Jerome Biggars, of Wichita, KS, had been a patient at one time or another for more than a quarter of his 45 years because of extreme obesity. He became a symbol of chronic conditions facing America, to the extreme. He reached a point where he carried nearly 500 pounds on his 6-foot frame. “It had gotten to the point where I was almost bedridden. I could barely stand for any length of time without having to sit down,” Biggars says. “I had all these medical issues—high blood pressure, high cholesterol, and my legs were so swollen that if I were to get a nick on them I had to go to the hospital and have them wrap them, because they couldn’t heal by themselves.” He admittedly became a drain on the system. Like many patients, he had been thinking, “Give me a magic pill,” he says.
But if there’s no magic pill, sometime’s there is a magic moment. “That little light switch has to be flipped,” Biggars says. For him, that occurred when he listened to his son’s high-school valedictory speech, a speech that often made references to his mom, but not his dad. Repeatedly, Biggars’ son talked of his mother attending school functions, but not his dad. Biggars says he had missed out because he didn’t have the energy to be involved in his son’s activities. But at that moment, Biggars says, he knew it was time to remold his body and his life.
With physician assistance, Biggars found a weight-loss program that suited him and, over a 16-month period, lost nearly 300 pounds. He has become a long-distance runner and bicyclist.
“A patient has to try to do it on their own, in their own mind. To actually go out and do it. If they don’t feel like it is important enough for them to lose weight, it doesn’t matter what else anybody tells them, or what anybody else tries to do to help them.”
Too many primary care physicians don’t press hard enough for patients to take care of themselves, to fully live up to what the responsibility of healthcare is all about, says William H. Bestermann Jr., MD, medical director for medical home quality at the Holston Medical Group in Kingsport, TN. Generally, “primary care physicians mean well and don’t do well,” Bestermann says. “If you talk to doctors and
ask why they don’t achieve these things, they’ll say, ‘My patients aren’t compliant enough and they don’t do anything I tell them.’”
Bestermann and a few other physicians at the Holston Medical Group have been rearranging their structures—increasing visiting times, for one thing, to get a sense of what patients need and how patients can be empowered to do more for themselves. “We are taking a little financial beating,” says Bestermann, who specializes in vascular disorders. “But we have stepped up and asked ourselves, ‘What would it take to do this?’ We want to give patients tools to succeed. I’ve come to believe a few people are just depressed and they don’t care if they live or die. But a majority doesn’t want to be sick, and doesn’t want to be unfit, if you give them tools and some hope.”
In the future, health insurance companies may reward patients who maintain their health through employee health programs that pay people to get active. For now, however, the future of reimbursement lies within the provider’s ability to keep a patient healthy.
The Southern California Permanente Medical Group runs an electronic program to correct any oversights in care that may have occurred, focusing on important patient-safety categories, including monitoring medication and potentially harmful interactions, says Kanter, the medical director of quality and clinical analysis.
Kaiser Permanente has a secure portal for patients that provides easy-to-read summaries of visits and reminders about needed care. In effect, it gives a snapshot of how patients are doing, Kanter says. Medical teams can determine if intervention is necessary. Patients can send text messages, including automated messages based on algorithms established by providers. Patients can use their cell phones to respond to questions and access summary reports.
Kaiser Permanente sends reminder messages, encouraging patients to adhere to their medical regimen. “Our physicians appreciate the extra layer of reinforcement for medication adherence and the physician feedback is impressive; patients are indeed responding,” Kanter says. “Our patients tell us that knowing their physicians and pharmacists are monitoring how well they are taking their medication prompts them to do a better job of keeping on schedule. Besides the fact that their doctor is going to bring it up in the next office visit, patients are feeling more responsible and engaged in doing their part to stay as healthy as they can be.”
Lane Savitch, president of the 249-staffed-bed Kadlec Regional Medical Center in Richland, WA, says the hospital has developed plans for a new “life skills training” program that aims to increase patients’ awareness of their conditions and help encourage, empower, and make them more responsible for their care, Savitch says. As Kadlec develops plans, it is examining a variety of services, “broadening our scope to include prehospital, posthospital, and even no hospital services,” Savitch says.
They are looking at consolidating various programs, such as cardiac rehabilitation, outpatient and inpatient rehabilitation for postorthopedic and postneurosurgical patients, a neurological resource center for patients, and a diabetes learning center. The hospital acquired a “large, warehouse-like” building near the hospital campus to accommodate the proposed services, he says.
“The life skills training center would be consolidated for each of our key service lines,” Savitch says. “The intent is that each of the service line leaders would have significant input into the type and scope of services that would be provided. In light of the mandates of healthcare reform, it is clear that hospitals are going to need to be more involved in keeping the community healthy and preventing unnecessary healthcare utilization than what we have done in the past.”
Kadlec will examine other hospital programs as it develops the center. “Hopefully we will be able to make this transition by capitalizing on those services for which we continue to be compensated, while the reimbursement mechanism is being restructured to provide a tangible benefit for providing health education,” Savitch says.
The patient will play an increasing role in determining healthcare costs. “It’s fallen more and more on the back of the patient to pay the costs of healthcare,” says Savitch. “All of a sudden, people are saying, ‘God it is expensive. How did it get so expensive?’ So I think now is probably the best time to be focusing on the patients’ responsibility to take care of their own health. I think it’s going to take a full generation or more.”
As providers and patients move forward, they must address accountability and ownership of ailments, says Jeff Buehrle, Banner Health’s CFO for the Arizona East region, and of the 94-staffed-bed Banner Behavioral Health Hospital in Scottsdale.
“When we are all focusing on improving our own health, we all take accountability for prevention,” Buehrle says.
As he spoke, Buehrle was a patient in a hospital bed in the Banner Health system. He had been in the hospital for three days with a leg infection. In between visits from hospital staff checking his well-being, he took the time to talk about his own patient responsibility. “When I leave the hospital, I will focus on taking my medication, elevating my leg, putting ice on it,” Buehrle says, “And I’ll do all the things I’m supposed to do, as a patient and healthcare worker.”