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INNOVATION & QUALITY IN
HEALTH CARE
St. Vincent Healthcare expands robotic surgery procedures
LARRY MAYER/Gazette Staff
Surgeons Jeff Rentz, left, and Mike Wilcox talk about their work with the da Vinci robot at St. Vincent Healthcare.
By CARMEN DAYE IRISH For The Gazette Robotic surgery has taken another step forward at St. Vincent Healthcare, expanding its use of the da Vinci surgical system into general abdominal surgical procedures. The da Vinci, a surgical robot, costing St. Vincent upward of $1.7 million, has rolled out as the fastest-growing general surgical specialty in the nation and is the leading alternative to traditional open surgery and conventional laparoscopic. Unlike traditional laparoscopic surgery, where rigid, hand-operated instruments limit surgeons, the da Vinci robotic system provides increased range of motion in tight spaces, said Dr. Jeff Rentz, a St. Vincent Healthcare general surgeon. He is one of two general surgeons performing robot-assisted surgeries at St. Vincent, and one of about 15 in Montana. “We gain seven degrees of motion that extend beyond the limits of the human hand,” Rentz said. “So, the technology is helpful in common procedures, but even more helpful in complicated general surgeries where areas can be difficult to get to and space is tight.” A product of Intuitive Surgical, the da Vinci surgical system is a sophisticated robotic platform first introduced in 2000. The technology is designed to allow surgeons to perform complex procedures through a small, single incision while utilizing high-definition, three-dimensional technology. General abdominal surgeries, such as gallbladder removal and upper gastrointestinal surgical procedures, are now less invasive than ever with the introduction of single-incision robotic surgery. Before the da Vinci technology, the only option for minimally invasive gallbladder surgery involved three to four incisions, each about 2 inches long.
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With the use of a high-definition camera and tiny robotic hands that are interchangeable with more than 200 surgical instruments, specially trained surgeons are able to do traditional operations with the enhanced robotic capabilities to treat broader ranges of conditions using the minimally invasive approach. Rentz and St. Vincent general surgeon Dr. Michael Wilcox began operating with the da Vinci in April. Both were skeptical of robotics at first as they questioned the added value to operative procedures. But, Rentz said, their apprehension soon turned to optimism as the benefits to patients became clear. “Every so often we stop and think, could things be done differently or should we accept the status quo?” Rentz said. “But I think that neither one of us feel like we’re done evolving.” “I personally don’t want to be doing things the old-fashioned way when there are better ways to do things,” said Wilcox, a 17-year general surgeon veteran. “If there is going to be a better way, I want to be involved.” Lana Feldman, the St. Vincent Healthcare robotic surgery coordinator, said at least 300 surgeries — primarily gynecological and urological surgical procedures — have been performed using the da Vinci since the hospital purchased the technology in early 2010. The system uses advanced technology that allows surgeons to see in greater depth and detail as well as operate with more dexterity and precision. Though it is referred to as a robot, the da Vinci cannot act on its own — the surgery is performed entirely by a surgeon. Seated at a separate console several feet away from the operating table, the surgeon views the magnified, three-dimensional image of the surgical field as they control the robot’s camera and surgical tools with hand-
Riverstone’s Epi team always ready... H2 Digital health ............................................... H2
grips and foot pedals. The surgeon’s fingers grasp the controls below the display, with hands and wrists naturally positioned relative to their eyes. The system seamlessly translates the surgeon’s hand, wrist and finger movements into precise, real-time movements of the robot’s surgical instruments inside the patient’s small incision. Meanwhile, the robotic procedure is also displayed on a large high-definition flat screen near the operating table where a second surgeon and clinical assistants monitor the surgery. Recovery time is often considerably shorter, and with less post-operation pain and discomfort. Other benefits may include reduced trauma to the
body, reduced blood loss, less risk of infection, shorter hospital stays and less scarring, Rentz said. Three gynecologists, two urologists and two general surgeons are trained to perform robot-assisted surgery at St. Vincent, Feldman said. Although not all hospitals have invested in the technology, the surgical procedure is quickly becoming standard practice, Rentz said. “It’s a phenomenal tool,” he said. “I expect that in five to 10 years, a good portion of surgeries will be performed with robotics.” Last year upward of 400,000 surgeries were performed nationwide with da Vinci technology, triple the number just four years earlier.
LARRY MAYER/Gazette Staff
Robotic surgery coordinator Lana Feldman watches a screen showing a macro view of work the da Vinci robot is doing at St. Vincent Healthcare.
Dental innovations ..................................... H6 St. Vincent proactive health care........ H6
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Foot amputation at Billings Clinic .....H10 Campaign to help caregivers................H11
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Riverstone’s Epi team always ready By LAURA BAILEY For The Gazette
a cluster of cases linked to one gathering that needs our breadth of expertise,” said Epi In February 2012, police arTeam member Debbie Hedrick, rested a man for spiking a coffee vice president of public health pot with methamphetamine at services at RiverStone Health. a local tax preparation office. At Earlier this year, the group least 11 people drank traces of responded to the nationwide the illegal drug. recall of tainted injectable And while law enforcement medications. Several doses were worked quickly to make an shipped to a Billings health care arrest, the tainted coffee also facility but found, unopened, prompted a response from the before they were distributed. RiverStone Health Epi Team, More recently, the Epi Team which quickly determined met to discuss the public-health protocols for testing and treatrisks associated with a countying people who may have been wide rabies quarantine. exposed to the drug. “Protecting public health is The episode was by far the our primary goal, and we try most unusual incident the Epi — to do that with a balanced and short for epidemiology — Team rational and very team-oriented had responded to, but for the response,” said John Felton, level-headed group of health president and CEO of Riverprofessionals, it was just a mat- Stone Health. ter of following protocol and Felton is the Yellowstone developing a response. County health officer and is The multidisciplinary team responsible for getting the is ready at a moment’s notice word out and issuing warnings to respond to public-health regarding critical public-health emergencies. Sometimes it’s a concerns. One of the primary serious flu outbreak, or a spike in focuses of the group is to get the cases of more serious infectious word out fast to the folks most diseases including norovirus, affected. West Nile, hepatitis, salmonella, The Epi Team maintains conE. coli, whooping cough and a tact lists for health care providlong list of others. ers, hospital emergency rooms, “It can be a single case with pharmacies, restaurants, day the potential to affect a large care centers, schools and local number of people or it can be news media to alert the public
CASEY PAGE/Gazette Staff
John Felton, president and CEO of RiverStone Health, talks about the Epi team’s role in a public health emergency.
when a public-health emergency arises. Each message to the public is different, and targets a different audience, but the team follows a set procedure for dealing with each situation. “There’s a fi ne line between getting the word out and unnecessarily panicking the public,” Felton said. “And there’s a lot of discussion as to how we get the message out, whether or not we go to the media.”
CASEY PAGE/Gazette Staff
Members of RiverStone Health’s Epi disease investigation team smile as they meet to talk about their roles in a public health emergency.
Each incident is followed by an after-action report, which the group believes is key to maintaining quality and making improvements. Policies and protocols are constantly under review as well. At monthly meetings they review any recent incidents, discuss possible health emergencies that might be predictable — the health hazards of wildfi re smoke, for example — and plan for new, unforeseen scenarios. Their work demands a high level of teamwork and consensus, often under a very tight timeline. “We’re right on top of it,” said team member Barbara Schneeman, the public-information officer at RiverStone Health. “We’re doing whatever we can to manage a situation in a very short amount of time.” The Epi Team also participates in emergency preparedness drills with other agencies in the community. Recently, members of the team trained with employees at the U.S. Postal Service to respond to hazardous substances that might be found in the mail. When a crisis does arise, they’re ready, and they are often able to stop an outbreak before it happens. “Most of the time the public is totally unaware of the activities of the Epi Team,” Felton said. “When you don’t hear about public health, it means that prevention is working.”
Connected digital health empowers patients and providers By CARMEN DAYE IRISH For The Gazette The goal of creating a more transparent, patient-centered health care delivery system has increased electronic medical record access to some of the most rural regions in the state where medical services are few and far in between. Billings Clinic, the state’s largest health care system, provides information technology services at 17 sites scattered across more than 40 counties in Montana, Wyoming and the Dakotas, bridging health care providers with patients hundreds of miles away. “Multiple care providers in different locations can simultaneously view a patient’s medical record, receiving real-time information, while streamlining patients’ health care needs,” said Chris Stevens Billings Clinic’s vice president of information. “All the information is more readily at the fi ngertips of both physicians and patients for a more efficient process and quality care.” Billings Clinic, which implemented electronic medical records into its system in 2004, has integrated all of the Billings Clinic outpatient clinics, pharmacy, ER and regional facilities. The goal is to easily coordinate care for all patients who enter the Billings Clinic system no matter where it is. Please see Digital Health, H10
Questions about the new Montana Health CO-OP? We have answers. All advertorial courtesy of Montana Health CO-OP
available for all Montanans, including the low-income segment of our population.
Change – that’s what the health insurance industry is in the middle of – significant and necessary change. This change is nationwide and has been in the works for some time now, at least since the enactment of the Affordable Care Act (ACA) in March, 2010, if not before. As always, change means people have questions.
We have trained staff ready and able to answer any questions you might have about not only the CO-OP itself but also about changes in the health insurance industry overall. Want to know exactly what a health CO-OP is? It’s a nonprofit insurance company operated by the people it serves – just like MHC. Curious about the Health Insurance Marketplace? It’s an online state-based exchange which lets you make apple to apple comparisons of competing health insurance plans. MHC is the only Montana-owned company operating in the Exchange.
At the Montana Health CO-OP we hear these questions every day: • What is a health CO-OP? • How do they differ from traditional health insurance companies? • What is the Health Insurance Marketplace? • How do I use the Marketplace? • Do I qualify for a subsidy? • When will my insurance coverage begin if I go through the CO-OP?
You can find the answers to these and many other questions on our website: www.mhc.coop or by calling our office at 406-447-9510. If you belong to a group or company which is interested in hearing directly from an MHC representative, you can schedule a meeting by contacting Karen Murphy at 406-626-2458. In addition, representatives from the Montana Health CO-OP will be speaking to groups in and around Billings about what we bring to the health insurance marketplace and answering questions from audience members. We want to hear from you.
These are good questions and Montanans deserve good answers. Health insurance and coverage are important to each and every one of us. We and our loved ones want to know we will be covered if we have a medical issue and that we will be able to afford good health insurance coverage. We want, and The new Montana Health CO-OP need, to know how we research all of our health insurance options to make sure we is affordable health insurance – by are making the best possible choice for Montanans, for Montanans. That’s our pledge to you, to provide the best possible ourself and our families. health insurance at affordable rates The Montana Health CO-OP (MHC) is for our families, friends, neighbors and here to help answer these questions. We coworkers. We work each and every day are a member-owned Montana company to make that a reality, but we can’t do it formed in response to the ACA and without you, so please let us answer your dedicated to making health insurance questions. Remember, we’re here for you.
THERE’S A NEW CHOICE FOR AFFORDABLE HEALTH INSURANCE There’s a spirit in Montana. It’s part of who we are — and how we care about one another. Now there’s a healthcare plan that shares these values. Introducing Montana Health CO -OP — offering health insurance with an elusive quality other healthcare plans can’t match: trust. Trust because Montana Health is a CO -OP — as a member you have a voice and a vote in how it’s run. Regain your trust in healthcare with the new Montana Health CO -OP. To learn more, call 855.447. 2900 or visit mhc.coop. AFFO RDABLE H EALTH IN SURAN CE BY M O N TAN AN S FO R M O N TAN AN S
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Billings Clinic has direct access to Mayo Clinic expertise
Courtesy of Billings Clinic
Hundreds gathered in the Commons to celebrate Billings Clinic being selected as a member of the Mayo Clinic Care Network. All advertorial courtesy of Billings Clinic
If you or your loved one needs care for a complex medical condition, sometimes two heads are better than one. Both Mayo Clinic and Billings Clinic have based their multi-specialty physician group practices around the notion of collaboration and teamwork. Now Billings Clinic doctors can access specialists and subspecialists at Mayo Clinic when they need extra help on a tough diagnosis or treatment plan. As part of the Mayo Clinic Care Network, Billings Clinic physicians can consult with specialists at Mayo Clinic through several unique electronic tools.
other electronic tool that enables the Billings Clinic physician to access Mayo’s dynamic medical expertise, including disease management, care guidelines, treatment recommendations and reference material, 24 hours a day.
Steve Arbogast, DO, Billings Clinic neurologist, diagnosed a patient with a rare neurologic condition. However, he was uncertain as to the best course of care. “I set up an eConsult with Mayo Steven Arbogast, DO Clinic and sent a summary letter, test Billings Clinic results, notes and neurologist images securely to a Mayo neuroimmunologist. Within 72 hours, Mayo provided a report with potential implications of the condition and validated the treatment plan I had been considering,” said Dr. Arbogast.
Billings Clinic dermatologist, Jeff Williams, MD, was concerned about a patient with a rare blistering skin disorder. The condition was an unusual one, and it wasn’t responding to treatment. “I conJeffrey Williams, MD tacted Mayo Clinic through eConsult Billings Clinic and shared the padermatologist tient’s clinical information and asked Mayo Clinic and Billings Clinic their opinion on this autoimmune disorcontinuing a tradition of teamwork der,” he said. “They got back to me within 48 hours with a very detailed report that contained a couple other suggestions for “One of the things we’ve believed in treatment and answers to my question. for a long time is that a multi-specialty My patient is improving, and it’s nice to group practice, where physicians, nurses have another resource for unusual cases.” and other clinicians work as teams to enhance communication and coordination, helps to better address complex probBenefits of Mayo Clinic lems,” stated Nicholas Wolter, MD, CEO,
Recently Ala’a Muslimani, MD, a Billings Clinic oncology/hematology specialist, had a difficult diagnosis to make for a cancer patient and sent the pathology electronically to a Mayo Clinic cancer speAla’a cialist for review. “I Muslimani, MD had two questions Billings Clinic oncology/hematology for them and they got back to me specialist with a modified diagnosis. Together care close to home we were able to confirm the correct treatment plan for my patient,” said Dr. Muslimani. “It is very good to have physicians Patients are not billed for the services who are leaders in their field to consult provided through the Mayo Clinic Care with on tough diagnoses.” Network. The physicians of Billings Clinic access Mayo Clinic expertise so that they Physicians in Billings or at any other Bill- can continue to provide the best local care ings Clinic site can reach out directly to a and keep their patients close to home. Mayo Clinic specialist. Through the Mayo Some patients will need to travel for speClinic Care Network tools, doctors can cialty care that isn’t available in their area, share questions and medical files through but a shared goal with Mayo Clinic is to an eConsult. In some cases, the physicians help patients avoid the cost and inconvemay talk by phone. AskMayoExpert is an- nience of such travel whenever possible.
“Mayo Clinic’s expertise and knowledge is an important tool that enables us to provide our patients the best care anywhere.”
Billings Clinic. “Mayo Clinic’s expertise and knowledge is an important tool that enables us to provide our patients the best care anywhere.” For nearly 150 years, Mayo’s approach to health care has been rooted in the idea that the best patient care is achieved when experts from a variety of medical specialties can work together, focused on the patient. Billings Clinic and Mayo Clinic are closer in many ways than they ever have been. Billings Clinic is a community-governed health care organization consisting of a multi-specialty physician group practice with 3,600 employees, 340 physicians and non-physician providers, a 272-bed hospital, 90-bed rehabilitation and assisted living facility and research center. Billings Clinic is Montana’s largest health care organization serving patients from Montana, northern Wyoming and the western Dakotas.
For more information, visit www.billingsclinic.com/mayo or to make an appointment, call (406) 238-2501 or 1-800-332-7156.
Courtesy of Billings Clinic
Dr. Nicholas Wolter, CEO and Dr. Scott Millikan, Chairman of the Board, joined Dr. David Hayes, President of Mayo Clinic Care Network, on stage for the announcement of the new relationship with Mayo Clinic.
- Nicholas Wolter, MD CEO, Billings Clinic
Courtesy of Billings Clinic
(Left) For 2013, Billings Clinic is the only hospital in our 5-state region to be named to the top 100 Hospitals in the nation by Truven Health. (Right) Many patients can benefit from the expertise of Mayo Clinic physicians without leaving home.
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Our Patients Deserve Excellence #1 in Nation for Patient Safety – Consumer Reports (August 2012)
100 Great Hospitals in the Nation The only hospital in our 5-state region
Nursing’s Highest Honor
Accreditations: • Hospital • Laboratory • Behavioral Health Care Certifications: • Primary Stroke Center • Total Hip & Total Knee Replacement
Critical Care Excellence
Gastroenterology & GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology & Neurosurgery, and Pulmonology
The only accredited Chest Pain Center in Montana and Wyoming
Breast Imaging Center of Excellence
Women’s Choice Award
One of 21 programs in the nation
The only QOPI certified program in Montana and Wyoming
Accredited Comprehensive Community Cancer Program
National Award for Cancer Research
Stroke Quality Achievement Award
Safety Superstar
Knee Replacement & Hip Replacement Cardiovascular Services
Top Performing Hospital
Cardiac Rehabilitation Outstanding Performance Award
Accredited Member Lab
American Institute of Ultrasound in Medicine Accreditation for Obstetric Ultrasound
The only Accredited Care Center in Montana
To make an appointment, call 238-2501 or 1-800-332-7156 www.billingsclinic.com
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For Promoting Quality in Endoscopy
Commitment to Quality Award
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Dental innovations make 70-year-old ‘feel 44’ By CINDY UKEN cuken@billingsgazette.com As a surprise for his wife, Dr. Shafiq Khaleel bought her a jetblack 2011 BMW 535i xDrive. Nice gesture, but she wouldn’t drive it. Tasneem Khaleel refused to get behind the wheel until her husband, a Billings veterinarian, got his unsightly, shifting teeth repaired. His teeth had fallen into such a state of disrepair that he found it difficult to chew a T-bone. Khaleel’s grown children were on their mother’s side, criticizing their father for his “horrible” teeth. Scared of needles and anesthesia, he reluctantly visited local
dentists to explore the options. He talked with two or three and walked away in disgust at prices, contradictory opinions among dentists in the same practice, and feeling like he was at a used-car lot. He eventually settled on Dr. William B. Winterholler at Winterholler Dentistry who offers the increasingly popular All-on-Four treatment. Khaleel said his fears were allayed by Winterholler’s compassionate bedside manner. “I was scared to death and I’m not kidding you,” Khaleel, 70, said, adding that he felt no pain and only slight discomfort. “I am so happy. I should have done this two years ago. I feel younger. People tell me I look 44.”
Shafiq Khaleel
Winterholler is one of a handful of general dentists in Billings offering the new alternative to permanent teeth. The procedure, which he began offering about two years ago, requires four dental implants per jaw to support a fully customized set of replacement teeth. People who want to get rid of their clacking dentures and those with shifting or rotting teeth find the treatment appealing. The modern implant-based dentistry provides toothless patients with something traditional dentures do not — immediate functionality and an increased quality of life, Winterholler said. Patients can again enjoy the dietary freedoms they had with their natural teeth, such as eating steak and corn on the cob. The entire treatment, which costs about $20,000 per upper and lower restoration, is completed while the patient is asleep. The best part, patients say, is that the procedure is painless and puts in a full set of replacement teeth in just
24 hours. “It’s one of the coolest things I’ve ever been involved with in dentistry,” Winterholler said. “It is one of the coolest, most satisfying end results.” The procedure is expected to gain in popularity as a growing number of people live longer. “There are a growing number of baby boomers who don’t want dentures like the ones their parents had,” Winterholler said. “They want an alternative to dentures. They want something that doesn’t come out of their mouth.” The advantage to having permanent implants is also longevity, Winterholler said. People without teeth or with diseased teeth and gums have a life expectancy 9.8 years less than those who have a healthy oral environment, according to a Harvard research study. The adult population in need of one or two dentures is expected to increase from 35.4 million adults in 2000 to 37 million adults in 2020, according to national epi-
demiological survey data. Clinical studies have reported that patients with dentures have shown only a marginal improvement in the quality of life when compared with implant therapy. Those who wear dentures also tend to be dissatisfied and complain of pain, areas of discomfort, poor denture stability and difficulty eating, according to the studies. Rosalind Pattyn, 61, of Hardin is also a believer in the implant alternative. For years, she suffered from gum infections, which caused a constant, low-grade fever. She was also sensitive to both hot and cold foods and beverages. She was scared to smile and also fearful of dentists. But on July 6, 2012, she walked out of Winterholler’s office a changed woman. “For the first time in my life I smile without even thinking about it,” Pattyn said. “It’s changed my life. I can crunch ice cubes for the first time ever.”
Paul ruhter/Gazette Staff
Courtesy Photo
(Top) Before / (Bottom) After Rosalind Pattyn
Courtesy Photo
Rosalind Pattyn
Courtesy Photo
(Top) Before / (Bottom) After Shafiq Khaleel
PAUL RUHTER/Gazette Staff
Dr. William B. Winterholler checks Shafiq Khaleel’s teeth during an appointment. Khaleel had his teeth removed and a set of prosthesis teeth were implanted by Winterholler.
St. Vincent program encourages proactive health care By ZACH BENOIT zbenoit@billingsgazette.com
vitals, such as blood pressure and temperature taken. The second station is a blood draw and the In less than 10 minutes, you third measures biometrics such can take a proactive approach to as height, weight and body mass your health by doing little more index. than moving through several The entire process takes about health screening stations without nine minutes. even leaving your office. After, participants are asked That’s one of the main ideas if they’d like to follow-up with behind St. Vincent Healtha health coach who can provide care’s new Living Well Program, extra guidance. designed to provide people with Results from the testing are easy, quick and cheap health asmailed to each person, and a sessments and screenings at work. medical review officer will reach “This is a tool that the hospital out within 24 hours to people is putting into place to think about whose tests show issues that need community health,” said Carol immediate attention. Beam, St. Vincent’s director of “This is our way of addressing strategy and business developpreventative health,” said Colin ment. “We can identify risks to Dow, a corporate outreach liaison help people stay healthier. It’s with the hospital who works more than just a screening.” closely with the program. “We The program generally works need to manage the health of our as a partnership between an community proactively instead of employer and the hospital. A team being reactive.” from St. Vincent comes directly Since the program began in the to the workplace, or another des- fall of 2012, it has screened about ignated site, and sets up several 2,100 people in the community. stations. One of them, Kama HumEmployees preregister and fill phrey, said she’d recently finished out a quick questionnaire to proa weight-loss program when she vide the health care team with a took the screening in April. little info. After checking in, they She opted to speak with a go through three stations. health coach after because even At the first, they’ll have their though she didn’t need to lose
BOB ZELLAR/Gazette Staff
St. Vincent Healthcare’s Regina Zeilstra shows one of the stations of the Living Well mobile health assessment program.
BOB ZELLAR/Gazette Staff
St. Vincent Healthcare’s Colin Dow and Glenna Sprankel stand in the reception area of St. Vincent’s Living Well mobile health assessment station.
much weight, she felt stuck in a rut with her old program. “I really just wanted to learn more about about making healthy choices,” she said. “My health coach, she’s made it so easy.” As events manager at the Billings Chamber of Commerce and the mother of two young children, one of Humphrey’s biggest concerns was finding time to exercise. Her coach suggested she use her lunch break and schedule the workouts into her work calender, which worked well. The screening also taught her that she has a previously undiagnosed thyroid problem. Since she’s been treating that, she said she has more energy through the day. “I feel great,” she said. “It’s the best I’ve felt in a long time.” Dow said the program removes barriers and excuses that often prevent people from taking a proactive approach to their health by bringing it to them in a comfortable atmosphere. He pointed to some of the results from the screenings: 15 percent of participants have learned they had high cholesterol, 5 percent learned they’re at risk for diabetes and a quarter learned they’re at risk for hypertension. “Those are things that really help people when they know
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BOB ZELLAR/Gazette Staff
St. Vincent Healthcare’s “Guy” Robert Rolando shows the blood draw station of the Living Well mobile health assessment program.
them,” he said. “They’re things that all too often go undetected but that can have a big impact on the general health of the community. We want to move away from the sick care and get into the true meaning of health care.” Beam agrees. She said working with people on their general health, long before there’s a problem, is a big part
of the future of health care and an important step in an overall healthier community. “It used to be just taking care of people when they were sick,” she said. “Now we’re changing the way we think because that’s just not going to be successful anymore in the long run. We can do better by addressing things up front and early on.”
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Health Insurance in 2014: An Overview for Montana Individuals and Families All advertorial courtesy of PacificSource Health Plans
If you’re a little fuzzy on the details of the Affordable Care Act – also known as the ACA, PPACA, Obamacare, or healthcare reform – you’re certainly not alone. A recent poll by the Kaiser Family Foundation found that 4 in 10 Americans are unaware that the law is still in place. In fact, some provisions of the ACA are already in effect, and many more are coming soon. For many of us, the ACA will bring changes, making health insurance much different than it is today. The biggest impact will be for those who don’t have insurance now and those covered under individual plans. If that includes you, then understanding these changes and how they impact you will better prepare you to make the best choices.
While many things will change, PacificSource Health Plan’s commitment to providing Montanans with award-winning service remains the same. If you already buy health insurance coverage on your own, or you don’t have coverage today, the most significant changes coming in 2014 are: 1. N early all Americans will be required to have health insurance coverage or face a tax penalty. 2. Y ou may qualify for financial assistance to help pay for individual health insurance coverage. Exchange marketplaces” will open as a place 3. “ where people can compare and shop for health insurance and access financial assistance.
Enrolling outside of Healthcare.gov: More choice and less complexity. If you don’t qualify for financial assistance, you may find advantages to maintaining or purchasing coverage directly from a health insurer. That’s especially true if you already have a PacificSource individual policy and would like to maintain your coverage. When your policy renews in 2014, PacificSource will automatically move you to the closest new qualifying plan, or you can choose any other plan they offer. You won’t need to re-enroll, and you’ll have uninterrupted access to all member services, including access to claims history, wellness tools, Enrolling in health insurance coverage through the and condition support programs. Plus, you’ll have access exchange marketplace isn’t a requirement, and Health- to all the PacificSource plans available through Healthcare.gov will operate alongside, but not replace, today’s care.gov (and at the same rates), plus additional options. health insurance marketplace. If you don’t qualify for You’ll find more comprehensive information about financial assistance or simply don’t want to use the exchange marketplace, you can shop for and enroll in cov- healthcare reform, including a consumer’s guide to plan erage as you do today, either on your own or with the and benefit changes, at HealthcareLawGuide.com. help of an insurance agent. All of the plans sold inside the exchange marketplace will also be available directly Need help sorting things out? To be sure, healthcare reform offers you choices from health insurance companies like PacificSource, at you’ve never had before. But that doesn’t mean you the same rates. need to go it alone. If you already have an independent health insurance agent, he or she can help you underThe Exchange Marketplace (Healthcare.gov): stand your choices and enroll in a 2014 plan. The best choice if you qualify for financial assistance. Financial assistance will be available to those whose household income is up to 400 percent of the Federal PacificSource also offers Coverage Advisors Poverty Level. As a point of reference, 400 percent of who can answer your questions, review your Federal Poverty Level includes individuals earning up to needs and help you understand your options $45,960 and families of four earning up to $94,200 in in the new marketplace. To get the informa2013. If there’s a chance your 2014 household income tion you need to make important decisions might be under those limits, you should check with about your coverage, call or email a PacificHealthcare.gov to see if you qualify. If you do, you’ll only Source Coverage Advisor at 855-330-2792 or receive that financial assistance by enrolling in new covreform@pacificsource.com. erage through Healthcare.gov. You might think of an exchange as a website similar to Amazon. You can shop for an item, compare products based on quality (consumer reviews) and price, and make a purchase. Healthcare.gov will let you compare plan benefits and costs among all the insurance companies that participate in the exchange marketplace, including PacificSource Health Plans. If details like whether phone calls are answered by a real person are important to you, you may want to supplement your Healthcare. gov research by visiting the websites of the health insurance companies you’re considering.
4. H ealth conditions will no longer disqualify you from getting health insurance, nor can you be charged higher insurance rates due to health conditions. ll individual health plans must meet new “es5. A sential health benefit” requirements, so the individual plans available today will be replaced with new qualified plans in 2014.
Exchange Marketplaces: A New Option for Finding Coverage The ACA calls for states to establish new health insurance marketplaces to help individuals and small businesses shop for coverage. These exchange marketplaces are intended to make it easier to compare health plans based on price, benefits, and quality. They will also be the gateway to financial assistance if you qualify. Montana will use the federal exchange marketplace, Healthcare.gov. It’s expected to open for business on October 1 so people can enroll in health insurance that begins January 1, 2014 or later.
Courtesy of Thinkstock
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Onsite and nearsite Medical Clinics help keep costs down By Tom Howard • thoward@billingsgazette.com
Courtesy of David Scott Smith
Dr. Tom James visits with Jody Sulser, a teacher at Lewis and Clark Middle School, and Bella Stabio, at the Lincoln Center miCare clinic.
Copyright 2013 Reprinted with Permission, Billings Business
It’s a tradition born in America’s industrial past, when miners, factory workers and their families lined up to visit the company doctor whenever they got sick. As part of an effort to rein in rising health costs, Billings School District 2 is the latest in a series of local employers to establish in-house health clinics that provide primary medical care to employees and their dependents. The clinics offer free medical exams and lab work. The district opened two miCare clinics recently — one at Lincoln Center, the other in the Heights — as part of a comprehensive plan to save money on health care, while improving employee health. MiCare is a subsidiary of Billings-based Employee Benefit Management Services Inc. As a third-party administrator, EBMS administers health plans for employers that have selffunded insurance plans.
“There’s no markup, no margin on any supplies or services, just the true cost of delivering health care.” - Jarrod Weenum Director of miCare and prescription services for EBMS
The clinics are staffed by a doctor, a nurse practitioner and two licensed practical nurses. Although School District 2’s clinics have been in operation for only a few months, employees have embraced them. Deb Klusmann, a kindergarten teacher for School District 2, stopped by the miCare clinic at Lincoln Center recently. She described the clinic as a welcome convenience. Because she often stops by Lincoln Center, she doesn’t have to make a separate trip to a medical office. These days, many employers find themselves caught in a bind as they prepare for the implementation of the new national health care law, the Affordable Care Act. Beginning in 2015, employers with more than 50 fulltime workers will be required to provide health insurance or face a penalty. The plan also calls for the establishment of state exchanges where people can shop for health care. The mandates were originally scheduled to take effect in 2014, but the deadline has been extended because of complications in establishing the insurance exchanges. While the ACA has few direct effects on self-funded insurance plans, the federal law will likely make the selffunding option more appealing to employers, EBMS officials say. Jerrod Weenum, director of miCare and prescription services for EBMS, describes miCare as grass-roots health reform that has succeeded in limiting health costs. The concept involves purchasing medical care at wholesale and deliver it to clients it in a cost-effective manner, he said. MiCare charges the district an administrative fee in exchange for the services. “There’s no markup, no margin on any supplies or services, just the true cost of delivering health care,” Weenum said. Before establishing an in-house clinic, miCare carefully designs a plan that suits the client’s needs. “We look at a client’s historical utilization and we come up with a number of clinical hours that they’re going to need,” Weenum said. Typically, a clinic’s staffing is split evenly between a doctor and mid-level medical providers who are either a nurse practitioner or a physician’s assistant, Weenum said.
BOB ZELLAR/Gazette Staff
Kevin Larson, right, president of EBMS and Jarrod Weenum, director of miCare and prescription services for EBMS, stand in the miCare office at Lincoln Center recently. School District 2 has two miCare Medical Clinic sites, at Lincoln Center and the Heights, for its employees. The miCare Onsite and near-site Medical Clinics are operated by EBMS.
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Courtesy of David Scott Smith
Jacquie Sorrels, miCare Clinic operations coordinator, left, speaks with Dani Kieckbusch, a teacher at Boulder Elementary, and her son, Conner, at the Lincoln Center miCare Medical Clinic.
“The whole goal is to remove barriers to care. So everything an employee goes there to do is completely free, from an office visit to the labs. Appointments can be scheduled online or by a toll-free number, and you can generally get in that same day or the next day,” Weenum said. MiCare focuses on wellness and reducing risks for chronic disease. “The school district has a lot of long-term employees, and you want to keep them healthy and well,” Weenum said. Another feature of miCare is that the provider spends up to 20 minutes with a patient. “We don’t double book appointments, so you don’t have to take a half day off work to go to the doctor,” he said. EBMS began its first miCare clinic in 2006 to serve 220 EBMS employees and their dependents, about 400 people. Other Billings-area clients that have joined the program include the Laurel School District, TrueNorth Steel and Wood’s Powr-Grip Co. Tom Partlow, chief executive of EBMS, said on-site health clinics are part of a trend where health care is moving closer to the consumer.
Courtesy of David Scott Smith
Jacquie Sorrels and Dr. Tom James in the miCare Onsite Medical Clinic Lab.
Many health experts worry that the ACA will create more demand for health care, and the industry will have a hard time providing enough doctors and services to meet the demand. By establishing on-site medical clinics, “our clients are saying to their employees, ‘I think quite a bit about you and I’m going to get some primary care where it’s more convenient for you,’” Partlow said. According to the Kaiser Family Foundation’s 2012 Employer Health Benefits Survey, 60 percent of employees who receive health insurance at work are covered by self-funded plans, up from just fewer than half of employees who received such coverage one decade earlier. Kevin Larson, president of EBMS, said the company is well positioned for growth as the nation’s health system evolves. Based on certain rules that are included within the ACA, the self-funded insurance industry is expected to grow. “It’s becoming more attractive for employers to look at self-funding,” Larson said.
Courtesy of David Scott Smith
Mark Sulser, athletic director for Billings Senior High School, arrives for his appointment at the Lincoln Center miCare Medical Clinic.
In self-funded insurance, a company sets aside money to pay for anticipated health costs for their employees rather than paying a premium to a health insurance company. Most self-funded plans hire a third-party administrator such as EBMS to handle claims and provide other services. Typically, the self-funded model has appealed to employers with 100 or more workers. But because of changes resulting from the ACA, small companies, with perhaps 25 to 50 employees, are looking at self-funded plans as an option, Larson said. While EBMS seems to be well positioned moving forward, third-party administrators face competition from traditional insurers such Aetna and United Health Care, which are looking at expanding into the self-funding arena, Partlow said. A self-funding option provides flexibility to employers and allows them to customize the types of programs to meet the needs of the organization, Larson said. “It’s a plug-and-play type of scenario where you can provide wellness programs or a vision plan and you can select what you want,” he said. EBMS operates 12 miCare clinics for its clients, and that number is growing.
Courtesy of David Scott Smith
Attorney Scott Heard, husband of Highland Elementary School Principal Jeri Heard, in the examination room with miCare Medical Director Dr. Tom James.
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“We’re uniquely positioned as far as third-party administrators go,” Larson said. “Historically TPAs have been transactional types of companies. Many years ago we decided to expand into additional offerings that help employers control costs by offering nursing programs, disease management programs, prescription management programs. We have a pharmacy that mails prescription drugs to eight states.”
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Woman thriving after foot amputation at Billings Clinic By ZACH BENOIT zbenoit@billingsgazette.com
she was in the basement doing laundry and tripped up the stairs, bending her foot at an Tanya Allestad was sick, tired odd angle. and fed up when she walked into For nearly a year, doctors told Dr. Giselle Tan’s office at Billher she’d probably just sprained ings Clinic. it, but the pain continued and Sick of the pain, tired of sur- her foot eventually began to geries and fed up with living on deform. crutches. Eventually, she learned that Years of constant pain will she’d dislocated three bones and do that to a person, she said, and torn ligaments in her foot. the day she had to drive a single Even after three surgeries, block to take her niece and the pain didn’t subside and her nephew to a Billings park was foot remained so deformed that the day she decided to change she could barely use it. that. “My toes had died and it “I just went, ‘This is not the was three-quarters of an inch way I want to live,’ “ she said. shorter than my other foot,” So she asked Tan, an orthoAllestad said. “The midsection pedic surgeon in the clinic’s Or- turned 60 degrees to the left. It thopedics and Sports Medicine just didn’t work and it hurt all department who specializes in the time.” foot and ankle problems, to cut Last year she moved to Cooff her foot. lumbus and soon after, met with After the below-the-knee Tan. After lots of research, she amputation took off her left foot asked to have her foot ampuand part of her leg about halftated. way up the shin, things couldn’t Tan was initially hesitant. have gone better. “I offered her lots of op“It gave me so much of my life tions,” she said. “Usually, most back,” said Allestad. people have it removed for some Now, she’s back to the acother reason, but that’s certaintive life she lived five years ago, ly not what was going on.” including nature photography Allestad pushed on and the and hiking. Billings Clinic doctor eventually The problems started sevagreed it was a good course of eral years ago when she lived in action. Eagle River, Alaska. That April, “She said she couldn’t guarantee I’d get back my quality of life, that she couldn’t guarantee I’d be able to run again,” Allestad said. “I looked at her and said, ‘Dr. Tan, I guarantee I will.’ She said, ‘I like you. We’ll do this.’” Since the June 2012 amputation, Allestad has seen huge improvements in her comfort level and is getting back to doing the things she loves. Dr. Terry Cahill, a specialist in the clinic’s Physical Medicine and Rehab department, and physical therapist Laura Cahill, both with Billings Clinic, helped her rehabilitate after the surgery and both said Allestad wanted to get out and get active the moment she started working with them. “We want to make that happen to the fullest extent,” Terry CASEY PAGE/Gazette Staff Amputee Tanya Allestad of Columbus Cahill said. “It takes a new way of thinking, learning the proper is back to the active life she lived way to walk or run.” before injuring her foot, including Jay Murray, CPO of Treasure nature photography and hiking.
CASEY PAGE/Gazette Staff
Amputee Tanya Allestad, left, talks with medical staff that helped with her amputation and prosthesis. From left: Dr. Terry Cahill and physical therapist Laura Cahill from Billings Clinic, Jay Murray of Treasure State Orthotic and Prosthetic, and Dr. Giselle Tan of Billings Clinic.
State Orthotic and Prosthetic, has worked with Allestad since the beginning to fit her with a prosthetic leg that fits her needs. “She’s definitely not your average patient,” he said. “You have a patient there who’s so knowledgeable, who’s motivated and really pushing the limits. Our goal is that we should be able to get you back to what you did before the amputation.” Less than two months after the surgery, Allestad hiked in Yellowstone National Park with Laura Cahill. She’s back to riding a motorcycle and can often be found chasing one of her hobbies, nature photography. Earlier this year, she walked in the Montana Women’s Run — on crutches because she’d had surgery to remove a bone spur a little earlier — and plans to run it as soon as next year. She credits the Billings Clinic team with much of that success, saying they worked with her through each phase of the
Dr. Karen Cabell and patient Larry Todd look over Todd’s medical records, which he can access through his smart phone. Billings Clinic is providing information and technology services to patients and says the service improves coordination of care and shared medical information. JAMES WOODCOCK/ Gazette Staff
Digital Health Continued from H2 The system, provided by Clinical Information System, is designed to improve how physicians and health care workers gather, document and share information about a patient’s medical history, conditions, medications, insurance and billing. The electronic system helps Dr. Karen Cabell with just about every part of her practice, she said. She keeps a close watch on hundreds of patients without the cumbersome paper trail. The new system requires physicians to input information and lab orders into the computer system immediately after examining a patient. The system is set up to flag bad drug interactions or medical complications. Doctors can see immediately if any problems may arise, Cabell said. Cabell said the system also provides access to “best practice” procedures. For example, if a patient experiences heart pains, the computer will provide the steps that should be taken to evaluate the patient, based on the latest research and methods. Prescriptions and medication refill requests can be forwarded to pharmacies electronically, too, saving time, paperwork
and hassles for both doctors and patients. While the system provides doctors with enhanced levels of visibility of their patient’s progress, it is also empowering patients to take more responsibility for their own health and care, Cabell said. “The whole concept going forward is engaging patients with an increasing transparency of information about their health,” Cabell said. “It’s about engaging patients in their health care.” Nearly 40,000 patients are accessing the electronic information system through a new patient portal on the hospital’s website called MyBillingsClinic. Once a patient has set up an account through the site, they can access information such as lab results, immunization records and medication lists. A separate function allows patients to view details about dates of services, charges, itemization of services and account balances. Another feature of the site gives patients the ability to set up a profile to track their own health-related activity such as calorie intake. “The portal provides a snapshot in time of what was recommended by doctors,” 66-year-old patient Larry Todd said. “It’s really helped me track and take charge of my own health.” Todd remembers the days before electronic medical record access
when he was required to schedule appointments with various providers every few weeks to get lab test results. “Because we are a mobile society, access and convenience are huge for patients,” Todd said. For several months, Todd has accessed the system with his smartphone and other mobile device interfaces. The use of technology to provide healthcare at a distance is also seeing new levels of capability being realized in rural communities. Stillwater Billings Clinic in Columbus implemented the electronic system one year ago when the hospital joined with Billings Clinic, bringing all of the medical resources under one roof. “We are on the front end of bringing these resources to the rural areas, and it’s pretty exciting,” the clinic’s CEO Tim Russell said. Russell said the 10-bed critical access hospital often serves patients who are back and forth between Stillwater and Billings Clinics. Electronic medical record access has streamlined patients’ care, he said. “Rolling these things out are challenging, but if we continue to look at the goal of improved patient care and reduced duplication, this system is going to be a key component as we move forward in health care,” Russell said.
Amputee Tanya Allestad of Columbus worked with Jay Murray, CPO of Treasure State Orthotic and Prosthetic, to be fitted with a prosthetic leg that fits her needs. casey page/ Gazette Staff
process. “I was on crutches for two years,” she said. “So it feels great to be able to just get out and do something.” And she’s incorporated her new leg into her fashion, pointing out her freshly pedicured prosthetic to match the bright
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pink toenails on her right foot. “It’s really easy to get pedicures now,” she said. “I can just take my leg off and put it up on the table. I’m still hoping to get a running leg and a swimming leg. And one with a fixed foot so I can wear my three-inch heels.”
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Campaign designed to help caregivers determine if they are at risk for distress, disease By CINDY UKEN cuken@billingsgazette.com
heart disease, diabetes, depression and various other physical and emotional maladies as a result of caregiver distress, a potentially dangerous condition brought on by the pressures of caring for a senior loved one. Studies increasingly point to caregiving as a leading cause of stress for families. In fact, one U.S. study showed that more than half, 52.8 percent, of those caring for individuals with diseases including cancer or Alzheimer’s had scores indicating depression. In response to this growing issue, the Home Instead Senior Care firm has launched a campaign — “Family Caregiver Stress Relief” at FamilyCaregiverStressRelief.com — to help family caregivers determine if they are at risk for distress and to minimize problems before they escalate. Included in the program are two new tools: The “Are you a Caregiver” quiz, which is designed to help a family member recognize the role of a caregiver, and the Family Caregiver Distress Assessment. The assessment allows caregivers to determine their risk for distress and resulting emotional and physical issues, including depression, heart disease, high blood pressure, diabetes and obesity. “So many spouses and adult children are unaware of their
potential risk of caregiver distress because they don’t see themselves as caregivers,” said Jean Holmquist, owner of the BillJEAN ings Home Instead HOLMQUIST Senior Care office. “These new resources enable them to understand their role, the stresses they may face as a caregiver, and how that stress might lead to more serious health effects.” A recent Home Instead Senior Care study discovered that caregivers are prone to hiding their emotions, and as a result their health suffers. Approximately 74 percent of caregivers who hide their feelings report fatigue, 53 percent report difficulty sleeping, 37 percent report depression, and 30 percent weight gain or loss. Research shows that certain characteristics make family caregivers more vulnerable to caregiver distress, the top being: Gender: Women report more psychological distress than men, although male caregivers have more negative physiological responses to caregiving, including high blood sugar and insulin levels, poorer cholesterol and immune function, and obesity.
Shirley Weinberger had a plan that would take effect when her mother, Hazel Hansen, could no longer care for herself. The plan called for Hansen to move in with Weinberger and her husband, Richard, so the two could foster their mother-daughter bond. Little went according to plan. Hansen, 86, was diagnosed with dementia two years ago. Her personality changed and she became forgetful. She could no longer live alone in her apartment. “I knew she was going downhill,” Weinberger said. “I was afraid to leave her alone. It was real hard for me to accept this whole thing and the loss of her personality. She was my best friend for 59 years.” Weinberger, 59, of Billings, and her sister, Ilene Leuenberger, 62, who splits her time between Sun City West, Ariz., and Billings, agreed that they, along with their husbands, would share the responsibility of caring for their mother. The sisters and their spouses joined the ranks of more than 65 million Americans who provide care to a loved one. For five months they shared the responsibility of caring for their mother, even enlisting the help of a home health aide. “We quickly learned what 24/7’s were,” Leuenberger said. The physical care of their mother was challenging. That, coupled with the emotional strain of losing the mother they once knew began to take a toll. Financial concerns also mounted, adding to the stress. Weinberger, who is bipolar and suffers from fibromyalgia and other maladies, said her health issues were exacerbated while caring for her mother. Leuenberger said she began to feel guilty because living in Arizona for part of the year prevented her from helping as much as she wanted. The guilt weighed on her. Nearly one-third of adults livCASEY PAGE/Gazette Staff ing in Yellowstone, Carbon and Stillwater counties are family Hazel Hansen, of Billings, center, sits with her daughters Ilene Leuenberger, caregivers who could be at risk for left, and Shirley Weinberger at Primrose Assisted Living.
CyberKnife® The No-Surgery Alternative to Tumor Treatment All advertorial courtesy of Benefis
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CyberKnife® treatment is a no-surgery alternative for cancer patients. Photo courtesy of Thinkstock
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Reluctance to ask for help: Caregivers who won’t ask for help are setting themselves up for the kind of exhaustion that can lead to distress. Chronic illness: Caregivers who are already sick or have existing medical conditions, such as coronary disease, hypertension and cancer, are more vulnerable to additional negative health effects resulting from caregiver stress.
“It’s important for caregivers to understand that stress can impact one’s ability to care,” Holmquist said. “If they don’t care for themselves, they may put their senior loved ones at risk. Whether it’s support groups, stress management techniques or respite help, caregivers need to realize the importance of managing their health, too.”
CASEY PAGE/Gazette Staff
Hazel Hansen, of Billings, center, sits with her daughters Ilene Leuenberger, left, and Shirley Weinberger at Primrose Assisted Living. The daughters took care of their mother for about five months before the stress of caregiving began to take its toll on their own health.
Info: Caregiver stress is the emotional and physical strain of caregiving. Individuals who experience the most caregiver stress are the most vulnerable to changes in their own health. Many caregivers fall into the trap of believing that they have to do everything themselves. They may be so focused on their loved one that they don’t realize that their own health and wellbeing are suffering. Signs of caregiver stress could include: Feeling tired most of the time Feeling overwhelmed and irritable Sleeping too much or too little Gaining or losing a lot of weight Losing interest in activities you used to enjoy (Source: Mayo Clinic)
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Telemedicine Provides St. Vincent Healthcare Pink Glove Dance Video Access and Hope Premiers in October; for Patients Billings Encouraged Across Montana to Vote and the Dakotas In 2009, a Portland, Oregon hospital did something very unexpected: the entire staff donned pink gloves and began dancing to the tune of “Down” by Jay Sean. Once posted on YouTube, the video went viral and a movement was born. Last year, St. Vincent Healthcare joined that movement when it produced and entered its first video “You Won’t Dance Alone”. This year, they’re out to do it again. “We are doing another Pink Glove Video again this year because of the opportunity it gives us to bring a greater level of awareness to breast cancer,” says Lynn Ratcliff, Marketing & Communications Manager at St. Vincent Healthcare. “Last year our associates were outstanding—everyone was willing and eager to participate in promoting this cause.”
Courtesy of St. Vincent Healthcare
Last year, St. Vincent Healthcare and Frontier Cancer Center came together to provide comprehensive, regional cancer care. The new St. Vincent Healthcare Frontier Cancer Center provides care for not only to the 120,000 people in Yellowstone County but also provides for the rural areas of Montana, through the telemedicine program, where other resources may not be available.
The population of Yellowstone County now tops over 120,000 and access to services—especially medical services—is plentiful for those living here. But much of Montana, and the states which surround it, remain largely rural. For individuals living in those communities, traveling to Billings can often be difficult, especially for those diagnosed with serious diseases. “Our goal is to ensure that every patient needing an oncologist has access,” says Cathy Bealer, CEO of St. Vincent Frontier Cancer Center. “Our telemedicine network provides that access without them having to drive to our facility.”
Bealer says that through this network, St. Vincent Frontier Cancer Center oncologists are able to conduct a virtual appointment with their patients. Patients can ask questions and report on any symptoms or side effects they may be experiencing, and physicians are able to assess patient progress.
Production of the video is taking place at various events throughout the area, including the “Celebrate Every Life” event held at St. Vincent Frontier Cancer Center in August. Upcoming filming opportunities will be held at next weekend’s Yellowstone Valley Weekend for Women and during a survivor cookie bake off on September 24th. A dance session featuring the Billings Fire and Police Departments is currently being scheduled. The video will be submitted to Medline in early October, and voting will begin on October 25. The winner will be announced November 15.
This year, the video receiving the most votes will garner a $25,000 prize, while second and third place winners will earn $10,000 and $5,000 respectively. Ratcliff says that should the St. Vincent Healthcare entry win, the funds will go to The Entrants in the video contest, which Eva Project, which helps uninsured womis hosted by Medline, have specific songs en receive their regular screening mamfrom which they are allowed to choose. mograms. St. Vincent Healthcare chose the song “We want—and are asking—every “What Makes You Beautiful” from Brit person in Billings and in surrounding Band One Direction. towns to watch and vote for this video,” “This year’s video pays tribute to the Ratcliff says. “This isn’t about a hospital. beauty, spirit and bravery of breast can- It’s about showing support for women cer survivors,” says St. Vincent Healthcare in and around our community who have Patient Navigator Ella Dugan Laemmle. had or are at risk for breast cancer.” “These women are remarkably strong If you or a loved one has been imand carry with them a message of hope for everyone affected by breast cancer. pacted by breast cancer and would like One of these ladies has been in remission to participate in an upcoming Pink Glove for 68 years, and hearing that means a lot Video filming event, please contact Lynn to women who just received a cancer di- Ratcliff at (406) 238-6220. agnosis.”
“We can also communicate with the patient’s primary care physician or other healthcare provider via this network as well as securely transmit medical information,” Bealer says. “It ensures that we are all on the same page, working together for the benefit of the patient.”
Breast cancer survivors proudly display the years they have been winning the battle against breast cancer during the Pink Glove Video Filming at the August 17 Celebrate Every Life event at St. Vincent Frontier Cancer Center. Courtesy of St. Vincent Healthcare
Big Horn Basin Regional Cancer Center Offers “Cancer Care Close to Home” There are a lot of wonderful things about living in a rural town. There’s nothing like a hometown football game or going to church on Sunday with all of your friends and neighbors. But there are also some realities that come with living in a place like that—and one of them is the limited access to specialty medical care. In the Big Horn Basin of Northern Wyoming, there is easy access to quality primary medical care. But for individuals diagnosed with cancer, treatment options have been limited. Thanks to a partnership between St. Vincent Healthcare and West Park Hospital, however, that situation has changed. “In October of last year, the St. Vincent Healthcare Foundation applied for and was awarded a $5.2 million grant from The Leona M. and Harry B. Helmsley Charitable Trust,” says David Irion, the Foundation’s President and CEO. “The Trust’s generosity allowed us to expand and improve the levels and types of services available to these patients.” According to Irion, the funding received was used to update the former oncology center in Cody to provide a more comfortable and healing atmosphere for patients. Most importantly, the Center was able to install a stateof-the-art linear accelerator. “This equipment is on par with that located in not only Billings, but also Denver, Salt Lake and other large cities in our region,” says Dr. Jeffrey Gilroy, radiation onCourtesy of St. Vincent Healthcare cologist with the Big Horn Basin Regional Cancer Center. “We are now able to offer our patients the best cancer Transportation to Big Horn Basin Regional Cancer Center is provided to patients living in and around Wyoming’s Park and Big Horn Counties for their comfort and convenience. treatments available right here in Cody.” Dr. Gilroy says that for cancer patients and their families, the ability to receive these treatments closer to home provides both physical and emotional comfort. “Traveling two hours or more to Billings or Casper is tiring and can be uncomfortable for patients,” he says. “At times it can require overnight stays, which then also adds additional costs. Receiving treatments here can eliminate many—if not all—of those concerns.” Big Horn Basin Regional Cancer Center is located at 1025 Ninth Street in Cody.
The Physicians of Big Horn Basin Regional Cancer Center Practicing medicine in rural communities is important to Dr. Gilroy, who loves living in the Big Horn Basin. He chose to join the Big Horn Basin Regional Cancer Center so that he had the opportunity to spend more time with his patients and get to know them better, while giving them unmatched access to the latest and best cancer treatments. Dr. Gilroy is certified by the American Board of Radiology as a radiologistoncologist. He is a member of the American Society for Therapeutic Radiology and Oncology and the American Society of Clinical Oncology. JEFFREY GILROY, M.D.
All advertorial courtesy of St. Vincent Healthcare
Dr. Gilroy is a graduate of University of Nebraska ColRadiation Oncologist lege of Medicine in Omaha and completed his Radiation Oncology residency at the University of Florida in Gainesville. His internship in Internal Medicine was completed at Creighton University, also located in Omaha.
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Dr. Collins decided to become an oncologist at the age of 11. At that time, her grandfather and best friend was diagnosed with lung cancer. She accompanied him to his chemotherapy and radiation treatments and, before he died, he asked her to promise to help people in his situation. Dr. Collins has been working since to fulfill that promise. Dr. Collins is a boardcertified hematologist and medical oncologist. She is also board certified in Internal Medicine. She is a member of the American Medical Association, American Society of Clinical Oncology and American Society of Hematology. She is a graduate of the University of Alabama CARLETTA COLLINS, M.D. School of Medicine in Birmingham. She completed Hematologist and her Internal Medicine ResiMedical Oncologist dency and Fellowship in Hematology and Medical Oncology at Vanderbilt University in Nashville.
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I’m not just in remission.
I’m the spirit of a survivor.
At St. Vincent Frontier Cancer Center, you don’t face cancer alone. And neither do your doctors. Radiologists, medical oncologists, radiation oncologists and a dedicated clinical staff work together to provide personal and comprehensive care. Our leading-edge facility combines the latest technology with bright, natural light and comfortable treatment areas to help you maintain the best outlook possible. To find out more about our approach to cancer care, call (406) 238-6290 or learn more at svfrontiercancer.org.
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Teaming Up For Kids “This teamwork-driven approach” Barker says, “is so important in making sure that the physical, emotional and spiritual needs of every child who comes to St. Vincent Healthcare are met.” Nationally there is a shortage of pediatric specialists; in fact, Montana and Wyoming are part of a region of states that have the fewest pediatric specialists of any area in the country. St. Vincent Healthcare is changing that by ensuring that all pediatric patients have access to comprehensive pediatric specialty care from highly specialized providers. In addition to housing a Level III Neonatal Intensive Care Unit and the region’s only pediatric intensive care (PICU) unit staffed by board certified pediatric critical care doctors, St. Vincent Healthcare has committed significant resources to expand and improve the types and levels of services they offer for children. “We are working to attract pediatric specialists and subspecialists to this region in an effort to meet the needs of these children,” says Jason Barker, president
Barker says that teams throughout the hospital have and CEO at St. Vincent Healthcare. “Certainly, we are fortunate to have The Children’s Clinic as one of our af- undergone pediatric care training, including the transfiliates as their physicians not only provide outstanding port teams on the HELP Flight aircraft and emergency pediatric primary care, but also partner wonderfully well department staff. with the pediatric specialists at the Fortin Pediatric Spe“This teamwork-driven approach” he says, “is so imcialty Clinic.” portant in making sure that the physical, emotional and According to Barker, the nurses who work with pedi- spiritual needs of every child who comes to St. Vincent atric patients, whether in a clinical office or in the hos- Healthcare are met.” pital, have also undergone significant training to help them understand the unique needs of children, as well as those of their families. St. Vincent Healthcare was also For more information about the the first organization in its service region to recruit child pediatric services available at life specialists, individuals who assist children in understanding aspects of their care or illness in language they St. Vincent Healthcare, please visit can understand and who also work with the children of www.svh-mt.org/pediatrics adult patients who may be experiencing trauma as a result of their parent’s illness or injury.
Seven Pediatric Specialists Share Their Vision of Center “One of the things that I was really attracted to at St. Vincent’s is the team approach . . . every specialty you can imagine comes to work together for the patient and family,” she said.
Dr. Salerno completed his fellowship in pediatric critical care from the University of Virginia. “There is a sense to a lot of people that children are just small adults, and that is not true,” Dr. Salerno said. “They have different medical needs, they have different psychological needs, and we try and treat all that.”
DR. RICHARD SALERNO Pediatric Intensive Care
Dr. Richard Salerno specializes in the diagnosis and treatment of children and adolescents with all types of emergency and intensive care conditions such as respiratory distress, respiratory failure, kidney problems, gastrointestinal problems, and trauma accidents. Dr. Salerno directs the St. Vincent Healthcare Pediatric Intensive Care Unit, where a team of pediatric critical care doctors and staff provide 24-hour support.
Families are, very understandably, overwhelmed when they come through the door. Salerno said, “That’s where the multi-disciplinary team approach comes in. We round every morning as a team to make sure that all aspects of the child’s care are taken care of.” Salerno credits some of his passion for his specialty to two mentors in his residency program. “They showed me how rewarding it could be to take care of the most critically ill children and their families.” See what Dr. Salerno says St. Vincent Healthcare patients love about their care here in Billings at http://www.svh-mt.org/salerno.
Dr. Zemel said that for her it is extremely gratifying to see a parent relax when they are told how the clinic team will help them deal with their child’s illness. “I went into pediatrics because of my desire to help children and families and the fact that caregivers and caretakers in pediPediatric Endocrinology and Diabetes atrics work as a team with the child’s health being paramount,” she said. “I chose endocrinology in particular because of the puzDr. Sharon Zemel evaluates and treats zle-solving nature and role of teaching and infants, children, adolescents and young long-term support. I enjoy all those facets.” adults with endocrine needs including dia betes, obesity, thyroid disease, growth and Her vision and hope is that financial condevelopment issues, and adrenal and pitui- straints that prevent adequate access and tary disease. care for so many of our kids and families can be eliminated. Dr. Zemel received her fellowship in endocrinology at the National Institute of See what discipline Dr. Zemel says is Health. like working on a puzzle at http://www.svh-mt.org/zemel.
DR. SHARON ZEMEL
atric medicine and a fellowship in pediatric gastroenterology, hepatology, and nutrition from the University of Colorado School of Medicine—The Children’s Hospital in Aurora, Colo.
Laborde Neuhardt chose to work in her specialty because “I get the opportunity to work with families over very long periods of time incorporating general pediatrics with very specialized care,” she said. “It is a field that is mentally challenging and always changing and helping families through very difficult, stressful times is a great privilege. Laborde Neuhardt has some advice for those families who find themselves with a child who has a major disease. “Patience, DR. CARRIE LABORDE NEUHARDT though at times incredibly difficult, is the Pediatric Hematology-Oncology key. At times things may seem like they are at a standstill but often the process is slowly Dr. Carrie Laborde Neuhardt specializes moving forward.” in the diagnosis and treatment of children and adolescents with cancer and blood disDr. Laborde Neuhardt calls this eases such as leukemia, solid tumors, hemoparticular feature at the Fortin philia and other bleeding disorders, and cerPediatric Specialty Clinic one of the tain genetic disorders. favorite things for their children patients undergoing chemotherapy. Dr. Laborde Neuhardt completed fellowGo to ship training in pediatric hematology-oncolhttp://www.svh-mt.org/neuhardt ogy at The University of Texas Southwestern to see what it is. Children’s Medical Center Dallas Texas.
DR. JAMES WIGGINS Pediatric Cardiology
“The most rewarding aspect of my practice is working with children with very special needs and challenges and helping both the child and family deal with all aspects of their child’s heart defect or disease,” he said. “Children are incredibly resilient and tolerant of physical issues that would overwhelm most adults and yet are able to maintain their ability to carry on despite what adults would consider disabling conditions. They inspire everyone around them.” Dr. Wiggins’ advice to parents with a child with special needs is to stay informed and up to date on their child’s condition since the medical community is making great strides.
Dr. James Wiggins treats infants, children, and adolescents with congenital and acquired heart issues including heart rhythm disorders, sports-related heart problems, chest pain or murmurs or syncope, and fetal heart disease.
“We have to do things uniquely for children to keep them comfortable with dealing with major health problems. I take pride with being able to manage patients on the day to day level with what they need to live a wholesome life.”
Dr. Wiggins completed his fellowship in pediatrics and cardiology at the Colorado School of Medicine.
See what Dr. Wiggins says pediatric doctors have unique in their treatments with their small patients at http://www.svh-mt.org/wiggins.
“We really work to make it individualized child-centered treatment at St. Vincent, and you’re not just another face in the crowd, and that really leads to the ‘People Healing People’ part of it. It’s more of a personal relationship with the child and the family.”
DR. TOM FLASS
Pediatric Gastroenterology Dr. Tom Flass specializes in the evaluation and treatment of infants, children and adolescents with gastrointestinal disorders. He treats such conditions as celiac disease, malabsorption disorders, childhood liver disease, feeding and swallowing issues, constipation, irritable bowel syndrome, and all conditions with the GI tract or issues with growth difficulties. Dr. Flass completed his residency in pedi-
Dr. Flass relates to patients who have gastrointestinal disorders because he has celiac disease and understands what patients often face. “I know where patients are coming from because when I first went gluten free, I had difficult experiences. Now it doesn’t phase me at all, and there’s a light at the end of the tunnel for those patients who are suffering from other GI diseases.” See what Dr. Flass says is the best part of his day at St. Vincent Healthcare at http://www.svh-mt.org/flass.
Dr. Van Orman completed a fellowship in pediatric neurology at the University of Calgary, Alberta Children’s Hospital and a fellowship in pediatric epilepsy at the Miami Children’s Hospital.
DR. COLIN VAN ORMAN Pediatric Neurology
Dr. Colin Van Orman treats infants, children and adolescents with a broad spectrum of neurological disorders including developmental disorder, epilepsy, brain tumors, movement disorders, and cerebral palsy. He is currently the head of the epilepsy program for children at the University of Utah/ Primary Children’s Hospital and a Clinical Professor in adult and pediatric neurology at the University of Utah.
“There is a growing number of pediatric specialists at St. Vincent, and the hospital has a real desire to recruit and retain pediatric specialists,” he said. “For a family to meet with a pediatric neurologist locally is a real plus.” Dr. Van Orman says that one of his most important responsibilities in caring for young patients is to help them and their family understand the condition they have and to work with them, in conjunction with their primary care provider, to carry out their treatment plan and manage their symptoms. With six children of his own and 28 years of pediatric medical practice see what Dr. Van Orman says about working with children at http://www.svh-mt.org/vanorman.
“You have to be able to understand that when the child goes back home if this treatment can actually be feasible and if it can actually be carried out,” she said. “You have to know where they are coming from and what it is like out there so you can give them sensible advice.“
DR. SANTHA CHAMBERLIN Outreach Pediatrician
Dr. Chamberlin is a pediatrician dedicated to outreach for the Fortin Pediatric Specialty Clinic and travels to those communities in Montana where there are gaps in pediatric care for children. Two of her practice locations Fort Peck and Fort Belknap, Mont., where travel to work requires a day to and from the rural frontier sites. She also coordinates the follow up treatment plan for children from these rural areas who come to St. Vincent Healthcare and then are discharged to their home community. Courtesy of St. Vincent Healthcare
Recently St. Vincent Healthcare installed one of the largest window graphics the city of Billings has seen on a building with a one-of-a-kind scene spanning the entire building front. The graphic depicts the seven pediatric specialists at the Fortin Pediatric Specialty Clinic looking to the St. Vincent HELP helicopter descending. “The scene shows the doctors looking to the sky to see what child the region is bringing us that needs the specialized healthcare service we provide for children..” said Lorna Dyk, Women’s and Children’s Service Line Director at St. Vincent Healthcare. “As the HELP helicopter comes in, they know their work begins.”
All advertorial courtesy of St. Vincent Healthcare
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“This outreach program is great. It’s a way of showing how St. Vincent wants to provide service to a place that has no healthcare and then fill in the voids,” she said. “We’re going to find these kids that really need the help.” Find out what Dr. Chamberlin says about traveling through rural Montana to provide healthcare services to children who would otherwise not have care. Go to http://www.svh-mt.org/chamberlin.
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Sunday, September 8, 2013
OUR COMMITMENT TO CHILDREN KNOWS NO BOUNDS. We founded Montana’s first 24-hour Pediatric Intensive Care Unit in Billings and employ a specialized transport team to ensure no child is beyond our reach. All of our nurses, specialists and board certified intensive care doctors are dedicated to one thing—getting kids back to being kids. Proceeds from the SAINTS Gala 2013 will benefit the St. Vincent Children’s Healthcare regional mission. For more information visit svfoundation.org.
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Blue Care Connection Program: Providing Expertise and Resources All advertorial courtesy of Blue Cross Blue Shield of Montana
Furthermore, by establishing prior authorization for procedures, precertification of inpatient facility admissions and review of ongoing treatment, the IHM staff ensures members will not incur charges for procedures that are not medically necessary or have not been proven effective.
Studies have also shown that approximately $1.5 trillion of the $2 trillion spent each year on medical care in the United States is attributed to treating chronic diseases, which are fueled by unhealthy lifestyles. Furthermore, approximately 20% of the people contribute to 80% of the claims nationwide.
Using a cutting-edge integrated predictive modeling tool, BCBSMT can proactively identify cases for outreach and offer members personalized care management options that motivate participation and support behavioral change. Members can be classified in three categories: well, low and moderate risk, and high risk and catastrophic care.
The Care Coordination program directly assists members who have complicated or chronic health issues. A team of registered nurses, certified case managers, licensed clinical social workers and licensed clinical professional counselors with oversight from the medical director, serves as a partner and advocate, helping those members improve their health outcome, reduce costs and address individual needs.
Through its Blue Care Connection program, BCBSMT reaches out to members in all three categories in different ways – by using discounts and incentives to help support an already healthy lifestyle for well members, by providing lifestyle or condition management programs with incentives to help low- to medium-risk members stay on track, and by improving the quality of life and health for high-risk and catastrophic-care members through guidance and support by health care providers and the use of incentives for continued participation. Studies have demonstrated a direct link between improved health and happiness – and happier members are proven to be more productive. By focusing on wellness, identifying risks before they become issues, and coordinating care, BCBSMT believes it can reduce future health care costs, while creating happier, healthier, more productive people. Courtesy of Thinkstock
A key component of Blue Care Connection’s success is an outcomes-based wellness program, which differs How do we go about improving our health and do- from standard wellness programs in that it rewards reing so in a way that doesn’t add to the rising costs of sults, not just participation. health care over the long term? The Total Health Management (THM) wellness proBlue Cross and Blue Shield of Montana (BCBSMT), gram provides strong financial incentives to members for which has served members in Big Sky Country for more completing preventive care and for controlling weight, than 73 years, delivers a robust and effective answer to blood pressure and cholesterol levels, while maintainthat question with Blue Care Connection, a program ing a tobacco-free status. THM uses quality metrics and that uses wellness, case management and disease man- requires an annual attestation from a primary care proagement programs designed to provide members with vider that the member has completed all recommended the expertise and resources needed to better manage preventive care and achieved the appropriate standards, or has improved in each measurement compared to the their health and control medical expenses. member’s baseline status. The incentive amounts to 20 “Integrated health management is the wave of the percent of the member’s share of his or her health insurfuture,” said Dr. Monica Berner, chief medical officer ance premium. at Blue Cross and Blue Shield of Montana. “Our highly BCBSMT’s award-winning wellness initiatives give successful care coordination model is improving patient outcomes while reducing the overall cost to deliver qual- members comprehensive resources, practical assistance and consistent follow-up to help them start livity health care. That is a win-win for Montanans.” ing healthier lives. With on-site support and a complete BCBSMT created its Integrated Health Management suite of online resources, members can evaluate their (IHM) department in 2007 to address the root cause of health status, build a specific roadmap to better health rising health care costs. The IHM program – adminis- and track their results. tered by board-certified physicians, registered nurses, Comprehensive wellness programs, however, can licensed behavioral health specialists, pharmacists and functional business experts – is designed to reduce costs only do so much on their own, and that’s where Blue by improving the health of members, while care coordi- Care Connection’s case and disease management sernators identify and interact with high-risk and chroni- vices come in. cally ill members to help them receive appropriate, coordinated and timely care.
Also key to the success of the Blue Care Connection program’s outreach and enrollment is physician collaboration. Blue Care Connection resources can help a member plan and manage his or her health, but does not replace the care of a physician. The intent of the physician collaboration is to alert physicians to gaps in health care and reach out to physicians to involve them in facilitating gap closure. Collaboration is designed to respect the physician’s knowledge and strengthen the relationship between the physician and his or her patient. Another specific strategy that results in member savings is the use of the patient-centered medical home (PCMH). The PCMH is another innovative model that BCBSMT is pioneering in Montana. The model rewards providers for administering a complete regimen of preventive care and achieving quality standards for chronic disease management. This cutting-edge health care delivery model has significantly improved the way primary care physicians proactively manage patient health. The program has led to reduced emergency room visits and hospitalizations, improved frequency of visits with primary care physicians, improved preventive care compliance and improved quality outcomes for members with chronic diseases. BCBSMT’s innovative thinking is paying off with proven results. Studies show that members with one or more conditions, like asthma, diabetes or coronary artery disease, who are enrolled in a Blue Care Connection program, have: • 4 percent lower hospital admissions per thousand versus the competitors’ care-management programs • 6 percent lower hospital days per thousand • 5 percent lower emergency room visits Blue Care Connection serves as proof BCBSMT is serious about backing up its mission to help Montanans lead healthier and happier lives with affordable, innovative health and wellness solutions, and topnotch customer service.
When it’s time to find the health insurance solution that’s right for you, choose the one voice that speaks on your behalf and has been there for you since 1940—Blue Cross and Blue Shield of Montana. True Blue.
800.447.7828 | bcbsmt.com
®Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
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