U.S. health officials are giving nearly $3 million to the American Hospital Association to help reduce central line-associated bloodstream infections in hospital intensive care units. The grant from the U.S. Agency for Healthcare Research and Quality will be used over three years to roll out a program designed to reduce these infections nationwide. When the safety program was tested in more than 100 Michigan intensive care units, infection rates dropped dramatically. Over three months, more than 50% of the participating hospitals saw their ICU infection rates drop to zero.
An analysis of the two approaches to reforming the U.S. healthcare system offered by John McCain and Barack Obama suggests Obama's plan has the best chance of making healthcare more affordable, accessible, efficient, and higher in quality. According to the Commonwealth Fund report, Democrat Obama's plan would cover 34 million of the nation's projected 67 million uninsured people in 10 years, compared with just 2 million covered under Republican John McCain's plan.
CEOs and other leaders at America's rural and community hospitals frequently complain to us that they have a hard time getting so-called rent-a-nurses or "travelers" to buy into their hospital's mission and methodology. And buying in to a hospital mission is particularly important with today's increased emphasis on teamwork and communication, standardized treatment plans using evidence-based medicine, quality outcomes, and the proper documentation of every move.
It's not that travelers are incompetent, reckless, or indifferent. But in many hospitals, they are seen as "outsiders" and "others," migrant workers who come in for a 13-week tour of duty and move on. And, let's be honest, there may be a little bit of generational tension out there. There is a perception among some hospitals leaders that travelers—particularly the younger nurses—aren't as committed to the mission of the hospital and are much more concerned with issues like pay and scheduling. That may be why they gravitate towards traveling in the first place.
Until recently, travelers were given the "outsider" status at Glendive Medical Center, a health system on the high plains of Eastern Montana that includes a 25-bed, acute-care hospital with 24/7 emergency care, a 75-bed, extended-care facility, an after-hours clinic, an assisted living facility, and a veterans' home. Like hospitals everywhere—and especially rural hospitals—GMC has had a hard time recruiting and retaining healthcare workers, particularly nurses. So they rely heavily on nurse travelers and other temporary, contract workers.
Scott A. Duke, CEO at GMC, says his hospital had an "A Ha!" moment about a year ago when, in the midst of what he called a planned "cultural transformation," they realized that travelers were a big part of the health system's operations but weren't part of the call for staff inclusion and connectivity. In Duke's view, nobody had really thought about enhancing that relationship before. "I've been to hospitals where the attitude is 'These people are travelers. They're not on our staff. We're not going to treat them bad, but we aren't going to treat them like our staff,'" he says.
Armed with this newfound realization, GMC made an effort to improve its relationships with travelers. It didn't involve any grand strategies or formal declarations. GMC had always provided orientation for travelers, but the emphasis and the approach now stresses inclusion. There was a systemic attitudinal change that made sure the travelers knew they were part of the system, that their role in the success of the health system was critical, and that their input and feedback was sought and valued. "We make them part of the family," Duke says.
A few travelers appreciated the inclusiveness so much that they joined the staff permanently, Duke says. Most, however, prefer to remain orphans. "They don't want to be a part of the organization or get to know staff in the same manner. It's part of who they are and how they want to work in their professional life. That's OK. As long as they are doing their job and providing professional high-quality care, they are filling a very necessary void."
At the end of their 13-week contract at GMC, Duke says, many travelers have expressed gratitude. "Several have said this is the best place they've ever worked at," he says. "They still want to be travelers but they want to be travelers at our hospitals." Duke says he can't say if the emphasis on inclusiveness is cost-effective. Traveling nurses are expensive and it's always preferable to have permanent staff. But if they feel good about the way they're treated, maybe more of them will join the staff. Or if they return for another contract, there are training and orientation costs that can be avoided.
Duke admits GMC doesn't have the data to suggest that their inclusive approach will save money. "We just feel this is more of a feel good approach, that if we are going to use travelers, this is the way to go," he says.
John Commins is the human resources and community and rural hospitals editor withHealthLeadersMedia. He can be reached at jcommins@healthleadersmedia.com
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Fueled by the needs of a growing elderly population, U.S. spending on long-term healthcare under the Medicaid program will soar in the next 20 years, according to a report by America's Health Insurance Plans. Spending for long-term care for elderly and disabled people under the Medicaid health insurance program for the poor will total $3.7 trillion in the next two decades, according to the report.
The nation's slumping economy is triggering growing Medicaid enrollment, according to state and national Medicaid experts. The trend could pose a challenge to states as they serve more uninsured people. "If the downturn is prolonged, and it contributes to large increases in Medicaid enrollment and spending, then this state and every other one will have to look at options to rein in spending," said Vern Smith, Michigan's former Medicaid director and coauthor of a report released by the Kaiser Family Foundation on Medicaid spending.
More than 90% of nursing homes were cited for violations of federal health and safety standards in 2007, and for-profit homes were more likely to have problems than other types of nursing homes, according to a report from the Department of Health and Human Services. About 17% of nursing homes had deficiencies that caused "actual harm or immediate jeopardy" to patients, said the report. Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.
Small companies that are concerned about spiraling healthcare costs, but don't have the ability to create effective consumer-directed healthcare plans (CDHPs), may have a gift from above. And when I say above, I don't mean the place of harps and angels. I'm talking about the state north of Iowa.
Blue Cross and Blue Shield of Minnesota will offer SureBlue plans starting in January that will allow small employers (51 to 249 employees) to lock in health insurance rates with the agreement that they gradually move employees to CDHPs.
Analysts predict healthcare costs will rise in the 8%-9% range in 2009, which is not the double-digit territory of recent years but would still continue to outpace inflation. That trend is expected to continue in the near term.
By agreeing to a three-year deal, employers will be able to restrict rate increases to 6% during the second and third years of the agreement. (BCBS of MN will follow the normal underwriting process for the first year.) The move is part of a growing trend as health insurers look for ways to both set themselves apart from the competition and guarantee business over a three-year period.
Knowing the rates three years into the future will allow for predictable budgeting, says BCBS of MN.
"We found customers are looking for predictable healthcare costs," says Shawn Patterson, vice president of marketing at BCBS of MN. "We found that some were saying that the unpredictable part of their budgeting process was healthcare and they would like to have a solution that they could absolutely put into their financial planning."
Patterson says BCBS of MN opened the plans to small companies because they have the greatest need. Small employers don't have human resources staffs that are large enough to create similar programs that guarantee cost containment and create a greater consumer focus.
SureBlue is a three-pronged approach: consumer-directed plans (high-deductible options with health savings accounts or health reimbursement accounts); whole person support via a health risk assessment and wellness programs; and consumer education so they can make informed—and cost-effective—health decisions.
The idea is that if the individual has to pay a larger chunk of money out of pocket he or she will be more careful about what healthcare to get and where to receive it. This dovetails with BCBS of MN's offerings that allow members to visit a retail clinic without paying a copay. Patterson says the insurer implemented that policy because it costs less to treat a patient at a retail clinic rather than a primary care physician's office or emergency room/urgent care clinic.
In the SureBlue program, employers have a choice of four plans that range from a traditional health plan to high-deductible plans, including one with a health reimbursement account that is backed by a 50% employer contribution.
The idea behind any CDHP is to transfer more healthcare costs onto the individual consumer. SureBlue plans allow employers to gradually increase deductibles and financial responsibilities to the individual over three years. SureBlue will also educate consumers and teach them how to mitigate risk by taking better care of themselves, says Patterson.
The SureBlue idea is a fascinating one. Being locked in to rates for two years while moving employees into CDHPs may seem like a slam dunk for both insurers and employers, but there is a potential downside. Employers won't be able to test the insurance market and potentially get lower rate increases over those three years—though as stated earlier, financial analysts don't expect healthcare rates to shrink to that level. The consumerism train is blazing down the tracks as health plans and employers attempt to engage members to take more control of their healthcare dollar. SureBlue is an option for small employers, but whether the plans save money and educate consumers is the million-dollar question that the rest of the industry will watch with interest.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
Sometimes we get so close to our own industry's jargon that we forget that those outside the healthcare system don't always speak the same lingo. Every industry does it. Car dealers don't sell used car anymore—they sell certified pre-owned vehicles. Grocery stores don't stock prunes, they sell dried plums. Catalogues don't describe a garment as green, they call it jade, emerald, fern, mint, citron, peridot, or stem. When you see a sweater in a catalogue described as "stem," what do you think?
Now put yourself in your customer's shoes. Do they know oncology means cancer and that neurology covers the spinal cord in addition to the brain? Do they know what you mean when you call your cardiac service line a heart academy or your ortho program a bone and joint institute or either one of them a center of excellence? Do you think that most people know the difference between a medical center and a hospital?
I'm guessing the average person either doesn't know or doesn't care. And those who do know the truth—that there really isn't a difference at all—think hospitals are just calling themselves a fancy but meaningless name, like saying they're stem when they're really just green.
So why do it? There are several reasons: to add cachet to the product, to avoid negative connotations, to instill consumer confidence in the service, and to stand apart from the competition. It's so much nicer to eat a dried plum than it is to eat a prune. And it's so much less frightening to get care at an academy than it is to be admitted to the hospital.
Susan Dubuque, president of Neathawk Dubuque & Packett in Richmond, VA, told me that consumers don't care what you call your cardiology program. Marketing multiple services under different names and brands causes confusion and is a waste of money.
"Consumers only have so many brain cells that they're going to devote to remembering anything concerning healthcare," she says in the article. "The more an organization splinters its brand identity into a zillion different parts . . . the more it dilutes the consumer's ability to digest the whole organization."
But Preston Gee, senior vice president of strategic planning and marketing for Trinity Health in Novi, MI, says the tactic can distinguish an organization or program. The strategy can work, he says, so long as it is based on research and you use wording that resonates with your audience.
In other words, if you must use a synonym for green, make sure it's something other than pond scum, toad, or moldy toast.
Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at gshaw@healthleadersmedia.com.
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When a cardiologist at Le Bonheur Children's Medical Center approached Marketing Manager Julie Ashby and said, "I've got this idea. You might think I'm crazy, but I want to see what you think about it," she was taken aback. But by the time he was done talking, Ashby says she was drooling.
Rush Waller, MD, told Ashby he wanted to wrap his new Dodge Nitro with LeBonheur graphics. And with the help of the marketing department, he did.
"Dr. Waller is not a wacky, loud personality. He's kind of a quiet reserved physician," Ashby says. "So it's kind of surprising that he would want to do this because it does take a lot to drive around in something that loud."
The car, which the hospital has dubbed an LUV (Le Bonheur Utility Vehicle), is wrapped with graphics that complement the organization's current print ads. It is brightly colored and features photos of former cardiology patients, some of whom Waller treated.
Waller has worked at the hospital since 1999 and said he was inspired to wrap his car to advertise the new children's facility that is scheduled to open in 2010.
"People have been so impressed, not only with how the car looks but with Dr. Waller's dedication and sincere love for Le Bonheur," Ashby says. "It's such a wacky idea and I think people were really blown away that he would offer to do this to his personal vehicle, and we're just so impressed that the reason really was to promote LeBonheur and the new hospital."
Since the driving billboard was unveiled in August, Waller has received a lot of attention around the community. Luckily, the marketing department foresaw this situation and created brochures for Waller to keep in the car.
"If he has five or 10 minutes to talk to somebody about it great," Ashby says. "If he doesn't, he can hand them this piece and they can go on with it. The design matches the car so it's really like a little marketing kit for his glove compartment."
Ashby says some other doctors have mentioned that they might like to do something similar for their cars, but she's not sure whether they'll really have the guts to do it.
Marketers are starting to realize that a technique that engages one ethnic group doesn't necessarily work for another, and ignoring the intricacies of Hispanic behavior online could negatively affect marketers' abilities to reach this growing audience. A recent study by Communispace Corporation looked at more than 1,000 Hispanic members in two private, online communities. The study revealed several trends that not only validate the effectiveness of using online media such as communities and social networks to reach Hispanic audiences, but also offer strategic guidance for doing so more effectively.
