The Center’s Workplace Wellness Program: Wellness-a-thon

By Kim Nordin, Program Coordinator

The National Rural Health Resource Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities. That, in a nutshell, is what we work for every day at The Center. It’s a no-brainer that we would also work to sustain and improve the health of ourselves. Workplace wellness programs are linked to greater productivity, less sick leave, and a reduction of long-term health care costs. And… they’re FUN! And fun has been linked to employee retention, overall happiness and morale. The Center started a workplace wellness program about three years ago, but with only about 20 percent of our staff still participating, we were in need of a revamp. 

This spring, we rolled out our new workplace wellness program. We call it, “Wellness-a-thon.” The goal was to come up with something that everyone could participate in and something that would encourage us all to work toward wellness. We “walk” across the nation, by individually earning “miles” for various activities from four different categories each week. Our categories are:

1. Fitness/Exercise
2. Mental Health/Mind-Body
3. Safety/Preventative Health
4. Nutrition

Location goals for our 2014/2015 Wellness-a-thon

Each month, we focus on a different category, and offer bonus “miles” for each person who completes the weekly challenge. These challenges are to get people to try something new, to get co-workers to engage in something together, and to consciously work on things to make us healthier. Examples of weekly challenges are, “No high fructose corn syrup this week,” or “Always use the stairs this week” (our offices are on the 4^th floor), or “Workplace humor week - send a co-worker something funny” or “Get your flu shot.” We’re also bringing in quarterly speakers to present wellness topics at our staff meetings. 

Shannon from Whole Foods Co-op in Duluth

presented on nutrition and produce tips at a staff meeting

One way to make our program more fun and interactive was to find reasons to gather as a team. We celebrated National Women’s and Men’s Health Weeks in May and June with a healthy food potluck and daily lunch walks on the lake walk. Just yesterday, 10 of us participated in a 5K walk/run fundraiser for our local YMCA. 

Casual Friday, taking a walk to celebrate National Men’s Health Week. I look shorter than I actually am here. I brought my dog, Truman, to work that day. Fact: Dog friendly workplaces make employees happier and more productive (and I can say, I’ve honestly never worked anyplace where the staff was as productive and happy as they seem at The Center. It must be due to the fact that we allow dogs and our fun wellness program!)

It isn’t “all work, no play” around here. We reward each person with a gift card (to a place where something wellness-related can be purchased) once they reach a milestone (130 miles, up to four milestones per year). We are also rewarding ourselves with a wellness activity we can all do together. This month, we are planning to rent bikes to take a group bike ride on our boardwalk together!

I’m proud of our new wellness program. We currently have over 90% of our staff participating in the Wellness-a-thon, and 15 out of 19 of us have reached our first milestone in three months. Over half of us walked or ran in a 5K together, and we’ve collectively “walked” over 3,000 miles in three months (with each staff person able to earn up to 20 miles per week)! 

One of my favorite things is when I overhear a couple of coworkers planning to take a walk together over lunch, or when someone sends me an idea for a challenge or a staff meeting. It tells me that people are engaged and invested in their health, which is what our wellness program aims to stimulate. It’s the little things that really add up when you’re talking about health and wellness, and I know The Center’s passion, diligence and enthusiasm will keep our workplace wellness program alive! 

Our Sidewalk Shuffle 5K teams, "Rurally Fast" and "Rurally Slow Centerites,"

minus Sally Buck, who was running over after a webinar

New Employee Perspective

By Alyssa Meller, MA, Director of Operations

When asked to write a blog post on my first six months at The Center, I said “Sure! What’s a blog and how do I do that?” I’m not sure that is something a person wants to hear from the new Director of Operations, but this is my first shot at blogging, and I want to get it right.

All kidding aside, I love working at The Center. The first six months have flown by. Each time I think I have my feet under me, ready to tackle the day, something different jumps up, and I’m learning something new. I wouldn’t change that at all. It is how I learn and what I like and thrive on.

Everyone at The Center has been supportive and helped make my transition into this organization go as smoothly as possible. The patience with my asking of many, many questions not once, but often a couple of times, amazes me.  Each person has their own style and unique qualities, and I value that. I find it impressive how The Center’s culture respects each person’s skills and experiences and supports their involvement to further not only the goals of each program but The Center’s mission as a whole.

During the interview process I was asked by a board member what I thought would be the most difficult thing for me if I was hired for this position. I responded, “Allowing myself the patience and time to learn my role, the organization’s style and how to work within the organization’s culture.” Now, I probably didn’t say it that eloquently, but it was what I meant and tried to portray. And I can say allowing myself the time to learn the ropes, the processes and how and when to interact has been my biggest challenge to date. I like to get it right the first time, and that doesn’t always happen when you are new to a position and organization.

As I continue in my role and get out and about, I look forward to meeting and working with each of you, The Center’s partners and friends. I am beginning to understand the depth and breadth of our involvement in sustaining and improving rural health care, not only in Minnesota but nationwide, and I feel honored to be a part of that. 

Fragmented, Affordable Healthcare in Argentina

By Leslie Quinn, MBA, Program Coordinator

My name is Leslie Quinn, and I have been a Program Coordinator at The Center for three years. I recently took two weeks off to complete a capstone project for my Master of Business Administration (MBA) program at the College of St. Scholastica. The capstone was a study-abroad seminar in Buenos Aires, Argentina to observe and engage in cross-cultural and global business settings.

The population of Argentina is 42.6 million; one-third of which resides in Buenos Aires. Argentina is an urban country with only 7.3 percent of the population residing in rural areas. It is one of the Latin American countries that spends the most on healthcare. In 2012, Argentina spent 8.5 percent of gross domestic product (GDP) on total health expenditures. The healthcare system in Argentina is comprised of three sectors: private, social and public. The private sector covers about 10 percent of the population, social covers about 50 percent, and the public sector covers about 40 percent. There is no national health system; it is the responsibility of the provinces.

Every citizen has the right to healthcare in Argentina. If they can’t afford insurance, they receive free care in the public sector. To get an appointment, you must go early in the morning, take a number and wait. The system allows foreigners to receive free care also. Medical tourism is a growing industry as people from industrialized countries seek lower cost care elsewhere.

On my last Delta flight I saw an advertisement for Medical Tourism in Argentina in the SKY magazine

Social

There are two defined structures within the social sector: Obras Sociales Provinciales (OSPs) and Obras Sociales Nacionales (OSNs). There is one OSP for each of the 23 provinces in Argentina and the autonomous city of Buenos Aires. The OSPs provide coverage for civil servants; around 5 million public sector employees and their dependents are covered through the OSPs. There are over 300 OSNs, which are managed by trade unions. We visited the Unión Obrera de la Construcción de la República Argentina (UOCRA), which is the construction workers’ union. Large unions, like UOCRA, have their own hospitals and providers that care for workers and their families.

Construir Salud: Obra Social Del Personal De La Construcción
(Hospital for the construction workers)

There are basic mandatory health services required by law that the insurance plans must cover. Employers provide health insurance, but employees can pay extra for a better plan. The government funds obras sociales for retirees and their families, through the Programa de Atención Médica Integral (PAMI), a Comprehensive Medical Attention Program. Did I mention acronyms are just as popular in Argentina?

Private

There are modern private healthcare facilities in urban areas that provide high quality care. Middle and upper class citizens pay for their insurance. Private insurance plan prices are determined by age and pre-existing conditions. There is a new law that everyone can get insurance with pre-existing conditions, but they will pay more. Argentina has higher rates of tobacco use than the United States, but smoking doesn't affect insurance. There is flexibility to move within the system; many people with private insurance utilize the public providers for surgeries and immunizations. Rare surgeries are provided in public hospitals with no bill or debts, but greater wait times. Pregnant women and children under one year of age receive free care, paid for by the government.

On the best insurance plans, you can get one cosmetic plastic surgery every year. Plastic surgery is common and affordable in a country obsessed with looking young, thin and beautiful; retail stores do not sell plus size clothing. Argentina has become a medical tourist destination for plastic surgery.

Providers

The public system has good doctors, but nursing is not professionalized. There is a shortage of people studying nursing because people think of them as maids in public hospitals. Public facilities have prestige as learning hospitals, so doctors want to work there, but they are not paid well. Public doctors are considered middle class citizens, so they usually work half days in public system and have a second job in the private system. There is a shortage of general practitioners in Argentina as most doctors are specialized. Patients don't need referrals; there is direct access to specialty care. Doctors use paper medical records and prescriptions are handwritten.

The wages in rural areas are three times lower than in urban areas. Doctors don't want to work in rural areas because they are not challenged. Rural doctors work in family practice clinics and it is common for people travel to a big city for major health issues. The rural population has lower standards of living, poorer health, more poverty, and higher school dropout rates.

Results-Based Financing

The 2001 economic crisis in Argentina resulted in a rise in the number of vulnerable people without health coverage and increased poverty. Health indicators, including child and maternal mortality rates, deteriorated in the poorest regions, and national averages worsened. This gave the government the opportunity to strengthen its role in the decentralized, provincial health services.

Plan Nacer, Argentina’s Provincial Maternal and Child Health Investment Program, was introduced in 2004. The program was aimed at increasing access to basic health services to address the causes of maternal and child mortality for uninsured pregnant women and children under six years old. The Plan Nacer program is publically funded and supports the introduction of highly innovative results-based financing mechanisms at the national, provincial and provider levels. The objectives were to reduce infant mortality and to modify the dynamics of financing health services.

The program increased the probability of a first prenatal care visit before week 13 and week 20 of pregnancy. The number of prenatal visits increased, and women also benefited from an improved quality of care, measured by increases in the likelihood of vaccinations and ultrasounds. The improvement in the quantity and quality of services translated into healthier births, an increase in average birth weight, and a decrease in the likelihood of children being born with very low birth weight. Finally, for children under age five, the program raised the likelihood of well-baby checkups.

The Plan Nacer introduced results-based financing mechanisms that promoted a new incentive framework for financing and providing health services that rewards providers for increased healthcare coverage, delivery, and staff productivity. This demonstrates movement away from the traditional healthcare system based on inputs and fixed budgets toward one geared at outputs and results. This is a promising incentive model that could be used by the rest of the world. Lessons from the successful Plan Nacer program can be used to strengthen any public health system.

Sources:
Cortez, R., & Romero, D. (2013). Argentina: Increasing utilization of health care services among the uninsured population. Washington, D.C.: World Bank. https://openknowledge.worldbank.org/bitstream/handle/10986/13289/749560NWP0ARGE00Box374316B00PUBLIC0.pdf?sequence=1

Health Information Technology in the Pennsylvania Mountains

By Tony Greseth, IT Coordinator

My name is Tony Greseth, and I am one of the IT Coordinators at the National Rural Health Resource Center. In an effort to expand my role at the Center, I took a 6-month Health Information Technology (HIT) course through Normandale Community College in Minnesota that focused on practice workflow and information management redesign. I am now an American Health Information Management Association (AHIMA) Certified Healthcare Technology Specialist (CHTS).

In April, I took a trip with our Chief Information Officer (CIO), Joe Wivoda, to DuBois, PA. We were heading out there to visit with the Pennsylvania Mountains Healthcare Alliance (PMHA), a Rural HIT Network Development (RHITND) grantee. Upon arriving in DuBois, we met with the PMHA CIO Greg Snyder and got a quick tour of the PMHA office. Before long, we were on the road again, this time headed to Jersey Shore, PA. We were there to meet with two of the PMHA network hospitals, Jersey Shore Hospital and Fulton County Medical Center.

A quick side note as to the pronunciation of DuBois, if you should ever be visiting. For whatever reason, I wanted to pronounce it as something similar to doo-bwah, but I was mistaken. The correct and simpler pronunciation is doo-boys. I find it interesting how other regions handle pronunciation slightly different, so enjoy that little piece of information!

Upon arriving in Jersey Shore, we sat down with members of both hospitals and talked about how things were going for them with their HIT. We talked about areas of success and those that were more of a struggle. There were questions about Meaningful Use and interpretations of the rules for Stage 2. An interesting point, and something that stuck with me, was made when someone said that “Rural is not small urban.” To me, that meant we can’t take the solutions that work for urban and just scale them down for rural communities.

It was interesting to learn more about interface engines and how they allow for communication between different systems. There was talk about data centers and the differences between cold, warm and hot sites. I also learned the differences between secondary, tertiary and quaternary care. It was a great learning opportunity for me as I try to build on my HIT knowledge. We concluded our stay in PA by sitting in on a PMHA conference call where there was more conversation about Meaningful Use.

DuBois is a beautiful town and the folks with the PMHA are doing great things. It was a wonderful trip for me as it allowed me to step outside my strictly-IT world and see how hospitals are using that technology to improve the quality of care they provide.

What if Don Draper had to Sell Wearable?

I'm a big fan of Mad Men.  Unfortunately, I'm old enough that it feels like my youth.  But beyond that, it’s an interesting window into another culture, America in the 60's.  I'm also intrigued by Don Draper's ability to sell anything, to make products that might kill you have emotional stickiness.

Why Google Glass.....
when you can put monitors right on your eyeball

Watching the show I've often transfixed by the technological changes in the last 50 years.  They use cord phones as their only way to communicate.  If Don wasn't in the office or at home, he couldn't be found.  In a recent episode, a computer was introduced to the office.  One of the characters was literally driven mad by the incessant hum emanating from the control room.  In contrast, we are constantly connected, always available, and soon to be, always monitored.  My question, how would Don Draper sell wearable technology?  How would he make it sticky?

I want to live forever, but I won't.  No matter what I do, my time is finite.  Ultimately it comes down to what I'm willing to give up today in terms of personal freedoms and additional anxiety (yes, the decision to monitor brings my frailties to my consciousness), in exchange for some benefit tomorrow. Ideally I would live an stress free world and then drift off in my sleep.  Unfortunately most of us spend part of our lives with a constant companion, a chronic illness, in our later years.

In order for wearable to truly take off, it will need some message, something that addresses our base instincts rather than simply offering something cool.

I don't want to be monitored.  I want to live without worry as long, and as comfortably as possible.  If he were to sell me on wearable, what would Don say?

Rural Mental Health in America

By Margo Kulseth, MLIS, Information Specialist

May is National Mental Health Awareness Month. But what does awareness mean? Who lacks awareness, and how can we rectify it?

Our societyin general lacks awareness about the factsof mental illness. One in four of us will experience mental illness in a given year. If you think you aren’t affected, consider that mental illness costs our country hundreds of billions of dollars each year for things like medical care for the uninsured, disability payments, and lost productivity.

The medialacks awareness and often contributes to the stigma surrounding mental illness and its siblings, substance abuse and suicide. How could we be fully aware about mental illness when we hear about it only in the wake of tragedies like school shootings and other acts of violence? This type of sensationalism in reporting is misleading. In fact, the majority of people with mental illness are not violent.

Many individualssuffer in silence due to lack of understanding or shame about admitting to a problem. Mental illness is not to be blamed on the patient any more than other medical conditions. Yet it is the stigma that prevents many from seeking help and receiving treatment. This problem is magnified in rural areas where neighbors know each other well and don’t want themselves or their vehicles to be seen at “that” clinic (if mental health services even exist in their area). The alternative is to drive great distances for treatment.

Our health care workforce lacks awareness about how to treat mental illness. Because of the lack of mental health services and providers, especially in rural areas, many people, if they get treatment at all, receive care from their family physician who is usually not optimally trained in this type of specialty care. It is often difficult to recruit and retain clinicians in rural areas, and mental health specialists are no exception. One solution is to use telemental health, which is long-distance counseling and treatment via teleconferencing or video conferencing. In a crisis, individuals may seek help in the emergency room, where, if the need is recognized and properly diagnosed, patients are still unable to be admitted or transported by ambulance to the nearest psychiatric facility, which may be full or simply too far away.

Police officers, who are often the first responders in a mental health emergency, especially in rural areas, lack awareness about how to recognize and handle people with mental illness. Again, the media tells tragic stories of police using force against someone who appeared dangerous, only to learn later that person was experiencing psychosis and unable to think clearly or act appropriately. One way this is being addressed is through crisis intervention team (CIT) training, which provides techniques and skills for dealing with this type of situation.

Staff at correctional institutions lack awareness about mental illness. Estimates are that 44% to 64%of inmates at jails and prisons in the US are mentally ill, and many are not getting treatment, prompting some to refer to our correctional institutions as warehouses for the mentally ill. Even those who enter the system while receiving treatment may be denied ongoing care while incarcerated.

Our legislatorslack awareness. Some states have cut back on funding for mental health care. Creigh Deeds is a Virginia State Senator who was stabbed in the face by his son with mental illness just before his son took his own life after seeking treatment and being turned away due to lack of available inpatient services. Senator Deeds’ face bears the scars of the attack. His personal experience and the resulting disfigurement, combined with his position of political power, provide some hope that his ideas about how to address the mental health care crisis in his state and in America will be given serious attention and result in positive action by our lawmakers.

There is good news! Our country as a whole is gaining awareness about mental illness. The Affordable Care Act will give millions of Americans access to affordable health care, which includes mental health and substance abuse coverage. There are a number of other major initiatives in progress designed to strengthen the mental health of all Americans, including some targeted to specific at-risk populations such as military service members, Veterans, children and rural residents.

So what else can we do? We must keep advocating for those who are not receiving proper mental health services for one reason or another. We must educate the public, service providers, and lawmakers and create a better plan for addressing the current crisis in our country. And we must integrate primary care, mental health, and all other medical services by working together, collaborating and embracing telemental health opportunities for the good of the patient.

Advocate.

Educate.

Create.

Integrate.

Collaborate.

To raise your awareness of mental illness, please visit the following websites as well as those linked in the text above for more information:

Mental Health America (MHA), formerly known as National Mental Health Association

MentalHealth.govfrom the US Department of Health and Human Services (HHS)

National Alliance on Mental Illness (NAMI)

National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), a component of the US Department of Health and Human Services (HHS)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Portals Are for Cattle, Personal Health Records (PHR) Should Be for People

There seems to be confusion around the term Portal and Personal Health Records (PHR) in healthcare.  Let me explain.

Portal displays or communicates with a practice or network

Portal is a hospital's attempt to improve customer service.  A typical portal allows you can log on to your hospital, see your records, schedule a visit, or possibly message your in network provider.  Compared to the days of fax and phone it’s clearly a step forward.  And it works as long as this is the only place you go for care.  However, unlike cattle, most people don’t tend to stay inside hospital fences.  People wander from hospital to hospital, clinic to clinic, sometimes going to a doctor in network and sometimes going to one out of network. Portal is limited tool for a single hospital or network.

PHRs are something else entirely.  Fundamentally, they are owned by patients.  The record collects all care, irrespective of the health system.  It is not a tool for marketing, tethering you the patient to a particular set of providers, but rather an organized way to tell others about you.  Ideally, a PHR would leave room for patient self report.  Healthcare systems seem to forget that most of health occurs at home.  Hospital records leave no room for patient self report.  Personally I feel how patients feel about themselves day to day, whether their happy or depressed, has far more to do with their health and outcome then whether they took their medicine or lost weight.  A true PHR would collect information across the continuum- from hospital to home, across all providers.

An ideal PHR would gather all information for the patient
and put it into the cloud

Without an effective digital tool, many patient’s literally resort to a shoebox for their PHR. Particularly for those with a chronic disease, there is a clear need.  So why hasn’t the market provided one?  Attempts have been made.  Both Google (Google Health) and Microsoft (HealthVault) literally spent hundreds of millions of dollars in what were largely failed efforts.  In part, this was do to a failed business model based on…. advertising.  Hospitals initially looked to leverage Microsoft’s HealthVault, but got stuck in their old ways of thinking by reverting to “portal” built on top of HealthVault.  For all their outward mission based altruism, in the end hospitals are businesses.  They have a hard time thinking beyond I win/you lose mentality and tend to look for market differentiators rather than collaborative strategies to deliver better care at a lower cost.  Too bad.  Can you imagine the first hospital to offer a true PHR?  Sure it would help their competitor by collecting records for the patient, but do you really think it would work equally well across providers.  The first hospital would do well by doing good.

With the new federal mandates it’s time to stop spending on fences (portals), and start thinking about continuum (PHR).  Grabbing patients via insurance plans or Accountable Care Networks will only go so far.  To actually improve care at a lower cost a true PHR, a patient owned record managed by a hospital would provide huge value for all stakeholders.  At the very least, we should stop referring to portals as PHRs, something they’re not.