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Healthcare Engagement: Most Companies Are Not Meeting Employee Expectations

nancyturettEdelman has been a leader in surveying and analyzing consumer health opinion on a global scale. In 2008 they released the results of a Health Engagement Barometer, confirming the public’s strong desire for personal engagement with health experts and peers online and beyond. I clearly remember Edelman’s revelation that medical bloggers (particularly healthcare professional bloggers) are one of the most trusted sources of health information online. That made me feel good.

This time around, Edelman created a new survey (The Health Engagement Pulse) focused on consumer expectations of their employers. The results reflect a further shift away from traditional siloed roles and relationships (where employers have nothing directly to do with healthcare) and a new era of blended responsibility. To understand this shift, I interviewed Nancy Turett, Edelman’s Global President of Health. Please listen to the audio interview or enjoy the synopsis below.

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Dr. Val: What questions did you have when you created the Health Engagement Pulse and what were you interested in learning?

Nancy: We wanted to get a general sense of what Americans were thinking and feeling about the role of their employers in their health, and if they had any expectations of businesses. Recently, healthcare reform has focused upon insurance reform but there’s a lot more to how we’re going to getting Americans healthy than just insurance reform. We want to know what role businesses should play.

Dr. Val: Did the results surprise you at all?

Nancy: I was significantly surprised. I figured that the public would be strongly supportive of an expansion of employee health benefits to include preventive or “wellness” services, but what I didn’t expect was the equally strong support of business to go beyond this – to invest in creating healthy communities within the local areas where they operate and to share innovations in health products and services. To figure out exactly what this might look like, we’re going to do a more detailed “Health Engagement Barometer” in 10 countries in March or April of this year to find out what employees want their companies to do exactly in their local communities.

We were also surprised to find a significant gap between the expectations that the public has for employer engagement in health, and how well they’re perceived to be doing right now. Only one in ten respondents think that businesses are currently doing an excellent or very good job of health engagement.The “report card” isn’t good, so this means both that companies need to take action to protect their businesses and that there are tremendous opportunities for companies that lead in this space.

Dr. Val: Are there any companies who are doing a good job now?

Nancy: I consider the following companies to be leaders in employee health: Starbucks, Johnson & Johnson, and GE. The wave of the future is for companies to engage more than their employees in healthy lifestyles, but the company’s customers, business partners, and local communities as well. Health is multi-dimensional. Good health requires participation from a wide range of stake holders, and it takes time to achieve high particpation rates. This is about evolution not revolution.

Dr. Val: What are the specific barriers that you see to having companies meet employee expectations of them?

Nancy: I think the barriers have to do with companies feeling that they lack health expertise so they don’t want to embark on complex health improvement strategies. Edelman is trying to demystify some of this for companies – and help them understand that health is not just the absence of disease, but it’s about maximizing physical and emotional wellbeing to enhance productivity.

I think another barrier is simply knowing where you are on the health spectrum. You can’t fix something if you don’t understand what’s wrong. We try to help our clients find “triple wins” where they can create and implement strategies that are good for themselves, for their partners, and for society.

Dr. Val: Do you think that cost is a significant barrier for companies to initiate health programs?

Nancy: I think it’s a significant problem, and it has to do with a lack of clarity on what’s actually being measured. Health is an asset that can help with productivity, motivation, loyalty, and partnerships. Yeah, it’s hard to “measure” relationships, and the ROI of initiatives that will drive reputation among partners and stakeholders, but that doesn’t mean it isn’t extraordinarily important. And often companies don’t have to create something completely new, they just need to leverage what they already have.

I think that health is the new “green.” There was a time when companies engaged in environmental activisim because they were on the defensive. Now being “green” serves the public’s demands and is a real business driver. I think health will slowly follow the “green” trajectory. Right now 60% of people think it’s as important for companies to engage in improving the health of their communities as they do reducing pollution and caring for the environment.

Dr. Val: So what does Edelman hope to achieve with the Health Engagement Pulse?

Nancy: Beyond using the Health Engagement Pulse as a tool to inform our next international deep dive survey – the Health Engagement Barometer – we wanted to find out how people would respond to companies who take the initiative to engage in healthcare in a robust way. Interestingly, 86% of those we surveyed said they’d be more interested in working for such a company or supporting them by buying their products or services.

This survey confirms what we’ve believed all along – that there’s a ground swell of support for employer engagement in healthcare strategies on many levels. Soon healthcare is not going to be “owned” by the healthcare industry. Now is the time for companies and non-profit organizations alike to take a serious look at how they plan to be a part of the healthcare solution.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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