NutriTutor™ Blog

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With all the changes coming in healthcare, the proverbial buck stops in front of those who either have, or are at risk for chronic disease. In 2014, the average American is expected to pay at least 30 percent more for health insurance. Smokers, people who are obese, and those with diabetes, elevated blood fats and high blood pressure will pay even higher.

To give employees a step up on what’s coming; companies are proactively rewarding staff members who take control of their health. Some employers report paying staff upwards of $800 per employee. Other companies, like CVS Caremark, are instituting penalties for non-participation in wellness programs. Family Dollar charges tobacco users, under one plan, up to $832 extra for their health insurance premiums. No matter how you slice it, cost increases will be bad for everyone, but even worse for people with chronic diseases.

To reduce costs, value-added alternatives to traditional medical insurance and education programs are gaining popularity with individuals and companies alike. Tele-companies such as Ameri Doc, Teladoc, PhoneDOCTORx, and NutriTutor® offer members convenient ‘after hours’ access to medical clinicians to raise the bar of patient-centered care, reduce costs, and improve long-term health. “Tele-medical plans work very well for fairly healthy people; including those who have early forms of diabetes, high blood pressure and/or high cholesterol”, states Van Wyckhouse, CEO of NutriTutor®. Van Wyckhouse adds in warning, “No matter the stage of chronic disease you have, it’s urgent that you act quickly. Since most Americans ‘learn’ a lot of wrong disease management information from deceptive advertising, getting real medical education is going to be essential.”

Surviving the upcoming cost increases will, no doubt, be a difficult transition for most Americans. With only eight months left to 2013, individuals and companies alike are preparing for the changes by investing in disease management and risk reduction programs. What do you need to do to prepare?

Solving the crisis of chronic disease in our country not only requires adequate patient training, but a structural change in the way the medical industry treats patients, according to the Partnership to Fight Chronic Disease (PFCD).  In their white paper entitled, “Needs Great, Evidence Lacking for People with Multiple Chronic Conditions”, they contend that the medical practice guidelines employed in the U.S. are focused on single diseases; thereby creating rather than solving problems for patients who have multiple chronic conditions.  27% of Americans have multiple chronic diseases.  This group costs our nation $2.00 out of every $3.00 spent on healthcare.  To find the easiest solution to this problem, we are compelled to understand the problem more thoroughly.

Patient self-management training is an essential key to reducing costs associated with chronic disease.  Few Americans receive this education.  Immensely more troubling; few voices are heard declaring this simple, foundational truth.  Well known to referring physicians is the deficiency of out-patient training sites for people with chronic conditions.  In my experience, very few people have opportunity to receive this high quality cohesive medical training because of meager reimbursement and restrictive guidelines, combined with poor patient motivation.

When Medicare first enrolled Registered Dietitians as providers, out-patient education programs rapidly grew in numbers.  It was discovered, however, that limited reimbursement, billing difficulties, and patient ‘no show’ volumes made these programs untenable.  As a consequence, out-patient education sites slowly disappeared.

Now, in the absence of adequate referral sources, primary care providers simply do not send patients to medical training.  When these patients are hospitalized, providers make use of the nutrition services available; however this training is less than adequate.  Out of necessity, patient education in the acute care setting focuses on teaching ‘survival skills’ for the condition that originally led to the hospitalization.  This lends credence to the lack of disease integration found in patient teaching noted in the PFCD white paper.

It seems to me that we are putting the proverbial cart before the horse.  The answer to controlling chronic disease in this country might be immeasurably simple.  We should not presume that people have learned how to manage their diseases from a reliable medical source.  Before seeking to change the practice guidelines by which physicians provide medical care, let’s first put the foundation of patient training into place.  Then, if training does not solve the problem, we can investigate other options.

All Americans should be given opportunity to learn how to prevent and treat their chronic diseases.  How can this be done?  Web-enabled medical training offers education that is integrated and customized without the expense of having clinicians present during the learning process.  It is cost-effective and capable of reaching into every home with real medical tools that transform lives.  Internet-based programs can even be branded to promote any business or agency, and launched quickly and easily.  Isn’t it time that Americans be given the tools they need to live healthy and productive lives?  We can solve this chronic disease crisis.

Electronic media will, indeed, change the face of healthcare as we know it.  Here’s a peak into how the internet will significantly reduce costs and improve the quality of patient education.

As an experienced Registered Dietitian, I know that very few people with chronic diseases receive the education they need.  For instance, according to the American Association of Diabetes Educators (AADE), potentially as few as 1% of people with diabetes receive training. Comparatively few facilities offer medical education services, and even when they do, programs are treated more as an after-thought.  Making matters worse, training options rarely supply critical skill development and are notoriously costly in both time and money.  Most people think it is easier and less expensive to “learn” how to control chronic diseases from advertising sources, despite questions of reliability.

Read more

Original article:

http://www.forbes.com/sites/brettnelson/2013/03/28/a-ray-of-hope-for-affordable-convenient-quality-health-care/

I’m interested in hearing your thoughts about the Wellness Employee Trends Study 2012, just published by HealthiestEmployers.

In summary, employees in this study recognized the value of their wellness plans, but did not feel they were quite what they should be.  They expressed desire for more assistance in the areas of nutrition, weight management, and exercise.  Proportionately few employees were interested in smoking cessation, but the authors warn readers that only a certain percent of respondents smoke; skewing the proportionate reliability of the data (19.3% of American adults smoke according to the CDC).  Proportionately few employees felt the need for diabetes and chronic disease management in their wellness plans.  The same caveat for smoking cessation applies here as well because only 8.3% of the population has diabetes and about half of Americans have a chronic disease; proportionately skewing the results.  I also suspect that the respondents already knew that strategies such as losing weight, eating better and exercising would help to prevent and treat their chronic diseases.  What do you think?

I found a noteworthy article on the Agency for Healthcare Research and Quality’s website, entitled “Chronic Disease Management Can Reduce Readmissions: A Conversation with Jack Meyer, PhD, Managing Principal, Health Management Associates”. I’ve summarized the main points in the following paragraph.

The Affordable Care Act includes provisions designed to reduce hospital readmissions, such as losing up to 1 percentage point in payment if hospitals do not meet targets for reducing 30-day readmissions for high risk diagnoses (myocardial infarction, heart failure, and pneumonia).  To prevent financial loss, medical providers must identify high users of health care services and place these individuals into a structure of care that strongly manages and monitors their progress and compliance with treatment.  These high risk individuals will need to be provided comprehensive self-management training that includes a realistic monitoring component so that they know when treatment is or is not working.  In this way, readmissions can be prevented.

High risk individuals have numerous diagnoses and complex treatment regimens.  People with longstanding diabetes are included in the high risk patient category.  Speaking about this group, Dr. James Webster, president of the Chicago Board of Health states, “As a patient group they are one of the most highly medicated groups because they frequently have other conditions like obesity, high cholesterol and high blood pressure problems and vascular issues”.  (http://articles.chicagotribune.com/2007-04-08/business/0704060562_1_diabetes-patients-value-based-benefit-designs-midwest-business-group)

NutriTutor® makes reducing readmissions reachable.  Our comprehensive diabetes training includes education for heart and blood vessel diseases, weight management, and hypertension…and we always teach people how to monitor their own progress.  These interactive, web-enabled programs are available for companies to offer as their own branded training from their own websites.  Learn more at www.nutritutor.com.  Read the original article at http://innovations.ahrq.gov/content.aspx?id=3867.

The good ol’ U.S. of A. continues to earn the prize for being the most litigious government in the world.   One would think that Health and Human Services would incentivize people to find more efficient ways to provide disease management programs while also reducing costs.  I started working on just such an idea seven years ago, and learned that this is not the case.  In fact, HHS has sewn us into a corner with infinitely tight regulations.

I am an experienced Master trained clinical educator who genuinely cares that people receive their best opportunity to live a healthful life.  When I see glaring barriers to learning, I create better programs.   In fact, using the interactive platform of the internet, I found a resourceful way to meet all organizational and legal requirements for reimbursable medical patient training that costs half the price and doubles the effectiveness.   Starting with Diabetes Self-Management Training, ten hours of comprehensive diabetes education, programs are not only patient-centered, but they are business-centric as well…and exceedingly flexible.  Five years have transpired since going live and we all continue to wait for the lawmaking powers that be to acknowledge value in better quality programming at a reduced price.

The American Association of Diabetes Educators DSMET Access Grant Project 2007 End of Year Report by Mark Peyrot, PhD documents the following barriers found in traditional diabetes self-management training programs.

• 41% of physicians do not have enough referral sources
• 28% of physicians do not like the quality of the programs
• 21% of people taking classes are not covered by insurance (average $633.00 out-of-pocket)
• 38% of patients report they cannot fit classes into their schedules
• Physicians and educators underestimate patient scheduling problems
• 17% of physicians do not believe the classes work

The programs I created solve all of the barriers listed above.  Best yet, this report also documents that 59% of patients state they would learn diabetes self-management on the internet.  Well…what are we waiting for?

Kudos to Dr. Jonathan Burroughs for his insightful article; “Reducing readmissions; it’s harder than it looks”.  As a Registered Dietitian and Master trained health educator for over 30 years, I’d like to comment on two of the ten changes he recommends as they relate to chronic disease; specifically the need to

1. Create significant financial incentives for management to invest in a disease management infrastructure
2. Implement rigorous disease management for high-risk populations

To summarize Dr. Burroughs recommendations; healthcare organizations need to be incentivized to keep patients healthy and to take responsibility for patient care after discharge when teaching can have the greatest impact.  He also notes that 5 percent of Medicare beneficiaries make up 35 percent of its costs, and that readmission rates are 50 percent higher for the uninsured and Medicaid recipients than they are for the insured.  He encourages companies to invest in these individuals by providing them with more intensified disease management training in order to reduce the over-all cost of care.

Dr. Burroughs is partially correct.  Indeed, hospitals and physicians need to be incentivized to invest in a disease management infrastructure for the out-patient setting.  In-patient dietitian teaching is notoriously ineffective and expensive.  In addition, the number of people with chronic diseases who receive medical training is pitiable, as is the availability of out-patient medical training.  Ask any dietitian how they believe the public learns to control their chronic diseases.  Unquestionably, people rely on phony marketing messages from purveyors of pills, magic foods, and books made to sound scientific.  Sadly, chronic diseases are progressive, enormously destructive, and costly.  In fact, these are some of the reasons that led me to put disease management training online.  All Americans need to know how to prevent and treat the chronic diseases common to this society.  We need a more global perspective on the topic of reducing readmissions and turning around the healthcare problem in our country.  Medical training is an excellent starting place to solve this problem.

While some people take their health very seriously and are willing to sacrifice their comfort and convenience to make healthful changes, it is wrong for us to assume that everyone is interested in sacrificing lifelong habits for the promise of a healthier future. In a recent discussion with a longtime clinician director of a county health department, I offered free NutriTutor® learning memberships in return for outcomes data.  She thanked me for the generous offer responding, “I’m sorry, but it wouldn’t be worth your effort.  Our clients do not show interest in participating in their own health.  I’m afraid you would not have any outcomes data to collect after all of your hard work.”   This clinical director’s view is persuasive because the health department does exactly what Dr. Burroughs suggests.  It invests nutrition and lifestyle education in the Medicaid and uninsured segments of our population.  My own experience as a WIC (Women, Infants and Children Supplemental Food Program) Dietitian supports this same conclusion.  Out of an estimated 980 hours of patient education, I distinctly remember a single returning client (all of whom had to return to remain in the program) who actually applied the information she learned.  Similarly, it is my experience that many Medicare recipients with CHF (congestive heart failure)—a diagnostic target for hospital readmissions—show minimal interest in how to prevent future incidents of the condition.  Is it any wonder that readmission rates are so high for these patient groups?

While I believe that all medical practitioners and healthcare facilities are responsible to assist their patients toward better health, let’s not lose sight of the fact that the ultimate decision lies with each patient.  Some people are willing to change, and others are not.  The average American understands little about how lifestyle habits create chronic disease.  In all fairness, we should all be afforded the information needed to be healthy.   I am willing to wager that intensive resources offered to the insured will not only reduce readmissions, but it will also reduce total healthcare utilization.  Of course, this concept will not be popular with the healthcare industry until both hospitals and physicians are incentivized to invest in a disease management infrastructure for patients who show signs of progression toward chronic disease.

So how do we help the high risk Medicare, Medicaid and uninsured patients to participate in reducing hospital readmissions?  From my experience, I cannot help but wonder if these high users of healthcare would respond differently if their healthcare allowance were limited or if readmissions were to cost them in personal resources.  After over 30 years of instructing patients from all socio-economic groups, I am convinced that no amount of intensive training will motivate this group to participate in preventing readmissions.  This does not mean, however, that we don’t try.  Since the reasons for non-compliance are multi-factorial, I suspect our friends specializing in psychology and spirituality might have useful input.  Never-the-less, all Americans should be afforded the opportunity to learn how to prevent and treat their chronic diseases.

So, how do we reduce hospital readmissions and healthcare utilization?  All Americans need medical home style training to accurately learn how to both prevent and treat chronic diseases. For population-wide teaching, customized web-enabled training is immensely learner-centered and cost-effective.  It also has the flexibility to train as intensively as patients are willing to learn and can be underwritten by more than one party.  Empowering patients who are willing to participate in their own health brings a guaranteed return on investment.  For more information about NutriTutor® medical home compliant training, please see https://www.nutritutor.com/front/index.html.

We’ve voted in massive healthcare changes, but this may play out differently than we thought.   In my review of emerging regulations, working people who have chronic diseases will pay more for their healthcare and receive less actual care.  Specifically targeted are people who smoke and are obese.  These are two of the greatest causes of chronic disease, along with a sedentary lifestyle.  Make no mistake, the proposed rules allow insurance companies to charge you more for your healthcare!

For my friends who smoke and carry extra weight, let’s think through the implications.  The changes, expected to begin 11 months from now, will lower your savings, thereby reducing your discretionary income and negatively altering your lifestyle.  At the same time, your retirement age will go up.  In addition, your quality of life will significantly fall because of the expected chronic diseases.  Is this the future you want?

If you have access to worksite wellness benefits, it is in your best interest to wholeheartedly get on board and work the program.  Every pound you lose and every cigarette you don’t smoke brings you one step closer to improved health and lowered healthcare costs.  If you are on blood pressure or cholesterol-lowering medications, get the medical training you need to come off the medicine.  If you have diabetes, statistics tell us that you cost insurance companies more than others with chronic disease because you usually also have blood pressure and/or cholesterol problems, and diabetes damages your entire body (“National Diabetes Fact Sheet”, 2011).  You need Diabetes Self-Management Training (DSMT); a program that helps you lose weight, control glucose, manage blood pressure and cholesterol.  Many hospitals offer DSMT, but it is also available online so that all learning happens at your convenience.  Learn more.

Thomas Brown of Zephyrhills, Florida (aka “Brownie”) gained a lot of weight during his career as a business analyst and co-owner / general manager of an international Human Resource training company.  Stressful work days with business travel , extended hotel stays,  weeks of restaurant meals and business entertaining  helped to bring Tom’s weight to an all-time high of 255 pounds; about 60 pounds above his ideal weight.  Despite having been naturally a tall thin individual, this extra poundage threatened his health and longevity by triggering triglyceride and cholesterol problems.  Try as he might, Tom’s overwhelmingly busy lifestyle made it difficult for him to focus on his own needs—that of controlling fats and sugars in his diet and avoiding a sedentary lifestyle.  He and his wife often promised each other that they would do better, but her schedule as a business owner and international instructor paralleled Tom’s.  Each year he noticed that his blood fat levels worsened, indicating disease progression.  It was the excessively high triglycerides, in fact, that caused his physician to perform a glucose tolerance test which ultimately identified the existence of type 2 diabetes.   Tom yearned for the day that he could put himself and his health first.

Tom trudged through the working years that passed in rapid succession, and he eventually found himself reaching retirement.  He and his wife settled into a beautiful golf course community surrounded by orange groves and fields of cattle.  “I can finally get physically active and drop the pounds now that I have some time for myself”, he imagined with enthusiasm.  Tom discovered, however, that he merely exchanged one set of problems for another.  Yes, he played more golf, but the golf cart did much of the ‘walking’ for him.  And there was always a social event or dinner invitation that was too good to pass by.  Tom got caught up in the retirement community frenzy of fun, friends, food… food…and more food.  He seemed to have less control than ever over his diet and exercise!

Not long after retiring, the unthinkable happened.  Tom’s precious wife met an untimely death.  Much to his amazement, Tom found that losing weight was easy…too easy, in fact. Overwhelming grief caused him to not only lose the extra weight, but to lose a lot of muscle too!  Now he was in worse physical shape than ever.

Without his beloved soul mate, Tom struggled to face each day with hope.  He began exercising at the YMCA, knowing that it would help him to feel better both physically and emotionally.  He also reached out to friends and signed up for volunteer work at a battered women’s shelter as a way to honor his late wife, whose death had been caused by a former spouse’s physical abuse.  His volunteer work entailed picking up and moving donated furniture for a thrift store whose revenue supported the women’s shelter, thereby providing significant and strenuous physical exercise.  Through mutual friends, he met Laurie Van Wyckhouse, a Registered Dietitian and Diabetes Educator.  “Maybe she can help me get back on my track “, Tom pondered.  Unbeknownst to Laurie and Tom, it turned out that they would both help each other.

As their friendship grew, Tom learned about Laurie’s passion to reduce physical pain and emotional suffering caused by preventable diseases.  She told him about her earlier work in Haiti and Peru to help alleviate the pain and damage caused by under-nutrition, and how she now hoped to do her part in helping to solve the nation’s healthcare crisis caused by chronic diseases.  Laurie was developing a series of web-enabled medical training tools that she believed would improve countless lives for a fraction of the cost.  She determined to alter the fact that 75% of current healthcare costs in this country are preventable.  A giver by nature, Tom caught the vision.  He offered to work with Laurie on her project–NutriTutor–and ultimately word-smithed her Diabetes Self-Management Program.

During Tom’s business career, he learned that if one makes a sincere effort on a business project, one cannot help but learn that project inside and out.  Thus he absorbed and implemented Laurie’s evidence-based medical teachings.  The principles of controlling diabetes and related chronic disease soaked in until they transformed into healthy behaviors.  Much to his surprise, his A1C values (reflecting average glucose levels) began to fall and his doctor took him off Metformin.  He was down-graded from having type 2 diabetes to now having prediabetes!

While Tom’s physician continues to monitor his glucose, blood pressure, and blood fat levels, his AIC tests have remained within the safe range for the last four years.  Grateful for improved health, Tom boasts that NutriTutor® Diabetes Self-Management Program made the difference in his life.  His new companion, Diane, could not agree more!