By Glenn Robinson

When you think of patient care, doctors and nurses are usually at the forefront of everyone’s mind. However, hospitals are increasingly utilizing supplemental programs in addition to the excellent care provided by their clinical staff to fulfill their mission of caring for “the whole patient.”

This month, we take a look at three lesser-known roles in health care that are just as vital to the patient experience and road to recovery as that of a physician or nurse.

Patient Navigators

If you’re going on a long journey to somewhere you’ve never been before, the best bet to get to your destination is being aided by navigation. The care process for a terminal disease or chronic illness is often described as a journey – physical, emotional, and spiritual – so one of the ways many health systems are making the road to survivorship easier is by offering patient navigation.

A patient navigator is a partner for patients and families from the time of the initial diagnosis and throughout their journey – wherever that may lead. A patient navigator strives to help patients make decisions and find their way through the complexities of the healthcare system so they can focus on recovery.

Navigators connect patients with resources and information to help them better understand their diagnosis and treatment options. They can also help remove barriers, whether they be financial or practical – like transportation to and from appointments.

Additionally, patient navigators serve as personal advocates to help ensure patients are receiving high quality care and have all the answers they need… even if it means challenging the status quo.

Another critical job of a patient navigator is to provide emotional support. Patients sometimes have a hard time expressing their fears and sadness even to their closest loved ones, so a navigator can be that listening ear.

On the road to survivorship, to some patients, the help and support navigators provide may be as important as the caregivers delivering the treatment. 

Community Health Workers

Community health workers have emerged as an effective strategy in engaging patients and caregivers in lowering costs for healthcare’s “frequent flyers” – patients who often visit emergency rooms and fill hospital beds.

Community health workers have been part of healthcare worldwide for decades. They generally are not doctors or nurses, and often are recruited directly from the communities they serve. Their purpose is to help individuals navigate the healthcare system, manage chronic illnesses more effectively, and access preventive care.

They also help patients tackle important health-related issues such as food and housing insecurity. Community health workers often serve people in impoverished communities who lack access to quality healthcare, lack the means to pay for healthcare, do not speak English fluently, or have cultural beliefs, values, and behaviors that differ from those the traditional U.S. healthcare system is geared towards.

New research suggests these workers may contribute to fewer days in the hospital for some patients. Patients with help from a community health worker were nearly twice as likely to report receiving high-quality primary care and spent fewer total days in the hospital.

Recognizing the value of these individuals, the Texas Department of State Health Services has a community health worker certification program to develop these dedicated individuals’ communication and navigation skills, as well as their knowledge of available community resources. 

Though typically not clinicians or administrators, community health workers are playing an increasingly important role in healthcare quality and cost. 

Volunteers

Often known as candy stripers in the past, today, hospital volunteers are a diverse group of men and women of all ages who perform a wide range of functions.

Volunteers are vital members of the community and the hospital team who share their time, talents, and passion for helping others, while either directly or indirectly making a difference in the lives of patients and families. 

There are many different roles for hospital volunteers. Some oversee the hospital information desk and provide directions and a warm smile to patients and visitors.  Others deliver flowers and packages to patients, run the gift shop, or perform a full range of back-office administrative tasks so other staff can keep their focus narrowed in on patient needs.

Many hospitals also have special volunteer programs. For example, pairing former patients who have successfully overcome a serious condition, such as heart disease or cancer, with patients who are now on that same journey. Or even more innovative programs like volunteers who share their musical or artistic talents with patients as a form of therapy. There are even animal-assisted therapy volunteer programs at some hospitals in which four-legged volunteers join their two-legged team members to bring smiles to patients’ faces.

Programs like these have been shown to raise the spirits of patients and can contribute to a better patient experience. But volunteers also benefit. Research has demonstrated that volunteers are often healthier, happier people.

Hospital volunteers truly create a win-win-win situation – for themselves, for patients, and for the hospital.

Glenn Robinson is the President of Baylor Scott & White Medical Center – Hillcrest. He has over 30 years of experience in hospital and health care management, and currently serves on several Boards associated with the Texas Hospital Association and the American Hospital Association. In addition, Glenn is Past-Chair and an active member of the Greater Waco Chamber of Commerce, and serves on the Prosper Waco Board.

The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email [email protected] for more information.

By Glenn Robinson

Cancer is now the leading cause of death in the United States and globally.  Few among us have not already been touched by cancer in some way, whether it be ourselves, someone in our family or dear friends and colleagues.  With that in mind, the following are a few notes on cancer care that will hopefully be helpful if cancer becomes a part of your life.  

Cost

According to a study in The American Journal of Medicine, cancer forces 42 percent of patients to exhaust life savings in two years. It is expensive to treat, with patients facing potential surgeries, chemotherapy, and radiation treatments – in addition to expensive imaging tests. There are hospital stays, multiple doctor appointments each month, and many tests… not to mention the high cost of cancer-fighting medications, or income lost from missing work.

A recent study found that cancer patients, on average, are more than twice as likely to declare bankruptcy as those without cancer. Should you or a loved one face a cancer diagnosis, here are steps that may reduce some of the financial burden:

1. Talk to your health insurance company and make sure you understand deductible and copay requirements.
2. Take someone with you to doctors’ appointments who is not afraid to bring up the cost question on your behalf, if necessary.
3. Tell care providers that cost is a potential issue.
4. Discuss therapy options – and their cost – with your provider. Beyond choosing a lower cost therapy, avoiding low-value tests and procedures can save a lot of money.
5. Consider hiring a financial counselor to help guide the family through this aspect of care.

Following these steps can help patients focus less on finances, and more on getting better.

Alternative Therapies

Nearly four in ten Americans believe that cancer can be cured solely through “alternative” therapies, such as oxygen therapy, diet, and herbs – according to a survey by the American Society of Clinical Oncology.

Many in the medical community were shocked by this finding and the danger it represents. A 2018 study underscores the danger, finding that patients with cancer using alternative medicine were more likely to decline potentially curative conventional cancer treatment, thereby increasing risk of death.

The National Institutes of Health has declared that no alternative health product or practice – such as acupuncture, chiropractic medicine and herbal medicine – has been proven to cure cancer. While these services may help patients manage cancer symptoms and side-effects from treatment, relieve stress, and improve quality of life, they are not a cure.

Patients facing cancer must keep in mind that delaying conventional cancer treatment can decrease the chances of remission or cure, and that using unproven products or practices to postpone or replace conventional medical treatment may be a costly mistake.

Even if they don’t delay conventional care, some alternative therapies may interfere with cancer treatments or be unsafe for cancer patients. Anyone diagnosed with cancer should consult their cancer care providers before using any alternative therapy for any purpose — regardless of whether it’s cancer-related.

Alternative therapies often do have a role in cancer care. As part of an ongoing discussion, patients and their physician can determine which therapies are safe and supported by evidence.

Advanced Treatment Options

For decades, when it comes to treating cancer, there have been three main options: surgery, radiation, or chemotherapy. Often these treatments are used in concert with one another to rid patients of tumors and eradicate any traces of the disease.

While these will likely remain staples of cancer care for the foreseeable future, a host of new advanced treatment modalities are coming online and are expected to expand the cancer care toolbox.    

One is immunotherapy, which looks for ways to bolster the body’s immune system to prevent the spread of cancer. Some cancers take hold and spread throughout the body because they aren’t susceptible to the body’s immune response and even develop immunity to chemotherapy drugs and radiation. Immunotherapy attacks the cancer’s defenses, potentially allowing for effective treatment.

A related field of cancer study is therapeutic viruses and dendritic cell vaccines. These are biological agents, engineered in a lab, capable of seeking out and destroying cancer cells while leaving healthy tissue alone.

Another exciting development in cancer research involves nanoparticles. This advanced, microscopic technology can be used to more precisely target cancer cells in multiple ways without harming normal cells. For instance, nanoparticles can deliver heat to tumors to shrink them, or be loaded with medication and sent to hunt down cancer cells.

There may never be one silver bullet to cure cancer, but rapid progress on many fronts hopefully will someday lead to its demise.       

Glenn Robinson is the President of Baylor Scott & White Medical Center – Hillcrest. He has over 30 years experience in hospital and health care management, and currently serves on several Boards associated with the Texas Hospital Association and the American Hospital Association. In addition, Glenn is Past-Chair and an active member of the Greater Waco Chamber of Commerce, and serves on the Prosper Waco Board.

The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email [email protected] for more information.

By Glenn Robinson

One of the hallmarks of the information age economy is consumerism – in this instance, defined as businesses making their goods and services more convenient, affordable, or otherwise desirable to customers.

For years, virtually every segment of our economy has embraced this trend… except healthcare. At least until recently. Increasingly, healthcare consumers are expecting that their experience with healthcare providers mirror the experience they have with some of the world’s top brands.

This rise in healthcare consumerism will continue according to a recent brief by Rice University’s Baker Institute for Public Policy. Not only have consumer expectations and experiences with other industries helped drive this trend, but so has the increasing popularity of high deductible health plans and incentives offered to those covered to make cost-effective choices.

In other words, as the financial burden of healthcare decision-making shifts to patients, patients are more apt to become more conscientious and expect more out of those rendering healthcare services.

This trend towards healthcare consumerism has already led to many noticeable changes in industry practices. The growing number of convenient walk-in clinics and the introduction of telemedicine are manifestations, as is the increasing focus healthcare providers put on patient experience surveys and online reviews. An entire cottage industry has grown up around healthcare design and construction to make the care environment more warm, welcoming, and comfortable.

However, one big obstacle still remains to true healthcare consumerism – pricing transparency.

It’s a complex issue, but one many organizations are working to solve. 

You know having a health insurance policy is important, but equally as important is understanding what is in the policy so you can plan accordingly. Unfortunately, much of the language used in health insurance plans isn’t part of the everyday vernacular.  With that in mind, here are some common terms and what they mean.

A premium is the amount of money you or your employer pays monthly or annually for your health insurance.

The deductible is how much you must pay out of pocket before your insurance starts to pay. Keep in mind, though, many preventive health services don’t require you to pay a deductible.

Co-insurance is how much you must pay out of pocket even after meeting your deductible. For instance, 80/20 co-insurance means you’re still responsible for paying 20 percent of charges.

This is different from a co-pay, which is a flat fee – for example 20 dollars – you might have to pay for a doctor’s visit. 

Maximum out-of-pocket expenses are the most amount of money you will be required to pay per year for deductibles and co-insurance.

The term covered expenses refers to what medical services or prescriptions are or aren’t paid for by a plan.

Beyond these terms, if you don’t understand something about your plan, how it works, and what it covers, you can call the toll-free number on the back of your health insurance card. Most reputable insurance companies have staff trained to explain the ins and outs of every policy.

Most Americans appear to believe: your health is your wealth. While wealth sometimes can create its own problems, health inevitably is a source of happiness… and the value of health increases with age, usually surpassing the importance of wealth.

If you had a choice, would you spend your time striving for health or wealth? A majority of Americans pick health, according to a survey by TD Bank. The company surveyed over 1,000 U.S. consumers who made a 2018 New Year’s resolution.

The top goal of respondents was to eat better, with 54 percent citing it as their priority. The top financial goal was to save more and spend less, with 39 percent selecting it as a priority. Millennials – young adults between ages 22 and 37 – said eating healthy and getting in shape or staying fit is more important than saving more and spending less money.

Health and wealth are not mutually exclusive. About 41 percent of those who indicated they were satisfied with their financial health are more likely to be satisfied with their physical health, emotional health, and family well-being.

People with good health are more likely to have the energy and stamina to excel in the workplace, and they are less likely to spend time and effort dealing with the debilitating effect of chronic health conditions and disabilities.

Although most respondents said they are less confident they will achieve their goals to get in shape, they are more likely to seek advice for financial issues. Health typically is something that you earn if you are persistent and disciplined – it cannot be bought.

 This report, and other episodes, are available at KWBU.org. 

Glenn Robinson is the President of Baylor Scott & White Medical Center – Hillcrest. He has over 30 years of experience in hospital and health care management, and currently serves on several Boards associated with the Texas Hospital Association and the American Hospital Association. In addition, Glenn is Past-Chair and an active member of the Greater Waco Chamber of Commerce, and serves on the Prosper Waco Board.

The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email [email protected] for more information.

By Glenn Robinson

When it comes to technology that makes our lives better, the trend has been smaller, faster, and better. When it comes to next generation medical procedures being rolled out nationwide, that trend has largely been mirrored.

Procedures that once took hours, now may take only minutes. Procedures that once involved long, unsightly incisions, are now being conducted with tiny tools that may only require an incision the size of a razor nick.

Perhaps nowhere have these advancements been more pronounced than in heart care and orthopedic medicine. Take, for example, procedures to repair or replace damaged valves in the heart. Ten years ago, these procedures often involved major invasive surgery, a week or more in the hospital, and months of recovery.

Today, many of the nation’s leading heart programs – including right here in Texas – offer solutions for certain valve problems that are so minimally invasive, qualified patients can leave the hospital in as little as one day and be fully recovered within a matter of weeks.

Similarly, major orthopedic procedures, particularly in the field of joint replacement, have come a long way since the turn of the century. Advances in pre-procedure imaging, artificial devices, and operational technique have led to artificial hips and knees that feel as good as the original with a fraction of the recovery time.

These and many other innovative procedures are creating better outcomes and giving more patients the opportunity to improve their quality of life. But how do scientific studies performed in labs turn into these actual medical treatments?

Translational medicine transforms basic scientific discoveries into innovative therapies for patients. This kind of research, often referred to as “bench to bedside,” seeks to implement evidence-based medicine safely, effectively, and as quickly as possible.

One of the most challenging aspects of translational medicine is gaining widespread adoption of new, evidence-based medical practices. It takes the complete commitment of an organization’s top management to recognize and reinforce the importance of this kind of research and its comprehensive, consistent application.

Many leading health care organizations are represented through research institutes, which facilitate translational medicine. These institutions focus on basic science, clinical trials, and healthcare quality-of-care research. They seek to understand the basis of a disease, identify potential treatments or preventive therapies, and enroll patients in research trials.

The institutes’ objectives are not only to make new scientific discoveries, but to implement research successes into community-based healthcare practices and then promote proven prevention and treatment strategies throughout the entire organization and greater healthcare community.

These institutes have been responsible for creating several novel therapies right here in Texas and have attracted millions in grants from U.S. and international government agencies to support important research efforts –  turning laboratory research into new standards of care for the entire industry.

Another new trend in the world of research is the use of artificial intelligence, or A-I. A-I can solve complex problems that exceed human capabilities. Through its ability to access vast troves of data, A-I algorithms can both exceed the knowledge of experts, and augment the abilities of non-experts.

A-I already is disrupting transportation, marketing, and financial services, among other sectors of the economy. In healthcare, this technology is gaining momentum and has the potential to significantly alter the industry not only by developing new treatment options, but also by streamlining back office operations.

As care providers look to better engage patients and improve efficiency, many are turning to artificial intelligence to help them succeed. A-I powered medical assistants can book appointments, remind patients to take their pills, monitor a patient’s health status, and perform other time-intensive tasks.

A survey of health consumers found 55 percent are willing to engage with A-I and robots for healthcare needs. At a recent South by Southwest conference, Mark Rolston of Argo Design said artificial intelligence and virtual reality will be important parts of healthcare’s future.

Likewise, Oscar Salazar, of the app Pager, said that A-I gives nurses “superpowers.” He predicts that A-I increasingly will take over decision-making for healthcare triage and diagnosis, dramatically changing the roles of healthcare professionals.

Don’t expect your doctor to be going away anytime soon though. Like many technologies, A-I works best when paired with smart, capable people.

 This report, and other episodes, are available at KWBU.org. 

Glenn Robinson is the President of Baylor Scott & White Medical Center – Hillcrest. He has over 30-years of experience in hospital and health care management, and currently serves on several Boards associated with the Texas Hospital Association and the American Hospital Association. In addition, Glenn is Past-Chair and an active member of the Greater Waco Chamber of Commerce, and serves on the Prosper Waco Board.

By Glenn Robinson

Pop quiz. Are the Baby Boomers – people born between 1946 and 1964 and now entering their retirement years – more or less healthy than previous generations? The assumption has long been that they are.

Not only has Americans’ life expectancy increased in recent decades, we also are healthier later in life. Since the early 1990s, the average 65-year-old has gained an extra nine months of life expectancy, but gained a full year of disability-free life on average. Research bears out that the change in disability rates has been substantial. In the early 1980s, one in four elderly people had difficulty living independently. Today, there are fewer than one in five.

In addition, despite a major increase in the number of elderly in our country, the nursing home population today is virtually the same as it was two decades ago – yet another testament that the health of the population is improving, even as more people live to older ages.

David Cutler, an economics professor at Harvard University who researches disability, has reached the conclusion that people in general are in much better health right up until the last year or two of life. This is in stark contrast, he says, to previous generations in which people spent their final six or seven years of life being very sick and in and out of the hospital.

Boomers were the first generation to have greater access to healthcare and services such as regular immunizations, preventive care, and widespread use of antibiotics. They also grew up in a generally prosperous economy, and many benefitted from greater educational and employment opportunities compared with earlier generations.

All these factors positively correlate to being healthier. Research comparing Baby Boomers with people from two decades ago in the same age bracket also shows that Boomers are healthier in some important ways, including being less likely to have emphysema or suffer heart attacks.

Two critical factors have played a vital role in dropping mortality rates from heart disease. First is the slow and steady decline in smoking rates over the past half-century, which is a critical risk factor for heart disease. According to the Centers for Disease Control, in 1965 more than 42 percent of adults smoked. By 1993, that number tumbled to 25 percent, and, as of 2015, only about 15 percent of adults were smokers.

While the decline in smoking is a big win for public health, the advancements in detection and treatment of heart disease is the major success story in medicine over the past two decades. From blockbuster new cholesterol and blood pressure medications being given more often to the right patients at the right time, to groundbreaking new imaging heart technologies and minimally invasive procedures straight out of a science-fiction novel, the medical advances to manage all facets of heart disease are perhaps unparalleled in medicine.

This may all paint a bright picture, but many of these positives are offset by the negative impact of weight-related health problems. The proportion of Baby Boomers with diabetes, high blood pressure, and obesity is increasing, so the answer to whether or not Baby Boomers overall are healthier than previous generations is somewhat mixed.

One solution to this lies in the concept of preventative care.

Nine out of 10 pet owners know when their dog or cat is due for their shots. Eight in 10 mothers know their child’s sports schedule by heart, and 80 percent of men know how often they should have their oil changed. Yet only 50 percent of family health care decision makers know their blood pressure, and only 20 percent know their own key biometric numbers such as cholesterol and body mass index.

While Americans are great at preventive care for their pets and cars, it appears that is not the case when it comes to their own health. This issue puts pressure on the entire health care system because the old adage, “an ounce of prevention is worth a pound of cure,” holds true to this day.

Preventive care such as regular check-ups and practicing a healthy lifestyle help individuals avoid or delay disease. It also can help people catch a health problem early on, when it is most treatable. The Affordable Care Act requires new private health insurance plans to fully cover the costs of 45 recommended preventive services. This means patients pay no deductibles or copayments, or otherwise share costs of these services.

Unfortunately, a Kaiser Family Foundation poll found that less than half of Americans were aware of the change, meaning many people may be avoiding preventive care out of cost concerns. To make sure you’re not one of them, take advantage of these preventive services when you go in for your annual check-up.

For all the challenges surrounding health care in America, this is one of our healthcare system’s good-news stories.

This report, and other episodes, are available at KWBU.org. 

Glenn Robinson is the President of Baylor Scott & White Medical Center – Hillcrest. He has over 30 years of experience in hospital and health care management, and currently serves on several Boards associated with the Texas Hospital Association and the American Hospital Association. In addition, Glenn is Past-Chair and an active member of the Greater Waco Chamber of Commerce, and serves on the Prosper Waco Board.

The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email [email protected] for more information.

By Glenn Robinson

Health care is among the most heavily regulated industries in America – virtually every aspect of the health care system is subject to government oversight.

There are regulatory mechanisms to supervise the doctors and professionals who render care; the institutions in which care is provided, such as hospitals and clinics; the medications and medical devices that are the tools of care; and the insurance coverage that finances it all. These regulations are developed and implemented by all levels of government — federal, state and local — as well as private organizations.

Everyone in health care agrees that regulations and standards are necessary to ensure compliance and to provide safe health care to every patient. Policy debates, for the most part, typically focus not on whether oversight should exist, but rather on how it should be structured. Impartial, external oversight is considered necessary to protect the public interest – even by those who are especially suspicious of government bureaucracy.

American health care has flourished over the past 100 years. Rather than hindering its progress, the complex system of government regulation actually may have served to support and nurture it.

Consider, for example, the public confidence engendered in the competence of physicians through licensure requirements and in the safety and effectiveness of prescription drugs through the Food and Drug Administration’s approval process.

Another form of regulation is known as HIPAA. At some point while filling out a bevy of forms at the doctor’s office, you may have run across this term.

The Health Insurance Portability and Accountability Act, or HIPAA, was passed by Congress in 1996 and was intended to improve health care efficiency by standardizing electronic data exchange and protect the privacy of patient records.

Since 2010, as part of national health care reform, there has been increased urgency in transitioning to digital versions of patients’ paper charts called electronic health records, or EHRs.

EHRs can contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, test results and more. But they’re not just a replacement for paper charts.

Part of what makes EHRs so powerful is that they also allow doctors and other care providers to access evidence-based tools that can be used to make decisions about a patient’s care in real time.

Another key advantage of EHRs is convenience. Health information can be created and securely managed digitally by authorized providers and shared with other providers at other locations.

This helps cut down on the number of forms patients must fill out and can eliminate the need for duplicate testing, as well as promote legible, complete medical documentation for streamlined coding and billing.

With all this information available to be shared with the touch of a button, precautions must be taken to ensure the privacy of the patient. As EHRs continue to evolve, so must our regulation of them.

The HIPAA law’s privacy standards strive to give patients rights over their health information, and set boundaries on who can receive a patient’s personal health information. Those who must follow the law include healthcare providers such as hospitals, doctors and nurses, pharmacies, insurance companies, and government programs such as Medicare and Medicaid.

The law limits the use of patient information by health care providers to specific purposes. Patient information can only be shared if it is necessary to coordinate treatment, pay providers for patient care, protect public health, assist police in criminal investigations, or assist family, relatives or friends responsible for care or paying medical bills – unless the patient objects.

HIPAA also requires healthcare providers to inform patients how they may use and share their health information, and grants certain rights to patients regarding their health information,  such as receiving copies of their health records upon request and being informed if their health information is being used or shared.

If you are ever concerned that your personal health information is being improperly used or shared, you have the right to file a complaint either with the federal government or your healthcare provider.

So while regulation may be seen merely as red tape in some industries; in health care, it provides a critical public protection.

This report, and other episodes, are available at KWBU.org. 

Glenn Robinson is the President of Baylor Scott & White Medical Center – Hillcrest. He has over 30 years of experience in hospital and health care management, and currently serves on several Boards associated with the Texas Hospital Association and the American Hospital Association. In addition, Glenn is Past-Chair and an active member of the Greater Waco Chamber of Commerce, and serves on the Prosper Waco Board.