Dr. Thriveni Sanagala of the Loyola University Health System in Maywood, Ill., advises women that if 60 to 90 minutes of daily exercise is not possible, try 10- to 15-minute segments.

Many women cannot imagine finding an extra 90 minutes every day for themselves, she says.

The most important thing is don’t disregard all the guidelines if you cannot meet a few; the new guidelines are a very important challenge and well worth it.

To reduce their risk of heart attack, women should be as meticulous about checkups for their heart as they are about scheduling their Pap test or mammogram, according to Sanagala.

Blood pressure, cholesterol, fasting plasma glucose and body mass index should be checked because abnormal levels are risk factors for heart disease.

Men often experience the traditional symptoms of heart attacks such as squeezing chest pain or pressure, while more subtle symptoms such as shortness of breath, dizziness, fatigue, nausea or vomiting and back and jaw pain are more likely in women, said C. Noel Bairey Merz, medical director of the Women’s Health Program and the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center in Los Angeles.

Getting immediate, appropriate care is the single most important thing you can do to help lessen the damage of a heart attack, advises Bairey Merz.

If a heart attack is suspected:

– Call 9-1-1 immediately. Don’t try to reach your doctor, don’t drive yourself or someone else to the hospital — every minute of delay means more heart muscle is damaged.

– Chew one aspirin. Most heart attacks are caused by blood clots in the arteries, and aspirin reduces the growth of these clots.

– If the person is not breathing, start cardio-pulmonary resuscitation.

Contact: Jennifer Rondon of the American Physical Therapy Association, +1-703-706-3216, jenniferrondon@apta.org

ALEXANDRIA, Va., Jan. 31 /PRNewswire-USNewswire/ — Because of increasingly demanding jobs, hectic daily schedules, participating in recreational activities, and caring for children, grandchildren, and elderly parents, back pain is becoming a common thread among baby boomers. However, this generation is less resigned to simply accept the changes brought about by aging, says the American Physical Therapy Association (APTA).

Baby boomers, those born between 1946 and 1964 and who now make up one fourth of the U.S. population, are leading more active lifestyles than previous generations. “Baby boomers are as active as they were when they were younger, but now they’re living with chronic low back pain or osteoarthritis,” says Jennifer Gamboa, PT, DPT, OCS, MTC, owner of Body Dynamics, a physical therapy private practice in Arlington, VA. “These conditions as well as others can benefit greatly from physical therapy intervention.”

Back pain among baby boomers will be the subject of a toll-free national hotline on Thursday, February 15, from 9:00 am until 5:00 pm, Eastern Standard Time, sponsored by the American Physical Therapy Association’s Orthopaedic and Sports Physical Therapy Sections. The toll-free number is 1-877-NEED-A-PT (633-3278). Physical therapists will be on hand to answer questions about injury prevention, exercise, and ways to prevent back pain. The hotline is offered as a public service to help people learn how to minimize back pain and is not a substitute for a visit to a physical therapist or other health care professional.

“Frequently, patients may unknowingly exacerbate their pain by exercising improperly or by having poor posture,” Gamboa said. Physical therapists can help to identify and correct those behaviors. Physical therapists work on increasing muscle strength and cardiovascular endurance, restoring and improving range of motion in joints, and decreasing muscle and joint pain.

Physical therapy interventions may include therapeutic exercise, manual therapy, and functional training, as well as exercises for strength, flexibility, and range of motion, and devices designed to rest or support the joint, such as orthotics or splints. “The goal of a physical therapist is to get you back to doing what you enjoy on a daily basis with as little discomfort as possible.”

For those patients who either are just starting an exercise regime, or for injured weekend warriors just getting back in the game, Gamboa recommends starting off slowly and not doing too much too fast. She notes that physical therapists devise step-wise plans in order for patients to gain strength and mobility.

Gamboa also suggests investing in an ergonomically correct chair for work, taking frequent breaks from computers, and participating in stress-relieving activities, such as yoga or meditation, to offset back pain.

Physical therapists (PTs) are health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability.

The American Physical Therapy Association (http://www.apta.org) is a national organization representing nearly 70,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information at http://www.apta.org/consumer.

SOURCE American Physical Therapy Association

(c) 2007 U.S. Newswire. Provided by ProQuest Information and Learning. All rights Reserved.

Kids!

It’s not bad enough that they leave their clothes on the floor, cost you a fortune and drive you crazy with worry.

They also may be making you fat.

So says a study that appeared in the Jan. 4 online edition of the Journal of the American Board of Family Medicine. Compared with adults living without children in the home, adults living with kids younger than 17, on average, take in an additional 4.9 grams of fat daily. And 1.7 grams of that additional fat is saturated fat the artery-clogging kind of fat that abounds in many meat and dairy products, processed foods and meals taken out from fast-food joints and eaten in restaurants.

The damage that children appear to wreak upon the diets of those who care for them piles up faster than the laundry. And the litany of dietary offenses committed regularly by parents and guardians reads like a nutritionist’s nightmare: Adults who live with children, the study found, “had significantly higher odds of frequently eating pizza, cheese, beef, salty snacks, cakes and cookies, ice cream, bacon/ sausage/processed meats and peanuts.”

To Stacey Gordon of Torrance, Calif., the difference is an inevitable fact of life with kids. A McDonald’s lies between her two daughters’ preschool and home, and she relents to their appeals at least once a week. Gordon, a full-time real estate agent in Los Angeles, says that each time she does so, it seems, she gives in to the urge to order a cheeseburger.

Before kids, Gordon says, macaroni and cheese, hot dogs and her daughters’ favorite cookies would never have been in her cabinets. Now, they’re not only a staple in her kitchen, they’re a quick and easy meal for her and the kids after a long day at work. “And I find myself making more cakes because they like them,” she says of her 3- and 5-year-old daughters. But each time she passes a tray of cupcakes, one seems to disappear down her throat. “They don’t last that long,” she says with a laugh.

The latest research is one of a raft of new studies that look at how family dynamics affect an individual’s propensity to become overweight. As the rate of child obesity has grown, researchers increasingly have focused on how parental influences genes, education, incomes, exercise and food choices are passed down to children. To save a child from obesity, this line of research suggests, one must first reform her parents’ diets.

The latest study, however, reverses that perspective, suggesting what the authors call “a reciprocal influence of children on adults.” In consumer studies, parents routinely cite their children as key drivers of snack food choice, home menu selection and restaurant visits. Perhaps, the authors suggest, the U.S. epidemic of obesity and an overweight population should be approached by looking at how children form their food preferences and how those preferences influence their parents’ decisions about what to buy and consume.

“Parents with children are likely to be susceptible in their food choices to both the marketing of convenience in food choices as well as indirectly to the marketing directed at their children,” wrote the study’s authors, Dr. Helena Laroche of the University of Iowa and Dr. Matthew Davis of the University of Michigan Health System.

Eating what the kids eat

Laroche and Davis combed through the responses of some 6,660 adults who were queried in a comprehensive survey of Americans’ health and nutrition conducted by the U.S. Department of Agriculture between 1988 and 1994.

They looked not only at a day’s worth of detailed food tracking recalled by respondents, but also at a separate survey that asked respondents how frequently they ate certain kinds of foods. This latter measure was where the high-saturated fat choices really stood out, Laroche said where parents and guardians fessed up to eating more pizza, ice cream, potato chips and salty snacks, sausage, cured meats and hamburgers than did adults without children in the home.

The study did not find differences in the total calories taken in on average by both groups. But compared with those who had kids at home, adults living without children took in more calories from leaner sources.

Laroche and Davis emphasized that children are not to blame for the high-fat eating habits of the adults who care for them. But they suggested that physicians who treat adult patients should be as aware as pediatricians have become that poor food choices can be a family problem, not just a challenge for the individual patient. “It’s hard to disentangle what’s adults influencing kids and kids influencing adults,” said Laroche. “This is just a first step toward understanding that.”

(c) 2007 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.

If you need or want to get less sodium in your diet, replacing the salt in your shaker with a substitute can help.

The most important strategy for getting less sodium is avoiding packaged or prepared foods loaded with salt sodium chloride since they account for 75 percent of the average person’s daily intake. Reading labels in the grocery store and asking questions in restaurants can help you eliminate a fair amount of stealth salt. What you do at home can make a difference, too.

Low- or no-sodium salts

Sodium and potassium are in the same chemical family. Their similarities make potassium chloride close enough in size, shape and chemical configuration to trigger taste buds designed for sodium chloride. Because potassium chloride isn’t a perfect fit, it isn’t quite as salty as table salt. It also has a bitter aftertaste, especially when heated. Some companies claim to have masked or neutralized the off taste by adding L-lysine, a common amino acid.

Some potassium-based substitutes are “lite” salt. These replace up to half of the table salt with potassium chloride. Sodium-free versions contain only potassium chloride.

Potassium-based salt substitutes are a double-edged sword. Most Americans get too little potassium. Increasing intake could protect against stroke, high blood pressure, heart-rhythm problems, kidney trouble and even osteoporosis. But extra potassium can be dangerous for people who have trouble flushing out any excess or who are taking medications that can increase potassium levels in the bloodstream.

Warning: Talk with your doctor before trying a potassium-based salt substitute. Too much potassium in the blood can lead to potentially deadly disturbances of the heart’s rhythm. This can be a problem if you have diabetes or kidney disease, if you have had a blocked urinary flow, or if you are taking an ACE inhibitor, angiotensin-receptor blocker, potassium-sparing diuretic or daily doses of a non-steroidal anti-inflammatory drug.

Spice it up

Instead of trying to mimic the taste of salt, light up your taste buds with something completely different. Using spices, herbs and other flavorings is a safer, tastier and healthier alternative to salt. Herbs and spices offer a world of flavors that salt can’t begin to match. And there’s growing evidence that substances in herbs and spices may fight cancer, heart disease, diabetes and other chronic conditions.

Ready-made blends are available in most grocery stores, and the Internet abounds with recipes for herb and spice salt substitutes.

Start slow, get help

The taste for salt is partly hard-wired but mostly learned or acquired. So you can train your taste buds to be satisfied with less salt. Instead of stopping cold turkey, gradually cut back on salt in favor of lemon, pepper, vinegar, herbs and spices, and other sodium- free flavorings. Over time, you might rediscover the true flavor of food and the subtle or super sizzle that herbs and spices have to offer.

You don’t have to figure out how to use substitutes on your own. Help is available from cookbooks such as the American Heart Association’s “Low-Salt Cookbook,” now in its third edition, and dozens of other books like it. You might also check out Salt-Free Life, an independent bimonthly magazine that’s full of cooking, shopping and dining tips (877-667-2588 toll free or saltfreelife.com).

(c) 2007 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.

FEBRUARY is American Heart Month, and it serves as an important reminder of the need to address the effect of heart disease on women.

Every minute in this country, someone’s mother, sister, wife or friend will die of heart disease, stroke and other cardiovascular diseases. These diseases have been the No. 1 killer of American women for more than 40 years, with minority women especially vulnerable.

Yet there are too many people in this country including health care professionals, researchers, policymakers and women who still mistakenly consider cardiovascular disease to be a man’s disease.

Only 8 percent of primary care physicians recognized that heart disease kills more women each year than men, according to a recent American Heart Association survey. Unfortunately this information gap results in women receiving less aggressive and sophisticated diagnostic screening and treatments, like stents and angioplasties, which could prevent a deadly heart attack or stroke.

Among women, only 55 percent recognize that cardiovascular disease is the leading cause of death for their sex, according to another AHA survey. Many more are uninformed about the symptoms of cardiovascular disease, which can be more subtle than those exhibited by men. And many don’t realize that such controllable conditions like smoking, physical inactivity or high blood pressure can put them at increased risk for heart attack or stroke.

Knowledge gap

This knowledge gap disproportionately affects minority women. Only 38 percent of black women recognize that heart disease is their biggest health threat, even though nearly half of all black women (49 percent) have some form of cardiovascular disease (compared to 35 percent of white women).

They are also more likely to have many of the risk factors for cardiovascular disease, including diabetes, high cholesterol, high blood pressure and physical inactivity. Much the same is true for Hispanic women.

But even when women and their doctors recognize the need for medical intervention for cardiovascular disease, they often don’t know if the treatments and medications available are equally effective or even safe for women.

That’s because previous scientific studies were frequently conducted with inadequate numbers of women in the study population, meaning their findings don’t always apply to women. In fact, women represent just 38 percent of subjects in National Institutes of Health-sponsored cardiovascular studies, and one-third of all the new drugs approved by the Food and Drug Administration in recent years have not included information about how they affect women.

Taking action

Federal officials need to take action to help reduce disability and death from cardiovascular diseases in women. There are several ways they can achieve this goal.

Congress needs to authorize grants to educate both women and health care providers about prevention programs and the most effective diagnostic and treatment strategies for cardiovascular disease in women.

Second, lawmakers must tighten FDA requirements for drug companies and device manufacturers to report gender-based data.

Third, they must expand the Centers for Disease Control and Prevention’s free screening program for low-income, uninsured women to all 50 states. Currently this program covers only 14 states.

The prevalence of cardiovascular disease in women is a national problem, and we need a national approach. We must help reduce the devastating effects of this disease in women to ensure that our loved ones have the opportunity to live longer, healthier lives.

* *

Jennifer Mieres is a cardiologist and director of Nuclear Cardiology at New York University School of Medicine. Distributed by McClatchy-Tribune Information Services.

(c) 2007 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.

At a time of year when everyone in North Jersey seems to be running around in circles, Shelly Frattarola took time Sunday to walk around in circles, slowly and deliberately.

Frattarola led a group of about a dozen hikers and nature lovers through the twists and turns of the Turtle Peace Labyrinth at the Teaneck Creek Conservancy. “Clear your mind, follow the path and get in touch with yourself,” she told the group, as they stepped off onto a narrow path laid out in a clearing in the park.

Labyrinths are elaborate designs, installed in the floor of a building or outdoors in public places, with patterns that guide walkers in a spiraling path to the center of the design. The ancient Greeks believed they could trap evil spirits. Medieval architects used them in cathedrals to symbolize man’s path to God. And at Teaneck Creek, labyrinth walkers often contemplate the life cycles of the park itself, from dumping ground to reclaimed natural habitat.

The 46-acre nature preserve, part of Overpeck County Park, sits alongside the intersection of Routes 80 and 95 in Teaneck. The construction crews that built those highways dumped concrete slabs and other debris there, and for decades the land served as Teaneck’s town dump and became the final resting place of stoves, refrigerators and other abandoned appliances.

“When we started here, this was nothing but a bunch of weeds and old refrigerators,” said George Reskakis, one of the volunteers who carted off rusty refrigerators and built hiking trails to create the park.

The volunteers recycled the construction rubble into a thing of beauty, carting chunks of concrete into a grassy knoll at the heart of the park and using the slabs to create the labyrinth’s pathways and a circular sitting area at the center of the labyrinth.

Larger concrete slabs were used to create “Migration Mileposts” along one of the park’s path. Carved into each slab is information about one of the species of birds that fly over the park during migration.

Three nature trails opened to the public in May. The trails were laid out with a nod to their Jersey roots, Reskakis said. They converge at a “roundabout” or pedestrian traffic circle. “This wouldn’t be New Jersey if we didn’t have a roundabout,” he said.

The Teaneck Creek labyrinth was designed by artist Ariane Burgess in the shape of a turtle, in homage to the original walkers on the land, the Leni-Lenape Indians, who believed the Earth was formed when a giant turtle rose out of the sea.

Before beginning the labyrinth walk, Frattarola performed a Leni- Lenape “cleansing” ceremony intended to drive away negative energy. She waved a smoldering bundle of sage around each walker as they entered the labyrinth.

Frattarola, who lives near the park, became involved in the reclamation effort five years ago. She said she often walks the labyrinth after work or on weekends and said following the path is a form of meditation for her. “It’s amazing how wonderfully meditative and contemplative you feel. It sort of puts you in a different state of mind,” she said.

As he walks the trails leading to the labyrinth, Reskakis looks and listens for signs the land’s reclamation has come full circle signs such as a pair of mating foxes, or a nesting hawk. But he’s still waiting for one sign: the sound of spring peepers, tiny frogs that signal a restored wetlands.

“We were out here this spring listening real hard for them, but not yet,” he said.

* *

E-mail: verdon@northjersey.com

(c) 2006 Record, The; Bergen County, N.J.. Provided by ProQuest Information and Learning. All rights Reserved.

Vitamin D might help protect people from developing multiple sclerosis, an incurable disease of the central nervous system, a study reports today.

If the link between vitamin D and MS pans out, people might be able to ward off the potentially crippling disease by taking vitamin D supplements, says lead researcher Alberto Ascherio of the Harvard School of Public Health.

“The idea that we could prevent many cases of MS with vitamin D is extremely appealing,” Ascherio says.

But the findings don’t prove the case for vitamin D just yet. A large, tightly controlled study is needed before public health officials can recommend high doses, which have risks of their own, such as kidney stones, Ascherio says.

Ascherio and his colleagues studied U.S. Army and Navy personnel who had blood samples stored in the Department of Defense Serum Repository. The team zeroed in on 257 men and women who had at least two serum samples that had been collected before they developed MS, a disease that causes vision loss, difficulty walking and other symptoms. They compared the MS patients with a control group of more than 500 healthy people in the Army or Navy.

Among whites, those with the highest blood levels of vitamin D had a 62% reduced risk of developing the disease. The protection was the strongest for people who were younger than 20 — a finding that suggests that to be effective, a protective agent might need to kick in very early in life, Ascherio says.

The team found no association between blood levels of vitamin D and MS in blacks or Hispanics, possibly because the researchers didn’t have very many black or Hispanic participants in the study.

MS afflicts 400,000 people in the USA and often strikes people in the prime of life — in their late 20s or 30s. But Ascherio and others say the disease might get started in the brain in the teen years. MS is thought to be the result of an autoimmune attack on a protective sheath (myelin) that covers the axons of nerve cells. When the immune system attacks myelin, nerve cells can’t transmit messages effectively and people develop symptoms, says Nicholas LaRocca, an associate vice president at the National MS Society in New York.

The study appears in today’s Journal of the American Medical Association.

The findings fit with previous studies in which vitamin D prevented an MS-like disease in mice, LaRocca says. But there’s no proof yet that vitamin D will protect humans from this disease, he says.

People need adequate levels of vitamin D to build strong bones so experts including Ascherio recommend eating foods rich in it, such as salmon or low-fat dairy products. And Ascherio says it can’t hurt to get very brief exposure to the sun — enough to get pink but not burned. The skin makes vitamin D after exposure to sunlight, he says. (c) Copyright 2005 USA TODAY, a division of Gannett Co. Inc.

Contact: Christine Junge of Harvard Health Publications, +1-617- 432-4717 or Christine_Junge@hms.harvard.edu

BOSTON, Dec. 19 /PRNewswire-USNewswire/ — Traditional high- protein dietsare heart killers, clogging the arteries with saturated fat from meat, eggsand cheese. But, according to a report from Harvard Medical School, a largestudy shows that there is such a thing as a heart-healthy high-protein dietthat can lower harmful LDL cholesterol, triglycerides and blood pressure.

The diet described in Healthy Eating: A Guide to the New Nutrition offersa healthful alternative to the old-fashioned Atkins- style diets that oozeartery-clogging saturated fat with every bite. Instead, this eating plan, oneof several studied in the OmniHeart trial, includes high-protein foods fromboth animal and plant sources that are lower in saturated fat. Along withchicken and fish, dietary sources of protein include nuts, beans, whole-graincereals and fat- free dairy products.

A high-protein diet doesn’t have to be all steak and eggs, according toDr. Frank M. Sacks, the editor of the report and Professor of CardiovascularDisease Prevention at Harvard Medical School. And not all low-carb diets arethe same. The most successful diet plans of any type have certain elements incommon, including an emphasis on vegetables, fruits and whole grains.

Healthy Eating is a 48-page report that includes a full discussion of thelatest scientific developments in the field of nutrition. Diet influences yourrisk for many diseases and conditions, including heart disease, Alzheimer’sdisease, diabetes, osteoporosis, eye disease and some forms of cancer. Thereport includes information on what foods can help protect you from certaindiseases — or make you more prone to them.

Also in this report: The Harvard Healthy Eating Pyramid; Vitamins andminerals that have extra health benefits; Additives to avoid; Food safetytips; and the soy-health connection

Healthy Eating: A Guide to the New Nutrition is available for $16 fromHarvard Health Publications, the publishing division of Harvard MedicalSchool. Order it online at http://www.health.harvard.edu/ HEor by calling1-877-649-9457 (toll free).

Release may be used in whole or part with attribution. Media inquirieswelcome.

Media: Contact Christine Junge at Christine_junge@hms.harvard.edufor acomplimentary copy of the report.

SOURCE Harvard Health Publications

(c) 2006 U.S. Newswire. Provided by ProQuest Information and Learning. All rights Reserved.

By Wells, Susan J

Consumer-directed health coverage requires employees to make wise decisions on care and spending. But will it improve health and cut costs?

Hailed by some as the last best hope for harnessing employers’ health costs, but criticized by others as the last step before all health costs are shifted to employees, consumer-directed health has been at the center of controversy-and news coverage-for several years.

Yet a fundamental question remains: Do consumer-directed health plans (CDHPs) actually alter employee health spending habits, as advocates maintain?

A preliminary answer emerges from the experiences of early adopters of the consumer-directed approach. Though far from definitive, the anecdotal evidence from these companies can provide important guidance for any employer considering adopting a CDHP. Such evidence not only can show the early returns on whether CDHPs work but also can show whether the concerns expressed by critics are valid and can be overcome.

Facts (and Assumptions) About CDHPs

The rationale behind CDHPs is that when employees must spend their own money for health care, they will be more judicious in making health care decisions. In turn, advocates say, careful spending will help hold down increases in health costs.

CDHPs aim to achieve this in the following way: The plans generally have high deductibles and are connected with tax-favored health spending accounts, such as health savings accounts (HSAs) or health reimbursement accounts (HRAs). HRAs are funded solely by employers; HSAs can be funded by the employer, the employee or both, and they have to be connected with a high-deductible plan. At the start of the calendar year, for example, an employee pays health care costs from such an account; if it becomes exhausted, the employee pays subsequent costs out-of-pocket until a deductible is met, which then triggers insurance coverage.

Critics maintain that when employers offer both high-deductible CDHPs and low-deductible traditional health plans, healthier members of the workforce will be attracted to the high-deductible plans. The concern is that those healthier workers might avoid spending for preventive or routine health care so they can roll over the unspent amounts in their HSA or HRA. This could cause reduced early care, leading to more-significant health care problems-and costs-down the road.

Another concern is that if healthy workers migrate toward CDHPs, they will leave traditional health plans with a preponderance of less-healthy workers, thereby putting upward pressure on premiums for traditional plans.

Reason for Concern?

At least some of the concerns about consumer-directed health appear to be valid, based on recent studies of employee attitudes and reactions to CDHPs.

“We know people are going to reduce their use of health care under these plans,” says economist Melinda Beeuwkes Buntin, lead author of a RAND Corp. study, released in October, on consumer- directed plans. “But what we don’t know is how this will affect overall health care quality and patients’ health.”

A 2005 Employee Benefit Research Institute (EBRI)/Commonwealth Fund survey asked participants if they avoided or delayed seeking health care because of costs. Those in high-deductible plans- including those with HSAs-were significantly more likely than those in comprehensive health plans to say they had done so. What’s more, people with health problems or with incomes under $50,000 reported high rates of avoiding care, the report showed.

The study also revealed that few people who have a CDHP or a high- deductible health plan are satisfied with their coverage. Moreover, one-third of those with such plans said they would change to a more comprehensive health plan if they could, and no more than one-third would recommend a CDHP to a friend or a coworker.

Another study, released this past August by the federal Government Accountability Office (GAO), reported on enrollees’ experiences with CDHPs, particularly HSA-eligible plans. While HSA enrollees generally said they had positive experiences and would recommend such plans to healthy people, most said they would not recommend the plans to those who have chronic conditions, use maintenance medication, have children or may not have the funds to meet the high deductible.

GAO focus group participants whose employers offer CDHPs suggested they would consider leaving if a CDHP became their only option.

The Early Experiences

Can employers overcome employee concerns about CDHPs and run them in a way that will have a positive influence on employees’ health behaviors and spending?

From a few employers who adopted CDHPs early, there is anecdotal evidence that such plans can focus employees’ attention on health decisions and reduce employers’ costs-all apparently without endangering the quality of care.

One early adopter of CDHPs was Textron Inc., a global, $10 billion company in Providence, R.I., with 37,000 employees in aviation, defense and other industries. In 2002, Textron launched an HRA pilot plan for about one-third of its workforce.

“It was a huge change for our employees,” says George Metzger, vice president of human resources and benefits. “It isn’t something you commit to tepidly.”

The change required a large-scale communication and education campaign that centered on making employees more aware of the partnership between the company and its workers regarding how to continue to pay for quality health care. “The message that resonates isn’t the one about the money you’re saving the company,” Metzger says, “but what you’re doing to preserve health.”

Early results show that Textron’s consumer-directed approach has had a positive impact on both medical costs and employee health, Metzger says. From January 2003 to December 2005, overall medical utilization decreased 16.8 percent while preventive care visits actually increased by 21.9 percent. “That tells me that employees are addressing and managing their health care conditions before they have a chance to worsen,” he says. “And that’s a nice difference.”

Employee satisfaction tends to be greater at both extremes of the spectrum, Metzger says. “Those with very high costs love it, because of the flexibility and capped costs; those with very low costs overall also love it, because it ends up being essentially a no- cost plan for them.”

Employees in the middle-those whose health expenses are neither high nor low in a typical year-aren’t collectively viewing the arrangement negatively, according to Metzger. They recognize that “the plan design gives them far more control over their health care expenditures than they have historically had,” he says. They also know that their maximum health outlays are capped, he adds, “and that they have the potential to accumulate savings if they don’t spend their entire HSA or HRA balance.”

After the initial plan met expectations, the company followed up in 2003 with a full-replacement CDHP for all employees. It took the place of about 138 health plans spread among the company’s various businesses and locations. An HSA option was added in 2005.

Next year, the company plans to offer two plans with HSAs (participation in a high-deductible health plan is a requirement for having an HSA) and one HRA plan. In addition to what Metzger sees as recruiting advantages with HSAs-portability, tax-free growth of contributions, tax-free distributions for qualified medical expenses- he also feels the plan design is another way to reinforce employees’ responsibility for managing assets available for health care.

An Expanding CDHP

Another early adopter of consumer-directed health is Logan Aluminum Inc., a Russellville, Ky., manufacturer with 1,100 employees. Three years ago, the company switched from a traditional preferred provider organization (PPO) to a CDHP to try to stem annual health care cost increases of 20-plus percent. That year- 2003-the company’s total medical costs fell 18.7 percent below costs in 2002, HR Manager Howard Leach says.

What’s more, while the number of emergency room visits and hospital inpatient days declined, overall health care utilization and the number of doctor office visits did not decline. “To me,” says Leach, “that says employees aren’t skimping on necessary health care.”

Leach acknowledges that employees initially thought the change could “cost them more. But if you fast-forward to today, there’s much more acceptance and better understanding of the plan.” (For one Logan employee’s take, read “As One Worker Sees It” on page 67.)

Part of the reason that employees’ concerns have subsided, Leach says, is the strong wellness and health-improvement program that the company integrates with its CDHP. More than 90 percent of employees complete a health-risk appraisal and receive incentives for doing so, he says. In 2007, the company will ask spouses of employees to complete an assessment.

Moreover, Logan plans to add 100 percent coverage of preventive services to its HRA and HSA options, Leach says, and the cost of preventive medications will be covered at 100 percent. “It’s a big step to take, but we’ve made believers out of our board of directors with the cost savings and improved health we’ve experienced.”

Maintaining those results takes considerable effort, investment and manpower. Leach \says consumer-directed health “is more complex from both the employer and employee aspect.” This past September, the company created an HR and benefits position-a health and wellness leader who will help employees adapt to the consumer- directed approach and health promotion goals, Leach says.

The company also continues to support a 20-member employee committee that discusses health care issues and costs several times a year.

Filling the Information Gap

Providing health care information to workers, as Logan does, is vital. Some experts say that an obstacle to greater acceptance of CDHPs is a lack of information on the cost and quality of care- information that’s necessary for consumers to make health spending decisions.

The EBRI report, for example, found that only one person in seven said their health plan-regardless of the type-supplies information on the cost or quality of doctors, hospitals and other medical providers.

Some insurers and third-party administrators are trying to close that information gap. Aetna Inc., for example, in August gave its members online access to physician-specific costs, clinical quality and efficiency information in several states.

Definity Health, a unit of UnitedHealth Group and among the largest CDHP managers, is expanding the availability of physician- quality ratings to 87 markets by the end of the year, up from 55 markets, says Meredith Baratz, director of market solutions in New York. The company has 1.8 million people and more than 14,000 employers enrolled in CDHPs tied to either HRAs or HSAs.

Definity also has replaced “explanation of benefits” statements with monthly health statements that resemble a credit card bill. The new statements provide summaries of employees’ health claims and health care account balances in addition to personally customized health messages based on individual health histories, age or gender, Baratz says. “These strategies are connected to really trying to make health care easier to navigate in ways that are consumer- friendly-and that encourage action.”

Among Definity members who read these personal health messages, for instance, the company has seen a 240 percent higher rate of mammography for women over age 50 and a decline in medical costs of $52 per person per year.

Some employers also are taking steps to fill the data void. In April, computer manufacturer Dell Inc. became the largest U.S. employer to offer employees online access to personal health records that regularly track and update medical claims and pharmacy information.

The voluntary tool, developed with technology from WebMD, a New York-based health information company, lets employees track and manage their own data on procedures, conditions and medications from multiple sources, including doctors, hospitals, pharmacies and other health providers.

So far, half of Dell’s 26,000 employees have signed up for the new “Well at Dell” effort, says Kathleen Angel, director of global benefits in Round Rock, Texas. It is part of Dell’s growing consumerism strategy, which includes health improvement programs and incentives for taking actions to stay healthy.

To help employees learn more about health care costs and outcomes, Logan Aluminum earlier this year created its own pricing database, drawn from its own anonymous medical claims data. Employees can enter specific conditions to get a list of claims by diagnostic code. The rundown gives them provider and physician names, the retail fee, and the rate Logan’s third-party provider negotiated.

In addition, Logan Aluminum offers employees using the database a voluntary survey for expressing their own ratings opinions, which co- workers also can view. “It’s our attempt to generate our own database of useful information,” Leach says.

The company also invests heavily in continuing consumer health education. For example, eight to 10 times a year the company offers employees a two-hour class taught by a member of the benefits department, titled “How to Establish a Relationship with Your Doctor.” The instruction is aimed at making employees better health care consumers, Leach says. Participants learn of ways to, among other things, build a collaborative and interactive relationship with physicians, ask about treatment options and discuss prescription drug alternatives.

Tools Ignored

But providing such tools without training, education and support- such as the kind Logan provides-may reduce their effectiveness. Several studies show that in the absence of any help, employees are unlikely to use such data.

A 2006 study of more than 18,000 employees by HR consulting firm Hewitt Associates in Lincolnshire, Ill., found that while the majority of employees believe their companies provide sufficient tools and information to choose and use their health plans, only half say they have used those tools.

Consumers spend twice as much time researching car and computer purchases as they spend selecting a doctor, and six in 10 probably wouldn’t change their ways even if price and quality information on health care providers were readily available. Those were among the findings of a national survey last August of 1,000 adults sponsored by Destiny Health, a CDHP provider, and conducted by Opinion Research Corp. Less than 40 percent of respondents were likely to shop around for health care.

Reluctance to delve deeply into consumer health tools may be linked to the makeup of the workforce-and with how HR and benefits managers design and tailor the content and delivery of data.

At American Financial Group Inc., a 5,000-employee property and casualty insurance company headquartered in Cincinnati, information tools that included a claims database with modeling and projections were of limited help to employees. “They said, Yes, that’s great, but I’m not going to spend an hour doing that,’” says Scott Beeken, director of human resources. “Instead, they told us, ‘Give me a quick cut-the last couple months’ worth of data-and tell me where I would do best.’ ”

When American Financial Group’s employees consider switching plans, they look first at fixed costs and then at out-of-pocket maximums, Beeken says. “So we pay attention to how we present all costs and risk trade-offs. Employees will decide how they value the plans and the spending.” The company offers two CDHP options and a traditional PPO plan; 52 percent of employees are enrolled in the CDHPs.

Looking to the Future

In the end, the prospects for consumer-directed health will depend on how well employers, employees, insurers and health providers overcome the challenges in dealing with health care as a consumer good, experts say. While the trend is likely not a passing fad, it may prove to be something less than a wholesale shift.

“Employers don’t have to offer a ‘pure’ CDHP to encourage behavioral change,” says Chris Calvert, vice president and senior consultant with the corporate health care practice of Segal Co. in New York. Elements of consumerism can be inserted into existing plans by, for example, offering access to health-data web sites or inviting employees to complete and act on health-risk appraisals.

In any case, Calvert says, change is in the wind, and probably no one can say what the final result will be. “The consensus is that [consumer-directed health] is likely here to stay. But it’s not going to look like it does now.”

Ethics and Cost Issues

Mark A. Hall, J-D., professor of law at Wake Forest University School of Law and School of Medicine, in Winston-Salem, N.C., raises an ethical concern over consumer-directed health plans (CDHPs). Hall is researching the law and ethics of consumer-directed health and its effect on medical practice and treatment relationships, and he to the author or editor of a dozen books on hearth care law and policy.

Consumer-directed health, Hall says, “gives doctors more reason to think about their patients’ finances.” And that could present an ethical problem for doctors, he believes: Should doctors recommend what to medically best for each patient-as if costs were no object- or should they tailor their recommendations based on the patient’s financial circumstances?

Concern over patients’ ability to pay for health care also is reflected in a position paper released last year by the American College of Physicians (ACP) in Philadelphia, the nation’s largest medical specialty society with 120,000 member physicians. The paper endorsed consumerism plans, but only if the account designs don’t threaten patients’ access to care.

The ACP, which considers health savings accounts (HSAs) “unproven,” stated that the growth in CDHPs should not erode current workplace coverage-and that employers need to offer low-deductible Insurance products, along with the high-deductible plans currently associated with HSAs.

There is anecdotal evidence that consumer-directed plans can focus employees’ attention on health decisions and reduce employers’ costs.

Online Resources

For additional information about consumerism in health care, see the online version of this article at www.shrm .org/hrmagazine/ 06December. There you will find links to:

* A survey report on employer health benefits.

* A survey report and a study on consumer-driven health plans.

* A press release on a report on consumerism in health care.

* A govemment report on consumer-directed health plans.

While consumer-directed health is likely not a passing fad, it may prove to be something less than a wholesale shift.

As One Worker Sees It

Steve Ray, a general technician with 21 years’ tenure at Logan Aluminum, a manufacturer In Russellville, Ky., says the company’s consumer-directed health plan options-coupled with Its focus on wellness and prevention-are making employees more consumer-oriented about health spending.

“Typically, you’ve got either a value-shopper mentality or an entitlement mentality,” Ray says. “This type of plan does swing you over to the value-shopper side.”

For example, many employees-incl\uding himself-have become a lot more knowledgeable about variations in prescription drug costs, Ray says. “I can tell you the price differences between [cholesterol- lowering drugs] Lipitor, Zocor and Vytorin, for instance.”

Logan employees’ Improved understanding of medical matters is largely a result of the company’s broad-scale education efforts In conjunction with Its consumer-directed options.

Ray also says the consumerism focus has encouraged him to plan for health care expenses and ask more questions of providers. “People tend to have a culture of the doctor Is always right,’ ” he says. ‘But we have a right to question the doctor, too-because we’re paying for it, and we’re there to get the best care and value we can.”

Ray acknowledges that Logan’s overall consumer-directed approach to health coverage “wouldn’t work at every plant We have a very responsible, engaged and Innovative culture here. And I think that speaks volumes about why this works for us.”

SUSAN J. WELLS, A BUSINESS JOURNALIST IN THE WASHINGTON, D.C., AREA AND A CONTRIBUTING EDITOR OF HR MAGAZINE, HAS MORE THAN 20 YEARS OF EXPERIENCE COVERING BUSINESS NEWS AND WORKFORCE ISSUES.

Copyright Society for Human Resource Management Dec 2006

(c) 2006 HRMagazine. Provided by ProQuest Information and Learning. All rights Reserved.