December 26, 2024: Case #2 – Meet Tom a 58-year-old spouse of an employee in your company

Case Report #2 Meet Tom a 58-year-old spouse of an employee in your company

Tom is the spouse of Elaine, one of your best employees. She has worked her way to a key supervisor position. Tom and Elaine have been married for 32 years. Tom works part-time from home as an editor for a book publishing company that often uses him to help new authors complete their manuscripts. They have three children who have all graduated from college. In his younger days, Tom was an active athlete who played golf and tennis. In the last 5 years, he’s become inactive because of pain in his knee that will not resolve. He tried physical therapy to no effect.

Tom has a Whole Person Risk ScoreTM*of 125. He has developed several chronic conditions. Two years ago he developed essential hypertension. Initially, he used medications to control his blood pressure. Then he allowed the prescription to lapse. He’s been untreated for the last year and a half. He’s had a few episodes of chest pain in the previous six months which took him to the Emergency Room for evaluation.

Tom does have a relationship with a general internist who he’s seen five times in the last year. His chief complaint when he goes to the GIM focuses on his knee pain. The GIM referred him to an orthopedic surgeon for evaluation of the knee pain. The Orthopod prescribed Oxycodone for the pain, He did not believe that surgery could be a helpful intervention. He recommended more physical therapy. Tom procrastinates in his decision-making.

In addition, he’s gone to the Emergency Room six times in the previous year for various complaints. One of these resulted in a 2-day admission to the hospital for a workup of his chest pain. Since the date of the inpatient stay, he has not seen his doctor.

Intervention

The medical team decided that the My Personal Health Assistant should make the first approach. The following is an outline of the game plan

  • Clarify Tom’s assessment of his health status
  • Clarify Tom’s confidence in the General Internist who provides his primary care
  • Assess Tom’s health literacy. Does he understand the seriousness of his health status?
  • Would Tom allow the PHA to talk with his General Internist?
  • What factors influence Tom to use the ER for care before contacting his GIM provider?
  • Is Tom aware of the point solutions that his wife’s health plan offers that could help him with his hypertension, musculoskeletal issues, and his smoking?
  • Is Tom aware of the health screening that could help him identify medical problems at an early stage (e.g. cancer screening, etc.)
  • Would Tom be open to receiving emails and texts from several point solutions offering to help with smoking cessation?

“The rest of the story” –

Tom’s story is common. The chance of him having a stroke, heart attack, or being diagnosed with COPD or lung cancer and becoming a high-cost claimant is high

The Converging Health MyPHA model provides him with a guide to create a relationship and engage him until his risk is reduced. The Converging Health model prioritizes actions and can save money (over $1,500/year/person) when he becomes engaged with his guide.

The MyPHA is able to reach Tom and they have a fruitful first conversation.

  • Clarify Tom’s assessment of his health status

Tom is worried about his health status but feels overwhelmed regarding where to start

  • Clarify Tom’s confidence in the General Internist who provides his primary care

Tom thinks his doctor is competent and knowledgeable, but he does not feel they have a strong working relationship. He’s not sure how to strengthen their relationship

  • Assess Tom’s health literacy. Does he understand the seriousness of his health status?

While Tom is concerned about his health, he does not think it is all that serious. Most days he wakes up feeling fine. He listens as the PHA provides some data about his risk

  • Would Tom allow the PHA to talk with his General Internist?

Tom welcomes the idea of the PHA talking with his doctor. He permits the PHA to share their conversation with his doc

  • What factors influence Tom to use the ER for care before contacting his GIM provider?

Tom underestimates what his doctor could do for him when he has an episode that he thinks needs care. He’s always used the ER instead of this doctor when he thinks what he is experiencing might be serious. He recognizes that his fear is driving his decision.

  • Is Tom aware of the point solutions that his wife’s health plan offers that could help him with his hypertension, musculoskeletal issues, and his smoking?

Tom remembers receiving some emails about these, but he’s never paid much attention to them. He’s surprised when the PHA explains their potential value

  • Is Tom aware of the health screening that could help him identify medical problems at an early stage (e.g. cancer screening, etc.)

Tom admits that his fear of a serious problem leads him to deny the value of the screening. He agrees to discuss this more fully when he next meets with his doctor. The PHA offers to schedule an appointment with his doctor in the next few weeks. Tom accepts the offer.

  • Would Tom be open to receiving emails and texts from several point solutions offering to help with smoking cessation?

Tom is open to receiving the emails and commits to paying attention more fully when he sees them

As a result of the conversation with the PHA Tom has agreed to take the first steps towards addressing his health issues. Supporting the doctor-patient relationship gets the ball rolling in the right direction. The PHA shares the full conversation with the doctor who is now more aware of how to work with Tom.