The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Month: November 2017 (page 1 of 2)

Behavioral Economics and Reshaping Patient Behavior to Improve Health

Deby Evans

Deb Evans is the MVC Site Engagement Manager

A recent article published in QJM, Journal of Medicine discusses changing the culture within healthcare by the use of behavioral economics. By combining lessons learnt through psychology and economics, behavioral economics tries to understand how emotions, self-identification, the environment and receiving of information has an influence on a person’s behavior. Many of our decisions are made from an emotional standpoint, or effectively “without thinking”. Thus, behavioral health relies not on education level but on how and why individuals make certain decisions. One method of understanding behavioral economics is the placement of healthy food in a grocery store. This placement can affect how people choose items to purchase. Behavioral economics can also incorporate the use of games or friendly competition and can appeal to the emotional nature of people through instant gratification and rewards. These tactics may trigger some motivation in people

Due to the number of individuals living with type 2 diabetes in the U.S. this condition is reaching epic proportions. The number of people diagnosed with type 2 diabetes continues to grow with a predicted world-wide growth of 54% from 2010 to 2030. In addition to this rapid growth, the global cost to manage this condition is also set to rise from $376 billion to $490 billion by 2030. Increased rates of type 2 diabetes can be related to urbanization, decreased physical activity, and increased access to processed foods.2 Using the principles of behavioral economics, healthcare facilities may be able to target those at risk of prediabetes, improve healthcare outcomes and reduce cost.

Other examples of ways healthcare facilities can use behavioral economics is through auto-filling prescriptions for longer periods of time such as 90 days instead of 30 days, this helps maintain a supply of medication and reduces the risk of the patient running out and less often, having a follow-up appointment already arranged prior to discharge so patients do not have to think about trying to arrange a visit or providing healthy meals for patients unable to shop or cook for themselves



Transforming Population Health Management through Health Information Exchange

Deby Evans

Deb Evans is the MVC Site Engagement Manager

A recent article published in the PM& R journal discussed ways in which two communities used an alert system to help target and address gaps in population health management. The authors noted that pivotal actions for reducing hospital readmissions and avoidable emergency department visits include communication that is more timely and focused, along with better chronic disease management using health technology.  One tool being used by some health systems is an electronic alert system that notifies the provider or site daily about a patient’s ED visit or hospital admission. Through these alert systems health care organizations can better coordinate care to help identify high and frequent utilizers and those patients that might benefit from increased intervention.

Current alert systems have three main steps:

  1. Visit to the ED or hospital admission triggers an Admission (A), Discharge (D), Transfer (T) message;
  2. Patient information is matched to participating site patient list and a secure messaging system sends an electronic alert; and
  3. The participating site receives the electronic alert

In addition, on a daily basis, participating sites receive a list of the patient alerts in a secure email message and can work on stratifying patient risk and conduct follow-up as needed. Healthcare facilities using the alert system have integrated:

  • Pharmacists to follow up on medication changes and additions or if a patient has a complicated medication list;
  • Behavioral and substance abuse centers to provide follow up or discharge planning help by a case manager;
  • Academic student health clinics to follow up on high-risk patients, ensure specialist referrals are made and education about available services;
  • Follow up by community health workers or a Care Coordinator for the uninsured, underinsured and vulnerable populations and/or
  • Monitoring chronic pain and pain medication management for potential abuse.

Adopting an electronic alert system may help to provide healthcare facilities with

  • Quicker and more appropriate engagement with high utilizers of the health care system
  • Method to identify target populations and the ability to risk stratify patients
  • Ability to track and measure outcomes and evaluate the effectiveness of interventions
  • Increased care coordination among providers and specialists
  • Facilitation of cost savings

The use of the HealthLINC technology was tested in two communities in Indiana and South Carolina. The main goal of this technology is to enhance communication between hospitals and providers. Although Indiana and South Carolina sites have begun to successfully use this technology, it is no stranger to Michigan hospitals. Since 2010, The Michigan Health Information Network (MiHIN) Shared Services has helped provide a variety of technological services and opportunities for hospitals, one being ADT message software. MiHIN strives to accomplish its goal of improving healthcare experiences by supporting the statewide exchange of health information data among appropriate stakeholders. To meet its mission, MiHIN partners with a variety of Michigan Health Information Exchanges (HIEs) such as PatientPing, Southeast Michigan Health Information Exchange (SEMHIE), Upper Peninsula Health Information Exchange (UPHIE) and many others, to help disseminate real-time ADT messages. This service can be very valuable in better understanding the many pieces involved in a patient’s care story.

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