Proactive Care in a Reactive World: Improving Health and Wellness in the West Valley

1. Proactive Care in a Reactive World: Improving Health and Wellness in the West Valley

2. Medicine – Historically Speaking For much of America's history, home doctor visits were the norm. Home visits died when medical insurance replaced pay-as-you-go, and administrative costs and malpractice insurance fees forced doctors to abandon individual practices and join together in groups. By the early 1970s, fewer than 1 percent of doctors made house calls. -Huffpost Healthy Living

3. Positive Factors of Doctors’ House Calls • Convenience • Doctor could observe patientin their own environment • Personal Touch • Everything was available in a black bag …But that’s when medicine was simpler…

4. Yesterday’s Physical Exam

5. Today’s Physical Exam Often includes: laboratory tests chest x-rays pulmonary function testing audiograms full body CAT scanning EKGsand/or heart stress tests vascular age tests urinalysis mammograms or prostate exams depending on gender

6. Medicine Today • Shorter physician visits • Greater pharmaceutical dependence • Decreased trust in physicians • Longer waits in ER and doctors’ offices • Shorter acute care stays • More frequent readmissions

7. From ‘Cure and Fix’ to ‘Health and Wellness’ The shift in medicine over the decades has been one from reactive to proactive. A cure and fix approach means to target what is wrong with a patient’s body. (Reactive) A Health and Wellness focus is on the patient’s total person. (Proactive)

8. ‘Reactive’ Model of Medicine Reactive medicine has the diagnosis or disease at its core Diagnosis

9. ‘Reactive’ Model of Medicine Doctor Visit D I S E A S E Temporary Fix Problem Change in condition

10. ‘Reactive’ Tendencies Following the emergency is when we tend to make changes that affect a better outcome: - Heart attack leads to healthier dietary choices and more exercise - COPD diagnosis contributes to decision to quit smoking - Car Accident leads to a re-evaluation of ability to drive safely - High stress indicates need for better self care - Family medical emergency invokes examination of advance directives - A fall and subsequent orthopedic fracture often expedites a change in living environment - Medical complications as a result of taking too many medications leads to a better medication management system

11. ‘Reactive’ Tendencies While these choices often lead to an improvement in quality of life, a notable disparity occurs when applying the reactive model of care to the prevention and management of chronic conditions. The truth is, many diseases and undesirable health outcomes can be prevented, yet our current health care system is only now making better use of its resources to support this process. Dr. Natasha Zamalowski ND - Proactivehealthcare

12. Proactive Care – The Health and Wellness Model The wellness model that people adhere to today moves beyond that traditional notion of health and wellness as being the mere absence of disease, to the holistic blending of all levels of patient functioning. Physical Emotional Psycho- logical Spiritual

13. Proactive Health Care PROACTIVE HEALTH CARE is inherently different from reactive health care for acute problems because it offers step by step, self implemented changes (accountability) that provide the satisfaction of knowing you are doing everything you can to live the best life possible for yourself and your family.

14. The Evolution of Patient Accountability • The fallacy of Long Term Care policies • The Hospitalist model • The competitive Senior Resource market • The era of Advance Directives • The pharmaceutical disconnect • The caregiver’s myth

15. Health and Wellness • Accountable • Assertive • Resourceful • Preventative The New AARP

16. The Question The Challenge is: How do you promote a higher degree of patient accountability without enabling patients themselves?

17. The Answer • EDUCATION and • PARTICIPATION Active Engagement in Health and Wellness programs is the secret to proactive medicine and patient accountability. Sun Health is an organization in the NW Valley whose mission supports providing answers to people looking for proactive healthcare programs.

18. Who is Sun Health Today?

19. Who is Sun Health Today? 3. Champion of Healthy Living - Sun Health Community Programs • Care Transitions hospital discharge program • File of Life/Vial of Life • Medication Management Program • Memory Care Navigator Program

20. 1. Sun Health Care Transitions Program

21. Sun Health Care Transitions Program Program Description • RNs and LPNs follow patients for 30 days post discharge • Medicare beneficiaries with CHF, AMI, PN, COPD, arrhythmias, CABG and other heart surgery, diabetes, stroke, hip fracture or other high risk orthopedic conditions • Education and self-management program based on the Coleman Care Transition Intervention® program and CTI’s “four pillars”

22. The Four Pillars 1. Patient is knowledgeable about medications and has a medication management system. 2. Patient understands and utilizes the Personal Health Record (PHR) to facilitate communication and ensure continuity of care plan across providers and settings. 3. Patient schedules and completes follow-up visit with the primary care physician or specialist physician and is empowered to be an active participant in these interactions. 4. Patient is knowledgeable about indications that their condition is worsening and how to respond.

23. Sun Health Care Transitions Program Program Description (continued)

24. Sun Health Care Transitions Program • Reinforce patient education, including self-management of chronic condition and “red flags” • Medication reconciliation, up to date list created using SunHealthMeds.org • Physician follow up visit • Personalized plan of care in health record binder • Referrals for other helpful community services

25. Sun Health Care Transitions Program Outcomes as of 2/28/13

26. Sun Health Care Transitions Program Outcomes as of 2/28/13

27. Sun Health Care Transitions Program Outcomes as of 2/28/13

28. Sun Health Care Transitions Program Outcomes as of 2/28/13

29. 2. Sun Health Medication Management Program

30. Medication Issues: The Statistics • 48 percent of older adults living at home suffer from medication-related problems (The Annals of Pharmacotherapy) • More than 2 million emergency room visits annually are related to adverse drug reactions (Drug Abuse Warning Network) • Poor adherence to medication plans account for 125,000 deaths each year (Center for Health Transformation)

31. Medication Issues: Not Me! • Do you have more than one physician who prescribes medications? (54% of seniors) • Do you have your prescriptions filled at more than one pharmacy? (35% of seniors) • Have you been recently hospitalized? Multiple physicians, multiple pharmacies and recent hospitalizations put you at risk for medication issues such as duplications and interactions!

32. Medication Issues: Not Me! • Do you sometimes forget to take your meds? • 75% of Americans report not always taking their prescriptions as directed, which can lead to: • Unnecessary disease progression • A lower quality of life • Reduced functional ability • Increased disease complications

33. Medication Issues: What can Sun Health Offer? • Community Education • Medication Safety Awareness • Medication Adherence Awareness • Medication Therapy Information • Tools to Improve Medication Adherence

34. Medication Adherence • Patients want information on prescriptions including why it was prescribed, the duration of the prescribed therapy, and what happens if they don’t take prescribed medication. • Healthcare professionals communicate inconsistently about prescriptions, spending an average of 49 seconds to discuss a new prescription. Source: Merck, 2009.

35. Medication Adherence 83% of patients reported they would never tell their provider if they did not plan on buying a prescribed drug 74% of physicians think their patients are taking their medicine correctly DISCONNECT Source: Merck, 2009.

36. Medication Adherence 2-Way Communication PHYSICIANS PATIENTS Source: Merck, 2009.

37. My Medication Profile My Personal Pharmacist Sun Health Medication Management • Free online secure medication profile • Pharmacist consultations and review of personal medication profile Program Components

38. www.SunHealthMeds.org

39. My Medication Profile

40. My Medication Profile Maintain a list of your medications, including pictures, instructions, and purpose for each medication. Set up text and email reminders so you never forget to take your medications. Add your healthcare provider and health insurance information for quick access.

41. My Personal Pharmacist Review Includes: • Potential safety issues such as drug-drug or drug-disease interactions • Duplicate therapies • Drug doses that fall outside the normal therapeutic range • Cost-savings opportunities • Adherence to national treatment guidelines • Opportunities to improve medication adherence • Patient education opportunities

42. My Personal Pharmacist • Comprehensive medication review by a pharmacist • Phone consultation/discussion between participant and pharmacist to discuss recommendations • Communication with physician(s) outlining medication recommendations and/or alerts • Continued access to pharmacist for questions and concerns, 24 hours a day, 7 days a week.

43. My Medication Profile My Personal Pharmacist Sun Health Medication Management • FREE • $120 per year Program Costs

44. 3. VIAL OF LIFE / FILE OF LIFE PROGRAM

45. VIAL OF LIFE / FILE OF LIFE • In your home • Recognizable standard in our community for years • Away from home • Use while traveling • Can hold additional useful forms such as advance directives

46. Vial of Life • Contains a preprinted Emergency Medical Information form and an orange notification cling • Fill out the form, insert in Vial and place Vial in refrigerator in visible location • Remove orange “V” cling from backing paper and attach to front of refrigerator or an outside window to notify emergency personnel that Vial of Life is inside

47. Emergency Medical Information Form Form does not include SSN, address or insurance ID #

48. File of Life • 2 GB capacity with 3 preloaded forms: • Instructions • Emergency Medical Information Form • Life Care Planning Packet (from the Arizona Attorney General) • Self-closing to protect USB port • Includes a lanyard

49. Emergency Medical Information Form • On the File of Life, this form is in a “fillable PDF” format that you can type on and save. • Requires free download of Adobe Reader® if you don’t already have this program. • Collects key information that is helpful in the event of an emergency: • Physicians • Medications • Emergency contacts • Medical conditions

50. What Else Can I Put on My File of Life (optional)? • Emergency medical info for family members • Photo • Key medical results such as recent labs or medical imaging reports, especially if you are being treated for a chronic condition. These may be scanned/saved on the flash drive. • If your physician uses an electronic medical record, they may have the ability to provide you an electronic Continuity of Care Document (CCD) that summarizes your most recent visit, medications and tests. Ask your physician.