Joint presentation with Dr. Dorothy Thayer for Wellness council of Maine

1. Dorothy Thayer, MD
Medical Director, Primary Care
Denise Dumont-Bernier, PT
Director, Workplace Health
Breakout Session 2:
Putting evidence into practice and maximizing outcomes in the workplace.

2.  The Right Care
No care, self-care, emergency care, primary care,
specialty care, occupational health care, complementary
care, community health program, palliative care
 The Right Time
now, today, few days, few weeks,
as scheduled, whenever, never
 The Right Place
◦ home, work, emergency department,
hospital, medical office

3.  Knowing:
◦ When to seek emergency care
◦ When and how to treat yourself at
home
◦ Your primary care provider
◦ When to see your provider or
contact provider’s office
◦ What preventive care services are
recommended
◦ Your healthcare preferences
◦ Your healthcare options

4.  Difficulty breathing
 Sudden or severe pain
 Chest pain
 Sudden weakness or trouble talking
 Sudden confusion or change in mental status
 Uncontrolled bleeding
 Large open wounds
 Sudden change in vision
 Severe head injury
 Suicidal
 and more

5. Uncertain or infant/young child?
 Call your PCP office for advice
Ambulance?
 If you think the medical condition is life-
threatening or the person's condition will worsen
on the way to the hospital, call 9-1-1 for an
ambulance.

6.  Illnesses
◦ Colds, Flu, Cough
◦ Backache
◦ Constipation
◦ Allergies
◦ Headache
◦ Fever
◦ Heartburn
◦ Nosebleeds
 Injuries
◦ Sprains & Strains
◦ Cuts and bruises
◦ Insect bites
◦ Animal bites
◦ Burns
 Online:
◦ Mayoclinic.com
more information
◦ Familydoctor.org
>healthy living > first aid
or search by topic
very basic
◦ Uptodate.com/patients
lots of detail
 Various printed self-care
guides

7.  Chronic disease:
symptoms and
exacerbations
◦ Asthma
◦ Diabetes
◦ Heart disease
◦ Arthritis
◦ Back pain
◦ Chronic pain
◦ Anxiety
 Chronic care self-
management
◦ Asthma Action Plan
◦ Diabetes Sick Day Plan
◦ Classes
◦ Special clinics
◦ Provider office care manager
◦ Insurance care manager

8.  Ideal Primary Care
◦ First contact for each episode
of care
◦ Continuity and Longitudinal
◦ Comprehensive
◦ Coordinated Care
 Primary Care
◦ Physicians: MD and DO
◦ Nurse Practitioners: family, pediatric, adult, geriatric
◦ Physicians Assistants
◦ Challenges: workforce shortage; payment issues; “designated”
PCP
◦ Promising: national recognition, Healthcare Reform, Patient
Centered Medical Homes, Accountable Care Organizations

9.  Persons who receive more “ideal” primary care services:
◦ Are hospitalized less frequently
◦ Are readmitted to hospital less
◦ Use the Emergency Room less
◦ Have lower healthcare costs
◦ Have lower morbidity and mortality
◦ Are more satisfied with their healthcare
 Learn about your primary care team/office
◦ Other staff, services, hours, on-call coverage, etc

10.  Urgent medical question or problem
 Evaluation of new concern
 Preventive health services
 Recommended follow-up chronic
conditions
◦ Monitor status and medications
◦ Learn ways to improve health status
 Follow-up care after seeing consultant
◦ to discuss options and to implement choices and
coordinate services
 Follow-up care after visit to emergency room
 Follow-up care after hospitalization

11.  Preventive health services—
◦ includes exams, tests,
discussion
◦ not the same for everyone
 Recommendations change with age, sex, family history,
personal medical history
 Recommendations change with personal behavior:
sexual, tobacco, alcohol, drugs
 Public health experts do not always agree!
What preventative services are
recommended?

12.  USPSTF: United States Preventive Services Task
Force; healthfinder.gov < myhealthfinder
 American College of Physicians
 CDC: Centers for Disease Control (especially
immunizations and infectious disease)
 American College of Cardiology
 American Cancer Society
 Your insurance company
 Your provider
What preventative services are
recommended?

13.  Evidence based medicine is the conscientious, explicit,
and judicious integration of current best external
evidence with clinical expertise in making decisions
about the care of individual patients.
 Evidence-based guidelines use evidence-based
medicine to produce guidelines, policy, and regulations.
And where is the patient/employee in this?
"Evidence based practice is an approach to
decision making in which the clinician uses the
best scientific evidence available, in
consultation with the patient, to decide upon
the option which suits the patient best."

14.  What matters to you? Why?
◦ provider’s recommendation, maximum function, minimum
pain, lost work time, longevity, avoiding contact with
healthcare system, complementary treatments, location,
expertise, cost, quality, family input and considerations
 What are your options?
◦ Risks, benefits, side effects, cost, lost work
◦ Exercise, losing weight, quitting smoking
◦ “Watchful waiting,” surgery, medication, palliative care,
hospice

15. By encouraging better health care
consumerism
How Can Employers Impact
Healthcare?

16. Why should it matter?
 In 2006, health care in the U.S.
totaled $1.99 trillion, almost 16% of
the GDP
 Companies paid an average of $8,748
per employee, a 62% increase since
2002
 (Towers Perrin, 2007)
 Many consumers use the system
inappropriately

17.  55.4% of ER visits are for non-
urgent conditions
◦ Headaches, sore throats, stubbed toes
 (CDC & Prevention, 2006)
 The average ER visit costs 5-6 times more than a
visit at the physician's office
 It is estimated that 25% of physician office visits
(228 million) are unnecessary
◦ At $60/visit, a great deal of money is spent unnecessarily
 (National Hospital and Ambulatory Care Surveys, US. DHHS,
2006)

18. What Can Employers do?
Design Benefits Plan to Motivate
Positive Health Choices
 Patient Centered Plans
◦ Employees control spending
◦ Health Savings Accounts
◦ Health Reimbursement Accounts
 Discourage ED visits with higher co-pays
 Encourage preventative care by covering 100%
 Reduce pharmaceutical co-pays for chronic disease
meds
 Higher Deductibles
 Integrate Wellness Rewards/Incentives

19.  Health Risk Appraisals (HRAs)
 “Know Your Numbers”
◦ On-site screenings
 Personalized Health Coaching
 Wellness Team
 Challenges & Activities that
motivate
 Supportive Environment
 Reward and recognize success
What Can Employers do?
Implement a Results Oriented
Wellness Program

20. What Can Employers do?
Advocate for PCP Relationships
 Know which practices in the
area are taking new patients
 Establish relationship with PCP
for when it may be needed
 Develop history with PCP
 Reward employees for seeing their primary care
physician
 Reward employees for getting age appropriate
preventative screenings

21.  Direct efforts to employees & spouses/dependents
 Newsletters
◦ (from employer or health plan)
 Self-care guides
 Home mailings
 Educational Seminars
 Internet Resources
 Videotapes-lending library
 On site health coaches
 Chronic care management
◦ Living Well Series
What Can Employers do? Promote
Medical Self-Care and Consumerism

22.  Tobacco free workplaces
 Encourage Physical activity
◦ Encourage stairway use
◦ Walking routes/paths
◦ Stretch Programs
◦ Bike Racks
 Healthy meetings/food options
◦ Vending machines/cafeterias
◦ Nutrition info at point of purchase
 AEDs
 Designated Areas
◦ Breastfeeding, diabetes self-care, stress reduction
What Can Employers do?
Create healthy workplace policies

23. Create A Workplace Culture
That Supports And Guides
Positive Health Behaviors

24.  Controls rising health care costs
 Reduces absenteeism
 Increases productivity
 Increases patient satisfaction,
empowerment and sense of
control
 Improves quality care
 Improves health
 Reduces health risks

25. QUESTIONS?
Thank You
Feel free to contact us:
denise.dumont-bernier@mainegeneral.org
W: 207-626-7250
C: 207.242.3924
Questions?