Levering the Trusted Clinician: Documenting Disease Management Program Enrollment. Disease Management 2007; 10:16-29.

Authors: Sharon Glave Frazee PhD, Patricia Kirkpatrick RN BS CPHQ, Raymond Fabius MD, Joseph Chimera PhD

Objective:
The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending) which combines telephonic-delivered disease management (TDM) with work-site based primary care center and pharmacy delivery would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard telephonic-delivered disease management (TDM) with a work-site based primary care and pharmacy delivery protocol led by "trusted clinicians". Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares them on both contact and enrollment efficiency. Results: The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Conclusions: Integrating a worksite based primary care and pharmacy delivery system led by "trusted clinicians" with traditional telephonic-based disease management increases contact and enrollment rates resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment into disease management programming.

Commentary:
The promise of population health management programs resides chiefly in its ability to engage worthy participants in a sustained way to allow for its positive impacts. Traditional telephonic approaches are inadequate: With each passing day people are relying on cell phones instead of land lines and utilizing caller ID and call waiting to screen the calls they answer. Unrecognizable numbers from disease management and wellness organizations performing outreach are not answered. Perhaps more remarkable the phone numbers delivered by health plans and employers are often outdated. For these reasons engaging 25% or less of the worthy population using telephonic techniques is benchmark. Utilizing the trusted bond established between clinicians and their patients can yield much higher engagement rates. This research encourages all efforts in population health to incorporate existing practitioners within their protocols. By doing so, you will engage more of the worthy population in your program and produce better returns for the dollars invested by your customers.

To read the full article, click here.

Levering the Trusted Clinician: Increasing Retention in Disease Management through Integrated Program Delivery. Population Health Management 2008; 11(5):247-254.

Authors: Sharon Glave Frazee PhD, Bruce Sherman MD, Raymond Fabius MD, Pamela Ryan RN BSN MHA CPHQ CCM, Patricia Kirkpatrick RN, Jeffery Davis MBA

Objective:
The objective of this study is to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, yields higher patient retention rates than traditional remote DM alone. An earlier study of the IDM protocol found that integrating a worksite-based primary care and pharmacy delivery system with traditional telephonic-based DM substantially increased contact, enrollment, and engagement rates compared to traditional stand-alone telephonic DM. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares participation rates at 6- and 12-month intervals as well as measures of continued retention in the DM program. Results: The IDM protocol showed a significant improvement in participation persistence over traditional TDM. Conclusion: Diseasse management’s (DM’s) value largely depends on achieving and maintaining participation. Simply being enrolled in a program does not guarantee engaged participation by enrollees, a necessary factor to achieve the improved health outcomes and subsequent reduced health care costs that are the ultimate objective of DM. Integrating a worksite-based primary care and pharmacy delivery system led by “trusted clinicians at the workplace”™ with traditional telephonic-based DM not only increases contact and enrollment rates, but also results in higher patient engagement and retention. These improvements in participation are expected to result in improved outcomes for a larger proportion of the target population than traditional telephonic DM.

Commentary:
The promise of population health management programs resides chiefly in its ability to engage worthy participants in a sustained way to allow for its positive impacts. Most efforts in disease management require patients to change behavior – either by converting to a healthier lifestyle or by being more compliant with evidence-based therapeutic guidelines. Without engagement and retention within programs this is not possible. Integrating population management programs with trusted clinicians particularly at the workplace or within community practices of high esteem is a key method to accomplish this. Leveraging the bond established between patients and their trusted clinician to create engagement, retention and ultimately behavioral improvements is a powerful and under-utilized effort in medical management.

To read the full article, click here.

A Prescription for Appropriate Antibiotics Usage: Physicians and Pharmacists Collaborate Within a Workplace Health Center. Journal of Health and Productivity 2007; 2(1):12-19.

Authors: Sharon Glave Frazee PhD, Pamela Ryan RN BSN MHA CPHQ CCM, Rochelle Broome MD FAAFP, Raymond Fabius MD, James Manfred, RPh

Objective:
Rising healthcare costs, particularly in prescription drug spending, are of great concern to self-insured employers and other healthcare payers. There is much concern especially among employer purchasers that this increased spending is not associated with healthcare improvement yielding greater value. Worksite based health facilities that integrate primary care and pharmacy provide a unique opportunity to reduce costs and improve patient outcomes. This study illustrates how antibiotic prescribing can be improved through programmatic collaboration of physicians and pharmacists at the workplace. Methods: This retrospective cohort study tests whether workplace health center treated patients receive a higher prescription rate of 1st line antibiotics than community treated patients over a 3-year period. Results: Dramatic differences were found between workplace treated patients and community treated patients. Workplace treated patients had much higher rates of 1st line antibiotic use than community treated patients. First line antibiotics were associated with an average nearly $20 less per prescription than community treated patients. Conclusion: Employers concerned with providing clinically optimal care while managing prescription drug costs should consider the use of collaborative workplace health centers that provide medical and pharmacy services.

Commentary:
Pharmacy benefit management efforts can take you only so far. The delivery of a triple or even four-tier formulary can take pharmacy benefits to new heights of efficiency. However, there is little being done to foster the effectiveness of prescribing itself. A system that marries the prescribing clinician with the dispensing practitioner can yield remarkable results. When the doctor and the pharmacist are working in concert aiming for the same goals and results there are checks and balances rarely seen in health care. This can produce better prescribing patterns less influenced by pharmaceutical detailing and economic issues. Not only can the right medication be provided but the patient is more likely to take it and take it correctly. When a patient hears the same recommendation from their trusted pharmacist and their trusted physician they are much more likely to comply.

To read the full article, click here.

Pharmacy Clinical Leadership: Physicians and Pharmacists Collaborate within a Workplace Health Center to Improve the Value of Your Pharmacy Expenditure. Benefits and Compensation Digest 2007; 44(9):1-6.

Authors: Sharon Glave Frazee, PhD, Raymond Fabius MD, Pamela Ryan RN BSN MHA CPHQ CCM, Rochelle Broome MD FAAFP, James Manfred RPh

Objective:
The burden of prescription drug costs to employers has risen precipitously over the past few decades without evidence that it has produced better health outcomes. This has led employers, insurers, benefit plan consulting companies, and the healthcare industry at large to use benefit changes to promote effective, lower cost options. This article describes an advantaged approach that improves the value of prescription drug spending through the collaboration between physicians and pharmacists dedicated to serving patients at a workplace health center. This collaboration can affect real change in prescribing behaviors of physicians to optimize the quality and value of prescription drug dollars. Moving beyond pharmacy benefit management to pharmacy clinical leadership can change prescribing patterns to improve healthcare quality, clinical outcomes, manage costs, and align healthcare delivery to best serve an employer’s community.

Commentary:
In the early days of managed care great emphasis was placed on utilization management. This focused on pre-certification, utilization review, case management and retrospective appeals. With time these efforts were enhanced and supplanted to some extent by disease management and population health. Attention shifted from short term efficiency gains to longer term effectiveness programs. This paper introduces the term Pharmacy Clinical Leadership because the writers believed that this effort will be the next generation of pharmacy benefit management. Like the progress that has occurred in the management of health benefits, the world of pharmacy benefits needs greater clinical intensity with an emphasis on appropriateness rather than unit cost.

To read the full article, click here to purchase.

Impact of Workplace Health Services on Adherence to Chronic Medications The American Journal of Managed Care; 15(7):53-60.

Authors: Bruce Sherman, MD; Sharon Frazee, PhD; Raymond J. Fabius, MD, CPE; Rochelle Brome, MD; James Manfred, RPh; Jeffery C. Davis, MBA

Objective:
The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending) which combines telephonic-delivered disease management (TDM) with work-site based primary care center and pharmacy delivery would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard telephonic-delivered disease management (TDM) with a work-site based primary care and pharmacy delivery protocol led by “trusted clinicians”. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares them on both contact and enrollment efficiency. Results: The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Conclusions: Integrating a worksite based primary care and pharmacy delivery system led by “trusted clinicians” with traditional telephonic-based disease management increases contact and enrollment rates resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment into disease management programming.

Commentary:
Early access to care along with medical and therapeutic compliance are keys to successfully treating the chronically ill. Teaching patients early warning signs indicating the need to seek care such as weight gain with those who suffer with congestive heart failure and assuring them fast-track access to that needed care has proven to be a successful approach within disease management. Equally important is to coach and motivate patients to comply with treatment plans, and to take their medicine, particularly chronic medications required to minimize the complications of chronic illness. This article demonstrates that workplace health services delivered by prescribing and dispensing “trusted clinicians” working in concert markedly improves medication adherence. Other studies have demonstrated the impact this can make on medical costs and have demonstrated a reduced need for hospitalization and emergency room usage. Health plans, employers and vendors who are focused on disease management should take heed from this publication. Patients who have easy access to medications and care through trusted clinical relationships adhere to treatment recommendations and optimize their health status.

To read the full article, click here.

Levering the Trusted Clinician: Documenting Disease Management Program Enrollment. Disease Management 2007; 10:16-29.

Authors: Sharon Glave Frazee PhD, Patricia Kirkpatrick RN BS CPHQ, Raymond Fabius MD, Joseph Chimera PhD

Objective:
The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending) which combines telephonic-delivered disease management (TDM) with work-site based primary care center and pharmacy delivery would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard telephonic-delivered disease management (TDM) with a work-site based primary care and pharmacy delivery protocol led by “trusted clinicians”. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares them on both contact and enrollment efficiency. Results: The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Conclusions: Integrating a worksite based primary care and pharmacy delivery system led by “trusted clinicians” with traditional telephonic-based disease management increases contact and enrollment rates resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment into disease management programming.

Commentary:
The promise of population health management programs resides chiefly in its ability to engage worthy participants in a sustained way to allow for its positive impacts.  Traditional telephonic approaches are inadequate:  With each passing day people are relying on cell phones instead of land lines and utilizing caller ID and call waiting to screen the calls they answer.  Unrecognizable numbers from disease management and wellness organizations performing outreach are not answered.  Perhaps more remarkable the phone numbers delivered by health plans and employers are often outdated.  For these reasons engaging 25% or less of the worthy population using telephonic techniques is benchmark.  Utilizing the trusted bond established between clinicians and their patients can yield much higher engagement rates.  This research encourages all efforts in population health to incorporate existing practitioners within their protocols.  By doing so, you will engage more of the worthy population in your program and produce better returns for the dollars invested by your customers.

To read the full article, click here.

Levering the Trusted Clinician: Increasing Retention in Disease Management through Integrated Program Delivery. Population Health Management 2008; 11(5):247-254.

Authors: Sharon Glave Frazee PhD, Bruce Sherman MD, Raymond Fabius MD, Pamela Ryan RN BSN MHA CPHQ CCM, Patricia Kirkpatrick RN, Jeffery Davis MBA

Objective:
The objective of this study is to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, yields higher patient retention rates than traditional remote DM alone. An earlier study of the IDM protocol found that integrating a worksite-based primary care and pharmacy delivery system with traditional telephonic-based DM substantially increased contact, enrollment, and engagement rates compared to traditional stand-alone telephonic DM. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares participation rates at 6- and 12-month intervals as well as measures of continued retention in the DM program. Results: The IDM protocol showed a significant improvement in participation persistence over traditional TDM. Conclusion: Diseasse management’s (DM’s) value largely depends on achieving and maintaining participation. Simply being enrolled in a program does not guarantee engaged participation by enrollees, a necessary factor to achieve the improved health outcomes and subsequent reduced health care costs that are the ultimate objective of DM. Integrating a worksite-based primary care and pharmacy delivery system led by “trusted clinicians at the workplace”™ with traditional telephonic-based DM not only increases contact and enrollment rates, but also results in higher patient engagement and retention. These improvements in participation are expected to result in improved outcomes for a larger proportion of the target population than traditional telephonic DM.

Commentary:
The promise of population health management programs resides chiefly in its ability to engage worthy participants in a sustained way to allow for its positive impacts. Most efforts in disease management require patients to change behavior – either by converting to a healthier lifestyle or by being more compliant with evidence-based therapeutic guidelines. Without engagement and retention within programs this is not possible. Integrating population management programs with trusted clinicians particularly at the workplace or within community practices of high esteem is a key method to accomplish this. Leveraging the bond established between patients and their trusted clinician to create engagement, retention and ultimately behavioral improvements is a powerful and under-utilized effort in medical management.

To read the full article, click here.

A Prescription for Appropriate Antibiotics Usage: Physicians and Pharmacists Collaborate Within a Workplace Health Center. Journal of Health and Productivity 2007; 2(1):12-19.

Authors: Sharon Glave Frazee PhD, Pamela Ryan RN BSN MHA CPHQ CCM, Rochelle Broome MD FAAFP, Raymond Fabius MD, James Manfred, RPh

Objective:
Rising healthcare costs, particularly in prescription drug spending, are of great concern to self-insured employers and other healthcare payers. There is much concern especially among employer purchasers that this increased spending is not associated with healthcare improvement yielding greater value. Worksite based health facilities that integrate primary care and pharmacy provide a unique opportunity to reduce costs and improve patient outcomes. This study illustrates how antibiotic prescribing can be improved through programmatic collaboration of physicians and pharmacists at the workplace. Methods: This retrospective cohort study tests whether workplace health center treated patients receive a higher prescription rate of 1st line antibiotics than community treated patients over a 3-year period. Results: Dramatic differences were found between workplace treated patients and community treated patients. Workplace treated patients had much higher rates of 1st line antibiotic use than community treated patients. First line antibiotics were associated with an average nearly $20 less per prescription than community treated patients. Conclusion: Employers concerned with providing clinically optimal care while managing prescription drug costs should consider the use of collaborative workplace health centers that provide medical and pharmacy services.

Commentary:
Pharmacy benefit management efforts can take you only so far. The delivery of a triple or even four-tier formulary can take pharmacy benefits to new heights of efficiency. However, there is little being done to foster the effectiveness of prescribing itself. A system that marries the prescribing clinician with the dispensing practitioner can yield remarkable results. When the doctor and the pharmacist are working in concert aiming for the same goals and results there are checks and balances rarely seen in health care. This can produce better prescribing patterns less influenced by pharmaceutical detailing and economic issues. Not only can the right medication be provided but the patient is more likely to take it and take it correctly. When a patient hears the same recommendation from their trusted pharmacist and their trusted physician they are much more likely to comply.

To read the full article, click here.

The Migration Strategy: Building a Benchmark Medical Presence at the Workplace. Health & Productivity Management 2007; 6(1):4-7.

Author: Raymond Fabius, MD, CPE, FACPE

Objective:
Workplace health services offer an employer with large facilities a unique opportunity to broaden the employee benefit package and contribute positively to the bottom line. Creating on-site health centers can improve the health of the workforce and their productivity. Leveraging the trusted clinician at the workplace™ can enhance any and all efforts to reduce health risks and promote wellness.

Commentary:
The presence of occupational health centers at the workplace has a long history. Originally established to treat industrial illness and injury these centers have worked hard to reduce their demand. By studying trends they have developed methods to prevent the re-occurrence of workplace injuries and illnesses. This has been accomplished through the science of ergonomics and the regulatory requirements of medical surveillance. As a consequence these clinicians have gained capacity or in some cases have moved from full time to part time roles. However, those employers who have leveraged these trusted clinicians at the workplace have received a significant return for this investment. Allowing these and other differently trained clinicians to assist with health care beyond risk management has led to improvements in disability and worker’s compensation management, absenteeism, presenteeism, and population health status.

To read the full article, click here.

The Trusted Clinician at the Workplace: Your Partner for Better Health and Productivity. HR.com. February 26, 2008

Authors: Sharon Glave Frazee, PhD and Raymond Fabius, MD

Objective:
As employers continue to struggle with rising health care costs, many are considering bringing primary care services into the workplace. Workplace health centers support employees and their covered dependents by partnering with human resources, benefits and safety departments to deliver strong value for the employer’s healthcare dollar by providing employees with exceptional clinical care, access to health services that promote health and productivity, and providing high levels of patient and employer satisfaction. One unique benefit of workplace primary care services is the positive health effect of bringing the “trusted clinician” into the work environment. The value of the trusted clinician at the workplace to promote health and improve the productivity of the workforce as well as promoting quality healthcare is discussed.

Commentary:
By placing trusted clinicians in the workplace employers reduce medical costs, improve workplace safety, augment the quality of care their employees receive and enhance the employer of choice status of their company. But perhaps the greatest impact of this investment resides in the improvements in workforce productivity. A healthy workforce is more productive and can produce a competitive advantage. Those employers who focus on keeping their workforce well will do better in the long run than organizations that center their attention on health care benefits and costs.

To read the full article, click here.

Impact of Workplace Health Services on Adherence to Chronic Medications. The American Journal of Managed Care; 15(7):53-60.

Authors: Bruce Sherman, MD; Sharon Frazee, PhD; Raymond J. Fabius, MD, CPE; Rochelle Brome, MD; James Manfred, RPh; Jeffery C. Davis, MBA

Objective:
The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending) which combines telephonic-delivered disease management (TDM) with work-site based primary care center and pharmacy delivery would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard telephonic-delivered disease management (TDM) with a work-site based primary care and pharmacy delivery protocol led by “trusted clinicians”. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares them on both contact and enrollment efficiency. Results: The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Conclusions: Integrating a worksite based primary care and pharmacy delivery system led by “trusted clinicians” with traditional telephonic-based disease management increases contact and enrollment rates resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment into disease management programming.

Commentary:
Early access to care along with medical and therapeutic compliance are keys to successfully treating the chronically ill. Teaching patients early warning signs indicating the need to seek care such as weight gain with those who suffer with congestive heart failure and assuring them fast-track access to that needed care has proven to be a successful approach within disease management. Equally important is to coach and motivate patients to comply with treatment plans, and to take their medicine, particularly chronic medications required to minimize the complications of chronic illness. This article demonstrates that workplace health services delivered by prescribing and dispensing “trusted clinicians” working in concert markedly improves medication adherence. Other studies have demonstrated the impact this can make on medical costs and have demonstrated a reduced need for hospitalization and emergency room usage. Health plans, employers and vendors who are focused on disease management should take heed from this publication. Patients who have easy access to medications and care through trusted clinical relationships adhere to treatment recommendations and optimize their health status.

To read the full article, click here.

Quantifying the Value of Worksite Clinic Non-occupational Health Care Services — A Critical Analysis And Review of the Literature. Journal of Occupational & Environmental Medicine; April 2012. Volume 54 Number 4 pp 394-403

Authors: Bruce W. Sherman MD and Raymond J. Fabius MD

Objective:
Confusion exists regarding the approach to quantifying employer value of worksite non-occupational care. A literature review and analysis was performed to characterize and critically evaluate existing methods to quantify the value of these services. Methods: PubMed was searched for publications describing measurement of value of non-occupational worksite clinics services in US locations. Nineteen studies and two methodologic reviews met criteria for further analysis. Results: Return on investment calculations were commonly based on the comparative cost-effectiveness of worksite clinic services relative to community health care. Only one study evaluated the impact of worksite clinics on healthcare cost trend among clinic users and none assessed the impact on total health and productivity costs. Conclusions: Significant variability exists among current methods for calculating return on investment of non-occupational worksite healthcare services; methodologic approaches are poorly aligned with employer health care cost containment objectives.

Commentary:
This paper suggests a standard approach to evaluating the value delivered by investing in and expanding worksite clinics to provide non-occupational health care services after reviewing the literature and finding no published guidance on the subject. While the authors believe that the provision of additional medical services has merit, we encouraged both purchasers and providers alike to calculate the return on investment. By proving this concept more employers would consider such provisions, improving the health and productivity of workforces.

To read the full article, click here.

The Broadening Horizon for Physician Executives: The Six Constituencies of Health Care. The Physician Executive 2007; 33(3):72-74.

Author: Raymond J. Fabius, MD, CPE, FACPE

Objective:
Physician executives have expanding opportunities to contribute to the betterment of health care using a new platforms and positions. In the past doctors in management were confined to working within the delivery system guiding providers of care. More recently high profile roles have evolved in the payer space. Today physician executives are finding bully pulpits within the purchaser, vendor, supplier, and consultancy constituencies as well.

Commentary:
Physician executives have largely confined their career to managing other clinicians within the provider space inside healthcare. This has been to the detriment of health delivery. When purchasers make decisions without clinical input they often don’t spend their money wisely. When payers make decision to allocate payments without physician leaders participating they are misaligned. When vendors and suppliers conduct business without a clear understanding of patient care they produce systems that promote short term profits over long term health care improvements. Consulting houses that advise the other sectors within health care serve their custom base best when they employ physician executives to participate in their advisement. Even consumer driven entities benefit from the guidance of physicians well versed in management and public health.

To read the full article, click here.

Medical Care Web Simulation: Clinicians Produce Real-time Competition Among Content Providers. The Physician Executive January/February 2008; 50-54.

Authors: Jay Rosan DO, Ray Fabius MD, Sharon Glave Frazee PhD and Nic Fonseca

Objective:
Finding a way for healthcare organizations to provide its clinicians with the best patient care enhancement tools is a challenge for all physician executives leading health care delivery systems. The goal is to provide tools that, with minimal time and effort, offer access to the most current evidence-based answers to their clinical questions. Evidence-based information retrieval systems have gained popularity in the medical marketplace to meet this need. They address the information needs of busy clinicians through quick access at the point of care as well as providing information for more comprehensive inquiries. However, there are many vendors who provide these services and each offer a slightly different approach which can create confusion for the physician executive customer.

This article describes a process by which one healthcare company went about sorting through the options available and selecting a vendor to ensure that their clinicians had the best tools available to deliver optimal patient care. To do this a representative sample from a network of dispersed clinicians participated in a virtual vendor evaluation process. Quantitative results from a formal feedback process were analyzed to capture the collective intelligence of the evaluating team and select the vendor that best met the needs of the healthcare organization. The process described in this article can be used by physician executives who manage small physicians’ offices or large hospital systems to assess tools and services which have the potential to enhance the care delivered by their clinicians.

Commentary:
Simulation is one of the best ways to test the impact of clinical tools. This article introduces the reader to the potential for creating a simulation to test the merits of web-based decision support tools. It also demonstrates the value of incorporating the end-user clinician in decisions impacting their work. Too often well meaning health care administrators make choices on behalf of their doctors and nurses based on costs and sterile content reviews. Those that deploy simulation testing that incorporates their providers of care will make better decisions and perform at better levels.

To read the full article, click here.

Levering the Trusted Clinician: Documenting Disease Management Program Enrollment. Disease Management 2007; 10:16-29.

Authors: Sharon Glave Frazee PhD, Patricia Kirkpatrick RN BS CPHQ, Raymond Fabius MD, Joseph Chimera PhD

Objective:
The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending) which combines telephonic-delivered disease management (TDM) with work-site based primary care center and pharmacy delivery would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard telephonic-delivered disease management (TDM) with a work-site based primary care and pharmacy delivery protocol led by “trusted clinicians”. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares them on both contact and enrollment efficiency. Results: The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Conclusions: Integrating a worksite based primary care and pharmacy delivery system led by “trusted clinicians” with traditional telephonic-based disease management increases contact and enrollment rates resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment into disease management programming.

Commentary:
The promise of population health management programs resides chiefly in its ability to engage worthy participants in a sustained way to allow for its positive impacts.  Traditional telephonic approaches are inadequate:  With each passing day people are relying on cell phones instead of land lines and utilizing caller ID and call waiting to screen the calls they answer.  Unrecognizable numbers from disease management and wellness organizations performing outreach are not answered.  Perhaps more remarkable the phone numbers delivered by health plans and employers are often outdated.  For these reasons engaging 25% or less of the worthy population using telephonic techniques is benchmark.  Utilizing the trusted bond established between clinicians and their patients can yield much higher engagement rates.  This research encourages all efforts in population health to incorporate existing practitioners within their protocols.  By doing so, you will engage more of the worthy population in your program and produce better returns for the dollars invested by your customers.

To read the full article, click here.

The Trusted Clinician: An Alternative Approach to Worksite Health Promotion? The Art of Health Promotion. January/February 2008; 1-7.

Authors: Raymond Fabius, MD and Sharon Glave Frazee, PhD

Objective:
The trusted clinician-patient relationship is the key to improving behaviors that lead to better health outcomes. Americans consistently rank their relationship with their physician as one of the most important and they depend upon their clinician for health information. The importance of this relationship is validated by research showing the value of physicians in helping patients make important health changes across all three levels of preventative health: primary, secondary and tertiary. The value of the trusted clinician at the workplace to promote health and improve the productivity of the workforce as well as promoting quality healthcare is discussed.

Commentary:
Health promotion requires the engagement and compliance of health consumers. Numerous studies cited in the article demonstrate the remarkable influence trusted clinicians can have on their patient population. Those organizations responsible for health promotion will have better results incorporating the trusted clinician into their process. Recent efforts to reward healthy behaviors extrinsically with money or lower co-payments instead of investing in the care delivered by trusted clinician is misguided. Those resources would be better spent rewarding primary care providers to educate and coach their patients to better health.

To read the full article, click here.

The Trusted Clinician at the Workplace: Your Partner for Better Health and Productivity. HR.com. February 26, 2008

Authors: Sharon Glave Frazee, PhD and Raymond Fabius, MD

Objective:
As employers continue to struggle with rising health care costs, many are considering bringing primary care services into the workplace. Workplace health centers support employees and their covered dependents by partnering with human resources, benefits and safety departments to deliver strong value for the employer’s healthcare dollar by providing employees with exceptional clinical care, access to health services that promote health and productivity, and providing high levels of patient and employer satisfaction. One unique benefit of workplace primary care services is the positive health effect of bringing the “trusted clinician” into the work environment. The value of the trusted clinician at the workplace to promote health and improve the productivity of the workforce as well as promoting quality healthcare is discussed.

Commentary:
By placing trusted clinicians in the workplace employers reduce medical costs, improve workplace safety, augment the quality of care their employees receive and enhance the employer of choice status of their company. But perhaps the greatest impact of this investment resides in the improvements in workforce productivity. A healthy workforce is more productive and can produce a competitive advantage. Those employers who focus on keeping their workforce well will do better in the long run than organizations that center their attention on health care benefits and costs.

To read the full article, click here.

Levering the Trusted Clinician: Increasing Retention in Disease Management through Integrated Program Delivery. Population Health Management 2008; 11(5):247-254.

Authors: Sharon Glave Frazee PhD, Bruce Sherman MD, Raymond Fabius MD, Pamela Ryan RN BSN MHA CPHQ CCM, Patricia Kirkpatrick RN, Jeffery Davis MBA

Objective:
The objective of this study is to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, yields higher patient retention rates than traditional remote DM alone. An earlier study of the IDM protocol found that integrating a worksite-based primary care and pharmacy delivery system with traditional telephonic-based DM substantially increased contact, enrollment, and engagement rates compared to traditional stand-alone telephonic DM. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares participation rates at 6- and 12-month intervals as well as measures of continued retention in the DM program. Results: The IDM protocol showed a significant improvement in participation persistence over traditional TDM. Conclusion: Diseasse management’s (DM’s) value largely depends on achieving and maintaining participation. Simply being enrolled in a program does not guarantee engaged participation by enrollees, a necessary factor to achieve the improved health outcomes and subsequent reduced health care costs that are the ultimate objective of DM. Integrating a worksite-based primary care and pharmacy delivery system led by “trusted clinicians at the workplace”™ with traditional telephonic-based DM not only increases contact and enrollment rates, but also results in higher patient engagement and retention. These improvements in participation are expected to result in improved outcomes for a larger proportion of the target population than traditional telephonic DM.

Commentary:
The promise of population health management programs resides chiefly in its ability to engage worthy participants in a sustained way to allow for its positive impacts. Most efforts in disease management require patients to change behavior – either by converting to a healthier lifestyle or by being more compliant with evidence-based therapeutic guidelines. Without engagement and retention within programs this is not possible. Integrating population management programs with trusted clinicians particularly at the workplace or within community practices of high esteem is a key method to accomplish this. Leveraging the bond established between patients and their trusted clinician to create engagement, retention and ultimately behavioral improvements is a powerful and under-utilized effort in medical management.

To read the full article, click here.

Impact of Workplace Health Services on Adherence to Chronic Medications The American Journal of Managed Care; 15(7):53-60.

Authors: Bruce Sherman, MD; Sharon Frazee, PhD; Raymond J. Fabius, MD, CPE; Rochelle Brome, MD; James Manfred, RPh; Jeffery C. Davis, MBA

Objective:
The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending) which combines telephonic-delivered disease management (TDM) with work-site based primary care center and pharmacy delivery would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard telephonic-delivered disease management (TDM) with a work-site based primary care and pharmacy delivery protocol led by “trusted clinicians”. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares them on both contact and enrollment efficiency. Results: The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Conclusions: Integrating a worksite based primary care and pharmacy delivery system led by “trusted clinicians” with traditional telephonic-based disease management increases contact and enrollment rates resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment into disease management programming.

Commentary:
Early access to care along with medical and therapeutic compliance are keys to successfully treating the chronically ill. Teaching patients early warning signs indicating the need to seek care such as weight gain with those who suffer with congestive heart failure and assuring them fast-track access to that needed care has proven to be a successful approach within disease management. Equally important is to coach and motivate patients to comply with treatment plans, and to take their medicine, particularly chronic medications required to minimize the complications of chronic illness. This article demonstrates that workplace health services delivered by prescribing and dispensing “trusted clinicians” working in concert markedly improves medication adherence. Other studies have demonstrated the impact this can make on medical costs and have demonstrated a reduced need for hospitalization and emergency room usage. Health plans, employers and vendors who are focused on disease management should take heed from this publication. Patients who have easy access to medications and care through trusted clinical relationships adhere to treatment recommendations and optimize their health status.

To read the full article, click here.

The Migration Strategy: Building a Benchmark Medical Presence at the Workplace. Health & Productivity Management 2007; 6(1):4-7.

Author: Raymond Fabius, MD, CPE, FACPE

Objective:
Workplace health services offer an employer with large facilities a unique opportunity to broaden the employee benefit package and contribute positively to the bottom line. Creating on-site health centers can improve the health of the workforce and their productivity. Leveraging the trusted clinician at the workplace™ can enhance any and all efforts to reduce health risks and promote wellness.

Commentary:
The presence of occupational health centers at the workplace has a long history. Originally established to treat industrial illness and injury these centers have worked hard to reduce their demand. By studying trends they have developed methods to prevent the re-occurrence of workplace injuries and illnesses. This has been accomplished through the science of ergonomics and the regulatory requirements of medical surveillance. As a consequence these clinicians have gained capacity or in some cases have moved from full time to part time roles. However, those employers who have leveraged these trusted clinicians at the workplace have received a significant return for this investment. Allowing these and other differently trained clinicians to assist with health care beyond risk management has led to improvements in disability and worker’s compensation management, absenteeism, presenteeism, and population health status.

To read the full article, click here.

The Trusted Clinician at the Workplace: Your Partner for Better Health and Productivity. HR.com. February 26, 2008

Authors: Sharon Glave Frazee, PhD and Raymond Fabius, MD

Objective:
As employers continue to struggle with rising health care costs, many are considering bringing primary care services into the workplace. Workplace health centers support employees and their covered dependents by partnering with human resources, benefits and safety departments to deliver strong value for the employer’s healthcare dollar by providing employees with exceptional clinical care, access to health services that promote health and productivity, and providing high levels of patient and employer satisfaction. One unique benefit of workplace primary care services is the positive health effect of bringing the “trusted clinician” into the work environment. The value of the trusted clinician at the workplace to promote health and improve the productivity of the workforce as well as promoting quality healthcare is discussed.

Commentary:
By placing trusted clinicians in the workplace employers reduce medical costs, improve workplace safety, augment the quality of care their employees receive and enhance the employer of choice status of their company. But perhaps the greatest impact of this investment resides in the improvements in workforce productivity. A healthy workforce is more productive and can produce a competitive advantage. Those employers who focus on keeping their workforce well will do better in the long run than organizations that center their attention on health care benefits and costs.

To read the full article, click here.

Creating a Competitive Advantage by Investing in Health and Productivity. Health & Productivity Management. Spring 2008; 24-26

Authors: Raymond Fabius, MD, Sharon Glave Frazee, PhD, Thomas Sabia MS, Rochelle Broome, MD, Pam Dulaney, RN MA COHN-S CMC

Objective:
The integration of workplace-based health centers, pharmacies, wellness programs and fitness centers creates the most significant impact on employee health and productivity. This integration of health and wellness programming improves employer of choice status, worker productivity, employee health, company visibility and social responsibility for businesses who invest in these services while managing employee health care costs. Leveraging trusted clinicians and health practitioners in the workplace can also produce significant increases in employee engagement and participation in these programs, an essential step in improving program results and cost savings.

To read the full article, click here.

Transparency Is a Prerequisite of Pay for Performance. American Heart Hospital Journal 2008; 2:170-174

Authors: Raymond Fabius, MD

Objective:
The ‘Pay for Performance’ movement seeks to improve the quality of health care at both the hospital and physician level by incentivizing transparency of clinical outcomes and fostering a health care marketplace that performs both more effectively and more efficiently. The article “Transparency Is a Prerequisite of Pay for Performance” delineates the working answer of some large employers to the question of how to obtain better value for health care dollars spent. The Leapfrog Movement that includes over 152 large self-funded companies has established a set of purchasing principles the purpose of which is to recognize and reward hospitals that meet the Group’s recommended safety practices and quality standards. Leapfrog members also agree to educate and inform their consumers of health care about the importance of patient safety in judging hospital quality.

Further, Bridges to Excellence also representing large self-ensured employers works to do the same at the physician level rewarding physicians that also demonstrate they have adopted safe and effective systems of care and use them to deliver good outcomes when managing patients with diabetes or cardiac disease. BTE participants commit to paying a fixed per patient bonus to physicians that meet certain performance measures. The three sets of performance measures focus on the systems of care in a practice and the outcomes of care for patients with diabetes or cardiac disease.

The efforts of Leapfrog and Bridges to Excellence have created significant change in the market by focusing purchasers on encouraging the publication of standard performance measures for hospitals and physicians and on creating rewards for better performance. These efforts can stimulate market change by encouraging consumers to select those physicians and hospitals with demonstrably better outcomes.

Commentary:
Since the publication of this article, there has been only increasing interest in transparence and pay for performance. Leapfrog and Bridges To Excellence remain leaders in the pay for performance movement. That movement has helped to create a ‘virtuous cycle’ where benchmark performers are featured by health plans employers and patients alike. They are rewarded by both increased compensation and market share. This offers them the opportunity to grow their practice and add additional practitioners. This leads to marked improvements in the care delivered by the community as best-practices grow relative to their average peer performers.

To read the full article, click here.