White paper healthcare

2 Whitepaper
0
NEEDED MEDICAL
1
1
Closing the Gap in Disparity
DOCUMENTATION
of Healthcare for the Elderly
Pairing EHR Web-Based Technology with
MEDICARE- APPROVED
WELLNESS EXAM

Epiphany Enterprise I, LLC
Velva Boles, MD
Microsoft
11/18/2011

EXECUTIVE SUMMARY
Very few senior citizens grasp the concept of a wellness visit to their primary care provider because they are
conditioned to go to the “doctor” when they are sick and in the “15-minute visit”, senior citizens are careful
not to take more time than they are allotted. Barriers to their taking advantage of the free annual Medicare
Wellness Examination, which does not require a co-pay, include the lack of clarity between the terms
“physical exam” and “wellness exam”. Senior citizens have limited avenues to learn of changes in Medicare
coverage and their primary care providers are reluctant to explain Medicare changes because explanations
disrupt productivity schedules. The current systems in place concord transportation arrangements to
healthcare facilities with appointments given for follow-up visits for diagnosed conditions therefore, there is
an inherent problem with getting transportation arranged for wellness visits. Finally many seniors adhere to
the general belief that, “if nothing is broken, don’t fix it”.

This whitepaper provides a roadmap to successfully providing preventive healthcare to an ageing population
who, out of ignorance, disempowerment, or limited access to private physician healthcare do not take
advantage of a health supportive process enabled by Medicare. It proposes that a specialized service provided
by a clinical practice with focused interest in geriatric healthcare and community stability can facilitate
improved healthcare as described in Affordable Care Act (ACA) and generate universal access to medical
records utilizing a network based electronic health record (EHR) in line with Health Information Technology
for Economic and Clinical Health (HITECH) Act recently adopted by President Obama’s Administration.

© 2011 Epiphany Enterprise I, LLC. All Rights Reserved 2|P a g e

OBSTACLES TO BEST HEALTH CARE

Multiple factors contribute to health disparities observed with senior citizens and ethnic minorities, including
socioeconomic factors, social environment/ neighborhood, educational and economic opportunities,
racial/ethnic discrimination, work conditions, and access to preventive health-care services.

Age is a major factor in health disparities because many older Americans exist on fixed incomes which often make
paying for health care expenses difficult. Additionally, they may face impaired mobility or lack of transportation
which make accessing health care services challenging for them physically. Too often, they may not have the
opportunity to access health information via the internet, as less than 15% of Americans over the age of 65 have
access to the internet, putting older individuals at a distinct disadvantage in accessing valuable information about
their health and how to protect it.

The Agency for Healthcare Research and Quality identified numerous barriers to good healthcare, a few of which
are listed below:

 Lack of a Primary Care Provider and Usual Source of Care. More than a quarter of African Americans do
not have a regular doctor. Compared to whites, minority groups in the United States are less likely to have a
doctor that they go to on a regular basis. People who do not have access to a usual source of primary
preventive health care are more likely to end up in the emergency department or in the hospital; indeed,
African Americans use the emergency department at twice the rate of white Americans. Emergency
Departments are not intended for comprehensive health care. It has been shown that care via a primary care
substantially improves health outcomes.

Sometimes communication problems stem from a lack of cultural understanding on the part
of white providers for their minority patients. A patient’s health decisions can be influenced
by religious beliefs, mistrust of Western medicine and familial roles, of which a white
provider may not be familiar.

 Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care,
more likely to go without needed medical care, and more likely to go without prescription medicines.
Minority groups in the United States lack insurance coverage at higher rates than whites. Racial and ethnic
minorities are more likely to be enrolled in health insurance plans which place limits on covered services
and offer a limited number of health care providers.

 Structural barriers. Poor transportation, that is, public transportation or unreliable family transport causes
an inability to schedule appointments quickly or during convenient business hours, and excessive time
spent in the waiting room can be problematic for the elderly on diuretics requiring frequent urination or
those with “brittle diabetes” who must eat at tightly scheduled times to avoid extreme drops in blood
glucose levels. All of these concerns affect a person's ability and willingness to obtain needed care.

 Lack of diversity in the health care workforce. A major reason for disparities in health care is the cultural
differences between predominantly white health care providers and minority patients. Only 4% of
physicians in the United States are African American, and Hispanics represent just 5%. Poor
communication with health care providers results in a host of problems including less access to
preventative care and higher rates of re-hospitalization. Miscommunication can lead to incorrect diagnoses,


improper use of medications, and failure to receive follow-up care. Health care providers may
unconsciously or consciously treat certain racial and ethnic patients differently than other patients. There
are data to support that ethnic minorities are less likely than whites to receive a kidney transplant once on
dialysis or to receive pain medication for bone fractures.

 Lack of preventive care. According to the 2009 National Healthcare Disparities Report, uninsured
Americans are less likely to receive preventive services in health care .

POOR HEALTH LITERACY –A MAJOR OBSTACLE

“Literacy and Health Outcomes”, an Agency for Health Care Research and
Quality report, states that low health literacy is linked to higher rates of
hospitalization and higher use of expensive emergency services. This Two-thirds of American
evidence-based literature review highlights numerous studies that adults age 60 and over,
have inadequate or
provide a detailed analysis of the correlation between low health literacy
marginal literacy skills
and poor health.

Health literacy is not simply the ability to read; it includes the ability to understand instructions on
prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent
forms. It also includes the ability to negotiate complex health care systems. Matriculating the health care
system requires a complex group of reading, listening, analytical, and decision-making skills and the ability to
apply these skills to health situations. Health literacy varies by context and setting and is not necessarily
related to years of education or general reading ability. A person who functions adequately at home or work
may have marginal or inadequate literacy in a health care environment. With the move towards a more
"consumer-centric" health care system - as part of an overall effort to improve the quality of health care and
to reduce health care costs - patients are expected to take an even more active role in health care related
decisions.

According to the American Medical Association, poor health literacy is "a stronger predictor of a person's
health than age, income, employment status, education level and race. Groups with the highest prevalence of
chronic disease and the greatest need for health care had the least ability to read and comprehend
information needed to function as patients". The American Medical Association defines health literacy as “the
ability to read, understand and use health information to make appropriate health care decisions and follow
instructions for treatment.” Many Americans face serious challenges interpreting basic information required to
choose a health plan and understand their health benefits. Patients with low health literacy have great difficulty
managing chronic conditions.

There are both direct and indirect consequences of low health literacy. The direct effects include non-
compliance and medication errors. The indirect effects are harder to measure, but often include insurance
issues, accessibility to health care and poor health behavior choices.

Among patients with Type 2 diabetes low health literacy is associated with poor blood sugar control and higher risk
of stroke. Patients with marginal health literacy are also less likely to seek out routine and preventive services. Low
health literacy is associated with poorer adherence to drug warning labels leading to increased safety risks. In
“Health Literacy: A Prescription To End Confusion”, the Institute of Medicine reports that ninety million
people in the United States have difficulty understanding and using health information. As a result, patients


often take medicines on erratic schedules, miss follow-up appointments, and do not
understand instructions like "take on an empty stomach". Eighty-one percent of patients
age 60 and older, at a public hospital, could not read or understand basic materials such as
directions on a prescription. Approximately half of Medicare/ Medicaid recipients read
Use it or lose it - Reading
below the fifth-grade level. Low literacy skills are multifold, many are abilities are typically three
attributive to a lack of educational opportunity, a decline in literacy that starts to five grade levels below
when school training stops and cognitive abilities decline in older adults as a the last year of school
completed. People with a
product of ageing. The relationship between literacy and health is high school diploma
complex. Literacy impacts health knowledge, health status, and access to typically read at a seventh
health services. Literacy impacts income level, occupation, education, housing, grade reading level.
and access to medical care. The results of the 1992 Adult Literacy Survey (National
Center for Education Statistics, US Department of Education) indicate that adults with
low literacy were more likely than those with higher literacy levels to be poor and to have
health conditions which limit their activities.

Inadequate health literacy is nearly twice as high among African Americans (75 percent) and Hispanics (73 percent)
as Whites (38 percent). Approximately 81 percent of adults age 65 and over have inadequate health literacy. The
United States spends more than any other nation in the world on health care - in 2007, $2.2 trillion was spent.
Despite consistent increases in spending, disparities among demographic groups persist. Patients with a poor
understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems
with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in
whites due to socioeconomic and educational factors. Low-income Americans and racial and ethnic minorities
experience disproportionately higher rates of disease, fewer treatment options, and reduced access to care. Four in
ten low-income Americans do not have health insurance, and half of the nearly 46 million uninsured people in the
United States are poor. About one-third of the uninsured have a chronic disease, and they are six times less likely to
receive care for a health problem than the insured.

In addition to the effects of low health literacy on the individual patient, there are economic consequences of low
health literacy on society. The National Academy on an Aging Society estimated that additional health care costs
due to low health literacy were about $73 billion in 1998 dollars. After adjusting for health status, education level,
socioeconomic status, and other demographic factors, people with low functional literacy have less ability to care for
chronic conditions and use more health care services. Increased attention must be devoted to the problem of health
literacy benefits.

GROWING OLD COMPOUNDS HEALTH CARE PROBLEMS

SENIOR CITIZENS- POOR HEALTH HISTORIANS

Senior citizens often forget with whom they have shared – or not shared - information, according to
researchers, at Baycrest Rotman Research Institute, Toronto, Canada who identify this phenomenon as
“destination memory failure,” or “destination amnesia.” They report that seniors are extremely reluctant to
admit they are wrong. This kind of memory faux pas can lead to awkward or embarrassing social situations
and even miscommunication at critical times, like in a doctor's visit. Ironically, after making these memory


errors older adults remain highly confident in their false beliefs. "Destination amnesia is characterized by falsely
believing you've told someone something, such as believing you've told your daughter about needing a ride to an
appointment, when you actually had told a neighbor.

LIMITED RESOURCES FOR HEALTH CARE

The financial plight of the oldest citizens in the U.S. is growing
very much worse. One out of every 10 senior citizens is living in WHY ARE OLDER ADULTS MORE PRONE
poverty and the rate of bankruptcy among those ages 65 and TO DESTINATION MEMORY FAILURES?
older has more than doubled since 1991. The number of senior A study funded the by Natural Sciences and
citizens (age 65 and older) in the U.S. living in poverty jumped to Engineering Research Council of Canada, Canadian
3.6 million in 2007, up from 3.4 million in 2006. The percentage of Institutes of Health Research, U.S. National Institute
on Aging and a Baycrest Jack and Rita Catherall
all seniors living in poverty increased from 9.4 percent to 9.7
Award showed that the ability to focus and pay
percent from 2006 to 2007. Individuals nearing or in retirement are attention declines with age, so older adults use up
realizing how difficult it can be to manage their debts as they age,” most of their attention resources on the telling of
says Elizabeth Warren, a Harvard Law School professor and national information and don't properly encode the context
expert on bankruptcy. Most Americans have two major assets: their for later recall.

homes and their retirement plans. And borrowing against those assets "Older adults are additionally highly confident,
can present new risks when home values and stock markets decline. In compared to younger adults, that they have never
some cases, older Americans trying to help children and told people particular things when they actually had,"
"This over-confidence presumably causes older
grandchildren, borrow too much, putting themselves at risk. "Age is
adults to repeat information to people."
increasingly associated with financial distress and more seniors are
seeking protection from creditors through the bankruptcy courts," says A critical finding in the study is that destination
memory is more vulnerable to age-related decline
Teresa Sullivan of the University of Michigan. Health care costs
than source memory (Source memory is the ability to
proved to be the top reason for many bankruptcies among senior recall which person told you certain information)
citizens according to Sullivan and Deborah Thorne of Ohio University
The first experiment required the individual to read
in a study published by the AARP Public Policy Institute. The
out loud 50 interesting facts to 50 celebrities (whose
growing cost of health care is much faster than inflation for other faces appear on a computer screen), one at a time,
goods and services and is the chief suspect in why more seniors are and then remember which fact they told to which
living in poverty. Social Security, the most significant or only income famous person. For example, "a dime has 118 ridges
around it" and I told this fact to Oprah Winfrey.
for many retired Americans is increased annually at a rate less than
the annual jumps in health care prices. The second experiment required the individual to
remember which famous person told them a
SPECIAL HEALTH CARE CHALLENGES FOR SENIOR particular fact: “Tom Cruise told me that the average
AFRICAN AMERICANS person takes 12 minutes to fall asleep".
Consistently, the Centers for Disease Control and Prevention In the first experiment for destination memory
Morbidity and Mortality Weekly Report (MMWR) describes health accuracy, older adults' performance was 21% worse
care disparities experienced by black Americans, most notably than their younger counterparts.
stroke, hypertension, diabetes, obesity, and childhood asthma. The In the second experiment for source memory
experience of racial discrimination may be a key factor in explaining accuracy, older performed 50% in recollecting which
why African Americans suffer at higher rates from diabetes and famous face told them a particular fact.
cardiovascular disorders according to Vickie Mays, a UCLA professor
of Psychology and Health Services and Director of the Center for Research, Education, Training and Strategic
Communication on Minority Health Disparities. “Discrimination causes enormous stress on a person’s mental and
physical health as shown by measurable physiologic responses of elevated blood pressure and heart rate. When a
person experiences discrimination, the body develops a cognitive response in which it recognizes the discrimination


as something that is bad and should be defended against. This response occurs even if the person merely perceives
that discrimination is a possibility. When the brain perceives discrimination, a series of physiological responses are
set into motion to protect itself from these stressful negative experiences. These physiological responses trigger
biochemical reactions which induces adverse health consequences.”

With marginally literate African Americans and many senior citizens, responses to
perceived discrimination occur so frequently that immunologic responses and The Journal of the
cellular repair mechanisms no longer function correctly. According to Professor American Medical
Mays, the experience of race-based discrimination is akin to the response a person's Association identifies race
body mounts when it experiences significant life-threatening danger. When the as a significant determinant
body mounts a response to protect itself against a "life-threatening" experience on a in the level of quality of
regular basis, it is strained and overworked. Many of the chemicals that come to its care, with ethnic minority
rescue cause damage in the body resulting in disease and obesity. African groups receiving less
Americans faced with constant discrimination for many years experience high intensive and lower quality
levels of stress. When the stress challenge to the cardiovascular system is prolonged care. Ethnic minorities
and excessive, the immune system is suppressed, blood pressure increases and, over receive less preventative
time, atherosclerosis can develop, resulting in coronary vascular disease. "As we care, are seen less by
deal with skyrocketing rates of obesity and rising rates of diabetes in African specialists, and have fewer
Americans and other racial and ethnic minority groups, we need to think about the expensive and technical
impact of race-based discrimination and how they respond to that stress," Mays procedures than non-ethnic
said. "It may not be just a matter of telling a person to eat better or exercise. We minorities.
may need to take a look at the person's environment and the race-based
discrimination that that person is experiencing."

TIME TO PLUG THE HOLES

ENDING DISPARITY OF HEALTH CARE

Defining a problem is not the same as finding a solution. Recognizing problems, however, provide an opportunity to
eradicate them. To reduce disparities of health care provided to racial/ ethnic groups and the elderly, health care
institutions must become more conscious of the staff within their facilities. It is essential that more minority groups
be represented within the various health care offices and clinics; health care professionals be trained to work with
minority groups; health care workers should be supportive and able to adjust health care plans according to the
patient’s cultural beliefs and traditional health practices because cultural competency is vital in obtaining consent
and adherence to treatment plans. There must be convenient locations of the healthcare offices for minority senior
citizens, public reliable transportation availability, evening and Saturday clinic hours, senior citizen accommodating
physical environment of the clinic, and good rapport between staff and patients to facilitate equable health care
according to the Agency for Healthcare Research and Quality. In a report on “how to eliminate health disparities”
compiled by the Commonwealth Fund, greater minority representation within the health care workforce was a major
recommendation.

A readily accessible comprehensive medical history log performed annually for citizens who do not have continuity
of care, who are poor historians, who, due to low income or illiteracy, have poor compliance to medical advice, is
the scope of a network based EHR service. For years, experts have praised electronic health record (EHR) keeping
for its potential to improve patient care, reduce medical error and the contain costs. President Obama’s


administration has made EHR adoption a major health care policy objective. The goal is for physicians to begin
using electronic health record keeping over the next decade and $19.2 billion has been committed through the
Health Information Technology for Economic and Clinical Health (HITECH) Act to make this a reality. To apply
these objectives, the HITECH Act facilitated the establishment of 60 regional extension centers (RECs) throughout
the United States. The Department of Health and Human Services (DHHS) allocated $640 million to the funding of
these centers, requiring their most intensive assistance to be focused on providers furnishing primary-care services,
with a particular emphasis on individual and small group practices and community health centers that predominately
serve uninsured, underinsured, and medically underserved populations.

To improve the health care of senior citizens, the Affordable Care Act (ACA) Schmitz, a retired engineer from
extended preventive coverage to more than 88 million patients covered by health Portland, Maine, was pleased when
insurance, and Medicare has codified that benefit in the form of an annual he read that, under the new health
care law, Medicare had begun
wellness visit. This has been available since January 1, 2011, but both clinicians
covering annual physicals free of
and eligible senior citizens have shown confusion over the type of examination charge. But after he had one,
to be provided. The official handbook, "Medicare & You 2011," explained its Medicare denied his claim.
intent by stating that "Medicare covers two types of physical exams — one when
"When I asked the doctor's office
you're new to Medicare ("Welcome to Medicare") and one each year after that what had happened, they clued me
(Annual Wellness Exam)." Both have value, but neither exam, described by in that I was mistaken about the
Medicare, was what patients or physicians usually regarded as a physical difference between [Medicare's]
wellness exam and a physical," he
examination.
says. "I was upset that the way it's
"The annual wellness visit can be performed without the patient ever having to set up is misleading."

undress, and that sums up the problem," says Yul D. Ejnes, M.D., a practicing
internist in Rhode Island and chair of the board of regents of the American College of Physicians. The annual
wellness examination requires the clinician to record and evaluate the patient’s medical and family history, current
health condition and compile a list of current medical providers and prescription/non-prescription drugs; to check
blood pressure, vision, weight, height and waist measurement to calculate body mass index (BMI); to perform
cognitive impairment testing; to review risk factors; to review functional ability; to establish a written
screening schedule for next 5-10 years; to establish list of risk factors; to discuss voluntary advanced care
planning, and to provide advice and referrals to health education and preventative counseling services
including: Smoking and Tobacco Cessation Counseling; Screening Pelvic/Breast exam; Screening Pap Smear
Collection; Medical Nutrition Therapy Services; Screening Mammography; Bone Mass Measurement; Colon Cancer
Screening. Such a visit would not include evaluating a new complaint or symptom with the expectation of treating
an ailment.

WHAT YOU NEED TO KNOW ABOUT FREE MEDICARE CHECKUPS

During a wellness visit, the doctor measures the patient’s height, weight, body mass
and blood pressure – and perhaps listens to his heart through his clothes. The rest
is a discussion of the patient’s medical and family history, any physical or mental
impairments, and risk factors for potential diseases such as diabetes and
depression. The doctor also establishes a schedule for future care, and may refer
the patient for tests and screenings, many of which are now free under Medicare.
In other words, the wellness visit provides a snapshot of the patient’s current
health, as a baseline for future yearly visits, and is intended as a preventative
service, a way of catching potentially serious health issues early.


“The fact that Medicare in now recognizing the importance of wellness visits and supportive services and then is
willing to pay for them is a big step forward. That cannot be overstated”, says Dr. Ejnes. “A lot of times, the
counseling that occurs is more important than the poking and prodding. You’re talking about weight, smoking,
exercise, and screening for depression. But it’s not what we would normally consider a physical. Hence the
resistance we’re seeing from physicians offering the wellness visit service and perhaps a sense of dissatisfaction
when the patient leaves and realizes that what they got wasn’t what they thought they’d be getting.” Research has
shown that most doctors don’t talk to their patients about weight loss or diet, but when they do take time to discuss
it, people often act on it. In one study, patients who were obese and advised by their doctors to lose weight were
three times more likely to try to lose weight than obese people who didn’t receive such advice.

G ETTING THE J OB D ONE
This white paper addresses an important problem – disparity of healthcare to American elderly citizens – and
describes an innovative method to overcome critical barriers that prevent progress towards a more homogeneous
healthcare system in the United States. Having an EHR web-based system in place, which catalogues
comprehensive medical history for segments of the population who utilize large portions of healthcare resources via
emergency room visits, will facilitate better responses to chronic health problems, as well as, minimize social
services interventions related to morbidity associated with advanced irreversible diseased states. Successful
implementation of the program described in this treatise will change the concepts, methods, technologies,
treatments, services and preventative interventions for the senior citizen community. The insights in this whitepaper
provide a step-by-step guide to achieving success with the proposed process.

8 Tips for improved health literacy and health care for Senior Citizens

INTERACT WITH THE COMMUNITY TO IMPROVE HEALTH LITERACY

1. Interact with senior citizens at an organized senior function in a Community
Center to establish trust and credibility

2. Work with churches to schedule health literacy classes as part of their health
program

3. Give Power Point Presentations and Webinars on Health-related Issues

4. Increase public access, especially for senior citizens, to computers with
internet service to utilize nationally- prepared teaching resources

SELECT DEDICATED CLINICIAN TO DO ANNUAL WELLNESS VISITS EVALUATIONS

5. Utilize Provider who is sensitive to the cultural needs and medical beliefs of
the community
6. Utilize Provider who works with network EHR to facilitate universally easy
access to Medical History.

7. Utilize Providers who work outside of traditional clinic settings

8. Utilize Providers genuinely interested in geriatric health disparity causes


TE AC H I NG TH E B E NEF IT S O F P REV E NT IV E C AR E

Being able to meet clients at the level at which they present is imperative to be successful in providing
quality clinical care. There is a lingering distrust of government programs, among elderly poor African
Americans in the south, from the government’s abuse of private citizens as recorded with the syphilis study -
Tuskegee Experiment. Only interactive community-based health providers can confront such fears. Local
clinicians are more likely to patiently listen and validate patrons concerns then provide clear statements of
the facts regarding the programs to be implemented. “Client Readiness Services” are necessary to recruit,
retain and serve the low socioeconomic income population and the elderly.

Preventative care is paramount to stopping the root causes of disease as well as detecting diseases in their early
stages when treatment is most effective. African Americans continue to have lower life expectancies on average than
whites in the United States. Even with rates adjusted for age, African Americans are 1.6 times more likely to die
from one of the 10 leading causes of death in the United States than European Americans. The life expectancy gap is
affected by collectively lower access to quality medical care. With no system of universal health care, access to
health care in the U.S. generally is mediated by income level and employment status. As a result, African
Americans, who have a disproportionate occurrence of poverty and unemployment as a group, are more often
uninsured. For a great many African Americans, healthcare delivery is limited, or nonexistent. And when they
receive healthcare, they are more likely than others in the general population to receive substandard, even injurious
medical care.

Better Outcome with Early and Consistent Intervention

Low-income women are 26% less likely than women in the highest income bracket to receive a mammogram, a
simple screening that is vital to the early detection of breast cancer, Although, African American women suffer from
breast cancer at a lower rate than white women; they die from the disease more often. Less than one-third of people
with low incomes receive proper care for diabetes; they incur kidney disease and foot amputations as late-term
consequences – conditions that are much more likely among African Americans. Diabetes requires consistent
management which includes hemoglobin testing, eye and foot examinations, influenza vaccinations, and lipid
management to prevent progression of the disease. African Americans are twice as likely to have diabetes as whites,
and twice as likely to die from the disease. Obesity affects 37% of men and 51% of women. This and other factors
contribute to hypertension, which affects 40% of all adults. African American men are twice as likely to have
diabetes-induced end-stage kidney disease, and twice as likely to die of it than white men of the same age. African
Americans are 1.7 times more likely to have a stroke and 60% more likely to die from it. Two reasons for poorer
health are lack of routine preventative medical care, such as mammograms and colonoscopies, and the absence of a
primary care physician.

Disease Happens with Sex After 50

HIV among adults over 50 is not a new phenomenon. Since the early 80's, HIV in persons older than 50, have
accounted for about 10 percent of all cases. Heterosexual transmission in men over 50 is up 94 percent and the rate
has doubled in women since 1991. And while prevention and education dollars are concentrated toward young adult
populations, seniors are not getting safer sex education and continue to get HIV infected. Studies have shown
physicians do not routinely assess for HIV risk factors in persons over 50. The incorrect belief that people over 50
do not have sexual risk factors for HIV is contributing to the incidence of unprotected sex among seniors and the

© 2011 Epiphany Enterprise I, LLC. All Rights Reserved 10 | P a g e

lack of safer sex education directed at people over 50. Lack of HIV
In Newark, New Jersey
knowledge combined with the belief that safer sex is only for young women
among senior citizens (50
wanting to prevent pregnancy leads to at risk behavior among our elders.
years and older) rates of
Without intensive education, post menopausal adults are less likely to
infection for HIV/AIDS
discuss condom use, since the risk of pregnancy is removed. It cannot be
make up 16% of all new
assumed that senior citizens understand the basic facts about HIV
reported cases. For this
transmission. Prevention programs must be developed specifically for this
population, the number of
population recognizing the stigma attached to discussing HIV-related
cases has doubled in the
behaviors. A broad baseline assessing senior citizens' knowledge and
last four years; yet there
beliefs about HIV risk reduction must be developed so that appropriate
are few programs in the
prevention programs can be designed and implemented.
United States that target
older adults, and little
African Americans are the American ethnic group most affected by HIV
research conducted to
and AIDS, according to the Centers for Disease Control and Prevention
measure their knowledge
(CDC). Black men are six times more likely to have HIV than white men
and attitudes about
and black women are nearly 18 times more likely to have HIV than white
HIV/AIDS.
women. A 2004 "CDC analysis of men who has sex with men in five cities
found that while only 18 percent of the HIV-infected white men were
unaware of their infections, 67 percent of the infected black men were unaware. We seldom think about HIV and
senior citizens. HIV surveillance shows that 11 percent of all new AIDS cases are in people over the age of 50.
Statistics also show that new AIDS cases rose faster in the over 50 population than in people under 40. Experts
report that more than half of persons over 50 are having sex a couple times each month. Unfortunately, knowledge
of safer sex practices among seniors is much less than that of persons in their late teens and early twenties. This
combination of facts explains in part why the HIV population among seniors continues to grow.

K EEPING THE F OCUS ON THE P ATIENT N OT THE D ISEASE

The key to successfully closing the gap of the disparity of health care for elderly citizens is personal interaction with
the target population. A relationship must be fostered so that the recipients of the information/care trust the
providers. Many government agencies advocate developing partnerships with community-based organizations,
public libraries, senior-citizen facilities, adult day care, assisted-living facilities, nursing homes, and health care
associations to have ready access to the target population of senior citizens, but these programs have marginal
success because too little culturally-sensitive elements are imbedded into the design of the plan resulting in the
target population not trusting those authorized to facilitate health care information programs.

The Medicare Modernization Act of 2003 mandated that the Centers for Medicare and Medicaid Services utilize a
commercial model for chronic disease management. The agency launched the Medicare Health Support Pilot
Program to test the model in 2005. The conscripted companies used nurse-based call centers to assess the needs of
patients with diabetes and heart failure. Each program used “coaches” to improve patients’ understanding of their
diseases, their ability to manage self-care, and their ability to communicate with providers. Companies were
required to meet preset targets for clinical quality and patient satisfaction and to hold health care costs under a preset
limit. The disease-management programs “had little success” in curbing hospital admissions and emergency
department visits for conditions amenable to ambulatory care according to investigators reporting in the New
England Journal of Medicine (2011:365:1704-12). The average monthly health care costs increased substantially for
all patients in the disease management groups. Dr. McCall and Dr. Cromwell of RTI International ( a consulting


firm) which evaluated the outcome of the Medicare Health Support Pilot Program made the following observations
about why the “disease-managed” program failed.

 Medical care of elderly, chronically ill patients- typically covered by Medicare and Medicaid- are
inherently difficult and expensive, unlike the care of the average patient covered by a commercial disease-
management program.
 Non-physicians involved in the care of elderly, chronically ill patients are usually surprised by the number
of health and psychosocial problems that are prevalent among Medicare patients and are less equipped to
address issues raised during conversations.
 The unpredictable nature and immediacy of chronic disease flare-ups call for real-time information on
health status which is inaccessible from disease-managed programs.

Partnerships with community-based organizations are necessary to develop outreach programs for senior-citizens
that provide health information. Public library should host health information classes as part of public service
initiatives. Literature that is multi-lingual, culturally appropriate and easy to read should be readily available on
mass transit systems, at shopping malls, grocery stores and on billboards. Low income and elderly citizens should
have ready access to computers, placed in supervised public places, with internet service so that published webinars
can be utilized.

The health care reform legislation signed by President Obama in March 2010 leverages health care information
technology to improve quality, cost and access for patients. This legislature supports programs to foster the reporting
of quality measures through the use of health information technology; directs the use of health information
technology (IT) in improving health care outcomes and supports health information technology education and
training among medical practitioners.

TO GET THE FREE WELLNESS VISIT CHECKUP

 Find doctor participating in the Medicare Program
 Ask the doctor for the free Wellness Visit Evaluation
 DON’T just ask for a physical—you will have to pay for it
 Get Wellness Visit Every Year – Always Free

Despite widespread use of information technology in other sectors, few physicians have embraced the long-term
value of electronic medical recording files. Regional Extension Centers (RECs) will support health care providers
with direct individualized and on-site technical assistance in selecting certified EHR product that offers best value
for the provider’s needs; achieving effective implementation of a certified EHR product; enhancing clinical and
administrative workflows to optimally leverage an EHR system’s potential to improve quality and value of care. As
part of an integrated solution, with practice management and patient communications services, electronic medical
recording systems can dramatically boost efficiency of continuity of care for the elderly and underserved
populations. When done right, focused effort on maximizing Medicare Wellness Examination accessibility and
recording the data via EHR-network based systems will result in an improved health care system providing more
equable care to the elderly and the underserved population. The office of the National Coordinator for Health
Information Technology has recommended that regional extension centers focus on the most at-risk communities.


Epiphany Enterprise offers a unique clinical service utilizing Medicare Wellness Visit – Preventative Health Care
initiative and HITECH-supported electronic health record web-based approach to electronic health records
compilation and storage to deliver greater clinical control and insights to medical practices while closing the gap for
the disparity of healthcare among the elderly and other underserved populations. Ready access to a patient’s
comprehensive medical history, doctor’s visits, laboratory reports, hospitalization course information and pharmacy
use ensures continuity of care for all American citizens. Such services promise:

Better patient care. Improved access to patient information and clinical data could mean reduced medical
errors, better patient safety, and stronger support for clinical decision making.
Process integrity. An electronic health recording system can help get things done the right way, at the right
time, and the same way each time – all based on best practice work flows.
Primary Care Provider and staff satisfaction. Use of electronic health record-keeping can strengthen a
practice team by allowing more time for direct patient care and reduced administrative burdens.
Greater patient satisfaction. Elderly persons often feel that insufficient time is spent on the “human” aspect
of providing medical care. Having ready access to information on social history and family history will
make it possible for a “new physician” to interact with greater familiarity with the patient and thereby
allowing the patient to relax and feel more trusting.

To learn more, visit http://circlepad.com/EpiphanyEnterprise1/Homepage


ENDNOTES

1. Office of the Actuary, Centers for Medicare and Medicaid Services, National Health Expenditure.
Projections for 2008. U.S. Department of Health and Human Services,
2. Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on
Scientific Affairs, American Medical Association, JAMA, Feb 10, 1999
3. Mead, H., Cartwright-Smith, L., Jones, K., Ramos, C., Siegel, B., Woods, K. (2008). “Racial and Ethnic
Disparities in U.S. Healthcare: A Chart book.” The Commonwealth Fund.
4. Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2008
5. Kaiser Family Foundation, Medicaid and the Uninsured, (Washington, DC: Kaiser Family Foundation,
2009).
6. Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2000). Inequality in quality: Addressing
socioeconomic, racial, and ethnic disparities in health care. The Journal of the American Medical
Association, 283(19), 2579-2584.
7. Brach, C. & Fraser, I. (2000). Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A
Review and Conceptual Model. Medical Care Research and Review, 57, 181-217. Retrieved March 31,
2008 from Google Scholar
8. Lohr, Steve. “Most Doctors Aren’t Using Electronic Health Records.” New York Times, June 19,2008
9. Title IV – Health Information Technology for Economic and Clinical Health Act. Prepared by the Majority
Staff of the Committees on Energy and Commerce, Ways and Means, and Science and Technology,
January 16, 2009.
10. New England Journal of Medicine (2011:365:1704-12): Medicare Health Support Pilot Program
11. American Medical News, AMA; American Medical Association. Vol 54, Number 22, November 21,2011
12. Internal Medicine News : Vol 44, Number 19, November 15, 2011
13. "Income Stable, Poverty Up, Numbers of Americans With and Without Health Insurance Rise, Census
Bureau Reports". U.S. Census Bureau News. August 26, 2006. Archived from the original on September
29, 2006.
14. "Ethics and Human Rights Position Statements: Discrimination and Racism in Health Care". American
Nursing Association.. March 6, 1998
15. "Risk Factors and Coronary Heart Disease". American Heart Association.
16. Tronetti, Dr. Pamela (18 January 2011). "Senior consult: Black health statistics are alarming". Melbourne,
Florida: Florida Today. pp. 1D.
17. "HIV Prevalence Estimates – United States, 2006". Centers for Disease Control and Prevention.


Epiphany Enterprise I, LLC
1429 Third Street
Alexandria, Louisiana
71301-8250

318-487-9254

At Epiphany Enterprise I, LLC we offer personalized service to elderly
clients always sensitive to their limitations and needs. This sensitive
allow us to be successful in breaking down barriers encounter by
primary care providers, emergency room personnel and other
institutions. To learn more about our service visit our website.


White paper healthcare

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to White paper healthcare

Similar to White paper healthcare (20)

Recently uploaded

Recently uploaded (20)

White paper healthcare