or ordering tests at a local health center.

What about security issues?

As with brick-and-mortar medicine, it is extremely important to protect patient health information. The information regarding a patient’s health should remain private between the physician and the patient and be stored securely, in compliance with the Health Insurance Portability and Accountability Act (HIPAA). American Well provides a secure space for patients to safely and confidentially consult with a doctor online. This is imperative for an effective and safe telehealth practice.

What does telehealth have to offer me as a doctor?

Telehealth is not only convenient for patients; it offers doctors flexibility at work, reliable pay, and access to new patients. And not only individual and group practices, but even large medical practices and hospitals, are starting to use telehealth to attract and retain patients and to expand their reach.

By incorporating telehealth, hospitals under accountable care organization (ACO) contracts, or otherwise caring for patients under capitation, reap the financial benefits of having healthier patients. Private offices can offer open access and after-hours care or designate that a subset of visits, like medication follow-up, be managed through telehealth. Practices can also bring in other specialties virtually into their office, like certified diabetes educators, dieticians, or behavioral health specialists.

Can I make money with telehealth?

There is high demand from patients for urgent-care-like telehealth services. Today, physicians across the country – including those in our national telehealth practice – make a very good living practicing medicine online, providing care anywhere from 10-40 hours per week.

Another option is for doctors to offer telehealth to their existing patients. In many states, doctors are already being reimbursed for services delivered to their own patients by including GT modifiers in their billing (this modifier is used to indicate telehealth services via interactive audio and video telecommunication systems). Currently 20 states mandate private payer reimbursement for telehealth services and 45 states reimburse for some telehealth services. As our doctors move from fee-for-service to capitated payment models under the Affordable Care Act, they are absorbing the risk (“rewarded for performance,” as some might say). Telehealth is one way to improve efficacy and efficiency of patient care. Telehealth lets doctors increase the number of touch points for patients, which potentially can improve outcomes as well.

Is telehealth the future of healthcare?

Telehealth isn’t really a new form of healthcare; it is the same healthcare that Americans are using every day, delivered in a faster, less expensive, more convenient way. Although not everything can be treated via telehealth, it’s a great option for many types of acute care, chronic care, behavioral health, and wellness services. Patients, doctors, hospital systems, employers, insurers, regulators, and legislators are all rapidly changing the way they view health care in order to incorporate telehealth. In the coming months, the proof that telehealth is here to stay will become even more evident. It’s time to embrace the now of health care.

Have you ever used telehealth? Would you? Share your thoughts and experiences in the comments section.

If you have any questions or to learn more about where and how I practice telehealth, email me at peter.antall@americanwell.com.

Dr. Antall is the Medical Director of Online Care Group, a physician-owned primary care group that offers its clinical services online using American Well’s technology. American Well’s web and mobile telehealth platform connects patients and clinicians for live, clinically meaningful visits through video, supplemented by secure text chat and phone. For more information, visit AmericanWell.com

Categories: Access to Care

Patient of the Month: Charles Fazio’s recovery from heart bypass surgery, kidney failure, and financial crisis

Patient of the Month is a new regular feature from Real World Health Care to illustrate the challenges and successes of the American health care system through the experiences of inspiring survivors.

Charles Fazio wasn’t sure how he could survive another health crisis.

Charles Fazio

Charles Fazio

Just three years after his four-way heart bypass surgery, he developed end stage kidney failure. In the worsening economy, he had lost his job as a traffic signal technician in Norfolk, Virginia and had since become too sick to work. On top of his serious health problems, Charles’ financial worries were overwhelming.

“It was like after having all of these other things happen, now I have to deal with this, too,” said Charles. “It was a big shock.”

Charles’ disability benefits had not begun to come in and he had to sell off his possessions to afford his medical expenses. Eventually, he lost his home and found himself homeless for several days.

“One night I stayed in my mom’s nursing home. I went in to visit her and I pretended like I just fell asleep in the chair next to her,” Charles said.

In short, it had been a rough few years, to say the least.

Charles was treated at Sentara Norfolk General Hospital and received dialysis for a year and a half at the Virginia Commonwealth University (VCU) Medical Center. Completing the process for Medicare allowed him to afford his dialysis treatments and living expenses.

Then, one day in 2012, Charles’ regular doctor appointment morphed into an overnight kidney transplant. “I was scared to death,” Charles said. “I didn’t know what to expect. I had read up on everything thoroughly, but when the time comes, you really just have to face it.”

By 4 o’clock the next day, he had a transplant kidney.

Charles continued treatment and testing at the VCU Medical Center after his operation. His recovery went smoothly, but he still required numerous medications and immunosuppressants. Again, he couldn’t afford the copays.

That’s when doctors and social workers introduced Charles to the HealthWell Foundation, a nationwide non-profit providing financial assistance to insured patients who are still struggling to afford the medications they need (and sponsor of this blog).. Charles was given a grant that enabled him to afford his medications.

“The grant I got from [HealthWell] took a lot of worry off of my back, a lot of tension,” Charles said.

With his financial stress reduced, Charles was better able to emotionally cope with his condition. “The help I got from Norfolk General, the VCU and [HealthWell] was the turning point for all of my frustrations, for feeling sorry for myself,” he said.

Now, Charles is doing quite well. At a recent annual check-up with his doctors at the VCU, his blood tests came back looking good. His transplant kidney is holding up well and his medication is stable. “You never know how you’re doing, even though you’re dieting and doing what your doctors are telling you,” he said. “In the back of your mind you’re asking, ‘How am I doing?’ and only a doctor can tell you.”

“But they said I’m doing well, and I feel good too.”

Charles is optimistic that his series of unfortunate events may now be in the past. He is recovering well and doing his best to stay healthy in his eating habits and his lifestyle. “When the weather’s nice, I try to take a walk once a week, and I hold on,” he said.

One step at a time, Charles. We’re all glad you’re here.

Categories: Access to Care, General

Four benefits of electronic health records

Leaders from industry, academia, and health care discuss the rollout of this technology at The Atlantic’s sixth annual Health Care Forum

Today The Atlantic Health Care Forum brought together leading policymakers and industry experts in medicine, public health, and nutrition to have conversations about the state of the nation’s health care system. The event was sponsored by Siemens, Surescripts, WellPoint, GSK and PhRMA. Real World Health Care attended to share insights from the panel “Health Care Tomorrow: Examining the Tools and Technologies that Will Revolutionize the Future Health Care System.”

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Much of the discussion centered around electronic health records, which are increasingly being rolled out in huge hospital systems after the federal government incentivized their adoption to the tune of billions of dollars five years ago. Four themes emerged from the panel, which included top executives from Johns Hopkins Medicine, athenahealth, PhRMA, and Carolinas HealthCare System.

 

1. Enhancing collaboration.

Electronic health records facilitate a team-based approach to hospital care, as well as allowing for better coordination between hospital systems. “What we’re going to see is it’s going to drive team-based clinical care because everyone in the system will have access to the same medical records,” said Dr. Paul Rothman, Dean of the Medical Faculty and Vice President for Medicine at The Johns Hopkins University and Chief Executive Officer at Johns Hopkins Medicine. “You’re going to see an [increased] level of collaboration not only between delivery systems, but also between the patient and the health care provider.”

However, Ed Park, Executive Vice President and Chief Operating Officer, athenahealth, warned that the decades-old technologies that many hospital systems are using are limited in their capabilities. “The current crop of [electronic health records] are documentation tools instead of care management tools,” he said, adding that they are primarily for use by insurers and lawyers. “What I fear is health systems beginning to buy their way into their own prisons that are built of their own IT…as opposed to dealing in an open environment,” he said.

 

2. Enabling patient-centered care.

Electronic health records enable patients to reap greater benefits from telehealth. “Having your information on your iPhone: that’s not far away,” Dr. Rothman said. “[Patients are] going to do EKG’s at home. They’re going to be measuring their blood sugar at home. The patient will have control of the data.”

Electronic records also hold the promise of helping to solve age-old problems in the U.S. health care system, including keeping contact with patients to encourage them to take prescribed treatment regimens. “There is almost $350 billion a year in inefficiency because of lack of compliance and adherence with medications,” said John Castellani, President and Chief Executive Officer, PhRMA. “If you could just get an improvement in whether patients take the medicines that are prescribed, you could capture this great savings.”

“You have kids who have kidney transplants, and you can give them reminders on Facebook that they have to take their medications,” Dr. Rothman added.

 

3. Targeting therapies for increased success.

Electronic medical records can help health care providers ensure that they prescribe the treatments most likely to work for their patients.

“What I think is the promise of electronic medical records is our ability to find subsets of diseases through the broad diseases we treat,” Dr. Rothman said. “Asthma isn’t one disease. Obesity isn’t one disease. Diabetes isn’t one disease. We are going to be able to find subsets of diseases and target therapies [that work]. That’s when you’re going to see efficiency and return on investment.”

 

4. Harnessing the power of big data.

Our health care system has already begun to see the benefits of ‘big data’ with examples such as the discovery of drug side effects and interactions through mining consumer web search data. “We have to use the technologies to bring down the cost of the drug discovery process,” Castellani said.

“Just taking care of the patient, we capture data,” said Dr. Roger Ray, Executive Vice President and Chief Medical Officer, Carolinas HealthCare System. “That allows us to know when a patient…may be at risk for hospital readmission. Having the ability to mine [data]…makes a difference for patients.

“We all, each of us, remember with longing a simpler time when we could scribble and walk off and our job was done,” he added. “What we know now is that’s not very good for the patient. We had no standardization allowing us to help patients avoid lots of different bad outcomes they could have.”

 

Have electronic medical records impacted your health or that of your patients? Share your thoughts in the comments section.

Five Ways to Manage the Costs of Your Medicine

While a main precept of the Affordable Care Act is to expand access to health care, in some cases that improved access means more patients are being treated with medications that come with a cost. As a pharmacist, I have to be an insurance sleuth, use common sense, and teach my patients the old-fashioned methods of negotiation.

Joel Zive

Joel Zive

I work in solid organ transplant, HIV, and Hepatitis C medicine. I have patients on regimes ranging from 4 to over 20 medications. For my patients, obtaining consistent, reasonably-priced medications – both over-the-counter and prescription – is vital.

1. Make sure all the medications are at one pharmacy.  It’s important to keep a clinical eye on things for drug interactions. As a bonus, the pharmacist and the patient know what costs need to be examined.

2. Seek out insurance prior authorization.  Some insurance companies require prior authorization to cover certain drugs. Your pharmacist can help you seek prior authorization for medications that require it using software that creates forms specific to each insurance company. Ask if your pharmacist can fill out the form as much as possible before sending it to your doctor.

3. Contact the drug company.  Many pharmaceutical companies offer patient assistance programs or co-pay assistance cards to help eligible patients obtain free medicines, particularly for biologics and expensive drugs. These programs are especially helpful for patients who have insurance gaps and need the medications quickly. Depending on the assistance from a case manager or care coordinator, I have received authorization for medications right away or within 72 hours.

4. Search for a co-pay assistance program that covers your condition.  If your drug company does not offer a patient assistance program or you are not eligible based on your income and insurance coverage, it is possible that a charitable patient assistance program through a non-profit organization such as the HealthWell Foundation may be able to help you.

5. Seek discounts for over-the-counter medications.  Over-the-counter medications can put a strain on the wallet. In many cases, purchasing over-the-counter medications is more expensive than prescription medications covered by insurance. Other items like vitamins, natural supplements, and enteral formulas (also known as ‘milks’) require the patient to do a little negotiating. If you tell the pharmacy or vitamin store you will be taking these items indefinitely, they may be inclined to discount. Also, be on the lookout for buy one get one deals (BOGOs). Finally, enteral formulas can be quite expensive, so if you get prescribed a specially formulated one, ask if you can take a more basic formulation instead. Remember to let your prescriber and pharmacist know which over-the-counter medications and supplements you are using.

In conclusion, while the path to affordable medications is not always easy, there are individuals, programs, and strategies that can help you meet your health care goals.

How do you manage your medications? Share your tips in the comments section.

Categories: General

Our Top 4 Most ‘Liked’ Health Care Stories

This week is Real World Health Care’s one-year anniversary. Over the past year, we showcased solutions that are proven to lower costs, increase access, and provide more patient-centered care. In celebration of this milestone, we are sharing the favorite posts as measured by Facebook ‘likes’ from our readers, who have visited the blog over 10,000 times.

 

#4 – Keeping Boston Strong: How Disaster Training at Osteopathic Medical School Helped Save Lives

In May, former RWHC editor Paul DeMiglio told the story of Dr. Danielle Deines’ emergency response to the Boston Marathon bombing. Dr. Deines’ education at the Edward Via College of Osteopathic Medicine – Virginia Campus (VCOM) required her to participate in a two-day, mandatory training curriculum on Bioterrorism and Disaster Response Program, which immersed her in real-life disaster training, field exercises and specialized courses.

(Photo courtesy of VCOM)

(Photo courtesy of VCOM)

The day of the bombing, after crossing the finish line, Dr. Deines found herself triaging runners in medical tents to make room for the victims. “The back corner became the most severe triage area, nearest the entrance where the ambulances were arriving,” she said. “I saw victims with traumatic amputations of the lower extremities, legs that had partially severed or had shrapnel embedded, and clothing and shoes literally blown off of victims’ bodies.”

Read the post: http://www.realworldhealthcare.org/2013/05/keeping-boston-strong-how-disaster-training-at-osteopathic-medical-school-helped-save-lives/

 

#3 – Making Life Easier for Patients and Loved Ones: Meet MyHealthTeams

In April, Eric Peacock, Co-founder and CEO of MyHealthTeams, contributed a guest blog about the need for social networks for communities of people living with chronic conditions. These networks allow patients to “share recommendations of local providers, openly discuss daily triumphs and issues, share tips and advice, and gain access to local services,” he wrote.

“Sharing with people who are in your shoes offers a sense of community that can’t be found elsewhere – these are people who know the language of your condition; they understand the daily frustrations and the small triumphs that can mean so much,” he added.

Read the post: http://www.realworldhealthcare.org/2013/04/making-life-easier-for-patients-and-loved-ones-meet-myhealthteams/

 

#2 – When the Health Care Blogger Becomes the Cancer Patient

In August, even as she was still undergoing daily radiation treatments, contributor Linda Barlow shared her personal story of being diagnosed with cancer and the slew of medical bills she faced even though she had insurance.

Linda Barlow

Linda Barlow

“While these out of pocket costs are certainly hard to swallow – I can think of a hundred other things I’d rather spend my money on – for my family, they are doable,” she wrote. “We won’t have to skip a mortgage payment or a utility bill. We won’t have to dip into a child’s college tuition fund. We certainly won’t have to worry about having enough money for food. But I know – from my work on this blog and with its main sponsor, the HealthWell Foundation – that many families living with cancer aren’t so lucky.”

Read the post: http://www.realworldhealthcare.org/2013/08/when-the-health-care-blogger-becomes-the-cancer-patient/

 

#1 – What If You Want Politicians to Get Moving But You Can’t Move?

Neil Cavuto

Neil Cavuto

Last week, Neil Cavuto, Senior Vice President and Anchor, Fox News and Fox Business, contributed a moving guest post about his triumphs over multiple sclerosis (MS) for MS Awareness Week. His deeply personal blog inspired resounding praise in the comments section and 1,300 Facebook ‘likes’.

“If I can pass along any advice at all, it is…to simply never accept a prognosis as is,” he wrote. “Fight it. Challenge it. ‘Will’ yourself over it. Many doctors say it’s a naïve approach to the disease, but attitude counts a lot for me with MS, as it did for me two decades ago when I was battling advanced Hodgkin’s Disease. Then, as now, it was about one day at a time, and staying optimistic and positive all the time.”

Read the post: http://www.realworldhealthcare.org/2014/03/ms-awareness-week/

 

If you would like to suggest a topic, contribute a guest post, or learn more about short-term co-sponsorship opportunities, please contact us at dsheon@WHITECOATstrategies.com. As a blog currently sponsored solely by the HealthWell Foundation, an independent non-profit providing nationwide financial assistance to insured Americans with high out-of-pocket medication expenses, co-sponsorship helps us keep Real World Health Care alive and well as a resource for journalists, health care professionals, policymakers, and patients. Plus, co-sponsorship will increase your organization’s visibility among thought leaders in the health care sphere.

Do you have a favorite Real World Health Care post? Is there something you’d like to see more of? Post to the comments section or tweet at us at @RWHCblog.

Should clinicians replace medication with an ancient spiritual practice?

Researchers from Johns Hopkins University sifted through over 18,000 studies on a potential treatment for pain, anxiety and depression, narrowing their meta-analysis to 47 scientifically rigorous clinical trials. The results, published in the journal JAMA Internal Medicine, revealed what many have experienced over thousands of years: while it’s not a cure-all, this treatment can help alleviate pain, anxiety and depression. The treatment? Meditation.

David Sheon

David Sheon

Meditation began as an ancient spiritual practice but is now also utilized outside of traditional settings to promote health and well-being. The study findings incorporate the effects of mindfulness meditation on over 3,500 participants who were selected to take part in either a meditation regimen or a different therapy, such as exercise. Overall, researchers found that the effect of meditation on participants was moderate and on par with that of prescription medications.

While this is a promising result on the benefits of meditation, the researchers identified a number of limitations. The study did not find any evidence of meditation affecting other health concerns such as positive mood, attention, substance use, eating habits, sleep and weight. Also, meditation did not provide any long-term therapy as compared to medication. “The benefits did attenuate over time — with the effectiveness of meditation decreasing by half, three to six months after the training classes ended,” said study leader Dr. Madhav Goyal, an assistant professor of medicine at Hopkins. “We don’t know why this occurred, but it could have been that they were practicing meditation less often.”

Still, Dr. Goyal said he is encouraged by the study’s results, specifically because of the short training periods for the participants. There may be greater potential for individuals with more instruction or experience in meditation. “Compared to other skills that we train in, the amount of training received by the participants in the trials was relatively brief,” he said. “Yet, we are seeing a small but consistent benefit for symptoms of anxiety, depression and pain. So you wonder whether we might see larger effects with more training, practice and skill.”

While the new study suggests that in some cases, meditation may be used in addition to or in lieu of prescription drugs to treat pain, anxiety and depression, it is important for patients to consult their doctors before altering any course of treatment.

At RealWorldHealthCare.org, we have been interested in meditation’s potentially positive impact on health. Last April, we posted about a recent study in which meditation halved the risk of death, heart attack and stroke in African American men.

Meditation may have economic benefits as well. According to a July 2013 Huffington Post blog, Aetna’s employee health care costs went down by 7 percent in 2012 after the company implemented a wellness program, which CEO Mark Bertolini attributes to reducing stress through meditation and yoga. In recognition of its positive health impact, some insurance companies provide benefits for meditation instruction. For example, CareFirst’s Options Discount Program offers up to 30% off fees for participating meditation instructors. In 2010, Americans spent more than $11 billion on antidepressants, according to the American Psychological Association.

The National Center for Complementary and Alternative Medicine of the NIH offers an introduction to meditation, its uses and guidance for those who wish to practice meditating. The National Meditation Specialist Certification Board, an organization that seeks to promote meditation as a specialized field in health care, keeps a directory of meditation specialists, and there are many other such directories available online or through participating insurance providers.

In a Psychology Today article guiding those interested in mindfulness meditation, Dr. Karen Kissel Wegela emphasizes that sick or healthy, meditation can help people cope. “The sitting practice of mindfulness meditation gives us exactly this opportunity to become more present with ourselves just as we are,” she says. “This, in turn, shows us glimpses of our inherent wisdom and teaches us how to stop perpetuating the unnecessary suffering that results from trying to escape the discomfort, and even pain, we inevitably experience as a consequence of simply being alive.”

Have you ever meditated? Have you or someone you know ever meditated to treat depression, pain or anxiety? Did you find it effective?

Categories: General