Tobacco now claims at least 1.3 billion users and kills more than 14,500 people every day, while debilitating and sickening many times that number. In this issue, discover whether cigarette smoking can increase Alzheimer’s disease risk as well as whether stopping smoking benefits lung cancer patients.

On the prevention front, a new report outlines 21 challenges and needs for global tobacco control, and 220 companies describe their smoking cessation programs.

More than 40 percent of employees identified their employers as supportive or extremely supportive in seeking care for health issues, according to a survey by the American Psychiatric Association (APA). The national survey also showed that barriers still exist for those employees who said their workplace is unsupportive of employees seeking treatment, especially for mental health treatment. Loss of status at work and concerns about confidentiality were identified more often as barriers to seeking treatment for mental health issues than for other illnesses.

Of these employees, 76 percent thought their status would be impacted for seeking treatment for drug addiction, 73 percent for alcoholism, and 62 percent for depression compared to 55 percent and 54 percent who indicated status as a barrier for diabetes and heart disease treatment.

The APA’s Partnership for Workplace Mental Health offers the following tips for employers who wish to create an environment that encourages employees taking care of their physical and mental health:

1) Lead by example. Supervisors and managers play a crucial role in creating a healthy environment by taking care of themselves. Set the tone and take care of your own health.

2) Promote prevention, early intervention, and wellness programs. Encourage regular preventive health screenings, conduct health fairs, provide healthy meals and snacks at meetings, encourage exercise, and promote work/life balance.

3) Discourage people from working while ill. Employees that need to take off time due to an illness should know that their employer wants them back—safely, healthy, and productive.

4) Promote the investment you are already making. Remind employees of the health benefits and programs available to them. Make sure employees know how to access care, including programs like Employee Assistance Programs.

5) Reassure employees about confidentiality—this is especially important for mental health treatment. Remind employees about the ways that their privacy is protected when they utilize services, including Employee Assistance Programs.

Two-thirds of healthcare organizations use telehealth for clinical or non-clinical purposes, according to a 2009 Healthcare Intelligence Network survey. The September 2009 survey also identified the most common applications for telehealth, the prevalence of remote monitoring, benefits and ROI, the greatest barriers to implementation and other telehealth trends among survey respondents.

Conducted online in September 2009, the survey’s goal was to document metrics in the use of telehealth and telemedicine and identify emerging applications of these technologies. Through responses provided by 139 healthcare organizations to 19 multiple choice and open-ended questions, the survey results offer a glimpse into a healthcare future where no patient is left behind because of a lack of access.

Survey Highlights

— Almost three-quarters of respondents — 66.9 percent — are using telehealth for clinical or non-clinical purposes.

— Specialist real-time remote diagnostic consultations was the most common application of telehealth by respondents (14.7 percent).

— Almost half of respondents — 49.3 percent — monitor the health conditions of some patients or members remotely.

— The telephone is the technology most often utilized in the telehealth initiatives of respondents (72.1 percent).

— Healthcare efficiency is the area most impacted by the introduction of telehealth, report 73.3 percent of respondents.

— Reimbursement has been the greatest barrier to implementation of telehealth, report 19.6 percent of respondents.

Key Findings

Prevalence of Telehealth and Telemedicine:

— Of the remaining 33.1 percent of respondents that do not engage in telehealth, 21.3 percent plan to do so in the next year.

— Private payors are the most common funding source for telehealth efforts, say 40 percent of respondents.

— More than half — 57.7 percent — do not know whether their state has passed legislation regarding reimbursement for telehealth.

Telehealth Targets and Delivery:

— A majority of respondents (61.9 percent) direct telehealth programs at their entire population, while 17.5 percent focus only on the chronically ill.

— After remote specialist consults, health information by telephone was the second most frequent application of telehealth (13.2 percent) followed by equal use of telehealth for distance education of patients and providers, EHRs, patient and caregiver e-mails and automated message reminders for appointments and medications (all reported by 10.3 percent).

— Heart failure was the condition most frequently tracked via remote monitoring, said 83.9 percent of respondents.

— Almost two fifths — 39.7 percent — deliver telehealth via a broadband connection.

In spite of President Obama’s plea last week for renewed commitment to healthcare reform, the nation’s priorities appear to be gravitating more toward job creation and budget deficit reduction. Meanwhile, a new Kaiser Family Foundation poll finds that even after a yearlong media blitz, many Americans remain unfamiliar with key elements of the two major healthcare reform bills passed in the House and the Senate. A featured story in this week’s Healthcare Business Weekly Update, the poll also found that while Americans are divided over health reform proposals, many become more supportive after being told about many of the major provisions in the bills.

We also present new data that could help control healthcare costs and utilization among Medicare beneficiaries. Contrary to popular thought, Brown University researchers now believe that increasing co-pays for outpatient visits — at least for senior citizens — may make care far more expensive. They determined that patients faced with higher co-payments did cut back on doctor visits, but ultimately required expensive hospital care because their illnesses worsened. Aetna hopes to avoid this with its user-friendly strategy for heading off high-risk complications among its elderly. Listen to the details in this week’s HealthSounds podcast.

New month, new survey. We’re taking another look this year at the way healthcare uses economic incentives to drive participation and results in health and prevention programs. Complete the survey by February 28 and get a summary of the results.

This week’s issue of the DM Update is all about the heart and keeping it healthy. Discover the link between COPD and heart function, as well as the risk of heart disease among America’s youth. And our prevention story for this week answers the following question about reducing heart attack risk: should treatment be tailored toward an individual’s heart attack risk or cholesterol levels?

Dr. Craig Samitt, president and CEO of Dean Health System, lists five essential strategies that can lead to a successful ACO in the healthcare industry.

The first strategy for a successful accountable care organization (ACO) is effective recruiting. We all have a tendency to fill a spot just because a spot is available. When one of our doctors leaves, we replace them with anyone who has the technical skills. The same thing occurs with staff. We are being a whole lot more selective than that. We feel that if we make the right hiring decisions in the first place, it saves us effort and turnover and we avoid staffing problems down the line.

Our second strategy is to create incentive systems that are aligned. Much of healthcare reform has to do with this as well. How well are physicians and staff and management in your organization aligned with the vision of your organization? Are we paying our staff and physicians to deliver better care at a lower cost, not just more care? At Dean, in essence, we have sought to redesign our compensation methodologies and our incentives for staff and management to deliver on better care at a lower cost.

Strategy three is about focusing on the customer. With all due respect to physicians, we have been a very physician-centric industry. Frankly, it is shifting to a consumer-centric industry. Are we delivering the product that consumers want, and are we focusing on service?

Strategy four is all about measurement. How many organizations use balance scorecards and dashboards, and how many can arm physicians with the information they need about their practices at the point of care? How many companies know how well they are doing in the service quality access arena? A June 1, 2009 article in the New Yorker by Atul Gawande talked about the differences in quality. Some of the markets that had very low quality weren’t even aware that they had low quality per the Dartmouth Atlas. How well do we share information and metrics to show how we are doing and to allow physicians to compare themselves to other physicians? For example, a scorecard that we shared when I was at Fallon Clinic compared all of the clinical units against each other for all of the elements of the patient satisfaction survey. We gave them A through F for all of the major questions. You can be sure that those departments that were getting Fs were reaching out to those who were getting As to understand what they were doing differently.

Strategy five is about reengineering processes’ and one example is the use of Lean Six Sigma. But, it doesn’t even have to be as sophisticated as that. It can just be basic process redesign. When we think of a medical home, we think of this as primary care redesign. We are looking at what we need our primary care practices to deliver on and reengineering the practices so that they make sense. We want to take our PCPs off of the treadmill that they are on and recognize what we really need PCPs to do, which is to focus on population health.

This week we’re talking about trends that could transform healthcare. In separate stories, learn why the doctor will see you now (at least in California) and maybe even in your car. Besides these consumer-centric concepts, this issue of the Healthcare Business Weekly Update also offers a blueprint for a successful accountable care organization (ACO). Loosely defined, ACOs are a set of providers associated with a defined population of patients that is accountable for the quality and cost of care delivered to that population.

According to healthcare consultant William DeMarco, “through technology, these small groups can link together and act, think and leverage themselves as a larger group, giving them a reward and also an asset value they didn’t have before. This also allows them to coordinate services virtually between the medical group and the hospital.”

Still haven’t taken our medication adherence survey? You’ll miss out on strategies from the 100 healthcare organizations that already have. There’s still one week left to take the survey and receive an e-summary of compiled results.

According to a study published this month in JAMA, progress has been made in reducing the rate of obesity in the U.S. In this week’s issue, you’ll learn about another recommendation for reducing obesity rates from researchers in Oregon. Also, discover whether or not obesity is a bigger threat to quality of life than smoking, and some encouraging news about obesity rates among young children.

Mary Cooley, manager of case and disease management at Priority Health, describes a discharge protocol that is preventing hospital readmissions among patients with cardio vascular conditions.

Our heart failure initiative sprang from our work in 2008 with cardiovascular conditions. Heart failure is one of those top readmission diagnoses for Medicare. We are following the Institute for Healthcare Improvement (IHI) Getting Started for Heart Failure Guide, which says that, “patients must be seen within five days of discharge.” We’re promoting that across our network of providers; the patient is seen in the office to review medications, any early symptoms, the patient’s progress since hospitalization and any questions they might have. We feel that that’s been a key ingredient to our success.

We want to be sure that we empower the patient to be an active participant or an active consumer in their healthcare. We want them to communicate their healthcare concerns and not wait until things get out of hand and an ER visit or an inpatient hospitalization is warranted.

One important concept is to not only discuss the red flags of management and document them in the personal health record (PHR), but to employ “teachback” strategies so that we’re sure that this is all in concert with our health literacy efforts. We want to be comfortable that the patient has heard what we have said, has been able to process that information and has been able to teach that back to us in a way that’s meaningful for them. That will serve them well in managing their condition moving forward.

We also want to not only address current concerns but also anticipate any needs and concerns, and to be proactive. Discuss with the patient that they should talk about their symptoms and any side effects of medication when they see their physician. Not necessarily to stop that medication, but to call the physician first and discuss what’s going on and maybe how that treatment plan can be remedied based on their current effects of the treatment protocols. And also, not only when to call the physician, but who to call. These patients have multiple comorbidities and when they are coming out of the hospital with many different symptoms, they don’t always know who to contact. It’s very important to say who is on first base and who to call when and if you’re having difficulty.

Marijuana is in the air. Last week, the Garden State became the fourteenth in the union to approve the use of medical marijuana, while the Golden State took the first steps toward legalizing the drug for everyone. While it’s unlikely that the California bill will come to fruition, the public safety committee of the state assembly voted 4-3 on a measure that would tax and regulate marijuana in the same way alcohol is controlled.

And in a first-run movie I saw last week, a pair of 50-somethings smoke a joint before attending a party at the home of one of their children. Hilarity ensues and their children are rightly mortified. Hollywood may not be so far off the mark. In a featured story in this week’s Healthcare Business Weekly Update, SAMHSA reports on a dramatic increase in levels of illicit drug use among aging baby boomers that is likely to strain existing substance abuse treatment services in the years to come.

On the flip side, healthcare companies recognize the value of proper adherence to a medication regime. In the first week of our survey on medication adherence, more than 60 companies have already told us about the individuals and conditions targeted by their medication adherence programs as well as the strategies, technologies and tools that are producing results in this area. It’s not complicated — take the survey by January 31 and get a free e-summary of these results.