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Patients are People Too

Gardener with plants

In the emerging field of patient engagement there is considerable debate about what exactly to call it: patient engagement, consumer engagement, person-centered care, the list goes on. Regardless of the name, the key is to first and foremost recognize that a patient's health care isn't at the center of their universe. And if it is, then we have failed; we have taken the care out of health care.

When I was in college, I worked as a nursing assistant at the nursing home close to campus. During my training I was told to think of the residents as though they were family members. How would I want my grandmother or mother to be treated? I was assigned to work in the Special Care Unit, which is where the residents with dementia or Alzheimer's disease lived. I was nervous at first but quickly fell in love with all of them. I learned that in order to provide the best care possible I had to meet them where they were. For one lady, that meant waiting at the bus stop (a chair just outside the nurse's station) for Alice so they could go to the movie. For another, it was asking him where he put the library book that he was so desperate to return. Reorienting them to person, place and time was not helpful—it only caused more distress. In many cases, I became a long-lost daughter or childhood friend and that was OK. It was more than OK; it made them calmer, more relaxed. Outside of each room was a memory box filled with mementos and photographs from their past. The purpose was to help the residents find their rooms, but they served another purpose for me. Every time I entered the room I would pause, just for a few seconds, to look at their pictures. The pictures told so many stories of families, of professions, of sacrifices, of love. I could recall similar pictures of my grandparents and parents. The task of treating them like family was easy; in a short time, they were my family.

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Caregivers: Not Just Nurses and Mothers Any More

Three gnerations of family in the park

I found myself thinking about what to write for this blog post on Mother's Day, which fell in the middle of Nurses' Week this year. Both moms and nurses have a long and intertwined history of caregiving. Most nurses are women, and if asked what nurses do, it would not be surprising if the answer was, "they take care of us." We would say the same about our mothers.

For about a decade before my father died, my mother and I were his at-home caregivers. It was a labor of love. However, it wasn't until after he was gone that I truly realized how much labor it had actually been. I was exhausted and had been for years without realizing it. I jumped every time the phone rang because I was afraid something had happened to my father that might involve calling 911 or rushing to his side. Over the years, I prepared a file of all the phone numbers and information I thought I might need "when the time came." I also tried to support my mother so she still had a quality life outside of caring for dad. Did I mention I was exhausted? Even as a registered nurse for many years, I was ill-prepared for this role.

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The Value of Diabetic Self-Management

Blood sample using finger

Diabetes continues to be one of those "sticky" problems -- one that is not easily solved by simple strategies. Typically, "sticky" problems take a variety of coordinated approaches to solve.

Diabetes is one of the leading causes of death in the United States. In 2012, the cost of diabetes in the U.S. was $176 billion for direct medical costs, and $69 billion in reduced productivity. A snapshot view of those who have diabetes demonstrates the criticality of the problem. According to the American Diabetes Association, 29.1 million people have this disease, which means 1 out of 11 people has been diagnosed with diabetes; 1 in 3 adults has pre-diabetes; 1 in 4 adults over the age of 60 has diabetes; and 1 out of 4 adults is living with undiagnosed Type II diabetes.

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Wearable Tech: Keeping Your Data Close to You

Smart watch

I'm sitting in a quiet room working on my computer when suddenly my watch alarm goes off. This isn't an alarm to tell me to get ready for my next meeting; it's a notification from a news aggregator letting me know about a trending article. I quickly tap my smartwatch, which loads the article on the watch face and allows me to read it. Afterward, I check my watch's pedometer to see if I should take the stairs instead of the elevator today to reach my daily step goal. At the end of my day, I can review my sleeping patterns to see if I'm sleeping soundly or not -- a good night's sleep, for me, is an indicator of my stress level. My smartwatch has become a tool that provides information that directly influences my health.

Wearable tech is a quickly evolving field and its impact on health care is becoming more and more significant. Wearable technology can be loosely defined as technology that is embedded into or used to accentuate devices such as wristwatches, glasses, shirts, dresses, necklaces or even shoes. Some wearable technology can even be embedded in contact lenses. My smartwatch provides a convenient approach to tracking my own health statistics such as heart rate, sleeping patterns, calories burned and glucose levels. No longer do I need to write down stats on a notepad -- I can simply use some mobile applications paired to my wearable tech to record, collect and oftentimes perform low-level analyses for me. There are other wearable devices that patients can use to store and update their medical history to have it available at a moment's notice or to share with their physicians. An infographic on Orange Healthcare's website shows how wearable tech can expand to fit a large number of potential needs for both patients and physicians.

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What Does HealthInsight Do, Anyway?

Peopl at a meeting

From time to time at HealthInsight, we engage in a little exercise to develop and define what we refer to as our "elevator speech." We try to think about how we could, in the 30-second time span of an elevator ride, best and most succinctly answer the question, "What does HealthInsight do?"

As you might imagine, HealthInsight does a whole lot of things in the field of health and health care improvement, and distilling a description of our work down to a clear, concise response to this question is neither obvious nor easy to summarize in a sentence or two -- the way it might be if we were, say, a law firm or a hospital. While we may continue to struggle to craft the perfect elevator speech response, we can point the reader to some recently published information that helpfully describes important work that we perform as the federally designated Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Medicare in the states of Nevada, New Mexico, Oregon and Utah. This report illustrates the kinds of things we do to improve health and health care.

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Taking Back the Trail

Taking Back the Trail at Sunset

Social determinants of health, the economic and social conditions that affect the health and development of people and their communities, are an important aspect to consider when attempting to create positive health outcomes for a population. Often the effects of these conditions occur subconsciously -- patterns of healthy behaviors are set by our environments and we accept them as a natural part of our day-to-day lives.

One of the social determinants of health is having access to a safe area for outdoor recreation, where people can walk their dogs, play with their kids or run to keep fit. My neighborhood park is like that -- my family calls the park "puppy town" due to all the dogs that can be found in the park every morning and evening.

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Looking Up to Reach the Stars

Hiker

HealthInsight, like many organizations working toward the triple aim of better health care and better health at a lower cost, has recognized the need to stretch ourselves beyond comfortable goals and targets. As we work with health care providers and other community stakeholders, it will take truly innovative and transformative effort to achieve the goals we seek. Just as we ask providers of health care in our communities to transform their work to improve care and reduce cost, we also ask the same of ourselves. How can we do our work in a way that gets fundamentally different results, extraordinary results, with the same amount of funding, or even with fewer resources? We believe what is required is to step back and look at the big picture -- stepping away from the way we usually have done things to be able to imagine new ways this work can be accomplished.

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What Employers Want from Practice Transformation

Doctor with Patient

This is the last in a series of blogs that shared various health care stakeholders' views on how outpatient practices need to transform to prepare for new payment models that move away from paying for units of care to paying for quality and efficiency. Having shared what we heard from patients and providers previously, I will now share thoughts from a representative of a different health care stakeholder -- employers.

I was fortunate to discuss this topic with Brian Klepper, PhD, health care thought leader and recently appointed CEO of the National Business Coalition on Health (NBCH), which represents 4,500 employers and 35 million employees and dependents. Why do employers care about practice transformation? Because in the United States we pay more than twice as much for health care and get poorer results than other developed nations, so we are disadvantaged in the global market and have less to spend domestically on education and other important infrastructure. This pattern, while unsustainable, is very well entrenched as our fee-for-service system has incentives that lead to more care and not better care. It's hard for a health care system to make changes to itself that will reduce its bottom line. Other stakeholders, often employers, are leading the way in changing to a pay-for-value model.

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Part Two: What Do Providers Think About Practice Transformation?

Little Girl with Doctor

Last week, I shared some thoughts from members of the Provider Advisory Group (PAG) for the New Mexico Coalition for Healthcare Quality. I sat down with this group to discuss practice transformation and the impact it has in transforming care. Members provided their own opinions of practice transformation and not those of the organizations where they work. Today's blog is part two of our discussion.

Providers thought interoperable electronic health records (EHRs) could go a long way in helping with essential coordination of care. They are still seeing a lot of faxing, and things that are easily done on mobile devices are very difficult to do in a less user-friendly EHR system. They thought that doctors shouldn't spend time typing information into the system that either the patients themselves or another staff member could enter. The data needs to be there to drive change, but they thought it was the whole team's role to make sure data was accurately entered and useable. In many practices, doctors are still entering most of the patient data. Providers need to improve their processes for sharing that work with all team members. Currently the EHRs create notes that have all the criteria for coding for a visit to be paid, but the notes are often not structured in a way that captures and displays information on quality of care. User interfaces of EHRs could improve the patients' experience if the systems were easier to operate, enter data into, and to quickly view the patient's past data and create reports in formats that are easily understandable for patients.

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What Do Providers Think About Practice Transformation?

Doctor with Patient

In last week's blog post, I shared some thoughts from members of a Patient and Family Advisory Council on what practice transformation could and should include. This week I have summarized a conversation with members of the Provider Advisory Group (PAG) for the New Mexico Coalition for Healthcare Quality, who serve as expert "ears on the ground" representing practice settings. Members provided their own opinions of practice transformation and not those of the organizations where they work.

They discussed the positive and negative aspects of having more of their income linked to improved patient health outcomes and satisfaction along with cost savings. These well-seasoned health care professionals think transformed care could provide a better patient experience while allowing them to practice medicine in a way that is more fulfilling, but they also recognized that there is a long way to go before we get there.

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