More on Healthcare Reform and growth of Medicaid Business

We knew this would be coming! - Medicaid is poised to explode and the day after the healthcare reform vote, all the major players stocks were up (Amerigroup, Molina etc.)

http://www.reuters.com/article/idUSTRE62T4J920100330?type=GCA-HealthcareReform

Healthcare Reform: How will this effect how long we wait to see a doctor?

Inquiring minds want to know...catch this report from ABC!

http://abcnews.go.com/Health/HealthCare/health-care-bill-newly-insured-find-doctors/story?id=10211989

Wellness coaches target women's heart health

BY ROBIN ERB
FREE PRESS MEDICAL WRITER

Grief and stress can be vicious, sneaking up and pressing in on you when you least expect it.

Lori Uyttebroeck went from joking -- "I tell everyone I'm a 46-year-old jobless widow with no income" -- to tearful in the time it took her to try to apologize for it.

"I'm sorry. I didn't mean to. ... It's just that I once thought nothing could be worse than losing my job. Then my husband, he was diagnosed with pancreatic cancer."

Francisco Salazar -- a man who faxed her poetry at work and was forever trying to concoct the best chili and soup recipes -- was diagnosed just before Christmas 2008. He was gone by July.

For Uyttebroeck, a former administrative assistant with a rental car company, eating became mindless and exercise dwindled.

She credits a personal cardiac coach, Peggy Manchester, for helping her drop more than 30 pounds and, just as importantly, find a bit of tranquility in a life that had careened off-course.

A mix of life coach, personal trainer and counselor, health and wellness coaches like Manchester, 44, of Dearborn, help clients forge better health habits one small step at a time.

"You can't believe how many times she called and I was on the edge," said Uyttebroeck of Rockwood. "I had no control over anything, but Peggy reassured me: 'Give it time, and you'll get back on track.' "

A new mindset

It's tough to say how many coaches there are in the United States. It's a mostly unregulated industry and no one tracks the numbers. But a growing focus on wellness coaching marks a major shift in health care, said Ewa Matuszewski, CEO of Medical Network One. The Rochester-based physicians group has a Chronic Care Travel Team -- dietitians, diabetes educators, exercise physiologists, nurses and wellness coaches -- that meets with chronically ill patients.

"Physicians practices are moving from the 'I' approach to the 'we' approach," Matuszewski said. "It's not enough to dictate. You have to work with a patient and provide them direction, but also find out how willing they are to change. We're talking self-efficacy."

International Coach Federation, which claims more than 16,800 members worldwide, says the industry is growing overall -- whether in executive, leadership, life or business coaching. However, those who list health and wellness coaching as their specialty is still small -- an estimated 1% of the federation's members.

For those with certain chronic conditions, Blue Cross Blue Shield is covering the $75 per half-hour sessions with a wellness coach, Matuszewski said.

But about 25% of the time, clients who want to get their health under control shell out the cost out-of-pocket, said Margaret Moore, codirector of the Institute of Coaching at the Belmont, Mass.-based McLean Hospital, a Harvard Medical School affiliate that is helping develop a national curriculum for coaching -- bringing standards, research and credibility to the profession.

Those who choose to pay often are working women in their 40s and 50s who are feeling stretched to the brink, said Moore, whose company, Wellcoaches, began in 2000 and now trains more than 1,000 coaches a year.

Taking charge

Oakwood Healthcare, based in Dearborn, has teamed up with Ford Motor Co. Fund & Community Services in a five-year study into women's heart health using wellness coaches with specialties in cardiac care.

The 400 metro Detroit women involved are at risk for heart disease. Half are assigned one of three personal cardiac coaches and can choose exercise classes, nutrition programs and stress-management seminars. The other half are not.

All of the women are assessed periodically -- weight, body mass index, blood tests -- to see if there is a measurable difference between those who make lifestyle changes and those who do not. Ultimately, study leaders are trying to understand the best way to improve women's heart health.

And though the clinical numbers aren't in yet -- the first participants don't complete their part of the study until this spring -- there's anecdotal evidence that such coaching might be one way to help clients wrest control of their lives again.

"Women don't practice good self-care. They're wonderful caretakers for the rest of their family. It could be their parents, it could be their kids. A lot of women are taking care of their grandkids," said Carla Schneider, one of the cardiac coaches in the study. "To get those women to practice good self-care so they can be good caretakers is important."

In fact, even the study's coaches were "astounded" by how much stress their clients faced, Schneider said.

In addition to caring for their own children or grandchildren, many were caregivers for parents or siblings, had suffered recent deaths of loved ones, bouts with serious disease and job losses.

"So it was pretty hard to say, 'I want you to go out and exercise five times a week, 30 minutes a day, and I want you to eat healthy,' " Schneider said.

Moore, at the Institute of Coaching, has seen it over and over again: "You're stressed out so you eat badly. You don't sleep. You don't exercise. It's one tangled knot and you have to look at that in a holistic way. I don't mean a New Age-y, flaky way. But what is causing what and where do I start untangling it?"

And that's when a coach and client take the first baby steps together -- identifying stress triggers and major health issues, then moving into a plan that's realistic -- and "realistic" is the key -- for each woman.

Sure, there are exercise routines or nutritional goals.

But often it's also helping an overwhelmed client get control of clutter, going grocery shopping to offer insights into food choices, or even helping knock down mental roadblocks.

"It has a lot to do with your mental state. You don't know how bad you're feeling until you're feeling well," said Toni Yanowski, 59, a school bus driver from Brownstown Township, another study participant.

She knew about exercise and nutrition. But fast food drive-throughs helped break the boredom of long hours driving a taxi van and a school bus, and the resulting extra weight fed frustration. A bout with breast cancer sent her further off-course, and she quickly gained 40 pounds.

It was her coach, Schneider, who first saw the tell-tale blood-sugar numbers: Yanowski had also developed diabetes.

Schneider has since helped her develop a better eating plan. And Yanowski no longer sees the elliptical machine and treadmill in her windowless basement as chores to avoid; she instead drives to a brightly lit gym to Jazzercize with her daughter, burning off stress and pounds to the tunes of Madonna and Lady Gaga.

Feeling better

For Uyttebroeck, memories of her husband bring on fast tears.

But she finds catharsis in yoga and belly dancing and BOSU exercise classes. She's down about 30 pounds and is fitting into sizes she hadn't seen in years.

But one of her biggest victories has been in something that no one else would notice. Panicking at her unraveling life last year, she had begun obsessing over the numbers that had been creeping upward on her bathroom scale.

Manchester challenged her to put the scale aside for two weeks.

That was months ago. It's still tucked under a credenza in the hallway. Uyttebroeck said the numbers are now secondary to how she feels.

"I tell everyone that we all have grooves in life," she said. "I'm in the process of cutting new ones."

Market Shift : Sluggish economy, returning workers squeeze health care jobs.

By Laura Raines

Pulse editor

2:57 p.m. Wednesday, March 3, 2010

In April 2008, Mariana Jordan’s husband lost his job for the second time due to the slowing economy.

“The next day, I got up, got dressed and headed out the door,” said Jordan, RN. “I’d been retired four years, and when my husband asked me where I was going, I said, ‘I’m going to get a job.’ ”

Jordan had worked at Northeast Georgia Health System’s Ronnie Green Heart Center in Gainesville before having both her knees replaced. At 63, she was looking for work that is less physically taxing than open-heart surgery. She found it at the first place she applied — Gwinnett Medical Center-Duluth, where she works in the intensive care unit.

“I’d been nursing since 1981, had a lot of ICU knowledge and looked pretty good on paper, so I got a call from Stacy Wait, the ICU director, within two days of my application,” Jordan said. “I give her so much credit for hiring someone my age.”

It was challenging at first. Jordan was concerned about learning new medications and technology, but she had confidence in her nursing ability.

“I was able to hold my own and it’s fun to share what I know with younger nurses. We teach each other,” Jordan said.

She enjoys the work and plans to stay for a while.

“Things got bad in a hurry when my husband lost his job, but we’ve pulled ourselves out of a real mess,” Jordan said. “Nursing is a wonderful profession. It was probably the best decision I ever made in my life.”

Jordan was fortunate not to be looking for a job in 2009, when the economy really went sour. The recession has abated the nursing shortage temporarily and made health care a highly competitive market for job seekers.

“We’re in a great position from a hiring standpoint,” said Theresa Brockenbrough, recruitment manager for Southern Regional Medical Center in Riverdale. “Last year our vacancy rate for nurses was 3 percent, down from 7 percent the year before. I haven’t seen it that low in the 12 years I’ve been here.”

In today’s job market, nurses are more grateful to have jobs and less likely to switch employers, Brockenbrough said.

“Atlanta is a very competitive health care market, and before, it was a real cat-and-mouse game with salaries between hospitals,” she said. “Not every hospital was able to give [salary] increases last year. Fortunately, we did.”

Brockenbrough also has noticed an upswing in employee referrals, with about 50 percent of applicants referred by current employees.

“We’re seeing former nurses return to work, and hearing stories about laid-off spouses and lost medical benefits,” Brockenbrough said.

At the same time, patient volume has decreased, making it harder to justify hiring recent nursing school graduates, who require more training.

“We still hired new grads last year, because you have to look to the future, but there’s a much bigger pool of applicants in all areas of health care these days,” she said. “We can be more selective and hire only the best-qualified.”

Physical therapists, occupational therapists and speech therapists are in short supply, but there’s an abundance of radiologic technologists because there are more schools in the area, Brockenbrough said.

With 11,000 employees, hiring for WellStar Health System’s five hospitals is like staffing a small city, said Kay Spruill, recruitment director. Last year, she was bombarded with far more applications than she had positions.

“Of the 133,000 applicants, about a quarter were in nursing, and we filled about 500 to 600 nursing positions,” Spruill said. “We’re definitely seeing a richer, broader labor pool than in previous years.”

Many nurses have delayed retirement due to fractured nest eggs and economic uncertainty. Others are returning to the profession or seeking new employers. Nurses who worked in doctors’ offices and other areas where demand has decreased are coming back to acute care.

“Nurses who were working part time or PRN [as needed] are interested in full-time positions, wanting the salary and benefits,” Spruill said. “Nursing vacancies have dropped to 2.6 percent, and the turnover rate is under 3 percent.”

WellStar is no longer spending much money on traveling or contract nurses. The WellStar Temps supplemental staffing program provides nurses who are hired to fill in as needed when full-time employees take leave.

The deteriorating housing market and high unemployment rates have slowed turnover in the labor market as a whole.

“Managers aren’t relocating because they can’t sell their homes and their spouses can’t find jobs in the new city,” Spruill said.

For the first time, she sees more first-time nurses and other new employees interested in pensions. “They’re looking at the whole package, not just salary,” she said.

Swelling the administrative applicant pool are people who have never worked in the health care sector.

“People are looking for stability. They’ve realized that their businesses aren’t financially sound, and they’re looking to health care as a safe place,” Spruill said. “We’re a stable ship in very rough waters, but we have to be smart in how we navigate.”

Spruill has tried to balance between hiring new nursing graduates and returning professionals.

“Both bring different strengths to the table,” she said. “We love the energy and motivation of new grads, but older workers often bring strong work ethics, rich life experiences and wisdom. We’re hiring a blend.”

Knowing that the abundance of applicants will drop off in better times, and that nursing shortages are likely to return, WellStar administrators aren’t neglecting retention strategies. They create a welcoming culture with succession and advancement planning, shared governance for nurses, tuition reimbursement and extensive benefits.

“Our orientation and training for re-entry nurses is similar to the extensive on-boarding of new grads, because we want our people to feel supported,” Spruill said. “We want to be the employer of choice.”

It proved to be the best choice for Lori Tricarico, RN, BSN. Last year, she took a refresher nursing course through Kennesaw State University and did her clinical course with WellStar.

After an absence of 14 years, Tricarico was hired in January to work in the operating room at WellStar Kennestone Hospital. She had worked in the OR for seven years before taking time off to raise her daughters.

“I always knew I was meant to take care of people and I missed nursing,” Tricarico said. “Now that my girls are 15 and 17, it seemed like a good time to get back in. I’m so glad to be in a profession where I can make a difference and support myself and my family.”

New technologies, electronic charting and streamlined operations created a steep learning curve, but Tricarico said her preceptors and managers never made her feel like a fish out of water.

“Everyone here has been so wonderful, and I was thrilled there was an opening in OR, and that I had those skills. I’ve heard that new grads are having more trouble getting hired,” she said.

Last August, Gwinnett Medical Center hired 48 new graduates, but the health system also has taken returning nurses who have kept up their licenses into its residency program, said nurse recruiter Johnetta Williams.

“If I post a position, someone who is working PRN will come forward to say she wants it,” Williams said. “Our vacancies are down. The recession has eased the nursing shortage somewhat. With the volume of applications so high, it takes us longer to find the qualified candidates, but there are still opportunities. Health care is stable.”

Having Prediabetes May Not Kick-Start Prevention Efforts

Most people still didn't lose weight or exercise, study find.

UESDAY, March 2 (HealthDay News) -- Knowing you're on the cusp of developing diabetes apparently isn't enough to make most people take steps to prevent it.

New research, published in the April issue of the American Journal of Preventive Medicine, found that only about half of those with prediabetes said they had tried to drop pounds or boost their exercise level in the preceding year.

An estimated one-third of U.S. residents 20 years and older are prediabetic, experts say, but more than 92 percent are not aware of it.

The study involved a survey of 1,402 people with prediabetes who were interviewed and given glucose tests. Of that group, just 7 percent said that they had been diagnosed with prediabetes and only 48 percent of them had been tested for diabetes or high blood sugar in the preceding three years.

Overall, the researchers said, people with prediabetes are generally older, more likely to be men and often have such heart disease risk factors as higher weight, waist size, systolic blood pressure and triglyceride levels. No ethnicity or race is more likely to have the condition, however, they said.

"Reversing the growing diabetes problem will require multiple levels of interventions, including promotion of healthy lifestyles and increased availability of evidence-based community prevention programs for people at high risk," the researchers wrote. "More efficient identification and awareness of prediabetes is a key first step to implementing these changes."

The researchers include representatives from Emory University, the U.S. Centers for Disease Control and Prevention and the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

More information

The American Diabetes Association has more on prediabetes.

-- Randy Dotinga

SOURCE: Elsevier Health Sciences, news release, March 2, 2010

Workplace Wellness Programs Work

Workplace Wellness Programs Work
Employees who used them lost weight, lowered heart disease risk, study finds

TUESDAY, March 2 (HealthDay News) -- Workplace wellness programs help employees lose weight and reduce their risk of heart disease, a new study shows.

U.S. researchers followed 757 hospital workers who took part in a voluntary 12-week, team-based wellness program that focused on diet and exercise. Data on the participants' weight, lifestyle behavior and heart disease risk factors were collected at the start of the study, at the end of the wellness program and a year after the program ended.

At the start of the study, 33 percent of participants were overweight (body mass index, or BMI, of 25 to 29.9) and 30 percent were obese (BMI of 30 or more).

The researchers found that obese participants lost the most weight -- 3 percent at 12 weeks and 0.9 percent at one year -- and were most likely to reduce their intake of dietary sugar. Overweight participants did almost as well, with an average weight loss of 2.7 percent at 12 weeks and 0.4 percent at one year.

All participants had similar improvements in levels of physical activity, along with lower cholesterol and blood pressure levels, and reduced waist circumferences at program end and at one year, the findings showed.

"Voluntary wellness programs can successfully address weight loss and lifestyle behaviors for employees in all weight categories, but more work is needed to improve long-term changes," the Massachusetts General Hospital researchers concluded.

The study was to be presented Tuesday at the American Heart Association's Nutrition, Physical Activity and Metabolism Conference in San Francisco.

Other research to be released Tuesday at the meeting found that aerobic exercise reduces levels of inflammatory markers in men with heart disease.

The Polish study included 100 men, average age 55, who'd had coronary artery bypass surgery about two months previously to treat angina pectoris -- chest pain experienced during physical activity.

The men were randomly selected to be in a control group or a group that did six weeks of exercise training, three times a week, at 60 percent to 80 percent of maximum heart rate. At the start of the study, at the end of the training period and after one year, all of the men underwent an exercise stress test and their blood was tested for levels of inflammatory markers such as C-reactive protein.

At the end of their program, the men in the training group showed significant improvement in exercise capacity and a significant decrease in inflammatory markers. This did not occur in the control group. One year later, levels of inflammatory markers among men in the training group were still significantly lower than they had been at the start of the study.