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March 2018 >> $5 ON ROUNDS

Small Town Charmer Oncologist Arun Rao, MD, finds practicing in rural West Tennessee very rewarding Small towns and medicine may not have been in his master plan but for West Clinic Oncologist and Hematologist Arun Rao, MD, the two have become the perfect match for him. Read the story on page 3.

Hope and Healing for Mental Illness is Possible Accountable, Accessible, Affordable Care Reduces Hardship — and Costs It’s common knowledge that early detection and appropriate treatment of medical conditions can considerably reduce hardship and costs. Yet with mental health conditions, patients who seek help may wait months — even years — for a diagnosis, and even longer for an effective personalized care and medication management plan. Read the story on page 4.


Teleneurology Impacting Rural Areas

Baptist Memorial Healthcare System expanding its neurology reach bY suZanne boYd

Every 40 seconds, someone in the United States suffers a stroke, which is one of the leading causes of death. Having access to an experienced neurologist can make a difference in the outcome but while the demand for neurologists is high, unfortunately the supply is short. This fact is further compounded for many who live in rural areas, which makes access to a neurologist even more limited. Fortunately, technology has made neurology more accessible in West Tennessee. Through the use of teleneurology, expert care can be quickly available to even the most remote locations, an important consideration since every second counts in treating stroke and other neurological emergencies. The American Academy of Neurology views teleneurology as an effective tool for rapid evaluation of patients in remote locations. Patients in rural West Tennessee are reaping the benefits of this technology. Baptist Memorial Healthcare began using a telemedicine platform for stroke and acute neurology in 2012. In 2015, the system


Ransomware Attacks, Breach Notification, Security, And Rule Compliance: What You Need to Know bY loretta duncan, facmPe

The Breach Notification Rule was introduced to healthcare in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. Since that time, more than 2200 covered entities and business associates have reported breaches affecting 500 or more individuals, with the total number of individuals impacted by these breaches exceeding 170 million. The majority of these breaches involve electronic protected health information. Ransomware occurs when a cyber-criminal obtains access to a

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covered entity’s ePHI and holds the data hostage until a ransom is paid. This type of attack on healthcare data is considered one of the “biggest current threats to health information privacy,” according to the Office of Civil Rights (OCR), the agency that enforces HIPAA Rules. A ransomware attack can virtually paralyze a medical practice’s operations. Following an attack, there will be a frenzy of activity to limit the damage and restore normal operations; however, there may be even more devastation and hardship from a HIPAA standpoint.


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Small Town Charmer

Oncologist Arun Rao, MD, finds practicing in rural West Tennessee very rewarding bY suZanne boYd

Small towns and medicine may not have been in his master plan but for West Clinic Oncologist and Hematologist Arun Rao, MD, the two have become the perfect match for him. Growing up in Mumbai, India, Rao always felt engineering was his calling. When he took his performance exams at the end of high school, he scored high enough to interview for both medicine and engineering. As luck would have it, his medical interview was first, and he was selected to attend one of the top medical schools in Mumbai. “My parents would not let me give up my seat,” said Rao. “My dad had missed an opportunity to go to medical school when he was younger and while he was a pharmaceutical representative, we had no doctors in our family at the time, so they were very happy I was going into medicine.” As he matriculated through the medical program, Rao discovered medicine to be very interesting, just not the surgical side of it. While he earned degrees in medicine and surgery at Grant Medical College in Mumbai, he took the advice of a friend, who had come to the United States, to pursue a residency in Internal Medicine at Wayne State University of Medicine in Detroit, Michigan. “I wasn’t sure what aspect of medicine I wanted to do but I knew I wanted to do research,” said Rao. “I met my wife during my residency in Detroit and wanted to settle in the United States.”

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In order to do that, Rao would have to go through a waiver process to convert his visa to one that would allow him to stay in the U.S. To be able to apply for a fellowship and get funding, he would have to either have citizenship or a visa. The conversion process involved him working as an internist in a rural area. He spent the next four years on the staff of UCI Medical Affiliates and Anderson Medical Center in Anderson, South Carolina. During his time there, he became very interested in treating cancer patients and began to

look for a fellowship in oncology and hematology. His search led him to the University of Texas Health Science Center in San Antonio which had a very strong breast cancer program. “The main attraction for me was that they offered me two years of research with one year of fellowship,” said Rao. “Immunology was very interesting to me so after my first-year clinical fellowship, I pursued basic science research working with an immunologist in the lab and even had my research published. After two years doing research I joined the faculty.” While his career was budding, his family was growing. He and his wife had a daughter while in South Carolina and a son while in San Antonio. Rao also felt some pressure to give up research and move back into private practice. “I was losing touch with the clinical side of things,” he said. “So, I joined the staff of Cancer Care Centers of South Texas in San Antonio.” After nine years in private practice, Rao was faced with another change. His wife, who is a neuroscientist, accepted an assistant professor position at the University of Tennessee Methodist LeBonheur in Memphis, so he began to look for a new place to practice. His search led him to the West Clinic and he knew it was the perfect match. “The clinic was expanding

and held great opportunities for me,” said Rao. “In 2014, the opportunity to see patients in Paris, Tennessee presented itself. Initially, I was there just a couple of days a week, but it has grown so much that I am now there three days a week and it has become my primary practice. Dr. Wang also sees patients here one day a week.” Rao says his time in Anderson, South Carolina opened his eyes to the charm of practicing in a smaller area and thinks it is why he gravitated to the opportunity to work in one again. “My residency in Detroit was totally different from what I had seen in India,” he said. “Then, when I went to South Carolina, the approach to everything was different. It was a totally new culture for me, and I really enjoyed working in a rural setting. When I came to Paris, it was so similar. The people are so welcoming and appreciative of all we do. I love being able to provide oncology and hematology care to this community. We have an outstanding staff in the office. I also have the opportunity to participate on a tumor board in Memphis, so I can present complicated cases from Paris there and have a multi-disciplinary team approach to these cases.” “If my family were not in Memphis, I would be in Paris all the time,” said Rao. “I love Paris, it is beautiful. The community has really embraced me, and I have to say I look forward to my time there.”

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Hope and Healing for Mental Illness is Possible Accountable, Accessible, Affordable Care Reduces Hardship — and Costs PATH TO A STIGMA-FREE WORKPLACE Published with permission from the National Alliance of Healthcare Purchaser Coalitions.

“There is no health without mental health; mental health is too important to be left to the professionals alone, and mental health is everyone’s business.” — Dr. Vikram Patel

It’s common knowledge that early detection and appropriate treatment of medical conditions can considerably reduce hardship and costs. Yet with mental health conditions, patients who seek help may wait months — even years — for a diagnosis, and even longer for an effective personalized care and medication management plan. Mental health conditions are the leading cause of disability worldwide. In the U.S., about one in five adults will experience mental illness in a given year, 60 percent of whom don’t get help. Many who do reach out face a daunting labyrinth of high costs, a dearth of providers, and unsuccessful treatment, leading to waning motivation, hopelessness, and progressively worse symptoms. Adding to the challenges, only 55 percent of the nation’s psychiatrists accept insurance, compared with 88 percent of physicians in other medical specialties. The difficulty in finding in-network mental health providers extends to other mental health professionals, too. It’s getting worse. The nation needs to add 10,000 providers to each of seven mental health professions by 2025 to meet the expected growth in demand. The lack of access has created a crisis throughout the healthcare system that is costly, harmful and frustrating — sometimes catastrophic — for patients, their families, and other healthcare providers. With unmet patient needs soaring, pressure on hospital emergency departments is untenable and quality and satisfaction levels are alarmingly compromised. Action Steps for Employers: The barriers to achieving the mental health system we need are many, but they are surmountable when payers and purchasers work together to drive long-overdue change such as: • Requiring independent validation of mental health parity compliance. • Evaluating and dealing with root cause issues related to in-network access to mental health professionals. • Promoting the Collaborative Care Model to improve mental health access and quality through primary care. • Supporting access to a full complement of mental health medication options to yield improved outcomes and lower overall costs. • Developing innovative strategies 4


MARCH 2018

1 IN 5 American adults has a mental illness

Mental illnesses are the leading cause of disability worldwide

1 in 10 full-time employees has an addiction

DID YOU KNOW? gaps by working closely with their health plans and other vendors to offer and pro The nationwide rate of current motecigarette things likesmoking EAPs, telemental among health, pharmacogenomics, online beadults with past year cognitive any mental illness (AMI)resiliency is 31.6% vs. havioral therapy (CBT), and without AMI. second opinion stress18.7% reduction training, services, and more.  About 10% of pregnant women

and 15% of postpartum women

Personalized Treatment experience depression.

By their nature, medications for mentalhealth do not work consistently Anxiety disorders, the mostfor all common mental patients like statins dohealth for people with 18.1% (42 high diagnosis, cholesterol. affects Mental health treatment of employees with a more than 35% of million) American adults. is complex, and studies show that medicamental illness take time managers feel they off because of it— receive no formal tions in the same class for the treatment of  About 90% of people who die up to 10 days a year support or resources to mental illness are not interchangeable the by suicide—the 10th leading help employees way cause medications in other classes may be. of death I the U.S.—have Policies that include overly restrican underlying mental illness. tive formularies (e.g., excluding newer mental health the workplace medicines), prohibit clinical exemptions to support, engageinand advocate for em- RESOURCES reduce disparities FOR and improve access and (e.g., mental Right Direction program, based on cost rather than science, or inployee health and well-being. EMPLOYERS: outcomes for mental health services. They stitute onerous prior authorization or step should examine by location: RESOURCES FOR IWILLLISTEN, In Our Own Voice) • Addiction andenough mentalnetwork health vs. therapy requirements can fail to achieve Ensure Parity Compliance • Are there providers EMPLOYEES:  Ensuring disparities their intended purpose of reducing overall It’s been return-to-work nearly a decadepolicies since Conbyphysical specialty?health: What Analyzing is the wait time for first • National Alliance on Mental Illness include accommodations and cohealthcare costs. These practices can pogress passed the Mental Health Parity appointments? in network use and provider tentially delay or hinder full recovery, andworker Addiction Equity Act of 2008, which • How is the plan attracting and reeducation. • Mental Health First Aid at Work lead reimbursement rates (Milliman longer periods of disability and lower promised to make mental health and subtaining providers? How are alternative • toRight Direction report) The easy steptreatment of removing productivity, and contribute to additional stance abuse as arbitrary easy to get as payment models used to motivate betStamp Out Stigma limits been taken. The harder visits and even hospitalizations. care forhas any other condition. But despite •terMoving access,Mountains improved quality, andHealth better • medical for Mental When it comes to mental health and suban opioid epidemic that is causing 91 value? If so, how is value defined? steps of ensuring true overall parity, and Well-Being (Article by Michael ENDNOTES: stance abuse, the  standard of treatment deaths a day, and suicide rates that have • What percentage of medical claims appropriate in-network access, and Thompson, National Alliance 1. today that physicians and patients work surged to a 30-year high (with mounting were paid for medical and surgical care dealing with the persistent issues By-the-Numbers president and CEO) together to define individualized treatment disparities between rural and urban comout-of-network vs. for mental health/sub2. related to payment, outcomes and stigma decisions consistent with medical guidemunities), accessing mental health care •stance abuseWell: disorder (MH/SUD)? What PMC3967759/ Working Leading a Mentally remain. difficult Employers can take lines and personalized circumstances.  remains for many, andpositive impossible is your plan to reduce disparities? 3. http://www.modernhealthcare. Healthy Business (a comprehensive com/article/20161231/ actions There are emerging trends showing for some.on their own to make it better but • How is mental health prevention TRANSFORMATION03/161229942 toolkit for employers, including promise for improving first-time prescriblevels related to benefit levels promoted? Are pregnant and post-partum will Parity also need to work together, uniting 4. health programs for the ing success and medication compliance. are generally well andthat have women and smokers screened for depresdeaths-cdc-report/index.html the purchaser voiceunderstood and insisting workplace) For example, pharmacogenomics uses generally been implemented by health sion? Do you promote and reimburse for 5. deliver on the promise— suicide-rate-surges-to-a-30-year-high.html information about a person’s genetic plans, behavioral health organization mental health and substance abuse screenand obligation—of effective mental Out-of-Network, Out-of-Pocket, Out6. makeup to choose the drugs and drug and plan sponsors. However, parity re- •ings? NQTLDisparityAnalysis/ health care for all. to “non-quantitative of-Options: The Unfulfilled Promise that are likely to work best. While quirements related • Do providers use a validated, stan- 7. doses of Parity (NAMI report) relatively new, the potential to avoid multreatment limitations” (e.g., utilization dardized instrument to monitor progress mental-disorders-and-medical-comorbidity.html 8. tiple initial and subsequent therapy fails management, medication management, and outcomes for specific conditions. PMC3628173/ and incorrect diagnoses can be mitigated. etc.) are much more complex. Plan sponIn addition, not complying with mensors have a fiduciary responsibility to enCollaborative Care Model tal health medication therapy can lead to sure compliance and would be prudent With responsibility for providing serious consequences such as relapse, hosto require their administrators to obtain mental health care falling increasingly to pitalization, incarceration, suicide, and independent assessment/accreditation of primary care providers (PCPs), and more poor quality of life. With today’s techthat compliance. than 68 percent of adults with a mental nology, we have “smart” pill bottles, disorder having at least one medical conNational Alliance would like to acknowledge the support it hasmobile apps, multi-dose delivery, and Evaluate Network dition, the Collaborative Care Model has received from APA Foundation Center for Workplace Mentalnewly FDA-approved ingestible pill sensors to Management the most evidence among integration modHealth, Clearview Health Quality Institute, and Takeda/Lundbeck aid compliance. From a quality and affordability els in controlling costs, improving access, Pharmaceutical perspective, issues related to access to inimproving clinical outcomes,Alliance reducingin the form of clinical expertise and to produce this ActionSupport, Brief. Engage, Advocate network mental health services can go stigma, andfunding increasing patient satisfacProgressive employers understand beyond the parity requirements. Among tion. Given the shortage of mental health DECEMBER that in a workplace culture where 2017 menthe findings in a November 2017 report providers, the system can be improved tal illness isn’t stigmatized — and seeking published by Milliman Inc.: significantly when patients with mild to help is encouraged and supported — em• In 2015, behavioral care was four to moderate mental illness rely on PCPs to ployees are more likely to be aware of and six times more likely to be provided outcoordinate and manage their care. A Coluse available resources such as EAPs, so of-network than medical or surgical care. laborative Care team is led by a PCP and they can start treatment sooner and re• Insurers pay primary care providers includes care managers, psychiatrists, and cover more quickly. And treatment works, 20 percent more for the same types of care other mental health professionals. Workeffectively reducing symptoms for 75 peras they pay addiction and mental health ing with vendors, employers can ensure cent of those with common mental health care specialists, including psychiatrists. that employees and their covered family conditions like depression and anxiety. • State statistics vary widely. In New members benefit from this Model. Just as with physical medical condiJersey, 45 percent of office visits for behavInnovation can also mitigate the actions, mental health outcomes improve ioral health care were out-of-network. In cess issues. High-quality, cost-effective, when illness is caught early in the most Washington D.C., the figure was 63 perevidence-based solutions that are approtreatable stage, and patients receive the cent. priate for the patient’s condition across care and support they need to get well. Plan sponsors need to set expectations the continuum of acute and chronic care (CONTINUED ON PAGE 6) for their health plans and other vendors to are available. Employers are bridging care



HR managers know the toll mental illness can take on the company. Yet, only 15% feel managers are training to recognize the problem and share support and resources



Teleneurology Impacting Rural Areas, continued from page 1 switched to the Patronus Neurology platform to provide the teleneurology consults. The clinical program is now in place at ten hospitals across the system, including Tipton County and most recently, Union City. Plans are to expand the program to all facilities system wide by 2019. Baptist Memorial Hospital – Huntingdon is projected to come online sometime next year. Options for telemedicine in the outpatient neurology setting are being explored as well. “Recruitment of specialists, especially in neurology and neurosurgery, is often very difficult for our small to mid-size facilities and communities. The neurologists we have on staff have their hands full with covering their clinic and in-house responsibilities. Having them try to cover outlying facilities would be difficult,” said Kimberly Hallum Stewart, system administrator of neurosciences for Baptist Kimberly Hallum Stewart Memorial Healthcare Corporation in Memphis. “Telemedicine brings those specialists to those areas. The company we work with, Patronus Neurology, are trained vascular neurologists with specific stroke training that only do telemedicine. They assign a team of physicians who work only with our system and provide an on-call physician as well as a back-up, so if we have multiple patients over multiple facilities we are covered.”

The lead time to start a telestroke program is about three to four months. The technical platform must be in place, which consists of the cart and software system that will be used. Clinicians have to be educated on the process for using the cart and activating a request for a consult. The EMR systems used by Baptist facilities and that used by Patronus all interface so that orders and reports can be transmitted electronically. Patronus physicians are introduced to the staff and physicians as well as credentialed at the facility. Staff also receive additional training on how to identify and care for a stroke patient as well as administer Activase (tPA). Overall, it is a pretty easy process,” said Stewart. “In a rural hospital, the age of the infrastructure can impact the time it takes to get things up and going. We have to make sure the wireless capability of the facility can handle the system. We do a ton of testing before it is up and running and take the cart everywhere it could possibly have to go to make sure there are no kinks. But just like with cell phones and computers, there can always be a glitch, but our physicians can always do the consult by phone if necessary.” Baptist Memorial Hospital – Union City was an ideal facility for this type of program says Stewart. “They have emergency department physicians and hospitalists that are on the ground to care for the patient during and after the telestroke consult,” she said. “The program is ideal for any adult

patient that is undergoing an issue that the healthcare provider, whether in the field or ER, feels needs a neurology consult.” A typical consult starts with a patient presenting to the ED or on an inpatient unit with a stroke or stroke-like symptoms (or any other emergent neurological event). They are quickly examined and in the case of a code stroke, the patient is immediately taken to CT. While the patient is in CT, the clinician enters an order in the EMR for a teleneurology consult that goes directly to Patronus. The Patronus neurologist connects to the hospital via a telemedicine cart and is able to see the patient, family, nurses as well as physician and communicate directly with them. “The neurologist controls the camera on the cart which can pan left, right, up and down to examine the patient and has an amazing picture quality,” said Stewart. “It also has 30x zoom lens, so they can look at the patient’s pupil. The nurse is always in the room with the patient.” The neurologist discusses the options with the family and determines the next steps to be taken, be that to start tPA, admit to the hospital or transfer to another facility that provides a higher level of care. All of this typically happens in less than 60 minutes. After the patient leaves the inpatient setting, the appropriate referrals and appointments are made for follow-up care whether that be with a specialist in Memphis or by a local physician. Stewart says the system has been well

received by both staff and patients. “When the cart rolls in, patients interact with the physician just as they would if they were in the same room,” she said. “The ER staff and physicians love it. The ability to have the Patronus physician be a part of the medical team and work with the patient and family is invaluable. They follow the patient in real time with real data from start to finish. If the patient is transferred, they make sure the admitting physician has all the information from the consult prior to the patient’s arrival in Memphis.” Across the Baptist system in 2017, over 2100 patients with neurological emergencies were treated and cared for via telemedicine. “Union City has a busy emergency department, so we expect the volume at the facility to grow each month,” said Stewart. “Based on what we see in other facilities their size, we expect there to be 10-15 consults a month.”

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MARCH 2018



Ransomware Attacks, Breach Notification, Security, continued from page 1 Guidance issued by the OCR states that a ransomware attack will be considered a breach unless it can be proven that the ePHI was not compromised. The sheer presence of ransomware indicates that a medical practice’s systems were compromised, and ePHI could have been at risk. The OCR states, “Whether or not the presence of ransomware would be a breach under the HIPAA rule is a fact specific determination.” Therefore, it is up to the organization to determine whether or not a breach occurred and to respond appropriately. This requires medical practices to perform a forensic investigation to uncover the underlying details of the attack and to ensure ePHI was not compromised. The primary purpose of ransomware is to extort the victim for money - at least, that is how it appears on the surface. Ransomware works by encrypting computer files, thus making them unreadable by the computer system that holds the data. To complete the encryption process, the ransomware must access and process the data in question. One must assume that additional payloads (malicious intentions) could be present and executed on the system. For instance, did the perpetrator read, alter, or transfer the data offsite prior to encrypting? Did they leave a backdoor that provides future access? These are just some of the facts that will be uncovered during a forensic investigation. Organizations need a well-defined incident response plan to guide their actions in the event of an attack. HHS OCR references NIST SP800-61 Rev. 2, Computer Security Incident Handling Guide for those needing additional information. In general, incident response plans include the following phases (NIS SP800-61 Rev.2): Preparation – includes educating employees, conducting risk assessments, development of incident response plans, and implementation of preventative con-


Detection and Analysis – identifies indicators of compromise plus preliminary analysis to understand the incident Containment, Eradication and Recovery – containment isolates the infected system and prevents propagation to other systems; eradication removes the ransomware; recovery restores encrypted data and returns systems to normal operations Post-Incident Analysis – examines the evidence to establish a detailed report of the incident; fulfills post breach responsibilities; includes lessons learned for future improvement It is during the post-incident analysis phase that the forensic investigation will occur and subsequently determine if a breach took place. Investigators will be interested in the particular strain of ransomware infecting the system(s). Antivirus vendors and security researchers closely identify, follow, and analyze ransomware as well as other types of malware. Once the strain has been identified, the characteristics and behaviors will be known. This knowledge can be used to demonstrate whether or not the ransomware exhibits behavior that puts ePHI at risk. Known characteristics and key indicators of compromise include: • infection and propagation methods • types of targeted data such as banking, health, or personal information • if data exfiltrated to the Internet • if backdoors used to give perpetrators unauthorized, future access Log files produced by technical security controls hold valuable information and aid the forensic investigation. These logs are found on desktops, servers, firewalls, web filters, and intrusion detection systems. However, these devices must first be configured to collect the necessary information. It is important that medical practices talk with their information tech-

About the Writer Loretta Duncan, M.S., FACMPE, is a Senior Medical Practice Consultant with SVMIC and specializes in assisting policyholders with HIPAA compliance. She holds a Master of Science in Health Law and Policy from Samford University, Cumberland School of Law.

nology and security providers to ensure the appropriate controls are in place and properly configured. If an entire medical practice’s patient database has been compromised in a ransomware attack, the practice will usually be required to provide written notification to all patients, notice to the OCR through their online portal, and notice to local media. This notification must take place within 60 days of discovering the breach. A breach of this magnitude will also require the practice to be listed on the OCR’s publicly accessible website that displays all covered entities and business associates with breaches involving 500 or more individuals. More importantly, this type of breach will prompt an investigation by the OCR. Even though a ransomware attack is not necessarily an intentional breach of ePHI, it can still lead to substantial costs to a medical practice. When the OCR investigates a breach of ePHI, whether due to a ransomware attack or the loss or theft of a device containing patient information, the dollar amount of a settlement or potential civil monetary penalty will be based on the covered entity’s level of compliance with the HIPAA Security Rule. Medical practices should review their compliance with the Security Rule, especially now, since cyber-crime is at an all-time high and healthcare information is so valuable. Steps that can be taken to help protect covered entities from a cyberattack:

• Conduct a risk analysis to identify threats and vulnerabilities to electronic protected health information (ePHI) and establish a plan to mitigate or remediate those identified risks • Implement procedures to safeguard against malicious software • Train authorized users on detecting malicious software and report such detections • Limit access to ePHI to only those persons or software programs requiring access • Maintain an overall contingency plan that includes disaster recovery, emergency operations, frequent data backups, and test restorations All of these steps are requirements of the Security Rule. Compliance with the Security Rule not only protects medical practices from a potential breach and a large potential settlement with the OCR, it also protects patients. If ePHI is held for ransom, corrupted or lost due to a computer malfunction, patients may not receive the care they need in a timely fashion. It is imperative that medical practices take the time and allocate the financial resources to ensure the security of all ePHI that is created, received, maintained or transmitted. Copyright 2018 SVMIC. Reprinted with permission. This article is intended for educational/informational purposes only and is not intended to constitute legal advice.

Hope and Healing for Mental Illness is Possible, continued from page 4 In addition to ensuring

professionals. Working withaccess vendors,to compliance and employers can ensure that employees high-quality mental health and their covered family members services, employers can take benefit from this Model.



a number of steps to iden-

Innovation also mitigate access tify, can engage and the support issues.employees High-quality,with cost-effective, mental illevidence-based ness suchsolutions as: that are appropriate for the patient’s condition across • Including mental the continuum of acute and chronic health questions relatedcare to are available. are and bridging stress, Employers depression subcare gaps by working closely with their stance abuse on health risk health plans and other vendors to offer appraisals. and promote things like EAPs, telemen• Training supervisors, tal health, pharmacogenomics, online managers and other leadcognitive behavioral therapy (CBT), ers to identify and compasresiliency and stress reduction training, sionately address the signs of second opinion services, and more.

Medical Provider


BH Care Manager


Psychiatric Consultant

ate in-network access, and dealing with the persistent issues related to payment, outcomes and stigma remain. Employers can take positive actions on their own to make it better but will also need to work together, uniting the purchaser voice and insisting that stakeholders deliver on the promise — and obligation — of effective mental health care for all.

Resources for Employers

• Addiction and mental mental illness. doing, employees are more likely to be health vs. physical health: • Educating employees medical guidelines and personalized 4. SUPPORT aware of and use resources such as EAPs disparities in network use and circumstances. Analyzing about things like preventive care, overall • Ensuring return-to-work policies PERSONALIZED so they can get support and treatment TREATMENT AND provider reimbursement rates (Milliman well-being, EAPs and other complimeninclude There are emerging trends accommodations and co-worker sooner and recover more quickly. And MEDICATION ACCESS report). tary programmatic resources addressing showing promiseeducation. for improving treatment works, effectively reducing By their nature, medications for mental • Moving Mountains for Mental mental health in the workplace (e.g., Right The easy first-time prescribing success and step of removing arbitrary for 75 percent of those with healthDirection do not work consistently for all Health and Well-Being (Article by Miprogram, IWILLLISTEN, Incompliance. limits For hasexample, been taken.symptoms The harder steps medication common mental health conditions like patients likeOwn statinsVoice) do for the great chael Thompson, National Alliance presiOur of uses ensuring true overall parity, appropripharmacogenomics information majority of people with high cholesterol. Mental health treatment is complex, and MARCH 2018 in the studies6show that medications same class for the treatment of mental illness are not interchangeable the way medications in other classes may be.


Policies that include overly restrictive

about a person’s genetic makeup to choose the drugs and drug doses that are likely to work best. While relatively new, the potential to avoid multiple initial and subsequent therapy fails and incorrect diagnoses can be mitigated.

dent and CEO). • Working Well: Leading a Mentally Healthy Business (a comprehensive toolkit for employers, including mental health programs for the workplace) • Out-of-Network, Out-of-Pocket, Out-of-Options: The Unfulfilled Promise of Parity (NAMI report).

Resources for Employees:

• National Alliance on Mental Illness • Make it OK • Right Direction • Stamp Out Stigma

Published with permission from the National Alliance of Healthcare Purchaser Coalitions which represents approximately 50 employee/purchaser-led coalitions whose membership collectively provides health coverage to over 45 million Americans. The National Alliance helps to drive improvements in health, well-being and value for our companies and communities across the country.  The Memphis Business Group on Health is a member and serves on the Board of Governors of the National Alliance.

depression and anxiety

Just as with physical medical conditions, mental health outcomes improve when illness is caught early in the most treatable stage, and patients receive the care and support they need to get well.



GrandRounds West Tennessee Women’s Center at JMCGH Awarded Prestigious Honor JACKSON - Recently published, CMS data shows that Jackson-Madison County General Hospital reports the lowest percentage of pregnant women in the nation who had elective deliveries one - three weeks early (either vaginally or by C-section) that were not medically necessary. Dr. Dave Roberts, Chief Medical Officer, said they were extremely proud to be recognized for the high quality of care provided and for the emphasis placed on quality and safety for moms and babies. By providing care to pregnant women that follow best practices, hospitals and doctors improve chances for a safe delivery and a healthy baby. There are many health benefits for the mother and for baby to not have an elective delivery before 39 weeks. Mothers may experience shorter labors and may de-

crease their risk of a cesarean section. Babies are still growing and developing in the last few weeks of pregnancy. Their brain, lungs, and liver are still developing at week 39. Full-term babies are alert and ready to breastfeed and have improved weight gain. The West Tennessee Women’s Center, located on the third floor of Jackson-Madison County General Hospital, delivers more than 3,000 babies annually and seeks to provide the finest health care to all women, children and their families.

Retirement Celebration for Dr. Robert Young UNION CITY – Dr. Robert R. Young, obstetrician and gynecologist, has retired after 50 years of service. He was a founding member and began work at The Woman’s Clinic in Union City in 1965. He was drafted and served in the U.S. Air Force from 1966-1968. He then returned to The Woman’s Clinic in February 1968. In April 2014, The Woman’s Clinic joined the Baptist Medical Group. A retirement celebration for Dr. Young is being held on Friday, March 16, from 2:00-4:00 pm in the tower conference room at Baptist Memorial HospitalUnion City.

PUBLISHER Pamela Z. Harris EDITOR Pepper Jeter SALES Kristen Owensby 219-781-1744 CREATIVE DIRECTOR Susan Graham GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Suzanne Boyd Loretta Duncan, FACMPE

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MARCH 2018



First and Only in Tennessee to implement the Corindus Vascular Robotics CorPathÂŽ GRX System. The only FDA cleared medical device to bring robotic-assisted precision to coronary angioplasty procedures while protecting medical professionals from radiation exposure occurring in hospital catheterization laboratories.

Tomorrow’s Cardiac Care Here Today Robotic Precision in Positioning Stents

More Safety and Comfort for Patients

Unparalleled Control

Enhanced Visualization

March 2018 WTMN  
March 2018 WTMN  

West TN Medical News March 2018