Patient Advocacy: Healthcare on your side

 

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Four New Trends in Medicine

Patients will Benefit from (part II)

Following part I of this report on the new trends in medicine, I will highlight longer-term changes and implementations this week.

Aimed primarily at generating the optimum cost/quality/result balance and at making the best use of resources while providing the most effective results, these innovations will bring patients the benefits and success they may not always enjoy at this time. 

The switch from a quantity, fee-for-service, wasteful, high cost and inefficiency system to one encouraging provider cooperation, patient participation, prevention and better management is likely to encounter hurdles and resistance, but will ultimately go a long way to resolving the healthcare system existentialist problems seen today. 

1. Predictive Medicine

Prepare for the rise in interest in your health by your insurance company, employer or governmental agencies (especially if they insure you). And for an early interest, before symptoms, before your first medical consultation and before you get that first prescription or treatment. It's all about risk, and how to minimize it in a system with scarcer resources, fewer denial options for insurance companies, reduced payments and greater access to data.  

The legal precedent set by the Supreme Court now allows genetic tests to become "generic". Once reserved to the already ill (i.e. breast cancer patients being tested in order to pinpoint the better treatment) or the at-risk population (those with a family or personal history), these genetic tests will multiply in scope and reach. According to Robert M. Wenzel, owner of London Global Laboratories, gene analysis will accurately predict of an individual's risks, based on algorithms derived from the analysis supported by Electronic Health Records and the universal access to and sharing of medical data.  

Predictions about a risk of disease, about the success of a specific treatment, or the effectiveness of a particular drug will become part of the medical arsenal. By making an early diagnosis (and with a prompt intervention), physicians will take a more efficient, pro-active stance, while patients benefit from cheaper, less invasive and more curative outcomes.  

2. Preventative Medicine

Once risks have been established, and for the population as a whole, expect an early intervention from those interested in your health, whether for clinical or financial reasons. The US system is definitely turning into a prevention-centric system, similar to the other health systems in developed countries, almost all of whom are government-run. 

Monitoring of vital signs, especially with the use of technology such as phone apps or sensors, aim at reducing the number of conditions made chronic by lack of medical care or responsible behavior. More data crunching will lead to the better use of diagnostic tools such as labs or imaging, and to more specific guidelines about proven processes. Early and consistent screenings, especially for those identified as "at risk", are expected to lower late and costly diagnoses, especially those requiring extensive treatments and heavy price tags.

Changes in lifestyle choices, advice on nutrition, emphasis on exercise or other healthy activities, intervention at early ages, and supportive measures are part of a trend that will require more and more personal involvement and commitment. 

A system of rewards or penalties is already growing, especially among employers seeking a reduction in premiums with a improvement of their employees' conditions or vital signs. Encouragement and resources are already becoming more available, and will become more widespread and commonplace as the emphasis on health becomes more prevalent, and important in people's minds. 

3. Personalized Medicine

"Trying out" this or that medication, undergoing multiple treatments, searching for the best way to a successful outcome might soon be viewed as a thing of the past. 

Biomarkers, nanosensors and virtual models are some of the tools medicine can use to establish an individual's profile and identify the most effective, most affordable course of action. Clinical trials could achieve better results by being more selective and focused. 

Technology can now bring real time diagnoses, ensuring the proper triage and intervention without using the ER as the default. Medical errors due to a lack of information, or unavailable medical history and medication list, will be reduced significantly. 

Based on quantitative data, selective criteria and established guidelines, any course of action will be better able to guarantee success than ever before. 

4. Smarter Medicine

Learning to practice medicine from a more technical and technological approach is new to medical providers. This trend will not be reversed; and physicians not "on board" may soon lose patients and funding and see a dip in their ratings or reputation. 

The new models point to a sharp learning curve, which the medical profession, and many patients, have been resisting out of fear, ignorance or financial concern. Stepping into a smarter, less invasive, more focused and better adapted system is not only good medicine, but the only way all players can survive and thrive. 

We will be seeing an accelerated number of new innovations, technologies, models and guidelines. Based on real time data, easily quantified and verified, these changes will not only bring the healthcare system into the current technological age, but will soon catch up with most other developed countries. The benefits and health levels enjoyed by those members can become a real possibility for all US consumers too. Financial rewards, in the form of lowered costs and elimination of waste, would also benefit all of us. 

Conclusion: 

Personalized healthcare and these new trends mostly mean "transparent healthcare". 

Access to medical records, widespread information, public data banks and analyses, as well as the monitoring of one's own bio readings can encourage communication and coordination of efforts. Rather than accepting a prescription or treatment at face value, patients will become more aware of risks, options and costs. Better informed about their diagnosis and a partner in their physician's decision, they will be able to participate more fully in their care. 

The days of turning one's life over to a physician with little participation and an obscure understanding might well be counted, as self-responsibility becomes a more essential and necessary part of the process. It can be easily argued that early detection, screenings, and prompt intervention will save lives and certainly dollars.
But it will be even cheaper and better for all if the population, especially as it ages, remains healthy and independent as long as possible without entering a hospital or being diagnosed with an incurable chronic condition. Hopefully, the entry of medicine into the age of responsible, applied, personalized and proven technology can help achieve this goal. 

©  [2016] Advimedpro.

©  [2016] Martine G. Brousse.

All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements. 

AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330

                                         www.advimedpro.com           contact@advimedpro.com

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

 IT'S  PRIVATE PROFESSIONAL 

PATIENT ADVOCATE WEEK!

As Trisha Torrey, the spokeswoman for patient advocacy and founder of the Alliance of Professional Health Advocates has noted, advocates have not been receiving the recognition for the successful work they have done on behalf of patients. For this reason, and to bring attention to this new but growing profession, she has declared the first week in March as "private Professional patient Advocates Week". 

As a Patient Advocate (one of a few hundreds in the U.S.), I spend, it seems, as much time getting the word out and explaining what I do than actually working on cases! Though the need is great, patients and their caregivers are unaware of the services advocates may offer, and that help, in many forms, is available. 

Whether locating that perfect nursing home for Grandpa, reviewing and negotiating down excessive medical bills, accompanying far away Mom to appointments, or helping a torn family find a united course of action in face of a serious diagnosis, advocates can provide the necessary knowledge, support, compassion and skills. 

Some advocates may specialize in researching treatment options and educate you on a new condition, while others provide in-home nursing care or hospital beside monitoring.
While I deal mostly with financial matters (finding assistance for cancer patients, handling medical accounts, appealing insurance payments or auditing and settling bills), some of my peers can advise you with end-of-life decision making, can guide you when applying for disability or other benefits or can research home birth alternatives. 

It is a sad but true fact that patients are not receiving the supportive care, detailed explanations, extensive reviews of conditions, treatments and options, or financial solutions from their medical providers that they often require. Navigating alone the intricacies of this vast and complex U.S. healthcare system in its various forms, can take a large emotional and financial toll. Medical providers are so stressed by time constraints and financial concerns that they and their staff are unable or unwilling to address more than the basic inquiries from patients. They in turn are left to face and try resolving multiple complex intricacies and details, often at the expense of the most important: their health. 

Who has time to learn a coding system to be able to read statements, or can understand an insurance policy at first glance? What are all your treatment options if the physician does take into account your preference or needs, or how this will affect you? How does a patient express to his loved ones and medical team that his choice should be respected despite their objections? 

A patient advocate is trained, and usually has extensive experience, in finding solutions, bringing clarity and understanding to a situation, removing obstacles and overcoming mistrust through collaboration.

Private patient advocates work on behalf of clients, as they are hired and paid by them, but also seek to find ways to involve all parties in the solution-seeking process. In fact, advocates often act as mediators, working toward an equally acceptable and beneficial agreement, with mutually respectful interaction and improved communication. 

And while hospitals and insurance companies count advocates on their payroll, patients are unlikely to be their primary focus, especially in a dispute, as this person will tend to the other side's interests above all. If you went to court, would you trust the opposing attorney to safeguard your rights? 

Personal advocates are often not welcomed by medical providers or billers out of fear and ignorance. But their growing number and influence will hopefully reverse this adversarial stand once more positive resolutions reflect their value.  

Patient Advocacy is still too new a profession to have a specific certification, training or licensing process. Most are using their background in nursing, medical billing or mediation as the first step of a new career. Using their experience and skills on the side of patients is their way to stop being part of the problem.

When hiring an advocate, consider matching your specific needs with the area of expertise offered by different individuals. Due to the lack of a nationally recognized set of credentials, many abide by a set of conduct and professional standards which promote integrity. Details at: http://HealthAdvocateCode.org/

APHA, the association founded by Trisha Torrey, keeps a list of vetted member advocates and  their credentials. Consult it to locate the most appropriate or skilled professional, or to learn more about the different ways we can assist you. 

http://advoconnection.com/register/

Consider hiring a private professional patient advocate next time you need to argue with your insurance company, require support finding info or financial assistance for a newly diagnosed condition, wish to have a local trustworthy person supervise a loved one's care or negotiate bills. A small financial investment can usually turn trouble into solutions and worry into peace of mind. It might also just save you a lot of dough too!

©  [2016] Advimedpro.

©  [2016] Martine G. Brousse.

All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements. 

AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330

                                         www.advimedpro.com           contact@advimedpro.com

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

   by Martine G. Brousse, 

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Three New Trends in Medicine

Patients will Benefit from (Part I)

The last couple of years have been very difficult for patients and medical providers alike. Multiple and deep changes have altered the healthcare landscape, with many more to come. 

The implementation of the ACA ("Obamacare") has brought its share of delays, problems, resistance and misunderstanding. More policy holders saw their policies cancelled by insurance carriers than expected, and finding out that current physicians were not part of the new Marketplace networks became all too common. Delays in getting appointments were the norm, while lists of contracted providers had to be corrected constantly for errors. 

On the other side, medical practices and healthcare providers have seen major disruptions in the way they render, account, bill and collect payment for services. The introduction of mandated EMR (Electronic Medical Records) or EHR (Electronic Health Records) accounts for much of the madness in the last 4 years. Upgrading software, testing systems and connections, meeting compliance deadlines and requirements, integrating internal and external modules, all while staying in business and providing care and services have proven daily challenges. Adding to this volatile mix were: two rapid changes in Medicare carriers for the Western states, the mandatory prescribing of medications in electronic formats, cuts in reimbursements, delays in releasing Medicare fee schedules (and payments) due to legislative impasses, and the influx of millions of new customers into the system. You might now understand why staff members at your local doctor's office have seem more overwhelmed or less friendly lately. 

However, these growing pains and disruptions are expected to bring major benefits for patients (and medical providers). Some can already be felt, especially as some provisions of the ACA became effective on January 1st, 2014. Others might not be felt for a while, but all are expected to change the healthcare landscape into a system more patient-friendly, affordable, accessible and effective. 

1. ICD-10: a more detailed diagnosis coding system

On October 1, 2015, the outdated diagnosis coding system ICD-9 was finally upgraded to ICD-10. 

While the rest of the developed world has been using ICD-10 for decades, the US is only now stepping up. The major difference between the 2 coding systems is the introduction of tens of thousand of new codes, reflecting the alignment with current medical practices and meeting the need for more detailed diagnoses, both for data analysis and precision of care purposes. 

Delays in payment to providers, coding errors, claim rejections, system errors, incorrect statements and frustration was anticipated. This implementation will require lots of patience with intense training on all parts. 


On a positive note, the introduction of ICD-10 will result in more effective, better targeted treatments and outcomes. Data analysis can allow better-defined advisory plans, and highlight ineffective or less beneficial treatments. Medical care models should be better focused and their effect better quantified.

2. Major Changes in Medical Care Administration

According to Robert M. Wenzel, founder of London Global Laboratories, one of the most significant trends in medicine is the way medical care will be administered in the near future. Cutting costs, improving quality, evaluating health risks, addressing a shortage of physicians for a growing aging population, making better use of resources and emphasizing prevention or lifestyle changes are some of the underlying reasons for this drastic change.

With the implementation of the ACA, medical providers will see a shift from a fee-for-service, often wasteful and expensive, payment system to a result-based, cost-effective, more productive and transparent reimbursement paradigm. Patients have already started seeing some of these implications. 

a. As of 1/1/14, a long list of preventive measures are mandatory in every insurance policy issued to subscribers. These services, such as immunizations, well-visits and screenings, are at no cost to patients, even if they have not met their deductible or yearly out-of-pocket liability. With early diagnosis and immediate intervention, the prevention of more serious chronic effects, (those with a high cost of treatment or management), can be better achieved. 

b. The mobile monitoring of certain conditions, such as in anticoagulation treatments for 

thrombosis prevention or blood pressure measurements, is becoming the norm. Devices allowing the supervision of activities or vital signs are already in wide use by individuals, whose results are easily tracked and sent to a physician for review. 
Expect technology in the form of apps, devices and sensors to play a growing role, saving time and money by eliminating "routine" or "maintenance" visits at the office. This also allows for more efficient, productive, sustained and routinely adjusted care, and real time (early) diagnostics. 
Apps and shared access to medical records will also keep important health details available to all medical staff involved in the care of a patient, eliminating duplicate or ineffective treatments, and providing an alert system in case of counter-indication or possible drug interaction. 

c. Welcome to a drastic shift in ways of communication with your physician! One-on-one contact with your physician in an office setting will soon be reserved for acute incidents, specific tests or treatments, or for documented or diagnostic needs. Many practices have already made the switch to communicating test results or answering non-urgent questions via e-mail, and use automated appointment recall systems. 
More patients will be able to contact their physicians via Skype or email, while others will watch recordings explaining an upcoming treatment or intervention. 

The use of technology in all forms can allow instant, direct and on demand access to health information, previously only available through a call or a visit to the office. Technological innovation is bringing more tools, methods and ideas to replace the need for a direct contact while allowing easy sharing with other healthcare partners.

d. Expect to see less Doctors and more support staff. With the recent influx of new health insurance subscribers and a growing aging population, demand for visits is likely to increase significantly, just as the number of doctors, especially in rural areas or in certain specialties, diminishes. Recent data shows an alarming shortage in oncology or general practice, among other specialties, where not enough practitioners (or students) meet the needs of the patients. Patients with less severe or non-acute conditions will be more and more under the care of Physician Assistants or Nurse Practitioners. They might be referred to a physician for an initial consultation, establishment of a diagnosis, prescription of a treatment or supervision of a serious illness only. The use of local "clinics", such as those in some drugstore chains, for non-life threatening emergencies is becoming more familiar, when a visit to the ER is not warranted, but a look by a clinician is. 

e. Expect your home and life to become part of the medical arena. The drastic shift in the way medicine is performed, from a curative or reactive model to a pro-active, preventive stand, will require more patient involvement and participation. Soon to be a thing of the past will be the current tendency to not address the individual unhealthy behaviors that have become so expensive to manage. 
If costs are to be reduced significantly, even as the population ages and harmful excesses come to negative consequences, then the lifestyle choices of the patient will need to be scrutinized, altered, and monitored. Getting a pill to cover a symptom while continuing an unhealthy routine, will no longer be as easy. Expect to get a medical analysis of your nutritional, exercise and lifestyle habits, advice and assistance on changing course, and stricter monitoring and positive reinforcement or rewards for doing so. 
This new healthcare paradigm bets that, with a more personalized approach and concrete, adapted suggestions, more individuals will adopt healthier behaviors, earlier, and participate more fully and knowingly in their health management. The goal of a long, healthy, independent living will involve more effort and less resistance by patients to these fundamental changes. 

3. Better record keeping and universal access

Finally! The days of hand-written, incomprehensible, incomplete or unsigned records are coming to the death they deserve. The ACA requirements for implementation of EHR (Electronic Health Records) or EMR (Electronic Medical Records) systems have met with fierce resistance on the part of multiple medical agencies, due to the complexity, cost and technological hurdles involved. Fortunately for patients, this implementation is now well under way, with significant gains for patients and their healthcare providers. 

Some of the benefits of this giant web of interconnected systems are expected to be include, among others: 

• immediate/easy access to all records for a patient, 
• elimination of duplication of services, tests, labs, prescriptions or exams,
• improved tracking of treatment effectiveness, 
• greater mobility for services, 
• lowering of risk of negative drug or medication interactions or bad reactions, 
• better assessment of medical need especially in emergency conditions, 
• improved coordination of care, 
• early intervention of potential chronic or serious condition
• optimum coordination of care between several specialists or healthcare providers
• lowered risk of recurrence, negative impact or side effects
• improved quality of care 
• immediate tracking of orders, tasks, referrals and prescriptions,
• better use of resources.

Patients have already noticed that the nurse or MD now type on their tablets while in the exam room, and may find that process lacking in direct care or contact. They should remember that better care is the prize.

So, while many changes in a short amount of time, may be disruptive, resisted to or annoying, the positive results they are expected to bring are well worth it. Streamlining the current network, and evolving into a more efficient, cost-effective, patient-oriented, result-based system is not only good medicine for the country as a whole, but absolutely necessary to avoid a financial crisis that could bankrupt us all. 

©  [2016] Advimedpro.

©  [2016] Martine G. Brousse.

All rights reserved.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements. 

AdvimedPro        (424) 999 4705 or (877) 658 9446       fax (424) 226 1330

                                         www.advimedpro.com           contact@advimedpro.com