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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Some good news to welcome in the new year: nearly two-thirds of the nation's leading healthcare executives believe the healthcare system will be somewhat or significantly better by 2020 than it is today as a result of national healthcare reform, according to a study published in the Health Affairs blog.

Additionally, 93 percent believe that the quality of care provided by their own hospital or health system will improve during that time period. The findings, based on research by the University of Pennsylvania and the Children's Hospital of Philadelphia, includes responses from 74 senior executives from large hospitals and health systems across the United States.

More good news: doctors, hospitals and other healthcare providers have formed 123 new Medicare ACOs, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States.

According to a CMS announcement, the new ACOs include a diverse cross-section of healthcare providers across the country, including providers delivering care in underserved areas. More than half of ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately one in five ACOs include community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities, CMS said.

Good news extends to low-income children as well, with our report that 23 states received over $307 million in bonuses for improving access to children's health coverage and successfully enrolling eligible children in Medicaid, according to CMS.

States that met at least five out of eight specific features to streamline enrollment, including using data-matching to reduce paperwork and eliminating face-to-face interview requirements, received performance bonuses, designed to offset the costs of insuring this demographic, and initiated by The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Some news to ponder: contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), those most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC).

Only rarely did respondents cite convenience as a reason for choosing ED care. About one in four people (24.8 percent) reported their doctor's office was closed when they needed help, and close to a quarter (24.1 percent) indicated their physician instructed them to go to an ED.

Wondering what healthcare industry areas are ripest for expansion in 2014? Check out our latest HINfographic: 7 Value-Based Priorities for Healthcare's Smart Money, based on the latest HIN market research.

And don't forget to take our current online survey on Reducing Hospital Readmissions in 2013. While great strides have been made in the reduction of 30-day all-cause hospital readmissions, CMS still docked reimbursement for more than 2,200 hospitals in 2013 for exceeding 30-day readmission rates for heart failure, pneumonia and myocardial infarction. In 2015, CMS penalties will extend to acute COPD and elective hip and knee replacements. Describe how your organization is working to reduce hospital and receive an e-summary of the results once they are compiled.

Your colleague in the business of healthcare,
Cheryl Miller
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to cmiller@hin.com.

HIN Associate Editor Jessica Fornarotto
Associate Editor:
Jessica Fornarotto, jfornarotto@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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Care Transitions in 2013 — Interventions Surge in Response to Payor Scrutiny; Home-Grown Approaches Trump Traditional Models

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January 6, 2014
Vol. XVI, No. 1

Sponsored by:
Award Winning Readmission Prevention Protocols — Navigating Care Transitions with Preferred SNF and Home Health Providers


This week's industry news:

  1. Patients' Sense of Urgency — Not Convenience — Contributes to ED Use
  2. 27 Interventions to Reduce Avoidable ER Use
  3. 23 States Receive Over $307 Million in Bonuses for Enrolling Children in Health Coverage
  4. Accountable Care Reimbursement Models
  5. Healthcare Business White Paper: Dual Eligibles Care Management in 2013
  6. Leading Healthcare Executives Optimistic About Healthcare Reform
  7. New Chart: Top Components of an ACO
  8. Leading a Hospital Turnaround: A Practical Guide
  9. FQHCs, Rural Health Clinics Among 123 Newly Minted Medicare ACOs
  10. Tactics from a Top-Performing Pioneer ACO
  11. Leveraging Technology to Increase Case Management Efficiency
  12. Case Management in Value-Based Healthcare
  13. HINfographic: 7 Value-Based Priorities for Healthcare's Smart Money
  14. Medical Home Neighborhoods
Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy and learn about our other news services.

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Take our monthly e-survey:
Reducing Hospital Readmissions in 2013

You'll be emailed a synopsis of the survey results.

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This week's industry news

1.) Patients' Sense of Urgency — Not Convenience — Contributes to ED Use

Contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), the people most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC).

Get the full story.

>>Return to this week's industry news


2.) 27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use This resource describes 27 separate initiatives launched by Kaiser Foundation Health Plan and WellPoint around the country that are effectively reducing avoidable emergency department use and redirecting patients to more cost-effective care venues.


Learn more about this resource.

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3.) 23 States Receive Over $307 Million in Bonuses for Enrolling Children in Health Coverage

Twenty-three states received over $307 million in bonuses for improving access to children's health coverage and successfully enrolling low income, eligible children in Medicaid, according to CMS officials.

Get the full story.

>>Return to this week's industry news


4.) Accountable Care Reimbursement Models: Moving from Productivity to Population-Based Incentives

Accountable Care Reimbursement Models This webinar will explore key structure, issues and challenges in evolving accountable care reimbursement models, including how to use real-time EHR data to identify risk, manage gaps in care and analyze performance to manage population health.

Learn more about this resource.

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5.) Healthcare Business White Paper: Dual Eligibles Care Management in 2013 — Case Management, Education Boost Compliance, Satisfaction

Dual Eligibles Care Management in 2013 Education and engagement are key to managing the health of dual eligibles but also the most formidable challenges, say a third of respondents to a new survey on Care Management of Dually Eligible by the Healthcare Intelligence Network. Care coordination of the 9 million Americans eligible for both Medicare and Medicaid is a growing priority for the nation's payors who wish to address this population's unique medical, social and functional needs in a coordinated and cost-efficient manner. Download this HINtelligence report for more data on dual eligibles as reported by 72 healthcare companies in HIN's 10 Questions on Care Coordination of Dual Eligibles Survey, including dual eligible care coordination program components, results and ROI, and successful care coordination strategies for dual eligibles in respondents' own words.

Download this complimentary white paper.

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6.) Leading Healthcare Executives Optimistic About Healthcare Reform

Nearly two-thirds of the nation's leading healthcare executives believe the healthcare system will be somewhat or significantly better by 2020 than it is today as a result of national healthcare reform, according to a study published in the Health Affairs blog.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top Components of an ACO

New Chart: Top Components of an ACO Care transition management is one of the top components of an accountable care organization, say nearly 90 percent of healthcare companies who respondend to HIN's third annual survey on ACOs. We wanted to see which other components make up an ACO.

Click here to view the chart.

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8.) Leading a Hospital Turnaround: A Practical Guide

Leading a Hospital Turnaround: A Practical Guide This resource, along with concrete tools and action plans, provides candid advice on hospital turnarounds: minimizing the fears of employees, physicians, and board members; and preserving crucial relationships while directly addressing difficult questions.


Learn more about this resource.

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9.) FQHCs, Rural Health Clinics Among 123 Newly Minted Medicare ACOs

Doctors, hospitals and other healthcare providers have formed 123 new Medicare ACOs, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States.

Get the full story.

>>Return to this week's industry news

10.) Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care

Tactics from a Top-Performing Pioneer ACO This resource provides first-year advice from Monarch HealthCare's Medicare ACO, one of 32 original CMS Pioneer ACOs engaged to test alternative payment and program design models for accountable care organizations.



Learn more about this resource.

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11.) Leveraging Technology to Increase Case Management Efficiency

The use of technology is a big influencer of case management efficiency, but the industry should be mindful of its use and participate in tool creation, advises Teresa M. Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM, CCP, president of Ascent Care Management.

Get the full story.

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12.) Case Management in Value-Based Healthcare: Trends, Team-Building and Technology

Case Management in Value-Based Healthcare This resource delivers advice for the profession on surviving and thriving in the post-reform healthcare landscape from Teresa M. Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM, CCP, president of Ascent Care Management and a familiar voice on the case management scene.


Learn more about this resource.

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13.) HINfographic: 7 Value-Based Priorities for Healthcare's Smart Money

With time and resources at a premium, healthcare organizations are increasingly selective about allocation of human and financial capital. There are, however, a select group of initiatives worthy of C-suite investment. Population health management, care coordination and integrated care delivery are among the top business opportunities in 2014, according to a new infographic from the Healthcare Intelligence Network. This HINfographic also identifies the other top opportunities, as well as metrics from existing programs.

Read this blog post.

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14.) Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care

Terry McGeeney If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years of his practice career in a large multispecialty group, has also seen some FQHCs and managed Medicaid programs that do a good job of linking community and social supports required in medical neighborhoods.

As for engaging patients in this emerging integrated care delivery system, try explaining the medical neighborhood’s value proposition for them, he suggests. Patients already get why the integrated approach is good for physicians and insurance companies but need to hear why they should buy in to team care, patient portals and other aspects of centralized care coordination.

Listen to this podcast.

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