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Your success depends on more than your vision and long-range planning. What you do in the short term - indeed, each day - can make you a more effective leader and colleague, help the bottom line, and tilt probabilities toward your success. 

Top healthcare executives shared 10 surprising ways to up your game daily with 

Jennifer Vachon, executive vice president at Blue Cross Blue Shield Association in Chicago, ends her workday with emails thanking staffers. “We tend to quickly move to the next thing, but this forces me to reflect,” says Vachon, who may commend a small gesture or a major effort. “It doesn’t take long but means so much to my team, making it a great time investment.”

Learn staff members’ names and special traits 

A casual conversation led to a daily resolution for Mooyeon Oh-Park, MD, MS, senior vice president and chief medical officer at Burke Rehabilitation Hospital. Oh-Park had just joined the physical rehab center in White Plains, New York, when an employee revealed knowledge about what her job required.

“Our strength as an institution is the diversity of our people,” she says. “I develop closer connections and know who can troubleshoot creatively.”

At Stanford Health Care in Palo Alto, California, leaders hold daily 15-minute meetings with their teams to brainstorm solutions for the day’s challenges. “It helps formalize touching base with your team each day,” says Alpa Vyas, vice president of patient experience. “Leaders understand what needs to be done, and employees are less reluctant to report problems because they know there’s a mechanism to solve them.”

Use your commute to bone up on business skills with audiobooks

Alexander Ronzino, founder and CEO at Coalition Recovery, a substance abuse treatment center in Tampa, Florida, listens to nonfiction management and finance books en route. “I find the perspectives of CEOs and entrepreneurs most candid and useful versus those of management consultants.” Military strategy and priority-setting audiobooks are most appealing to Oh-Park. Her recent favorites are “Essentialism: The Disciplined Pursuit of Less” by Greg McKeown and “The Art of War” by Sun Tzu.

“During moments of high anxiety, I noticed my mood could be felt by those around me - and was infectious,” says Oh-Park. “That didn’t help anyone.” Smiling eased her distress and the distress of others. “A positive mindset helps us find the best solutions.”

Get in early, before the members of your team

It pays to arrive a half-hour to an hour before anyone else, say several healthcare executives. “I never was a morning person - until I opted to become one,” quips Ronzino. The extra time and clear head give him a chance to prepare mentally and adjust his schedule to face potential challenges. “It’s made a tremendous difference in my overall productivity,” says Ronzino. Likewise, Ernie Schwefler, chief contracting officer for the University of Southern California’s Keck School of Medicine, arrives early to focus “before fires have to be put out. Knowing my priorities enables me to be nimble.” Rhonda Mims, executive vice president and chief public affairs officer at WellCare Health Plans in Tampa starts her workday at home with her eyes shut and mind open. “That helps balance me,” she says, adding that as a mother it’s her sole chance at solitude. “I run through any talking points mentally.”

Prepare for the next day before leaving the office 

Karen Murray, MD, physician in chief of Cleveland Clinic Children’s and president of the Cleveland Clinic Children’s Hospital for Rehabilitation, ends her day by getting ready for the next one. She might study an applicant’s CV, review the topics to be discussed at a meeting, or reserve time to talk with influencers. “I walk into the office with clear goals and the security of knowing people’s likely decisions,” says Murray.

Talking can be so easy, especially if others believe they must listen to you because you’re the boss. But Murray strives to listen - and listen intently. “Ultimately, everything is my responsibility,” she says. “So, if someone comes to me with an opportunity or concern, I try to really hear what they’re saying and what they’re not saying.”

Don’t wait for organized meetings to check in with your team, suggests Schwefler. He keeps his door open and regularly strolls through the workspace to speak with his team. “You have a view [of what’s happening in your organization], but those in the trenches may have a different one,” Schwefler says. For Ronzino, “casual chats foster a culture of collaboration and result in projects getting completed faster.”

Schedule tasks for when you will do them best  

With so many roles at Cleveland Clinic, Murray is careful to block out time for each function, whether it is an administrative task, a clinical visit, or writing papers. “I block time for when I’m most productive at that task,” she says. She also checks in with staff beforehand. “Medicine is a team sport, and the workflow needs to be best for everyone involved.” 

Michele Meyer is a freelance writer from Houston. 

Articles

Your success depends on more than your vision and long-range planning. What you do in the short term - indeed, each day - can make you a more effective leader and colleague, help the bottom line, and tilt probabilities toward your success.

Ten Habits That  Lead To Success

Everyone wins when healthcare organizations successfully motivate chronically ill customers to get-and stay-healthy.

Patients know it. The healthcare industry knows it. But that’s not enough.

“Human behavior is pretty complicated. If it was easy, everybody would be making healthy choices,” says Richard Safeer, MD, medical director of employee health and wellness at 

 at The Johns Hopkins Bloomberg School of Public Health in Baltimore. “Also, people have different needs, and you have to meet them where they are on their health journey.”

Here are five fresh and surprising ways to tailor experiences so patients adopt healthier behaviors when faced with chronic conditions such as type 2 diabetes, heart disease, cancer, and chronic obstructive pulmonary disease (COPD).

1. Let consumers decide how they want to hear from you

If you reach customers by the means they prefer, they’re more likely to listen. Don’t assume. Ask.

“Our survey shows that (health) plans are not quite keeping pace with the digital demand,” says Bryce Williams, president and CEO of 

, A clinical technology firm with a clinical analytics platform in Dallas. “Plans need to meet beneficiaries on their terms and cater to their preferences.”

HealthMine’s survey of 781 Medicare Advantage or Supplemental members shows 47% favor digital communication with their plan, but only 34% actually receive it. A study by Survey Sampling International found only 18% wish healthcare providers reached them by regular mail.

Five Communication Strategies Managed Care Organizations Can Prioritize for Improved Chronic Care

Communication is critical for the complicated healthcare of individuals with chronic disease, says Tashfeen Ekram, MD, chief medical officer and co-founder of digital health firm 

 in San Francisco. “So much of what affects patient health outcomes has little to do with patient office visits but is tied more to what happens in between them. Patients and providers must be able to communicate effectively throughout the patient lifecycle.”

Knowledge is power: Patients can express their concerns while healthcare staff can learn of and address medical issues early on.

Serve patients and physicians alike by automating time-consuming tasks before the patient even walks through the door: scheduling, visit reminders and the filling of insurance and medical forms.

Not only does this shave phone and in-person wait-times, but also “this aligns with quadruple aims of value-based medicine: improved outcomes, enhanced patient experiences, increased provider satisfaction and reduced per-capita costs,” Ekram says.

To be fully effective, such portals and mobile- and text-driven platforms should be fully integrated with as many electronic health record (EHR) and practice management (PM) systems as possible, so patient data will be synced and up-to-date.

EMindful’s eM Life digital app and web platform offer 15 to 20 daily interactive mindfulness classes on-demand and online to Aetna employees and others.

“We looked at modern content consumption and saw that easy access is paramount. Patients are less likely to adopt new habits if they have to drive to classes or wait to speak with a professional,” says Zev Suissa, chief innovation officer, strategic partnerships at 

, an Orlando, Florida, firm that offers online and mobile interactive mindfulness courses.

Two randomized control trials of 239 Aetna employees used a perceived stress scale and the Pittsburgh quality sleep index to find: 81% of 239 participants in the live, active format were “meaningfully engaged” and 65% practiced meditation or mindfulness techniques two or more times weekly, according to a 

 published in the Journal of Health Psychology.

Those using mindfulness tools self-reported experiencing 28.6% less stress and 20.3% improved sleep quality, according to the study. Corporations using the platform reported a 55.4% reversal of metabolic syndrome, a cluster of conditions that hike risk of type 2 diabetes, cardiovascular disease and stroke.

What You Don’t Know About Remote Patient Monitoring

These include hypertension, high blood sugar and excess body fat at the waist. Ultimately, Aetna reported $550 improved health claims yearly per patient and $43.80 an hour in enhanced productivity among participants: 

“Ultimately that frequent and consistent use drives behavior change,” Suissa says.

Similarly efficient and effective are telemedicine and teledentistry, says Abbas Dhilawala, chief technology officer at 

, Houston-based creators of a connectivity software platform. “Anyone with a phone line and an internet connection can consult with a doctor. A worker on break might be able to see a doctor and get a drug prescription within 20 minutes instead of taking the day off to commute to the doctor’s office.”

We all like to win. Harness that desire by offering rewards to those who participate in wellness programs, have annual physicals or confer with dietitians.

 found 83% of those who received wellness rewards were satisfied with them. Yet only 38% of hospitals and healthcare organizations give such incentives.

And just 25% of Medicare Advantage beneficiaries say their plan offers personalized incentives, according to the HealthMine survey.

Value and timing are crucial to successful rewards, says Theresa McEndree, vice president of marketing at 

, a firm that specializes in branded rewards incentives via gift cards, digital payments and loyalty points, in Pleasanton, California.

Blackhawk’s research showed participants prefer immediate lump-sum rewards over incentives paid out gradually. The most immediate and tangible- gift and prepaid money cards-are employees’ favorite.

“You often hear cash is king,” says McEndree. “People do love cash, but it has to be an on-the-spot digital e-card or literal gift or prepaid money card.”

A catalog of specialty products or gift cards at multiple wellness-oriented retailers ties gifts to positive goals and makes incentives more meaningful to the individual, she says. “I have a 1-year-old, so I spend a lot of money on diapers at Target. Someone else might love a gift card to Petco.”

The best rewards also are linked to small milestones along the way to larger goals, such as losing three pounds rather than 20. “The goals must be achievable: a hill to climb, not a mountain,” McEndree says.

The more difficult, onerous, or expensive the action desired, the higher the incentive should be, adds Tom Wicka, CEO and co-founder at 

, a national healthcare consumer engagement firm in Minneapolis. “Having a cancer screening involving blood or biopsy in a physician’s office is a bigger ask than going to your local pharmacy for a flu shot.”

4. Communicate clearly in lingo-free language

When you talk above patients’ heads, you lose their focus.

Patients whose doctors communicated poorly were 19% less likely to follow their care plan, according to a review of 106 studies over nearly six decades ending in 2008, according to a 

Training doctors in communication skills led to 1.62 times higher patient adherence than those without that training, as the study findings concluded. As many as 50% of chronically ill patients fail to follow the full regimen of medicine, appointments, screenings, exercise, and diet, the study said.

Why Chronic Care Management Isn’t Gaining Traction: Health Execs Identify 3 Barriers

“Patients may leave doctors’ offices, pharmacies, and hospitals without a clear understanding of their conditions, medications or the next steps they need to take,” says Christopher K. Lee, MPH, CPHQ, clinical solutions marketing manager at 

, a provider of healthcare and supportive services. “They may nod in agreement, but they don’t understand or won’t remember when they get home.”

That’s especially true when they’ve been given anesthesia or a harsh diagnosis.

Patients also are bombarded with too many and too complex instructions. “They’re not necessary and not patient-friendly,” he says. “Nobody reads all that.”

Worse, questions often are left to already time-strained pharmacy staffers, “who realistically have 30 seconds to explain medications,” Lee says. “The burden should fall on healthcare providers. We need more dedicated care coordinators and case managers who are trained to meet patients at their level and are given the time to do the job right. Health information texts may help-but nothing replaces human interaction.”

Employers can greatly influence their workers’ healthy behaviors in the workplace, says Safeer, a board member at the 

, a professional medical association for physicians, clinicians and allied health professionals in lifestyle medicine, in Chesterfield, Missouri, and former medical director of preventive medicine at 

, a network providing medical, dental and vision insurance in Maryland, Washington, D.C., and Northern Virginia. “The more approaches you offer the more likely employees will adopt healthy behaviors.”

Fill vending machines with fruit and low-fat snacks, not sugar-filled sodas and packaged snacks. If you have a company cafeteria, put fruit near the checkout register, not pastries. Price better choices lower.

“Policies greatly influence behavior,” he says. That starts with not docking pay for employees going to medical appointments and providing space for lactating new mothers to breast-pump.   

Place signs at elevators directing to nearby stairs-and make sure the latter are well-lit, safe and appealing, with fresh paint, carpeting, and pictures on walls, Safeer says. “Outdoor green space and indoor greenery make people more likely to engage in physical activity.”

In contrast, leave smoking areas roofless and forbid smoking in areas through which other workers pass, he says. “You encourage the habit by protecting smokers from inclement weather.”

Provide on-site free or low-cost programs where workers-and their families-can learn strategies for weight loss, diabetes prevention, low-fat food purchasing and preparation, stress relief, smoking cessation, or Alcoholics Anonymous.

“Peer support is a big driver of behavior,” Safeer says. “People are more successful when part of a group. Insurance companies should cover lifestyle program participation for spouses of individuals with heart disease or diabetes-even if they don’t have those conditions. If families make healthier choices, it’s more likely patients will succeed.”

Also entice management to model desired behaviors. “If leaders walk at lunch it’s a sign to other employees that it’s OK not to work through lunch and to perhaps walk instead.” Your employee communications can spotlight active leaders and employees-and walking meetings can be encouraged.

Hire upbeat leaders who provide clear instructions, consistent priorities and shared decision-making authority, Safeer says. “The more upbeat and better HR practices are, the better employees feel inside and how they feel inside influences how likely they’ll adopt healthier behaviors and strategies,” he says.

Michele Meyer is a freelance writer from Houston.  

Here are five surprising ways to tailor experiences so patients adopt healthier behaviors when faced with chronic conditions like diabetes, heart disease, cancer, and COPD.

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The costs of chronic obstructive pulmonary disease (COPD) are so complex that keeping pace may seem as tough as trudging up sand dunes.

But that challenge must be met, says Robert A. Wise, MD, professor of medicine at Johns Hopkins University School of Medicine in Baltimore.

“The cost of drugs places a substantial burden on COPD patients-more than any other chronic condition,” he says. “If drugs were more affordable for patients, you’d have better adherence, and that would lead to fewer adverse effects and hospitalizations.”

Three Ways to More Cost Effectively Manage COPD

Instead, COPD carries a hefty price tag for the healthcare industry: $50 billion yearly and $7,100 per hospital stay, according to a University of Tennessee survey, “

The clinical and economic burden of chronic obstructive pulmonary disease in the USA

Eighty-four percent of those whose COPD drugs were not reimbursed stopped taking their medications or took less than prescribed, versus 59% of those with single-tier coverage that shaved some patient drug costs, according to a  2006 

“The drug companies spend billions on marketing efforts but that doesn’t guarantee patients take drugs,” says Jeromie Ballreich, PhD, MHS, director of the Masters in Health Economics and Outcomes Research Program at Johns Hopkins University School of Public Health in Baltimore.

 costs-and boost patient adherence to their prescriptive drugs:

1. Combination-inhaled medications are game changers

Combination-inhaled meds accomplish two benefits: patients can take fewer drugs, which raises compliance to their regimen, and drugs become potentially more affordable.

Integrating two or three drugs in a single inhaler could-and should-cut patient costs as much as two-thirds, Wise says. “Yet formularies don’t always cover combination inhalers.

With 50 new medications in the pipeline, according to the University of Tennessee survey, Wise hopes that changes. “Patients have been taking two to three different inhalers-which is harder for them to keep track of.”

Some new longer-acting combination agents-with both bronchodilators and steroids-only need be taken once daily, says Stephen Clum, MD, PhD, pulmonary and critical care specialist and assistant professor of medicine at University of South Florida in Tampa.

While expensive, he says, insurers are short-sighted if they fail to assume much of the cost. That expense is far less than a hospitalization for acute exacerbation. “Compliance goes up astronomically if a drug that’s administered twice a day goes to once a day,” he says. “If we improve compliance, the healthcare system wins, the patient wins, everybody wins.”

Insurers need to recognize that drugs are not all created equal-in part because three types of inhalers exist-and often patients’ limitations due to their disease, arthritis or other ailments make them unable to use one or more of them, Wise says. “Formularies will prescribe particular inhalers, which may be cost-effective for the insurer. The type of inhaler may make no difference to some patients-and a significant difference for others.”

 are the most common. When users press on a button, a quick aerosol blast comes out. That requires coordination to press and inhale at the same time, which can be tough for chronically ill COPD patients.

, in which capsules or blister packs are filled with powder, require the strength to breathe in quickly and deeply.

, such as ipratropium bromide and albuterol (Combivent Respimat), have slow-moving, long-lasting and fine droplets that patients may find easier to breathe in, allowing the medication to more deeply into their lungs.

Many drugs lose their patents, enabling competitors to create lower-priced generics, cutting the cost to patients 80%.

That’s not the case for COPD medications: The drug itself might lose its patent or market exclusivity, but pharmaceutical companies patent the inhaler itself, Ballreich says. Any alteration to the inhaler gives the drug makers market protection.

That’s why top-selling anticholinergic inhaler drug tiotropium (Spiriva Handihaler) dates back to 2004 yet has no generic competition. “True generics compete on price, whereas branded drugs essentially have a quasi-monopoly,” Ballreich says.

Failure to discount unaffordable prescriptions backfires for insurance companies since many patients cannot afford to fill them.

“The biggest benefit for patients is keeping them out of the hospital-and that’s delivered via the right medication,” Clum says.

Many COPD patients get caught in the financial gulley known as the donut hole. That occurs once they’ve reached the copay out-of-pocket threshold (TrOOP) for Medicare Part D prescriptions yearly of $3,750. They then pay in full all prescriptions till they reach catastrophic coverage of $5,000. At that point, they are charged 5% of prescription costs.

“In between, patients often are not taking their medications-and that’s crucial with COPD medications, a number of which are most effective when taken regularly,” Ballreich says.

Sometimes the patient is first to learn their prescribed drug no longer is covered by Medicare or insurance.

If that occurs between appointments and patients fail to alert their doctor that insurance has changed and they’ve stopped taking a drug that’s no longer affordable, “by their next clinic visit, the damage is done,” Wise says. “Acute exacerbations occur, and the drop in quality of life may be irreversible.”

Six Surprising Ways COPD Can Affect Patient Health

While physicians use EPIC or other electronic health record software that lists formularies, these records are not always accurate, he says. “You get warnings that a drug isn’t covered when it actually is, or that a drug you think is covered actually isn’t.”

6. A sliver of patients get pulmonary rehab

Just 1.9% of COPD patients take advantage of pulmonary rehabilitation within six months of being hospitalized for a COPD exacerbation-despite Medicare’s policy since 2010 to cover such services, according to a 

Doctors may be to blame in part: 62% of people diagnosed with COPD had never heard of pulmonary rehab, according to that same study. Records of 223,832 patients hospitalized with COPD in 2012 were reviewed, and more than half of those who started pulmonary rehab completed at least 16 sessions of physical, psychological, and smoking cessation counseling.

Medicare typically pays for up to 36 sessions. The study did not determine why participation was so low.

“These programs are markedly beneficial to COPD patients,” Clum says, “but may not be covered by their insurance. Anything we can do to get them to stop smoking will decrease risk of hospitalization.”

COPD is a costly disease for patients and payers alike-but in order to control costs, you must first know what’s behind them.

Six COPD Trends You Need to Know

Outcomes-based payments, also known as risk- or value-based agreements, are arrangements in which drug companies must partially reimburse insurers if the drug fails to earn its keep by improving chosen health outcomes, such as lowering the number of patient emergency room visits or hospitalizations for acute exacerbations.

“It’s like a money-back guarantee,” says Jeromie Ballreich, PhD, MHS,. “Insurers get a rebate that takes a bite into their high cost of hospital care.”

While these agreements are a “very hot topic” in the drug price arena, they have yet to catch on for COPD medications, says Ballreich.

That’s because these arrangements occur typically for expensive cardiovascular and oncology drugs that face competition from branded drugs and generics.

That’s not the case for COPD. But that may change with the advent of new combination drugs, Ballreich says.

Ballreich knows of just one outcomes-based arrangement for COPD. It is between Highmark and Astrazeneca’s combination-inhaled budesonide/formoterol (Symbicort).

Symbicort is a relatively new drug battling well-established drugs for good placement in formularies, says Ballreich. “AstraZeneca had to have a creative solution to get Highmark to place it on a preferred drug tier.” 

In return for that placement, AstraZeneca will reimburse Highmark an agreed-upon amount of money if patients have bad outcomes taking Symbicort, Ballreich says.

Ballreich believes drug companies and insurers will take a wait-and-see approach before making other risk-based agreements for COPD medications. “Not every drug and disease is amenable to such agreements,” he says.

The ultimate objective is a drug that patients will buy and use. “Outcomes need to matter to the manufacturer and the insurer,” Ballreich says.
With a complicated disease such as COPD, the hitch may be measuring or agreeing upon adverse outcomes. These are not as easy to define as with cardiovascular drugs (strokes and heart attacks) or cancer drugs. “There’s potential,” Ballreich says. “But as the old saying goes, the devil is in the details.”

Express Scripts slashed 48 drugs, including long-acting beta agonist nebulized arformoterol (Brovana) and pulmonary anti-inflammatory ciclesonide (Alvesco), from its 2019 formulary. CVS Caremark dropped 23 drugs, including anticholinergic aclidinium bromide inhalation powder (Tudorza PressAir), while adding other drugs, including combination drugs such as outcomes-based Symbicort.

Since patients may belong to a variety of Medicare Part D or insurance plans, pulmonary specialists often rely on EHRs such as Epic when determining if a drug is on formulary.

But EHRs aren’t always up to date, and sometimes say a drug isn’t covered when it is-or the reverse, says Robert A. Wise, MD, professor of medicine at Johns Hopkins University School of Medicine. “We’re playing roulette trying to prescribe something that’s effective and affordable.”

COPD patients may choose their Medicare Part D plan based on the drugs they take, Wise says. “Then the formulary changes-and suddenly they cannot have the drugs that work for them or have to pay an inordinately high price for them.”

Even accepted lower-tier drugs may cost $300 or more monthly for COPD patients, many of whom need multiple drugs for that disease and other ailments they suffer, says Stephen Clum, MD, PhD, assistant professor of medicine and pulmonary care specialist at University of South Florida in Tampa.

“You’d have to be wealthy to be able to afford all the drugs COPD patients need,” Clum says.

In these arrangements, drug companies must partially reimburse insurers if the drug fails to earn its keep. Will COPD drugs be included in such arrangements?

Will Outcomes-Based Payments Hit COPD Drugs? 

Chronic obstructive pulmonary disease (COPD) causes lasting lung damage even before symptoms show. By the time mild COPD is detected, patients already may have lost more than 40% of their small airways, found researchers at the 

 in Vancouver, Canada. They reviewed 30 years of specimens in a Canadian lung tissue registry.

“Many people have undiagnosed COPD, so the importance of screening is greater,” says Timothy J. Scialla, MD, pulmonologist at Duke University’s Duke Asthma Allergy and Airway in Durham, North Carolina.

Scialla says six other medical conditions often accompany COPD, and providers should heed them as signs that COPD screening may be needed. “COPD is not just a disease of the lung,” he says. “It can affect your whole body.”

Here are the six conditions to watch for:

. Muscle fibers deteriorate, going from fast-twitch to slow-twitch fibers, and sometimes muscle atrophy. “The muscles become less efficient in exercise and especially in patients who are sedentary,” Scialla says. “That creates a vicious cycle: Patients are weak so they don’t move, and they don’t move so they get weaker.”

. COPD and heart failure are chronic, progressive disorders that curtail a major organ’s ability to meet the body’s demands. COPD lowers oxygen levels in the blood, which in turn can induce heart failure. The two conditions share many symptoms, including shortness of breath with effort. They also have common causes: smoking, inactivity, and systemic inflammation. “The heart and lungs are bed partners, living in the same area of your body,” Scialla says. “When one is struggling, the other has to strain to do its job.”

. Smoking sparks not only COPD but also gradual mental decline due to low oxygen and high carbon dioxide levels, as well as blood vessel damage, Scialla says.

. COPD patients have a higher risk of bone brittleness and loss. 

The National Health and Nutrition Examination Survey

, which included 14,828 subjects aged 45 or older, noted a 16.9% prevalence of osteoporosis in COPD patients compared with 8.5% in subjects without coexisting COPD. Inflammation, smoking, and lack of exercise fuel both diseases, which also tend to be undetected in early phases.

Also, drugs used to treat COPD and acute exacerbations-corticosteroids and bronchodilators-impair the body’s metabolism of calcium and vitamin D.

This, in turn, hampers bone-building, say researchers from Pradesh, India, in a 2015 issue of the journal 

Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine

Spinal breaks-known as vertebral compression fractures-can constrict lungs and their ability to function. Each break drops lung capacity by 9%, according to a 2007 University of Alberta, CA, 

. “Which comes first, COPD or depression? I don’t know,” Scialla says. But depressed patients are less likely to exercise and more likely to stay indoors, thus decreasing their vitamin D levels, all contributors to COPD.

. Smoking, genes, and chronic lung inflammation contribute to both COPD and lung cancer, he says.

These six medical conditions often accompany COPD, and providers should heed them as warning signs.