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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

It's a new year, time to ring out the old, ring in the new, and reassess existing notions that, like some of those old sweaters, just don't fit anymore.

For example, a new study from the Yale School of Medicine suggests that previously used ways to assess hospital quality might be in question. Until now hospitals, health insurers and patients measured hospital quality on the number of patient deaths during hospitalization. New research reveals that this measure could be misleading given that some hospitals keep their patients for a shorter time due to patient transfers, and that these hospitals are being favored. The study suggests an alternative approach: measuring patient deaths over a period of 30 days of admission, even after they have left the hospital. This finding could have wide implications as quality measures take on more importance in the healthcare industry.

And an international study suggests that the U.S. healthcare system can be modified to decrease readmission rates, showing that up to one third of heart attack readmssions might be preventable. The study of more than 5700 heart patients in the United States, Canada, Australia, New Zealand, and 13 European countries showed that readmissions may be preventable because rates are nearly one-third lower in other countries.

The HHS finalized its core set of Health Care Quality Measures for Medicaid-eligible adults; it comprises six major categories, among them prevention and health promotion, management of acute conditions, and availability of care. Healthcare providers and insurers can use these measures to track care delivery among adults enrolled in Medicaid, as well as monitor and improve quality. More details can be found in this issue.

And lastly, a new initiative welcomes an old friend: Dr. Janice Pringle, a valued contributor on medication adherence, has been named an Innovation Advisor; she is one of 73 selected for this initiative from CMS, designed to improve healthcare for patients. She and others will test new models of care delivery, form partnerships with local organizations to drive delivery system reform, and improve their own health systems.

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 Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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This week's featured download: Healthcare Trends for 2012

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January 9, 2012
Vol. XIV, No. 1

Sponsored by:
Mapping the Way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach

This week's industry news:

  1. U.S. Heart Attack Patients More Likely To Be Readmitted to Hospital
  2. Guide to Reducing Medicare Readmissions, Vol. II
  3. Six Principles of a Medical Home Pilot
  4. Case Studies in Comprehensive Primary Care
  5. Healthcare Business White Paper: 2011 Benchmarks in Accountable Care Organizations
  6. Dr. Janice Pringle Named One of 73 Innovation Advisors
  7. New Table: Top 2012 Trends for Hospitals and Health Systems
  8. Roadmap to the ACO Rule
  9. Death Rate Measure Used to Judge Hospital Quality May be Misleading
  10. 2011 Benchmarks in Reducing Hospital Readmissions
  11. HHS Finalizes Medicaid Quality Measures
  12. Managed Medicare and Medicaid Factbook: 2010
  13. 6 ADA Guidelines to Transition Diabetes Patients into Adulthood
  14. HealthSounds Podcast: Transitioning from ICD-9 to ICD-10 Code Sets
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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Reducing Readmissions in 2012 — Third Annual Survey

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This week's industry news

1.) U.S. Heart Attack Patients More Likely To Be Readmitted to Hospital

Patients in the United States suffering a ST-segment elevation myocardial infarction (STEMI) following a heart attack were more likely to be readmitted to the hospital within 30 days than patients in other countries, according to a study published in JAMA.

Get the full story.

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2.) Guide to Reducing Medicare Readmissions, Vol. II

Guide to Reducing Medicare Readmissions, Vol. II This 120-page resource examines innovative interventions to reduce preventable admissions, rehospitalizations and ER visits by high-utilizing Medicare beneficiaries.



Learn more about this resource.

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3.) Six Principles of a Medical Home Pilot

Coordinating a collaborative care plan that encouraged patients to take active roles in their healthcare planning was one of the principles that guided the Group Health Cooperative (GHC) when constructing their their medical home pilot program, explains Michael Erikson, M.S.W., vice president of primary care services for GHC.

Get the full story.

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4.) Case Studies in Comprehensive Primary Care: Guidance from Group Health Cooperative and Geisinger Health System

Case Studies in Comprehensive Primary Care This 50-page report takes a look at the successful patient-centered approaches by two innovators: Group Health Cooperative and Geisinger Health Plan, sharing key strategies and lessons learned from program implementation.


Learn more about this resource.

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5.) Healthcare Business White Paper: 2011 Benchmarks in Accountable Care Organizations

A significant segment of the healthcare industry is reframing its care delivery structure as an accountable care organization (ACO) or will do so in the near future, according to new market research by the Healthcare Intelligence Network. This white paper summarizes awareness of and readiness for ACOs at 228 healthcare organizations, based on their responses to a February 2011 ACO Readiness Assessment. This research was conducted before CMS released its proposed rule governing ACOs.

Download this complimentary white paper.

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6.) Dr. Janice Pringle Named One of 73 Innovation Advisors

Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy and a frequent contributor to HIN, has been named one of 73 Innovation Advisors, part of a new initiative from the CMS.

Get the full story.

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7.) New Table: Top 2012 Trends for Hospitals and Health Systems

Top 2012 Trends for Hospitals and Health Systems With unprecedented economic conditions continuing to impact the industry, emerging healthcare payment and delivery options and the ongoing implementation of the Patient Protection and Affordable Care Act, healthcare organizations have much to monitor in the year ahead. For example, physicians under pressure will increasingly look to hospitals for relief. Also, health plans will likely acquire market position with seniors and gain the knowledge of how to manage care. We wanted to see what other trends hospitals and health systems should prepare for in 2012.

Click here to view the table.

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8.) Roadmap to the ACO Rule: 25 Key Considerations from CMS's Proposal for Accountable Care Organizations

Roadmap to the ACO Rule This 22-page quick reference extracts 25 common sense factors to consider while weighing participation in an accountable care organization (ACO) — whether as a healthcare provider or private payor.



Learn more about this resource.

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9.) Death Rate Measure Used to Judge Hospital Quality May be Misleading

Hospitals, health insurers and patients may have to reconsider previously established approaches to asessing hospital quality. A new study from the Yale School of Medicine supports measuring patient deaths over a period of 30 days from admission even after they have left the hospital.

Get the full story.

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10.) 2011 Benchmarks in Reducing Hospital Readmissions

2011 Benchmarks in Reducing Hospital Readmissions This 45-page resource quantifies efforts by 90 healthcare organizations to reduce avoidable readmissions in their most vulnerable and high-utilization populations, as reflected by responses to HIN's second annual survey on Reducing Hospital Readmissions.

Learn more about this resource.

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11.) HHS Finalizes Medicaid Quality Measures

HHS has published a final notice of its initial core set of Health Care Quality Measures for Medicaid-Eligible Adults in the Federal Register.

Get the full story.

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12.) Managed Medicare and Medicaid Factbook: 2010

Managed Medicare and Medicaid Factbook: 2010 In this comprehensive resource you will find the most relevant and timely facts presented in a way that provides one, easy-to-access resource of all the managed Medicare and Medicaid data you need to develop sound strategies for your future plans.


Learn more about this resource.

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13.) 6 ADA Guidelines to Transition Diabetes Patients into Adulthood

To ensure continuity of care for patients with diabetes transitioning from pediatric to adult providers, the ADA has outlined six strategies to effectively transition patients between 18 and 30 years of age.

Read this blog post.

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14.) HealthSounds Podcast: Transitioning from ICD-9 to ICD-10 Code Sets

Babette Apland The mapping between ICD-9 and ICD-10 code sets will have two major impacts on healthcare, predicts Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan, which has created a roadmap for the transition that it is sharing with the industry. Winkler describes where health plans should be on the ICD-10 timeline at the start of 2012, and defines the two major challenges the health plan expects to face as it enters the testing phase of the transition.

Listen to this podcast.

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