Posts Tagged Healthcare
On Data Privacy Day, I thought it might be helpful to write a little bit regarding the nature of privacy in the healthcare world. Many people know that there are laws like HIPAA that are in place to protect patients from their personal health information being breached. And while there are stories regularly about breaches, the amount of effort that goes into protecting health information is immense. Maybe by providing some insight into that world you, as a reader or one of our clients, might gain a greater sense of confidence or understand ways in which you can also protect yourself.
It’s more than just privacy
In order to manage the private information of all of our clients across the United States, MINES employs the use of an electronic health record system that stores and protects access to information, even from within our own company. We use layers of access and control as well as tracking our own users within the system. This also means that we have to employ some pretty strict control mechanisms within the system to ensure that security of data is maintained.
But, there are many times when we need to exchange information with other groups on your behalf. An example of this is providing an authorization to the provider that they are pre-approved to receive payment for services. To do so, many providers elect to receive this information via email, in which case the provider is sent a notification email where they are prompted to log into a secure website where that information can be accessed. We have structured our agreements with these providers to protect that information as best we can from the very beginning.
Identity and security
As mentioned above, a critical element to protecting your privacy is tied to identity. Without going too deep into how this is handled across the healthcare industry, identifying an individual is usually done at MINES by their date of birth and last four digits of their social security number. From there, all internal work is handled by using a unique identifier, called a Patient ID. This allows us to be able to reference information from the central patient database without using your name, or other personally-identifiable information; decreasing the likelihood of erroneously sharing your data.
A note on confidentiality
Your information is never shared with your employer except in the case of Work Performance Referral in which case you will be asked to complete a letter explicitly allowing us to communicate with your employer regarding your progress. Your information is also confidential from disclosure to other employees at your company or anyone else for that matter without your permission. For example, even your spouse or family member cannot receive information about you from our staff without your permission. The exception to this is when information that we receive poses a threat to others, in which case we may be legally required to act.
Ways you can protect yourself
This isn’t meant to be alarmist, or to suggest that you shouldn’t provide as much information as you can with MINES. We implement a lot of control to make sure that the information that you provide to us is protected. However, below are a few things that you can do to help protect yourself.
If you elect to receive email from us – for example, to communicate about an upcoming session, or request additional information – you should know that email alone is not secure. While most information that would be sent isn’t highly sensitive, it’s certainly something to be aware of. Regarding corporate email, specifically, most information that flows through corporate email servers is logged, stored, and likely accessible to IT professionals on some level at your organization.
Request a copy of the privacy notice
As mentioned above, regarding the confidentiality of your information, when you call into MINES to receive access to services, the staff will ask if it is okay to leave voicemail. By providing a voice mailbox that is accessible only to you, we can make sure that your information is not being shared with other parties.
What’s on the horizon for us
In an effort to continue to meet the needs of privacy in an ever-more-connected world, MINES is engaged in a number of initiatives that will further protect and ease information exchange to simplify how we work with you. Soon, you will be able to create an online account with us where your history with MINES can be accessed. You and your provider will be able to use this platform to communicate with each other in a secured environment. You will be able to create your own account with us without calling in, so that if you want to request services but are concerned about someone overhearing the call, you can do so silently. And perhaps most exciting from my perspective, you will be able to create and access your account using a Facebook or Twitter account, allowing you to quickly authenticate your identity without pesky usernames and passwords!
We take security very seriously at MINES. We want you to have peace of mind when sharing information with us. If at any point in time you have questions, concerns, or suggestions regarding how we handle privacy and security, we welcome your insight. You can email or call us during regular business hours at firstname.lastname@example.org or 800.873.7138.
To your health,
Chief Information Officer
MINES & Associates
Thanksgiving is tomorrow and as such many of us are thinking of what we are thankful for in each of our lives. Good friends, loving family, and good health re: some of the common things that we find ourselves thinking of. So it is this spirit that MINES wants all of us to take a moment and thank the (sometimes thankless) caregivers that look after their loved ones who depend on them, often times sacrificing their own wellbeing in the process. There are countless reasons why one might become a caretaker or need a caretaker themselves but since it is Alzheimer’s awareness month we will focus on those that fall into the Alzheimer’s and dementia circle. About 15.7 million adult family caregivers care for someone who has Alzheimer’s disease or other dementia. [Alzheimer’s Association. (2015). 2015 Alzheimer’s Disease Facts and Figures.]
Unsung (and unpaid) heroes
Given that a large percentage of caregivers are family members or friends of those that they care for, they are rarely paid or reimbursed for any of the time and resources that they spend caregiving. In fact, approximately 43.5 million caregivers have provided unpaid care to an adult or child in the last 12 months. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.] Not only do these folks go unpaid, they are often paying out of their own pocket for supplies, transportation, and lost wages due to missed work in the line of caregiver duty. Alzheimer’s and dementia are already ranked as some of the most expensive medical issues facing the US today, but with personal expenditures and lost wages for caregivers being hard to calculate exactly, this problem might be even worse than what the current stats say.
Who are they?
Despite their superhuman capacity for empathy, caregivers are normal people, and oftentimes do not have any formal caregiving training or background. They also come from just as diverse of backgrounds as that of the people that they care for. Typically, they are adults with the average age being 49.2 years old, with 48% of caregivers falling in between the ages of 18 and 49 years old. About a third of caregivers are older than 65. In terms of ethnicity, according to a 2015 survey, 62% of caregivers identify as White, while 17% identified as Hispanic, 13% as African-American, and 6% as Asian-American. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]
Women and Caregiving
A very important aspect of the Alzheimer’s/dementia crisis is that women are right at ground zero. Not only do women face a 60% greater chance of getting Alzheimer’s or dementia, but upwards of 75% of all caregivers are female, and may spend as much as 50% more time providing care than males. [Institute on Aging. (2016). Read How IOA Views Aging in America.]
While women account for the vast majority of caregivers, they also make up a large percentage of the individuals being cared for. In fact, 65% of care recipients are female, with an average age of 69.4. The younger the care recipient, the more likely the recipient is to be male. 45% of recipients aged 18-45 are male, while 33% of recipients aged 50 or higher are male. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.] Much of this is due to the fact that Alzheimer’s and many types of dementia tend show up in women a much higher rate than men. Researchers are trying to determine what the reason is behind this. It was once thought that it was because women tend to live longer than men, but as the average life expectancy becomes closer this is being challenged and other factors are being considered.
Who are they caring for?
While many caregivers do so professionally, many make the leap into the role of caregiver in order to care for family or close friends. This group actually makes up the vast majority of caregivers with 85% of all caregivers caring for a relative or other loved one. Of these caregivers 42% are caring for a parent, 15% are caring for a friend or other non-blood related loved one, 14% for a child, 7% for a parent-in-law, and 7% for a grandparent-in-law. [National Alliance for Caregiving and AARP. (2015). Caregiving in the U.S.]
What are they doing?
There is no set job description for caregiving. The day to day tasks vary from one individual to the next depending on the needs of those they care for. It is estimated that 96% of caregivers are charged with assisting or completely taking over normal everyday activities such as shopping, cooking, picking up prescriptions, and so forth which adds up fast, leaving little time for the caregivers’ own needs. [AARP and United Health Hospital Fund. (2012). Home Alone: Family Caregivers Providing Complex Chronic Care.]
According to a recent survey, on average, caregivers spend:
- 13 days each month on tasks such as shopping, food preparation, housekeeping, laundry, transportation, and giving medication;
- 6 days per month on feeding, dressing, grooming, walking, bathing, and assistance toileting;
- 13 hours per month researching care services or information on disease, coordinating physician visits or managing financial matters. [Gallup-Healthways. (2011). Gallup-Healthways Well-Being Index.]
To make matters worse, many of the tasks are complex and often medical in nature. A recent report that talked about caregivers who provide ongoing chronic care, 46% had to perform medical and nursing tasks on a regular basis, sometimes without the ability to obtain proper training to perform the needed tasks. [AARP and United Health Hospital Fund. (2012). Home Alone: Family Caregivers Providing Complex Chronic Care.]
It is important to mention that Alzheimer’s and other dementia related disease call for some of the more intensive and long term caregiving commitment. Measured by duration of care, Alzheimer’s and dementia caregivers provide care on average 1-4 years more than caregivers caring for someone with an illness other than Alzheimer’s disease. They are also more likely to be providing care for five years or longer. [Alzheimer’s Association. (2015). 2015 Alzheimer’s Disease Facts and Figures.]
How can we support them?
Caregivers report having difficulty finding time for one’s self (35%), managing emotional and physical stress (29%), and balancing work and family responsibilities (29%) (NAC, 2004). About 73% of surveyed caregivers said praying helps them cope with caregiving stress, 61% said that they talk with or seek advice from friends or relatives, and 44% read about caregiving in books or other materials (NAC, 2004). If you find yourself close to someone who is providing care for someone and you’d like to help out, keep in the mind the best way that you can help is to stay out of their way and instead go do daily tasks that they do not have time to do themselves such as shopping, picking up kids from school/activities, or offering company when they do get the rare moment to themselves. But remember if they just want to be alone make sure to give them the space they need to unwind.
So with all this in mind it’s easy to see that we should all be thankful to the caregivers in the world. Many people would be suffering even more without the time and personal sacrifices made by these special people every day. So this holiday season everyone at MINES says THANK YOU CAREGIVERS! Thank you for everything you do!
To Your wellbeing,
The MINES Team
Sources and Resources:
Let’s dig a little deeper into the concept of Salutogenesis and what it might mean at your workplace.
Antonovsky’s explanation of Salutogenesis was well depicted by a river. His concern with the current model of health (Pathogenesis) is that it’s generally believed that we are healthy from the beginning but that because of environmental / circumstantial events, we become sick. Antonovsky expressed this as a river, where all healthy people stand on the bank, safe from the raging river’s flow. Once one stepped into the river – got sick – then something needed to be done. Salutogenesis, however, sees all people already in the river; but at different distances from the mouth. General resistance resources (GRRs), a term Antonovsky used as well, are the supportive mechanisms that make it possible to engage in their health generating activities. These allow for someone to swim against the current or maintain a position against the current. The result of thinking this way is the freedom to abandon the bias that one has failed at being healthy, but rather that they are always working at generating more health.
Sense of Coherence
Antonovsky’s continued his explanation of Salutogenesis as hinged on a Sense of Coherence. Sense of Coherence is defined by three major parts:
- Comprehensibility (I get this). The ability to understand one’s circumstances. If you look back at some of my previous postings on Cognitive Bias, we are unable to fully comprehend our experience because, as Kahneman has pointed out in Thinking Fast and Slow, we are subject to a number of biases including base rate neglect (not having the ability to assess, objectively, where things are from the start before making an opinion of what is possible).
- Manageability (I got this). The ability to assess resources for dealing with one’s circumstances. “The right tool for the right job” comes to mind here. To adequately meet the needs of Manageability, one must not only have the resources available, but the knowledge that they can be used.
- Meaningfulness (I’m good to go). The ability to comprehend the anticipated results as helpful. We oftentimes recognize that there is a change to be had, but taking that step can be difficult without a fire under your bottom.
Taken together, these three points sit at the nexus of the ability for any given person to be able to effectively engage with their health. When all three are maximized for performance, individuals can effectively mitigate the potential of their circumstances. Education obviously plays a big role in the process of becoming healthier, but education alone cannot make people healthier.
Your role as a benefits provider
As someone that is providing benefits to a group of people, you have a key role in the ability to help those covered to become healthier; to actually create health. It’s easy to provide a benefit that is available when it’s needed and provided by an external vendor, but that doesn’t have to be the end. Visionary organizations are engaging their population in small, but every day, ways.
What can be done
Engagement is key. First off, you have to take on an organizational wellbeing plan in earnest. If you’re willing to put in the effort, your population will be more likely to stay engaged. If you’re not behind it 100%, they probably won’t be either. But what can be done to engage in health more actively in the worksite?
Let’s look at some of the GRRs that Antonovsky identified and where they may occur in the workplace.
Money: Money enables us to purchase services and products that can enable health generating activities. It can also be used to incentivize or disincentivize activities – the so-called carrot and/or stick approach. But, money also has some significant impact on engagement. When individuals make a purchase, they are actively exchanging the value of their dollar for the value of what is being purchased. If you’re familiar with the concept of Behavioral Economics, this might include devaluation of a certain program because it is provided for free. Instead, incentivizing purchase of products or services that help in the generation of health means personal investment in its use.
Knowledge: You know that conference or meeting room that is usually set aside for meetings with clients, or teams within your organization? It may also be a great location to have a training or two related to health generating activities. Including helpful information in your break room, like healthful recipes, may be a continual reminder of what your population is putting into their bodies.
Commitment: Commitment may be especially easy to generate in the workplace because you’re already showing an investment in those you provide benefits for. Showing your commitment to the program can help create mutual investment, as well!
Social Support: Encourage people to support each other in your health generating activities by rewarding employees who provide assistance or encouragement in the health of other employees. This creates a social structure for engaging in health, and we know that community is the key to health.
Taken together, this is a powerful recipe for getting the kind of motivation needed to stay actively engaged in your population’s health. And, the long-term benefit of a healthier and happier workforce is what drives productivity and profitability.
To our health,
Have you read the book The Experience Economy? To explain it very quickly (and not do true justice to the ideas proposed in the book), there are various levels of economic offering that warrant different valuations, and thereby ability to generate revenue. The levels of development discussed in the book are elegantly displayed in the graph below by Pine and Gilmore (the authors of the book):
This progression has expanded over time with new levels being added as the market strives for differentiation. Many of the examples brought up are clear and concise, such as Starbucks as a purveyor of coffee (a commodity) that really charges the market at the level of a Service. Pine and Gilmore stop at the level of Service in their description of Starbucks, but I would readily argue that they reach towards the level of experience. Starbucks actually refers to this in their training materials as creating “The Third Place;” it’s not your work, or your home, it’s that other place where you can unwind a little bit. Even though the customer isn’t actually brewing their own coffee, as is a hallmark of many experiences, they are engaging with the sounds and smells of the coffee shop in a very intentional way.
The book spends a great deal of time discussing offerings that are on the level of Experience but certainly takes a moment to tip its hat toward Transformations, a burgeoning new market offering. Transformations are marked by the engagement of the customer in a way that enables that person to learn or grow, exactly to Transform, themselves in a way that is truly valuable to the customer. It includes giving the customer the skills and motivation to make changes that will both provide some immediate value but also cascade down into further value down the road.
In healthcare, this understanding of the market is significant and valuable. As we, as an industry, discuss Accountable Care Organizations, capitated care models, and participatory medicine, it’s important for us to keep in mind where value is derived in the typical marketplace. Healthcare, while arguably different in many ways from other industries by its virtual necessity in every citizen’s timeline, still must compete under the same rules as many other industries. Many times, in healthcare, we present ourselves on the level of Service – that is that we are doing something for someone, for a fee. As we look at these new systems, it is time for us to consider what the future of healthcare delivery will require under a population health model of delivery.
Eschewing the fee-for-service model opens up the possibility for the healthcare industry to reconsider offering the long-term value of teaching individuals how to keep themselves healthy, at least in terms of the 80% of healthcare costs that are mediated by behavior. This decreases the time and services that must be provided creating new forms of cost savings. As we move further up the economic offering ladder, it will become more necessary to move our industry into the Transformation realm. In fact, there is no other industry more suited to it.
To our health,
Now is a great time to work in the Healthcare industry. While the changes in the landscape following the Affordable Care Act (and the challenges to the Affordable Care Act) have led to some pretty interesting scrambling to meet “the market,” it has also been fun to see new, emerging voices that have the foresight to begin considering the effect that Health IT can have on our overall well-being as patients.
Today’s inSite highlights a very well-written article (Do We Need Doctors or Algorithms?) that lays out some of the ways in which Healthcare may be changing, be it through our intentional effort or our naturally-occurring social meanderings (I use the Wikipedia article intentionally!).
Consider some of these possibilities with a view of their overall impact on our Healthcare landscape. While some of these may, at first, seem far-flung, they are quite insightful and not as far off as one might think when you consider what we are already capable of accomplishing with mobile technology as well as data integration and management systems. While it may be a natural reaction to respond with some concern – how fantastic would it be to have systems that imbue all providers with the confidence and accuracy that a system like the one mentioned in this article could provide. Then our providers could be really focused on treating the relapse issues that can often creep their way into the patient’s treatment compliance. It’s very possible that our docs’ roles may be shifting once again from diagnosis to advising to (now) nudging as patients become more empowered and informed to make their own decisions.