Sherry Rohlfing

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As we all now know, SARS-CoV-2is an extremely communicable, novel virus with the potential for death and long-term disability that’s spread through respiratory droplets. Wearing suitably protective masks and social distancing are critical to stopping its spread. Yet a significant number of Americans refuse to wear a mask, guaranteeing the pandemic will rage on.

For managed healthcare executives, the lack of mask wearing isn’t surprising because they know how difficult it is to engage people with their own health and well-being. Those of us who work in healthcare sometimes lose track of the fact that health and healthcare are on a long list of concerns that people have: personal finances, housing, work, children, aging parents and even food — people live complicated lives. There are also those who cope with health problems by denying them.

But for health plans, getting people to care about — and be involved in — their healthcare is critical to their improved health outcomes. And for high-risk members, engagement can be a lifesaver, literally.

lndeed, care and disease management programs are a core competency critical to a health plan’s success, starting with health risk appraisals, and then identifying high-risk members and engaging them in appropriate care-focused activities.

If we’re fortunate, a COVID-19 vaccine will become available fairly soon. Still, healthcare executives must view this disease as a long-term issue. Many of them have knowledge and experience with managed care techniques that could be helpful as the pandemic drags on, such as:

Stratification methodologies for member risk levels based on demographics, social determinants of health and health status.

Engagement strategies that improve compliance with current guidelines from the CDC and include information on staying safe, early identification of symptoms, and minimizing the risk of transmission.

Home care services for members with chronic conditions or COVID-19 to keep them away from hospitals, clinics and long-term care facilities where transmission could be especially harmful.

Guidelines for mask usage and distribution of free reusable masks with easy-to-understand instructions on their use and cleaning.

Public health messaging about the seriousness of COVID-19 and reinforcing the steps necessary to reduce exposure and
transmission.

COVID-19 is now woven into the fabric of our lives, yet the consequences are unpredictable. Managed care organizations can help by stepping up and bringing to bear the expertise they have in dealing with members with chronic illness and applying it to COVID-19 care.

Hope resides in the short- and medium-term responses to the epidemic, especially in the progress being made toward the development ofa vaccine. Clinicians and researchers are also making headway in the treatment of the disease. But there’s a long haul ahead, and for that we’ll need planning, implementation of those plans, an abiding sense of purpose — and each other.

Don Hall, M.P.H., and Sherry Rohlfing are principals of DeltaSigma, LLC, a consulting firm that specializes in strategic problem solving for managed care organizations.

Articles

Principals of DeltaSigma, LLC , Don Hall, M.P.H., and Sherry Rohlfing provide Managed  Healthcare Executive an opinion piece on how managed care organizations can address COVID-19 transmission.

Opinion: 5 Ways MCOs Can Address COVID-19 Transmission

When most people think about epidemics, they think of Ebola, SARS, and now, especially, the new coronavirus. But until COVID-19, when healthcare executives had thought about epidemics, they should also be thinking about diabetes, because it is growing, expensive - and deadly. 

The impact of diabetes on the lives of patients can be absolutely devastating. It is the underlying cause of serious complications, such as heart disease and stroke. Many people with diabetes are afflicted with chronic pain; it is also the leading cause of kidney failure, blindness, and amputations. Diabetes, and the complications resulting from it, ranks third behind heart disease and cancer as a cause of death in this country.  

Over 34 million Americans have been diagnosed with diabetes, mostly with the type 2 variety that is linked with being overweight or obese. Another 88 million Americans have prediabetes: They have blood sugar levels and other risk factors that could put them on the road to having full-blown diabetes. Nearly $250 billion is spent on healthcare costs related to diabetes, with an average medical expenditure of $15,000 per person with the disease. As far as drug costs are concerned, diabetes is the most expensive traditional therapeutic class on a per-member, per-month basis. 

21st Century-Style Diabetes Disease Management: Coaches and Tech-Enabled

The causal factors of the type 2 diabetes epidemic are well characterized: poor diet, obesity, lack of exercise, and aging. Diabetes also occurs more frequently in some groups because of social determinants of health, such as unsafe neighborhoods with a lack of access to recreation.

The good news is that managed healthcare can have a significant impact on all aspects of diabetes prevention and management. Through analytics and health risk appraisals, health plans can identify members with diabetes and those who are prediabetic. Focused disease management programs, combined with value-based provider contracts, can encourage engagement of members and incentivize providers to improve outcomes. Health plans can help by, among other things,  covering smartpens that can monitor injections. The same goes for stick-free glucose monitoring, which improves adherence to blood testing and insulin management. Health plans are also well positioned to work with community organizations to support efforts to educate people about proper nutrition, exercise habits, and weight management. 

When and how is difficult to say, but COVID-19 will recede. Diabetes will not. It will continue to grow as our society struggles to control the impacts of poor lifestyle habits. However, managed healthcare plans continue to play an important part in ensuring that members receive the most impactful information and care possible to manage and ultimately stop this epidemic.

Don Hall, MPH, and Sherry Rohlfing are principals of DeltaSigma, a consulting firm that specializes in strategic problem solving for managed care.

Americans have been diagnosed with diabetes, mostly with the type 2 variety linked with being overweight or obese.

Diabetes: The Quiet Epidemic That Is Not Going Away

We recently returned from an educational summit of the Swedish healthcare system sponsored by the TPG International Health Academy. The group of 25 was made up of healthcare executives from Canadian and the U.S. organizations including Kaiser Permanente, LA Care, National Indian Health Board, Centene, Cigna, Affinity Health Plan, and others. We studied a number of aspects of Sweden’s universal, government-sponsored system including its organization, financing, access-to-care, and current challenges.

While there were a number of key points learned from the study, two things stood out to us.

First, their focus is on care delivered in a primary care setting. In the Swedish system, primary care, which does not include pediatricians or internal medicine, accounts for over 20% of all healthcare costs. As a comparison, in the United States we spend about 5% (including pediatricians and some internal medicine and non-delivery OB-GYN). Primary care in the Swedish system is largely delivered in clinic settings that include general practitioners, nurse practitioners, nutritionists, psychologists, and physiotherapists in a holistic approach to patient and family care.

Through this approach, more comprehensive care is provided in the primary care clinics and fewer referrals to specialty and other care are required. In addition, an emphasis is put on patient education and self-care. The result is lower cost and better healthcare results, which demonstrates that primary care medical homes work.
	
	The takeaway is that health plans should improve efforts to create more robust medical homes for their members to improve outcomes and lower overall healthcare costs.

Second, Swedish leadership incorporates an interesting management approach that takes an old Swedish practice called a fika (pronounced fee-ka) and turns it into a communication channel with their teams. Fika is much like our concept of a coffee break, taking time away from work to relax with a hot beverage and some food. Managers take traditional fika further by making it a time for everyone to get together for a break-management and staff. During this time, leaders have the ability to informally hear from their employees and get to know them on a more personal level. It’s like an informal focus group every day.

The takeaway is that executives should develop a similar mechanism, whether a break or lunches, to spend time with more than just the management team to better understand their employees and how to make their company a better place to work and more aligned with their customers.

As we strive to improve healthcare in the United States, it’s useful to travel to other countries to learn about their cultures and healthcare systems. Sweden’s approaches provide useful insights.

Don Hall, MPH, and Sherry Rohlfing are principals of DeltaSigma, a consulting firm that specializes in strategic problem solving for managed care organizations. They work with the TPG International Health Academy on Educational Summits and will study healthcare in Columbia and Italy in 2020. 

U.S. health executives can glean useful insight from studying how other countries approach healthcare.

Author | Sherry Rohlfing

Articles

Opinion: 5 Ways MCOs Can Address COVID-19 Transmission

Diabetes: The Quiet Epidemic That Is Not Going Away

Learning From Others