Curing What Ails Healthcare

Hospice and Palliative Care Blaze a Path for Needed Changes:

We’ve all heard the old healthcare adage: “The cure is worse than the disease.”

Medical education trains physicians to fight disease. Generally, that means treating the symptom that the patient is experiencing. And then the next one. And then the one after that.

How much say does the patient have in the treatment plan? Too often, very little, if anything at all.

That’s a real problem, according to Dr. Timothy Ihrig, an internationally recognized authority on palliative care who joined Crossroads Hospice & Palliative Care (a SPRYTE Communications client) as Chief Medical Officer earlier this year.

Dr. Ihrig believes patients deserve to be fully informed of their condition, what it entails, the likely prognosis, and the likely trajectory of the disease. And that  patients should be involved in important decisions that can affect their quality of life.

“True palliative care” offers an important, proactive, inclusive way of addressing individual patient needs and wishes, while at the same time serving as a key driver in the effort to reduce healthcare costs.

In his blog, What’s Wrong with Healthcare? It Doesn’t Care (Part I), Dr. Ihrig begins to map out how that perspective underscores his desire to “start a movement of thought and inspire others to seek not healthcare reform but a reforming of how we care for others within the healthcare system.”

Published August 14, 2018 by Spryte Communications in Public Affairs

Patriotic Symbolism Helps Promote a Timely Cause

What do July 4th and the Opioid Crisis Have in Common?

Tie-ins to patriotic holidays are a time-tested avenue for promoting a product or business.

How many times have we seen Presidents’ Day promotions for Lincoln lounge suites or Washington white sales? (Far too often, I think you’ll agree.)

Getting Serious

But from a public affairs standpoint, despite the all-too-common campy come-ons, there is still value in the patriotic connection strategy – if it is done in a way that respects and pays homage to the historical precedent.

Anyone who has read a newspaper or watched the TV news is aware that opioid abuse has reached epic proportions across the United States. Our client, Relievus, a physician practice specializing in pain management, wanted to enhance its brand reputation in a way that reflected a commitment to the communities it serves.

SPRYTE recommended a letter to the editor campaign encompassing community newspapers throughout Relievus’ service region – including 15 locations across South Jersey, as well as Philadelphia’s Mainline, Northeast Philadelphia and the surrounding suburbs. To emphasize the local connection and maximize impact, the doctors’ offices in each respective community were correlated to individual local papers.

The theme was Independence Day and was timed to land right as the Fourth of July holiday took place. The analogy of patients struggling to overcome opioid addiction as a modern day fight against oppression and the need to band together for a common good proved to be a popular message, as the letter to the editor was picked up by newspapers throughout Relievus’ New Jersey and Pennsylvania footprint:

Toward a New Independence Day

Dear Editor,

On July 4th, millions of Americans will come together to celebrate the signing of the Declaration of Independence, an historic testimonial against oppression that still inspires people around the world.

Today, millions of Americans are confronting another kind of oppression – opioid addiction. At Relievus, we see the effects of this horrible epidemic every day. It has destroyed families, ruined lives and even led to an historic decrease in lifespan among sectors of the U.S. population.

According to recent reports,  in 2016, 11.5 million people misused prescription opioids, while over 42,000 died from an opioid overdose. Roughly 40% of those deaths involved a prescription opioid. But the impact isn’t limited to opioid abusers. Another report puts the economic impact of each opioid overdose death at approximately $800,000.

It’s important to understand that people who abuse opioids are not weak or inferior. They simply are people trying to deal with their pain. Eventually this pain becomes difficult to manage until it begins affecting their quality of life.

Weaning patients off opioids is an important step. But managing pain takes an intense, multi-faceted approach. Most need social support, behavioral therapy and/or individual counseling. They cannot do it alone. It will take a united and coordinated front.

On this Fourth of July, let us reignite the spirit of American courage and community. Let us work to create a new dawn of independence from the oppression caused by the abuse of opioids and other drugs.

Young J. Lee, MD
Relievus

Local Office Location
Street Address
Telephone
Email Address

Moral of the Story

Even in our current, often-divisive times, a message of community and concern for the greater good can still resonate widely. Perhaps today, more than ever, it’s important to look back to those positive themes that helped establish and develop our nation and use them as a guide as we create our future. As hallowed forefather Benjamin Franklin observed just before signing the Declaration of Independence: “We must, indeed, all hang together, or most assuredly we shall all hang separately.”

The Costs of Public Healthcare Benefits

Understanding How Healthcare Impacts State Budgets

There is an oft-quoted saying, usually attributed to Otto von Bismarck, the 19th century Prussian leader who became the first Chancellor of the united German Empire, that compares the production of sausage to the process of creating legislation: “It’s better not to see them being made.”

The process can be messy and unappetizing. The end product can amount to an amalgam of disparate contributors and ingredients. And while it might be satisfying when first ingested, there might be some unforeseen side-effects that crop up after the initial passage.

Because many states, including New Jersey, are in the midst of annual State Budget negotiations (with an official deadline of June 30th for passage), interested viewers will have a ringside seat as they get to watch the legislative budget deliberations at their most intense. (Note: Governor Wolf signed Pennsylvania’s FY2019 budget on Friday, June 22, the first on-time budget of his tenure.)

Healthcare Communicators Under Pressure

For healthcare communicators, particularly those who work for public organizations or entities that receive some kind of public healthcare funding, it’s important to appreciate the pressures and influences that often come together during peak budget deliberations.

At a recent meeting of the Health Issues Committee of the Chamber of Commerce of Southern New Jersey, Tom Byrne, Managing Director and Head of Equity Portfolio Management for Byrne Asset Management, provided an overview of the role public healthcare benefits increasingly play in state budget deliberations.

For New Jersey in particular, public healthcare benefits and pensions “are a huge albatross,” said Byrne. That includes the costs of providing healthcare coverage and pension contributions to the many thousands of public employees, including elected officials and their staffs, judges, police, fire and rescue personnel, teachers, superintendents and other personnel throughout New Jersey’s approximately 678 operating public school districts, and more.

Many of these public employees are protected by unions and guaranteed contracts, so there is little incentive for them to agree to shed benefits in the budget deal-making process.

Underfunded Pensions in NJ

One of the key challenges New Jersey budget negotiators face is the past. Over the course of years, budget-negotiators sought to balance the books by underfunding public pension allocations, hoping to make it up at some point in the future when the state’s economic situation became rosier.

Unfortunately, spending on other concerns always seemed to take precedent. As a result, New Jersey faces one of the most dire pension shortfalls in the country. How serious is it? Other states have come out of similar pension problems, but never one this deep, Byrne said.

public healthcare benefits
Tom Byrne, Byrne Asset Management

In March, New Jersey Governor Philip Murphy proposed an allocation of $3.2 billion toward pensions in FY 2019, a 28% increase over last year’s contribution. The proposal noted that this contribution would be larger than the total of all contributions made during the previous administration’s first four years. Even so, it’s only a start to making it whole.

More Funding for Education, Healthcare

In addition, Gov. Murphy proposes increasing state funding for public education, including an expansion of Pre-K and STEM education, Pursuing Tuition-Free Community College, and expanding student aid.

In addition, he has proposed increases in funding for healthcare coverage for low-income citizens, family planning, mental health and addiction services, developmental disabilities services, the Supplemental Nutrition Assistance Program (SNAP) and hospital funding – all worthwhile-sounding investments.

But to arrive at a balanced budget, what’s given out in one area has to be taken back in another – unless the pie is enlarged. That means raising taxes. With New Jersey property owners already paying some of the highest property taxes in the nation, the practicality of continually going back to that well is questionable. An increase in the sales tax is one proposal. Also a “millionaire’s tax” and a proposed fee on carried interest that would focus on Wall Street earnings.

Pushback Expected

Byrne said he expects there to be some discussion about revising public healthcare benefits – incorporating more wellness and in-network programs and requirements as a means to lower overall spending. But such suggestions are only part of the answer, Byrne said.

The fact is, pension and healthcare costs are crowding out a larger and larger share of discretionary spending. And powerful interests with a desire to maintain an existing state program or allotment will be pressuring lawmakers to protect those concerns.

“If you cut eight million dollars from the state budget as a line item, you won’t get eight million thank-you notes from people for saving them a dollar each,” explained Byrne. “But you may upset powerful interests.” That’s something most elected officials try to avoid.

Adding to the uncertainty is the fact that many legislators simply don’t have expertise in public finance, pensions and public healthcare. Byrne said they need to become better educated in order to effect solutions on such complex issues. And soon.

Healthcare will likely be a major component of any solution, but public healthcare reform is not a panacea. There are too many other interconnected variables and links that need to be sorted out before this state budget sausage is fully cooked.

Each year, as annual budget negotiations begin to percolate, healthcare communicators should make the effort to understand how the interests of their organizations line up with pending budget proposals as well as the viewpoints of their allies in the legislature and other influential government officials. Budget negotiations are often referred to as a numbers game. But the number of friendly votes you can count on are often as important as the budgetary numbers themselves.

Juneteenth – America’s Other Independence Day

Patient Experience Relies on Understanding Diverse Perspectives

Americans love their Fourth of July holiday. After all, it’s America’s birthday – the day we traditionally set aside to celebrate the signing of the Declaration of Independence and the establishment of a free nation where “all men are created equal.”

But for many, those hallowed words proved hollow. Hundreds of thousands of slaves throughout the young United States – especially in the South – would need to wait almost another century before their rights to equality were officially recognized.

Another View of History

On July 5, 1852, famed African American abolitionist Frederick Douglass, himself a former slave, delivered an impassioned speech spelling out the irony inherent in the July 4th celebration:

“This Fourth of July is yours, not mine. You may rejoice, I must mourn,” Douglass said. “What, to the American slave, is your Fourth of July? I answer: a day that reveals to him, more than all other days in the year, the gross injustice and cruelty to which he is the constant victim…”

It would take another 13 years, hundreds of thousands of lives, and a Civil War that tore apart the fabric of the American nation before four million African-American slaves would get their own taste of freedom.

Juneteenth – Freedom Reborn

On June 19, 1865, Union General Gordon Granger, military commander of the defeated Confederate state of Texas, read aloud General Order No. 3, telling the populace of Galveston that: “The people of Texas are informed that, in accordance with a proclamation of the United States, all slaves are free.”

Spontaneous celebrations among the newly freed African American population quickly erupted across the South as Juneteenth was born. African-American communities across the U.S. soon adopted Juneteenth as their own holiday, using it as an occasion for celebrating freedom with public events, picnics and church gatherings.

Understanding Leads to Compassion

Once we understand the history of Juneteenth and how it came into being, it’s easier to appreciate why many African Americans consider Juneteenth to be a day to celebrate not only the vision of freedom President Lincoln described in his 1863 Emancipation Proclamation but also the original promise of the Declaration of Independence.

Since our childhood, we’ve been told that America is a melting pot, comprised of people from all over the world, representing a multitude of religious backgrounds, races, cultures, customs, languages and lifestyles.

Healthcare providers face the everyday challenge of understanding how these differentiating factors may affect individuals’ or families’ attitudes toward illness, pain, coping and death. It is important to appreciate why these attitudes are held, because they can significantly influence their willingness to explore various treatment options. Hospice, in particular, can be an especially touchy discussion topic.

For example, according to statistics, African-Americans comprise approximately 12% of the U.S. population, but they make up only 7.6% of hospice patients. Ironically, African-Americans have a disproportionately higher rate of cancer and heart disease, which are among the top hospice diagnoses.

Researchers point out several reasons for this incongruity. As a rule, African-American families tend to be less trustful of the American healthcare system. In addition, because medical decisions tend to be made within the family, there may be a reluctance to consult with a new, unknown healthcare professional or someone outside the home. Finally, statistically speaking, African Americans tend to be especially reluctant to cease life-prolonging procedures such as tube feeding, organ donation, and palliative care in the hospice setting – because extending life is generally seen as something to be preferred.

Honoring Differences

Healthcare communicators need to recognize that their messages may be perceived very differently by diverse audiences and adjust accordingly to ensure positive patient experience.

As the U.S. healthcare system continues to evolve to one that is more population health-oriented and patient-centered, there is a growing need for healthcare providers to educate patients, families and the general public about what they can do to stay healthier, as well as the nature of specific healthcare challenges and treatment options.

Understanding their emotions, how they think, and the reasons behind these different perspectives is vital to helping patients and families make treatment decisions that are most appropriate for their individual situations.

It’s not unlike coming to appreciate the Juneteenth holiday. The better we understand the history and background of our patients, the better we can understand and honor the views and emotions that influence their decisions and actions.

Healthcare’s Future Lies in Transformation

Dr. Ezekiel Emanuel Offers a Compelling Argument

What will the future of healthcare look like? It’s an issue that public affairs commentators and policymakers across the political spectrum continue to debate.

In 1994, the late Dr. William Kissick, a professor emeritus at Wharton and the University of Pennsylvania Schools of Medicine and Nursing, identified three competing issues that the healthcare industry has struggled to address effectively. These issues – access, quality and cost containment – what Dr. Kissick called the “Iron Triangle of Healthcare,” continue to perplex policymakers and healthcare decision-makers to this day.

Recently one of the nation’s leading healthcare policy experts, Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global Initiatives and Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, offered some important insights into where the national healthcare system is heading, and what it might mean for the Philadelphia region. In part he rejected the conventional notion that it is possible for health care systems to only achieve two of the three parts of the Iron Triangle.  He argued all three had to be achieved together. It was all part of a symposium on “Shaping Health Care” sponsored by the Chamber of Commerce for Greater Philadelphia and The Wistar Institute.

Lowering Costs

Finding a way to provide high-value care for all Americans – namely care marked by high quality and low costs with universal coverage – is a goal shared by providers and policymakers alike. According to Dr. Emanuel, “the only way to lower healthcare costs is to change the delivery system to ensure high quality care.”

Traditionally, one of the most significant contributors to the high cost of healthcare has been the combination of providing unnecessary services and inefficiency in how necessary healthcare services are delivered.   One example is standardization of practices so everyone – from physician to nurse to medical assistant – handles the same complaint according to agreed-upon guidelines. For instance, physicians in one local oncology practice were treating mouth sores after chemotherapy in different ways.  The practice standardized to one optimal practice that everyone followed.

Another common example is the fact that some health care groups allow their physicians to control their schedules, leading to double-booking, limited hours, and an inability to work around no-shows or walk-ins.

Creating Efficiencies

Dr. Emanuel identified 12 transformational practices that he says can help physician practices and healthcare organizations improve the quality and cost of care they provide to their patients:

  1. Scheduling
  2. Registration & rooming
  3. Shared decision-making
  4. Performance measurement
  5. Standardization
  6. Chronic Care management
  7. Site of service
  8. De-institutionalization
  9. Behavioral health management
  10. Hospice
  11. Community interventions
  12. Lifestyle interventions

Many of these practices will improve  efficiencies – lowering per unit costs by finding ways to improve a healthcare process or system, or working in collaboration with partners in a way that benefits all involved parties. Others will eliminate unnecessary and undesired services – lowering total costs.

Even seemingly minor changes can show major results. For example, streamlining scheduling practices can offer several benefits: 1) It allows practices to accommodate walk-ins without long wait times instead of sending them to the more expensive emergency room; 2) it increases provider efficiency, as physicians no longer double book or adjust schedules; and 3) it decreases the amount of time wasted due to missed appointments.

Similarly, Dr. Emanuel noted that transformational organizations are providing more services, such as palliative care, in the home. This care is initiated well before a patient becomes terminally ill and is ready for hospice. This approach elicits patients’ preferences for life-sustaining treatments, such as respirators, ICU admission, or dialysis, and tries to keep them at home for the last year of life. It also makes transitioning to hospice in the last weeks of life less abrupt. All these changes lead to care that is both less costly and more in accord with patients’ wishes.

Performance Measures

The pathway for healthcare providers to truly transform also involves the use of real-time performance measures, Dr. Emanuel said. Standardizing clinical practices and treatment procedures based on measurable qualitative data is vital to reducing costs and improving outcomes.

While some physicians may insist that “their” way is the best, organizations need to convince them to adhere to guideline-driven standards. Paradoxically, one effective way to persuade doctors to adapt to standardized measures is to task them with developing the standardized practices and encourage adherence through financial incentives.

At the same time, organizations need to improve their risk adjustment skills in order to continue to improve their healthcare management practices. Risk adjustment is defined as “a statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their healthcare outcomes or healthcare costs.”  This ensures physicians who see sicker patients are not penalized.

The ultimate goal is to transform the U.S. healthcare structure into a truly patient-centered, efficient and cost-effective system.  Dr. Emanuel notes that the Philadelphia region is a leading example of how organizations are learning to work together to achieve those goals. He said he is confident that by 2030, the entire world will be looking at the United States to understand how healthcare transformation is accomplished.

Palliative Care Comes of Age

Once Seen as an End-of-Life Specialty, Palliative Care has Moved into the Mainstream

“It is not death that a man should fear, but he should fear never beginning to live.”

– Marcus Aurelius

For David R. Barile, MD, a geriatric medicine specialist based in Plainsboro, NJ, it was the steady calm of one of his patients – a grandmother and a woman diagnosed with a terminal illness that reinforced his vision of the promise of palliative care.

Faced with a life-threatening illness, she most likely was looking at weeks of chemo and radiation therapy that may or may not cure her. But either way, the treatments would sap her strength and make it extremely difficult to carry on with everyday activities she enjoyed.

But there was one more thing. No matter what, she did not want to do anything that would cause her to miss her grandson’s bar mitzvah. The best approach for helping her achieve her goal of living life the way she wanted? Palliatve care, which focuses on providing relief from the symptoms and stress of a serious illness.

A Question of Choice

For many doctors, the idea that a patient would choose to exert such a strong influence on her course of treatment might sound unusual. But to Dr. Barile, that kind of insight is something that has been lacking for too long.

Dr. Barile is also the founder and Chief Medical Officer for Goals of Care Coalition of New Jersey, an interdisciplinary partnership of leaders representing healthcare providers and systems, government agencies, and community organizations whose mission is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness and to document their preferences in a care plan. Increasing awareness about benefits of palliative care is a key part of the effort. Recently, Dr. Barile discussed the topic of palliative care as a featured speaker at a Health Issues Committee Forum sponsored by the Chamber of Commerce Southern New Jersey. (Note: SPRYTE Communications’ CEO Lisa Simon is a member of the chamber’s board of directors.)

“The Coalition’s fundamental purpose is to organize medical care to help patients achieve their life goals,” explained Dr. Barile. The approach consists of four basic steps:

  • Diagnosis
  • Prognosis
  • Identifying patient goals
  • Aligning treatment to achieve those goals

Setting Goals

It sounds simple. But as Dr. Barile notes, it’s also somewhat uncommon. More common is the  approach of “diagnose then treat.” That works well in most health situations, but falls short in end-of-life care, Dr. Barile says. And for many patients it creates a very stressful and unwanted burden.

What is often lacking is patient input, he says. What are their personal goals? And what kind of treatment plan can be developed that will enable them to meet those goals?

Another advocate for increasing awareness about palliative care is Dr. Timothy Ihrig, Chief Medical Officer for Crossroads Hospice & Palliative Care (full disclosure: a SPRYTE client).

Dr. Timothy Ihrig

Dr. Ihrig is an internationally recognized expert on hospice and palliative care and a longstanding advocate for treating patients with life-limiting illnesses according to their individual priorities and life goals – incorporating full transparency and quality of life as key values in their care programs.

 

His TED Talk, “What We Can Do to Die Well,” urges doctors to focus not so heavily on clinical interventions at the expense of overlooking patients’ overall quality of life and helping them navigate serious illnesses from diagnosis to death with dignity and compassion.

According to Ihrig, at its best, palliative care is meant to be an empowering force for patients, taking into account each patient’s perception of what it means to live with a severe, chronic, potentially fatal condition and helping them live their lives with the highest quality possible.

Improving Education

Both Drs. Barile and Ihrig believe more needs to be done to incorporate end-of-life issues into medical training, so healthcare professionals can better recognize what is happening to their patients. Better training will also enable them to communicate more effectively with their patients, help them achieve informed consent in their decisions, and mutually agree on a treatment program that will meet patients’ personal goals while providing a better quality of life.

“We need to work on the language for end-of-life care,” Dr. Barile says, noting that news stories about former First Lady Barbara Bush reported that she had “stopped treatment.”

“Palliative care is a treatment. But the range of treatment options available to patients needs to be better explained,” he says.

More Cost Effective

There’s an added benefit. According to a study publishd in April by the journal JAMA Internal Medicine, patients with serious or life-threatening illnesses who have palliative care discussions with their doctors at the beginning of treatment focusing on improved quality of life, managing pain and defining goals often experience shorter hospital stays and lower costs.

The JAMA study found that overall, for patients who received palliative care, hospitals saved an average of $3,237 per patient over the course of a hospital stay compared to patients who did not. Hospitals saved an average of $4,251 per stay for cancer patients, compared to an average of $2,105 per stay for non-cancer patients.

Their conclusion: “Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.”

Higher quality care with lower costs. Perhaps an idea worth looking into.

Philadelphia Opioid Crisis: An Approach to Save Lives

 

All Hands on Deck Against the Opioid Threat

One of the most serious public health issues facing us today is the opioid crisis. As the crisis has continued to grow over the course of the past decade, its impact is far-reaching in terms of financial losses as well as human costs.

As medical professionals and public policy officials strive to find answers to this continually growing problem, it is incumbent on healthcare communicators to be ready to work with their respective partners to develop strategies to reach out and bring together those impacted by this dreadful epidemic – not only abusers, but loved ones, family members, healthcare professionals, community leaders, elected officials and more.

Opioid Crisis by the Numbers

In November, a report from the Council of Economic Advisers estimated that in 2015, the economic cost of the opioid crisis was $504 billion, or 2.8% of the nation’s Gross Domestic Product that year. That number was more than six times larger than the previous estimated cost of the epidemic.

Prescription opioids are a particular problem. According to the Centers for Disease Control and Prevention (CDC), prescription opioids are a key contributor to the opioid epidemic in the United States, accounting for more than 40% of all U.S. opioid overdose deaths in 2016, with more than 46 people dying every day from overdoses involving prescription opioids. 

In Philadelphia, the impact of the opoioid epidemic has been devastating. According to the city’s Department of Health, fatal drug overdoses from 2013-2015 increased by more than 50%, from 459 deaths to 702. During 2015, Philadelphia experienced more than twice as many deaths from drug overdose than from homicide. Eighty percent (80%) of these involved opioids.

What’s to be Done?

Recently, the Healthcare Leadership Network of the Delaware Valley convened a CEO Roundtable, hosted by Cooper University Health System, on what can be done to deal with the many challenges posed by the opioid epidemic. The panel discussion sought to offer perspectives from clinical, public health, governmental policy, health system and evidence-based treatment points of view. The general consensus – there were many contributing factors to the problem and it will take a dedicated commitment of coordinated effort to bring about an effective solution.

Dr. Susan Freeman, President & CEO of Temple University’s Center for Population Health, described her organization’s approach as an “all hands on deck” effort to address many of the multi-faceted issues exacerbated by opioid abuse. Temple’s Substance Abuse Task Force Action Plan, for example, focuses on six primary areas:

  • Building trust with patients/substance abusers
  • Ceasing addiction
  • Proactively identifying patients at risk
  • Reviewing physician prescription practices
  • Education and research
  • Partnerships with entities such as the Philadelphia Department of Health and other like-minded organizations.

Focus on Families

Similarly, Douglas Tieman, president & CEO of Caron Treatment Centers, noted it’s important to remember that substance abuse is a chronic disease that doesn’t end after a 28-day rehab visit. The most effective treatments are multi-disciplinary, including medication-assisted therapy, bio-psycho-social treatment, evidence-based treatment programs such as motivational interviewing, 12-step integration, trauma and family counseling, and a continuing care plan to lessen the chances of recidivism.

Such integrated approaches can have long-term positive effects. If behavioral health, substance abuse and mental health issues are treated in time, “the costs of other health-related issues go way down as well,” he said.

Even so, getting patients and families to participate in long-term programs can be a challenge in itself.

“We live in a microwave society that wants everything immediately,” noted Alan Oberman, CEO of John Brooks Recovery Center. “Most families, unfortunately are dealing with a ‘crisis of now’ and aren’t willing to listen to discussions of long-term chronic issues.”

A Center for Healing

Adrienne Kirby, PhD and chairman and CEO of Cooper University Health Care, said her long-term goal was to create at Cooper a “center for healing” that would address many of the related factors that contribute to problems faced by substance abusers. She said Cooper has been on the front lines, working with Camden County Police, to identify and reach out to patients in need. She said intervention needs to be combined with treatment, as well as other support services, such as housing.

Another key aspect of Cooper Health’s approach is to upgrade the curriculum so that students, residents, as well as faculty, are trained to recognize and treat substance abuse patients effectively.

Information is Key

A key challenge to implementing a coordinated strategy is the sharing of information. In addition to HIPAA regulations, the infrastructure simply doesn’t exist yet to allow the exchange of bio-social information among health care entities and community-based support organizations.

“We don’t have the infrastructure for mental health that we have in physical health,” said Dr. Kirby. “The law doesn’t allow us to be there yet.”

Nevertheless, such an information-sharing capability could help ensure that substance abuse patients receive the continuing care and social support they need. For example, with patients’ permission, telemedicine apps could combine with GPS to manage patients’ long-term illnesses, monitor their activities and ensure they are complying with what is needed to maintain a healthy recovery.

Information can be even more important in terms of prevention – stopping substance abusers before they get started. Caron, for example, works with 600 grade schools and high schools to educate students about the dangers of substance abuse. According to Caron’s Tieman, if students can be persuaded to postpone their introduction to alcohol, marijuana and other substances, it can significantly delay the onset of substance abuse.

There is no panacea. The opioid epidemic has been years in the making and will no doubt take years to overcome. In the meantime, healthcare communicators who work with organizations involved in the issue need to keep abreast of news and developments so they can provide their respective audiences with timely information and advice.

 

Consumerism: The Future of Healthcare

Patient-Focused Care is a Growing Challenge

Even before the advent of the Affordable Care Act, a primary goal for healthcare providers has been to get consumers more involved in their own healthcare decisions.

From the now-defunct federal Health Systems Agencies (the original HSAs), to Health Maintenance Organizations (HMOs), to Flexible Spending Accounts, to Health Savings Accounts (the new HSAs), to the more recent Accountable Care Entities, engaging and empowering consumers to make informed choices about their healthcare needs has been both an ongoing objective and challenge.

Healthcare communicators, who are at the heart of providers’ consumer relations and community relations efforts, need to understand what’s driving this important movement.

 

Key Drivers of Healthcare Consumerism

In a recent webinar sponsored by Thomas Jefferson University’s Jefferson College of Population Health and IBM Watson Health, Dr. David B. Nash, dean of the college, noted that the two biggest factors driving the evolution of healthcare consumerism are utilization and costs.

Dr. Nash pointed to data from 2015 showing that the total expenditure for healthcare in the U.S. topped $3.2 trillion, accounting for 17.8% of the country’s gross domestic product. Per capita national health expenditures amounted to almost $10,000. Almost 60% of those expenditures were tied to two areas of spending: Hospital Care (32.3%) and Professional Services (26.2%).

One key problem, he noted, is quality. More “socialized” national systems found in Canada and Europe provide consumers with better quality at a better price compared to the U.S. health system. At the same time, U.S. consumers are shouldering more of the total healthcare cost burden, including unanticipated costs. According to the Kaiser Family Foundation, U.S. workers’ share of health insurance premiums grew 221% since 1999, while premiums themselves increased 203%.

From a healthcare finance perspective, it’s an unsustainable situation. Empowering consumers to exercise more control over their healthcare spending is part of the solution.

 

More Education, Transparency Needed

Unfortunately, too many consumers don’t understand what they’re paying for – or how they’re paying for it. Lack of awareness about insurance terms, processes and pricing tend to inhibit patients from getting involved more directly in their healthcare decisions.

“If you can’t define what a copayment is, you won’t be an empowered consumer,” Dr. Nash explained.

Consumers want to understand what is happening, but available data can be overwhelming. Many are turning to social and public sources for information, but lack the ability to translate the data in a meaningful way that would help their decision-making.

 

Social Determinants of Health (SDOH)

Other key factors driving the evolution of healthcare consumerism are social determinants that describe conditions in which people live, learn, work and play – all of which can have significant impact on an individual’s health risks and outcomes.

Poverty, not surprisingly, is the number one social determinant of health. Those without insurance, or access to regular healthcare checkups inevitably fare worse in terms of early detection of adverse conditions and ensuing complications, chronic health issues, and life expectancy.

A recent Robert Wood Johnson Foundation survey asked American physicians what kind of prescriptions they wish they could write to assist patients with social needs. Among their top answers: Fitness Programs (75%), Nutritional Food (64%), and Transportation Assistance (47%). For doctors whose patients were predominantly urban and low-income, the responses were just as telling: Employment Assistance (52%), Adult Education (49%), and Housing Assistance (43%).

 

Engagement is Key

To help address many of these needs, many health systems are increasing their focus on community-based care, meeting patients closer to where they live and addressing their individual needs. This trend can be seen in a number of ways:

  • Increasingly, large regional health systems are affiliating with traditional community hospitals, based on level, type of condition or geography.
  • The popularity and prevalence of retail clinics continues to grow, as health systems see a means to deliver lower-cost local services beyond primary care.
  • Bedless hospitals are springing up – newer entities that are often multi-specialty and offer traditional hospital services except for inpatient care.
  • The BCBS Institute is partnering with the ridesharing company Lyft to address transportation-based SDOH. The Institute and Lyft will work together to coordinate rides in neighborhoods with limited public transit access and low rates of vehicle ownership.
  • The growing popularity of telehealth, mobile technology and digital therapeutics, that allow physicians to provide lower cost care and regularly monitor their patients’ progress almost anywhere at any time.

In addition, spending more time with patients – encouraging them to ask questions, taking time to explain procedures, treatments and options – can be a major factor in improving healthcare outcomes individually and in the community. Healthcare insurance professionals can also play an important role by working closely with consumers to make sure they understand options and nuances involved in their insurance decisions.

Healthcare communicators have a major role to play as well, by paying close attention to the evolving nature of healthcare consumerism and working with their colleagues – healthcare administrators, physicians, nurses and other medical professionals, as well as their allies throughout the community – to reach out, identify and educate consumers to ensure as many as possible get the care and support they need to live healthy, happy lives.

Social Workers Bring Help and Hope

For Them, Caring is a Calling

“Never, never, be afraid to do what’s right, especially if the well-being of a person or animal is at stake. Society’s punishments are small compared to the wounds we inflict on our soul when we look the other way.” – Martin Luther King, Jr.

What is it that makes social workers tick? With March being National Social Work Month, we at SPRYTE thought what better time to delve into some of their motivations and inclinations?

For healthcare communicators, who are often tasked with showcasing the conscience of their organization – whether through corporate social responsibility programs, employee communications, or thought leadership initiatives – understanding how and why social workers do what they do can help shine a bright light on the path ahead.

For Episcopal Community Services’ Neibert Richards, MSW, LSW, it was always about caring and people.

“I originally went to school to major in nursing, but soon after I arrived, the school decided to phase out the major,” she recalls. After that, she was undecided as a major. That’s about the time she was introduced to the opportunity presented by social work.

“The biology and all the other classes just weren’t fitting with what I wanted to do,” says Richards. But the idea of helping others was clearly a guiding force.

 

A Caring Tradition

Those roots run deep. Her father was a minister. Her mother, a teacher. There were four children in all. The family moved to the U.S. from Guyana when she was eight.

“Family was always a huge factor for me,” Richards says. “I was always longing for connections, wanting to know who my cousins are. I was the one who always had an issue when someone couldn’t come to be with the family for the holidays.”

Soon after getting her Master’s in Social Welfare, she joined Episcopal Community Services (ECS), where she signed onto the foster care program. Today, 22 years later, she is Director of Permanent Housing at ECS.

 

Changing Times

Over the years, there have been many changes in the way social workers are viewed, she says.

“I think the career path is better organized. Social workers are viewed more as true professionals.” she says.

Hopefully, that view will supplant what Jeanne Morrison, MSW, Support Services Director for Crossroads Hospice & Palliative Care in Philadelphia, says is probably the biggest misperception people have about social workers.

“Lots of times, people use the term ‘social worker’ for someone who is actually a caseworker,” explains Morrison. “Especially in child welfare situations, there is a belief that it’s the social worker who is there to take the child away.  The reality is that the social worker’s goal is to keep families together whenever possible.”

 

Looking at Strengths

Morrison notes that social workers are trained to evaluate clients from a strength standpoint – whether it’s the family, an individual, or a group dynamic. The initial goal is to identify existing strengths that can be built upon to help address certain issues that the client is facing.

She says the effort is a true collaborative partnership between the social worker and the client.

To do that effectively, it’s important “to meet people where they are,” she says. “In order to identify their hopes and plans, you need to understand things from their standpoint. You can’t expect people to come to you. If you do, you’ll get nowhere fast. But if you can understand and meet them where they are, you can start identifying their hopes and dreams from that stanpoint.”

 

Next Generation of Social Workers

Emily Blumenthal is a student at the George Warren Brown School at Washington University in St. Louis currently working toward her degree in social work.

She says the holistic perspective that social workers are trained to utilize is one of the things that led her in this direction.

“As a social worker, you’re trained to look at the environment the individual is in – you need to pay attention to who they’re surrounded by, family, friends, whatever is going on. It’s important to get the whole perspective,” she says.

Blumenthal is currently in the midst of a practicum with Perinatal Behavioral Health Service working with pregnant women with mood disorders or depression, doing screenings and providing information in a clinical setting. Following this, she will move on to another practicum (focus to be determined) that will last about a year. The experience will provide her with a broader base of training and insights that will assist in a future career decision.

She says her ultimate goal is to go into counseling, perhaps working with young adults, couples, and young famiies. But she’s confident that her background and training in social work will enable her to choose from a number of options.

 

Remembering what’s Important

For ECS’ Neibert Richards, that diversity of opportunity is one of social work’s greatest strengths.

“Social workers are a lot of people who care about helping others, giving someone a helping hand to advance to the next stage of life so they can move in a positive direction,” she says.

“They’re the ones, walking the streets, counting the homeless every year for HUD,” Richards explains. “They’re the ones who have no problem going into a home that’s drug-infested, letting someone know that we have a bed here, the kids can come. They’re trying to get them to think beyond this life that they’re in. It isn’t easy for them. Social workers do it because they care.”

For healthcare communicators, when you’re telling your story, caring and people are usually good places to begin as well.

Public Affairs and PR: Perfect Together

Government Relations and Public Relations a Team Effort

As our hometown Super Bowl Champion Philadelphia Eagles recently proved (yeah, we’re still celebrating!) to be successful, a football team needs a great offense. That means a dependable line as well as a talented backfield. And while it’s the backs that tend to get most of the glory, they can’t do it on their own.

The linemen are responsible for the nitty-gritty. They do their job in the trenches – mostly out of sight from the casual observer, blocking would-be tacklers, protecting the quarterback, opening lanes for the speedy running backs and talented receivers.

Running Backs and Linemen

A successful public affairs campaign often works much the same way. The Public Relations pros are like the running backs – running with the broader story, alerting the public to the importance of the public policy being promoted, showcasing activities and events in ways that seek to create wider public awareness and broader public support.

Their Government Relations teammates, meanwhile, do the nitty-gritty – working within the power structure, targeting the appropriate legislators, governors, staff members or other public officials to make sure the public policy initiative is moving in the right direction, fending off the opposition, opening lanes for negotiation and agreement.

When they work together in a well-coordinated team effort, magnificent things can happen.

Case in Point

As part of a recent webinar sponsored by the New England Society of Healthcare Communications (NESHCO), presenters from Care New England discussed their efforts to promote statewide legislation in Rhode Island mandating fertility preservation coverage for women undergoing cancer treatments (such as sterilizing surgery, chemotherapy or radiation) that could render them infertile.

Early on, Government Relations and Public Relations team members understood the need to work collaboratively. This was important, because, as noted, their focus can sometimes be at cross purposes.

The process began with internal meetings with clinicians, cancer specialists, lawyers, and Government Relations and Public Relations team members. The purpose: to ensure everyone on the planning team understood the issues involved so they could set a strategic direction for moving forward.

Working Inside / Outside

From there, Government Relations worked with their lobbyists and legislative staff to draft proposed legislation to provide protection to women undergoing cancer treatments. At the same time, the team worked on identifying and educating potential sponsors in both the House and Senate, and to garner support from the leadership of both chambers.

In the months ahead, the Government Relations team worked to identify and evaluate potential witnesses (doctors and patients) to appear at legislative committee hearings as well as be available for supporting media opportunities. The team also helped draft testimony and kept in close communication with legislators to alleviate any concerns that might arise as a result of the hearings and provide regular updates to key internal stakeholders.

Going Public

Meanwhile, PR worked to get the message out to the general public, in order to start building popular support for measures designed to protect the health and lives of women facing such daunting challenges. Various allies, including the American Society for Reproductive Medicine (ASRM), assisted and provided an official statement in support of the legislation that was included in a news release. That kind of support helped spread the love by encouraging others to raise their voices as well. News stories subsequently appeared in key publications including The Providence Business Journal, Providence Business News, HealthLeaders Media, US News and Beckers Hospital Review. In addition, clinicians from Women & Infants Hospital of Rhode Island provided a supporting op-ed that appeared in the New England Journal of Medicine.

Happy Ending

On July 5, 2017, Rhode Island became the first state in the nation to require insurance coverage of fertility preservation prior to radiation or chemotherapy treatment that could result in infertility.

At SPRYTE, members of our team have been involved in similar efforts over the years, including an effort in Pennsylvania to eliminate the use of certain chemicals in children’s products. The experience was very similar – working a two-pronged approach, one aimed at legislators and regulatory officials, the other focusing on building awareness in the media and among the public about the chemicals in question.

Our experience mirrored what took place in Rhode Island: working with legislative staff and sponsors, identifying and vetting expert witnesses, and updates about new scientific studies supporting the claims that children were at risk. Our story ended somewhat differently; after several legislative hearings, industry representatives agreed to stop using the chemicals in childrens’ products.

Nevertheless, the lessons remain the same. Government Relations and Public Relations professionals each bring different, but often complementary, skill sets to the table. To work together, they need to plan together, establish mutual goals, and map out a clear strategy that allows each team to do what they do best without getting in each other’s way.

From a public policy standpoint, the results can be game-changing.