By Carolyn M. Clancy, M.D.

February 7, 2012

With Valentine’s Day around the corner, hearts shapes are everywhere – on cards, candy, and clothing. But every day of the year, your heart plays a big role in your health and well-being. And conditions or habits that harm our hearts, like high blood pressure or smoking, put our hearts at risk.

The risk is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services (HHS) (PDF File, PDF Help). People with heart disease are often unable to work or enjoy normal activities. They are also at higher risk of early death.

To help combat heart disease, especially heart attack and stroke, HHS recently joined several groups that include doctors, nurses, pharmacists, insurance companies, and drug stores in a campaign called Million Hearts.

Over the next 5 years, the partners aim to help millions of Americans improve their heart health by preventing and treating high blood pressure, high cholesterol, and tobacco use.

The goals are ambitious. But the good news is that heart disease can be prevented or reduced with two approaches.

The first is making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume. Today, 19 percent of the U.S. population smokes; in 5 years, the partnership aims to cut that to 17 percent.

The second approach is making treatment for heart disease available for people who need it. Simple but effective techniques, known as the “ABCS,” help focus these efforts. The ABCS stand for: Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation.

We have good tools to treat heart disease, but they’re not used enough. Today, less than half (47 percent) of people at risk for heart disease take a daily aspirin. The Million Hearts campaign hopes to increase that to 65 percent by 2017. Reducing salt intake, a factor in high blood pressure, by 20 percent, is another goal.

HHS is working with partners to help attain the Million Hearts goals. The partners include:

• The American Heart Association  is offering access to online tools , including one that helps you understand your heart health.

• America’s Health Insurance Plans  and its members are hosting programs to reduce heart disease with programs that promote fitness, lower obesity and manage chronic disease.

• The Y is expanding coverage of its diabetes prevention program  and other national disease prevention programs to better address risks for diabetes, heart attack, and stroke.

My Agency, the Agency for Healthcare Research and Quality (AHRQ), supports the Million Hearts campaign and has tools and knowledge that can support its goals.

For example, one AHRQ-funded resource that highlights innovative practices describes how pharmacists can help people lower their risk for heart disease.

In the HealthyHeartClub.com program, pharmacists educate patients to lower their heart risk by changing their diet, exercising more, and taking the right medicines. Working with primary care doctors, pharmacists meet with patients, email them weekly, and provide access to classes and tools that support their goals. It works! After 3 months, patients’ weight, blood pressure, and daily activity all improved.

AHRQ’s Effective Health Care Program produces free, plain-language booklets that can help you learn about treatment options for high blood pressure and high cholesterol. They describe treatment options, discuss risks and benefits, and identify areas where more research is needed.

All these resources for the Million Hearts initiative have one thing in common—they are an excellent source of information to share with your health care provider. Together, you can discuss steps you need to take to be sure you’re healthy for many more Valentine’s Days in the future.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

U.S. Department of Health and Human Services: Million Hearts

New public-private initiative aims to prevent 1 million heart attacks and strokes in five years
http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf [PDF Help]

Million Hearts
http://millionhearts.hhs.gov/

Heart Disease Prevention: Million Hearts
http://millionhearts.hhs.gov/about-hd-prevention.shtml

Agency for Healthcare Research and Quality

AHRQ Innovations Exchange: Innovation Profile
http://innovations.ahrq.gov/content.aspx?id=3182

Effective Health Care Program

Choosing Medications for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and DRIs
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=75

Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351

American Heart Association

AHA
http://www.heart.org/HEARTORG/

American Heart Association/American Stroke Association 

My Life Check
http://50.56.33.51/mlc01/main_en_US.html

America’s Health Insurance Plans (AHIP)

AHIP Statement on Million Hearts Initiative
http://www.ahip.org/News/Press-Room/2011/AHIP-Statement-on-Million-Hearts-Initiative.aspx

The Y

The Y Joins CDC, HHS, CMS in Million Hearts Initiative
http://www.ymca.net/news-releases/20110913-cdc.html

Current as of February 2012

Internet Citation:

Million Hearts Campaign Aims to Lower Risk, Improve Care. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 7, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020712.htm

Credit: Wikipedia - Creative Commons License

By Carolyn M. Clancy, M.D.

January 3, 2012

Whether it’s music, lifestyles, or a refuse-to-age outlook, Baby Boomers think of themselves as trailblazers.

Now, that generation born between 1946 and 1964 can claim credit for another “first”—a dramatic increase in knee replacement surgeries.

Women and men between the ages of 45 and 64 were more than twice as likely to have had knee replacement surgery in 2009 than in 1997, recent data from the Agency for Healthcare Research and Quality (AHRQ) show. The rates among women were even higher.

Knee replacement surgery is most common in people whose knees have been damaged by osteoarthritis (OA), rheumatoid arthritis, or injury.

Due to their age and fondness for sports, Baby Boomers fit neatly into each category.

The percentage of people who have osteoarthritis, the most common type of arthritis, grows with age. About 27 million Americans have this condition, and, after age 45, it is more common in women. Osteoarthritis occurs when the cartilage that coats the end of each bone breaks down. This can cause the bones to rub against each other, causing pain and stiffness.

Knee pain may also be caused by rheumatoid arthritis, a less common form of arthritis that occurs when the membrane surrounding the joint becomes inflamed. Over time, inflammation damages cartilage, resulting in pain and stiffness. Rheumatoid arthritis affects about 1.3 million people—more women than men. It often begins in middle age, but can occur in children and young adults.

Arthritis after a serious knee injury or repeated stress is another reason for knee replacement surgery. Pain caused by ligament tears or bone fractures caused by sports injuries, for example, may be managed non-surgically for years. Over time, however, pain and limited knee function causes some patients to consider knee replacement surgery.

If you have knee pain from one of these causes, you’ve probably heard about treatments that are intended to relieve pain and even postpone the need for surgery. Some, but not all, of these options work, a review of 86 research reports funded by AHRQ has found.

What has been shown to work?

• Exercise. Becoming more active—whether through walking, swimming, or water aerobics—can reduce pain and make movement easier. Physical therapy may also help, so ask your doctor if you would benefit.

• Maintain a healthy weight. A 10 percent weight loss combined with a moderate exercise program reduced knee pain in patients with knee osteoarthritis by 50 percent, a recent study  by Wake Forest University researchers has found.

• Pain medicines. Medicines can relieve osteoarthritis pain, AHRQ’s research review concluded. Your doctor or nurse may prescribe an over-the-counter or prescription medicine. Learn more about choosing pain medications for osteoarthritis in this guide developed by AHRQ.

What has been shown not to work?

• Glucosamine and chondroitin. Some people take nutritional supplements to help build new cartilage. Studies have found that people who take these supplements report less pain, but people who don’t take the supplements report the same result.

• Joint lubrication shots. This treatment is a gel-like substance given by a shot into the knee. Studies have found that most people who get the shots do not improve very much.

• Arthroscopic knee surgery. In this procedure, a flexible tool is inserted into the knee, which is used to rinse the joint. It can be helpful for other types of knee problems, but not for knee osteoarthritis.

If conservative treatments don’t provide relief from pain, it may be time to consider knee replacement surgery. The good news is that this procedure has been shown to give a better quality of life that makes it worth the cost, a Government-funded study has found.

The benefits of this procedure are even better if the surgery is done at a hospital that does a large number of knee replacement procedures.

Before you have surgery, prepare yourself for the best possible outcome by asking questions of your surgeon. You will feel more in control of your health if you have a good idea of what to expect before, during, and after surgery.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Healthcare Cost and Utilization Project

Statistics on Hospital-Based Care in the U.S., 2009
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

Effective Health Care Program

Osteoarthritis of the Knee: A Guide for Adults
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=132

Choosing Pain Medicine for Osteoarthritis
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayProduct&productID=4

Having Surgery? What You Need to Know
http://www.ahrq.gov/consumer/surgery/surgery.htm

National Institute of Arthritis and Musculoskeletal and Skin Disease

Handout on Health: Osteoarthritis
http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp

Handout on Health: Rheumatoid Arthritis
http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp

Total Knee Replacement Found Cost-Effective for End-Stage Knee OA
http://www.niams.nih.gov/News_and_Events/Spotlight_on_Research/2009/knee_OA_replacement.asp

American College of Rheumatology

Weight Loss Best Medicine for People with Knee Osteoarthritis
http://www.rheumatology.org/about/newsroom/2011/2011_ASM_21_weightloss.asp

Current as of January 2012

Internet Citation:

Baby Boomers Trigger Major Increase in Knee Replacement Surgeries. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, January 3, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc010312.htm

Good doctor-patient communication is a key to improving the quality of your care, the agency says. and a good way to start the conversation is with a question.

But because so many doctor’s visits are so brief, the agency is providing tools to help you prepare their questions before your appointments.

The tools are available online at the agency’s website “Questions are the Answer“. The site also provides brochures, videos and other tools providers can use to encourage their patients to speak up.

The website provides:

• A 7-minute video featuring patients and clinicians who discuss the importance of asking questions and sharing information – this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.

• A new brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit.

• Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

To promote the initiative, the agency is also offering providers the opportunity to co-brand the materials so that providers can add their organization’s name and logo to the brochures and notepads.

Providers interested in learning more about the initiative can contact the agency by phone at 1-800-358-9295 or by email AHRQpubs@ahrq.hhs.gov.

To learn more:

• Read Dr. Carolyn Clancy’s article: Patients should ask more questions about their care

Welcome to November—with its shorter days, cooler weather, and, for many, decisions about choosing a health insurance plan for the coming year.

Whether you’re covered by an employer’s plan, by Medicare, or you are self-employed or unemployed, doing homework during “open enrollment” can help you get the best value for your money.

You may find that you have more options for 2012.

Overall, employers that offer health coverage are providing more choices, according to recent data from my agency, the Agency for Healthcare Research and Quality (AHRQ).

Large firms that offer health insurance are more likely to offer workers two or more plans now than they were 10 years ago. Unfortunately, our report also found that the percentage of employees who are offered health coverage is less today than it was a decade ago.

When you know your options and how they work, you can better decide which option fits your personal situation. Your choice may be different depending if you have a spouse or dependent children or if you need certain medicines.

Getting Started

To help people covered by Medicare review their options, the Federal Government expanded its open enrollment period for 2012. Open enrollment continues through December 7, 2011, which is the deadline to pick a new Medicare plan. (You don’t have to do anything if you want to keep the one you have.)

Compare your choices using Medicare’s Plan Finder. This tool will help you find and compare the different kinds of Medicare Advantage health plans (or Part C) and Medicare prescription drug plans (Part D). An online demonstration of this tool is available on YouTube.

If you’re self-employed or unemployed, finding a health plan takes more work. Healthy individuals who can afford out-of-pocket expenses might consider a high-deductible plan.  Under these plans, you will have to pay much more yourself before the plan covers any expenses.

The advantage is that premiums are lower than other types of coverage. The National Association of Insurance Commissioners offers tips  to help you understand and apply for individual coverage.

If you’ve lost health coverage due to a job loss, you may be able to continue it for 18 months. You will pay higher premiums, however. A Federal law known as COBRA lets workers who have lost group coverage continue those benefits. Select for more information on how this law works.

If you are uninsured because of a pre-existing condition, you may be able to receive insurance through a temporary high-risk pool created under the Affordable Care Act. The program is funded by the Federal government, but States can choose how or if they want to participate. The program began on July 1, 2010, and ends on January 1, 2014.

Understanding how different health plans work can make it easier to choose wisely. You may prefer to pay more to get a wider choice of doctors, for example, or to use generic medicines instead of brand-name ones to save money.

Keep in mind that not all health plans pay for the same services or pay the same amounts for services. (One exception is Medicare, which is required by the Affordable Care Act to pay for certain preventive benefits.)

Plans also vary in how much you’ll pay before your insurance covers you. These are called out-of-pocket costs, and they usually are in the form of deductibles or coinsurance. The deductible generally is an annual amount that is not covered by your health plan. It must be paid before your health plan starts to pay for your care.

Coinsurance is the percentage of your health insurance bill that you must pay when you file a claim. You must usually pay this percentage in addition to the deductible.

The Alphabet Soup of Health Plans

Health plans differ in what they offer and the providers you can choose. You are likely to pay more for a plan that gives you many options for choosing doctors and hospitals. Health plans typically fall into one of these groups:

• Conventional indemnity: The least restrictive type of coverage, indemnity plans allow you to see any health provider without affecting what you pay. These plans are not common in populated areas, but still exist in rural areas.

• Preferred provider organizations (PPO): A form of indemnity insurance where coverage is provided through a network of selected providers. You can go to providers outside of the network, but you will pay a larger portion of the costs.

• Exclusive provider organizations (EPO): This is a more restrictive type of PPO. It covers services only if you go to doctors, specialists, or hospitals in the plan’s network, unless it’s an emergency.

• Health maintenance organizations (HMO): The most restrictive type of health plan, HMOs provide medical services to members in exchange for a fixed fee. They stress preventive care as a way to keep patients healthy and save money.

• Medicare Advantage Plans (Part C): These private insurance companies contract with Medicare to provide you with Part A (hospital) and Part B (doctor, outpatient care, home health) benefits. Many, but not all, of these plans include the Medicare prescription drug benefit (Part D).

Readers of this column know I am passionate about making health care better. That’s why I urge you to pay attention to the information about the quality of health plans , including Medicare Advantage plans. This can help you understand what a plan does well, what it needs to do better, and whether it’s a good fit for you.

Of course, choosing a good health plan is no guarantee against getting sick. But a wise choice will make it easier for you to continue to take an active role your health.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality

Medical Expenditure Panel Survey, Statistical Brief No. 344: The Number of Health Insurance Plans Offered by Private Sector Employers in 2000 and 2010
http://www.meps.ahrq.gov/mepsweb/data_files/publications/st344/stat344.shtml

MEPS Insurance Component: Glossary of Health Terms
http://www.meps.ahrq.gov/mepsweb/survey_comp/ic_ques_glossary.shtml

Center for Medicare and Medicaid Services

Medicare Plan Finder for Health, Prescription and Medigap Plans
http://www.medicare.gov/find-a-plan/questions/home.aspx

Medicare Plan Finder at a Glance (YouTube)
http://www.youtube-nocookie.com/embed/iQQJ7ry_H6k

U.S. Department of Health and Human Services

Temporary High Risk Pool Program
http://www.healthcare.gov/news/factsheets/2010/07/temp-high-risk-pool-program.html

Medicare Preventive Services: HealthCare.gov
http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html

National Association of Insurance Commissioners

Consumer Alert: Limited Benefit Plans, High Deductible Plans and Health Savings Plans
http://www.naic.org/documents/consumer_alert_high_deductible_plans.htm

Health Insurance: What You Need to Know When Applying for an Individual Health Insurance Policy
http://www.naic.org/documents/consumer_alert_ind_health_insurance.htm

U.S. Department of Labor

An Employee’s Guide to Health Benefits Under COBRA
http://www.dol.gov/ebsa/publications/cobraemployee.html

National Committee for Quality Assurance

Report Cards: Choosing Quality Care
http://www.ncqa.org/tabid/60/Default.aspx

Current as of November 2011

Internet Citation:

How to Get a Good Value When Choosing a Health Plan. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, November 1, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc110111.htm

As individuals, we want choices that reflect who we are and what’s right for our situation. Getting the right health care is no different.

Until recently, information that showed which treatments work best for certain groups of patients, especially women, was hard to find.

Illustration from Managing Pain From a Broken Hip

Now women’s health research is a growing field. The Women’s Health Initiative (WHI), a long-term study launched by the late National Institutes of Health (NIH) Director Bernadine Healy, MD, has provided important information on preventing and treating heart disease, breast and colorectal cancers, and osteoporosis in women aged 50 to 79.

The WHI and the Office of Research on Women’s Health, led for two decades by Vivian Pinn, MD, helped to ensure that women are fairly represented in NIH-sponsored studies. Before the WHI began, very few studies focusing solely on women had been conducted.

Today, far more research is helping to identify which groups of patients will benefit from which kind of treatment. My Agency, the Agency for Healthcare Research and Quality (AHRQ), sponsors patient-centered outcomes research that asks just that question. The goal of this research is to help you make better, more informed treatment choices.

Several recent consumer guides developed from this research focus on conditions that affect women. Written in plain language, these guides can help you understand the benefits and potential risks of treatments for different conditions.

One such guide helps women talk to their doctor or nurse about medicines to reduce their risk of breast cancer. Two medicines can lower the risk for women who are at high risk but have not had breast cancer before.

However, both of these drugs have side effects, some of them serious. If you are at high risk for breast cancer or if you’re unsure, talk to your doctor or nurse. They can help you decide whether a medicine to reduce the risk of breast cancer is a good choice.

Some questions included in this guide include:

• Is my risk of breast cancer higher or lower than other women my age?

• What if I don’t want to start medicine at the age I am now? Can I start later?

• Is my risk for blood clots higher than usual?

• Can I do anything else to lower my risk for breast cancer?

Another very helpful guide examines how to manage pain from a broken hip. Both men and women are at risk, but women are twice as likely as men to suffer a broken hip by age 80.

The guide describes why it is important to manage pain, outlines medicines that may help you, and provides risks and benefits on other ways to manage pain.

To help you make a decision on how to manage pain, the guide suggests key questions to ask, such as:

• Which options do you think are best to manage my pain?

• How quickly can I expect relief from my pain?

• How long do you think I will need to manage my pain?

• Are you concerned about the side effects from any of these options?

Other consumer guides from AHRQ that address women’s health issues cover breast biopsy, osteoporosis treatments, gestational diabetes, and induced labor. They provide helpful background on health conditions. Some even include basic price information on medicines. Select for a complete list of patient and consumer guides.

A new consumer guide to help women over age 50 learn which screening tests, medicines and daily steps to follow to stay healthy is also available.

We have made remarkable progress in understanding how treatments affect different groups of patients. Make sure to use that information when you talk to your health care team about the right treatment for you.

I’m Dr. Carolyn Clancy, and that’s my opinion on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Explore Your Treatment Options
http://www.effectivehealthcare.ahrq.gov/options/

Managing Pain From a Broken Hip: A Guide for Adults and their Caregivers
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=677

Reducing the Risk of Breast Cancer with Medicine: A Guide for Women
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=389

Effective Health Care: Guides for Patients and Consumers
http://www.effectivehealthcare.ahrq.gov/index.cfm/guides-for-patients-and-consumers/

Women: Stay Healthy at 50+
http://www.ahrq.gov/ppip/women50.htm

Office of Research on Women’s Health
http://orwh.od.nih.gov/

Women’s Health Initiative: Participant Web site
http://www.whi.org

Current as of September 2011