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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Our congratulations to three frequent contributors to HIN for taking top honors in Thomson Reutersí annual Best Hospitals list: Banner Health, a leader in ER efficiency, Geisinger Health System, on the forefront of comprehensive primary care, and Baptist Health, a model for bundled payments. These three esteemed health organizations, and 12 others, were singled out from more than 300 organizations for having achieved superior clinical outcomes based on eight metrics that gauge clinical quality and efficiency: mortality, medical complications, patient safety, average length of stay, 30-day mortality rate, 30-day readmission rate, adherence to CMS clinical standards of care, and HCAHPS patient survey score. A full list of the 15 winners can be found in this issue.

At the same time CMS issued its annual report on healthcare spending, showing historically low rates of growth for 2009 and 2010, the HHS has determined that Trustmark Life Insurance Company proposed unreasonable health insurance premium increases in five states, hikes that would affect nearly 10,000 residents. HHS is requiring the insurer to immediately rescind the rates and issue refunds to consumers, or publicly explain their refusal to do so. The ACA requires that insurance companies disclose and justify rate increases over 10 percent. States also have the authority to reject unreasonable premium increases since the passage of the law, to date, 37 states have this authority.

Certified Diabetes Educators and case managers are instrumental in diabetes management, according to the results from our 2011 survey on diabetes management strategies. More than three-quarters of healthcare organizations said they were taking a disease-specific approach to improving health outcomes and self-management in patients and health plan members with diabetes. And the majority of respondents said that weight management was the greatest challenge of managing diabetes. More details can be found in this story, and our complimentary downloadable white paper.

Of course, the best strategy in diabetes management is prevention and education, particularly in the young, and especially in light of an alarming new trend: gastric bypass surgeries for obese teenagers. At a time when most of them should be consulting their friends on Facebook, they are instead consulting with doctors for the best stomach reduction surgery option. You can read more about this in our blog.

And donít forget to take our newest survey: Reducing Hospital Readmissions Benchmark Survey. Describe how your organization is working to reduce hospital readmissions for 2012 by taking HIN's third annual survey on this subject by January 31, 2012 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 Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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January 23, 2012
Vol. XIV, No. 3

Sponsored by:
Diabetes Management in the Medical Home

This week's industry news:

  1. Baptist, Geisinger and Banner Among Top Performing Health Systems: Thomson Reuters
  2. Case Study in Bundled Payments
  3. 5 Percent Of Americans Account For More Than Half Of Healthcare Costs
  4. Comorbidity Care Models
  5. Healthcare Business White Paper: 2011 Benchmarks in Healthcare Case Management
  6. 3 Strategies for Reducing Avoidable ER Use by Medicaid Patients
  7. New Chart: Which Delivery Models Will Reduce Cost and Improve Care Quality in 2012?
  8. 27 Interventions to Reduce Avoidable ER Use
  9. New Data on Diabetes Management: Heavy Reliance on CDEs
  10. Diabetes Management in the Medical Home
  11. Insurance Premium Increases in 5 States Deemed 'Unreasonable' by HHS
  12. Health Insurance Exchanges
  13. Gastric Bypass Surgery — Extreme Makeovers for Obese Teens
  14. HealthSounds Podcast: Evaluating CMS' Bundled Payment Initiative
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.) Baptist, Geisinger and Banner Among Top Performing Health Systems: Thomson Reuters

Baptist, Geisinger and Banner Health Systems are among the top 15 U.S. health systems named so for their balanced system-wide clinical performance.

Get the full story.

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2.) Case Study in Bundled Payments: The Baptist Health System Experience

Case Study in Bundled Payments This 24-page report documents the care payment experience of Baptist Health System in the CMS ACE demonstration pilot, which aligned payment for services delivered across episodes of care or "bundled" care. ACE focused on the cardiac and orthopedic diagnosis-related group (DRGs), two of the public payor's most frequent and largest cost disease areas.

Learn more about this resource.

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3.) 5 Percent Of Americans Account For More Than Half Of Healthcare Costs

The top five percent of Americans accounted for nearly half of all healthcare expenditures in the United States, a report from the Agency for Healthcare Research and Quality (AHRQ) says. In contrast, half of the population spends little or nothing on healthcare, statistics show.

Get the full story.

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4.) Comorbidity Care Models: Integrated Action Plans for Complex Healthcare Needs

Comorbidity Care Models This 38-page special report presents emerging models of care for comorbidity, with a special focus on the needs of aging multi-morbid patients as well as those whose comorbidity encompasses physical and behavioral health conditions.


Learn more about this resource.

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5.) Healthcare Business White Paper: 2011 Benchmarks in Healthcare Case Management

Not only are more organizations utilizing healthcare case managers, but the practice of embedding case managers at the point of care is becoming de rigueur, according to the second annual Healthcare Case Management e-survey conducted by the Healthcare Intelligence Network. This white paper documents the details of contemporary case management and the evolving responsibilities of todayís case manager from the 201 healthcare organizations that responded to HIN's January 2011 survey.

Download this complimentary white paper.

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6.) 3 Strategies for Reducing Avoidable ER Use by Medicaid Patients

Examining financial incentives for PCPs and ER physicians, engaging PCPs in their patients' progress after they leave the ER, and ensuring PCPs' accessibility during and after discharge are some of the ways Wellpoint has reduced ER utilization, explains Karen Amstutz, MD, MBA, and vice president and medical director of Medicaid and senior markets, and Barsam Kasravi, MD, MPH, and managing medical director for state-sponsored programs.

Get the full story.

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7.) New Chart: Which Delivery Models Will Reduce Cost and Improve Care Quality in 2012?

Which Delivery Models Will Reduce Cost and Improve Care Quality in 2012? As if digesting the plethora of care delivery initiatives rolled out by CMS over the last year wasn't enough, the healthcare industry faces a presidential election, looming health IT mandates and continued economic uncertainty this year. We wanted to see which healthcare delivery models healthcare companies believe will have the greatest potential in reducing costs and improving quality of care for the new year.

Click here to view the chart.

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8.) 27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use This 45-page resource details provider- and patient-focused interventions that target the high numbers of avoidable visits, high and ultra-high utilizers and the sub-populations noted for frequent ER use. Five interventions target these sub-populations: asthma patients, those recently discharged from the hospital, non-network patients, nursing home and assisted living residents and dual-eligibles.

Learn more about this resource.

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9.) New Data on Diabetes Management: Heavy Reliance on CDEs

Certified diabetes educators (CDEs) and case managers are key influencers in diabetes management, according to a 2011 survey on diabetes management strategies by the Healthcare Intelligence Network (HIN).

Get the full story.

>>Return to this week's industry news


10.) Diabetes Management in the Medical Home

Diabetes Management in the Medical Home During this 45-minute webinar on January 26th, Kathy Brieger, R.D., C.D.E., chief operations officer at Hudson River HealthCare (HRHC) will share the inside details on their diabetes management program and its impact on its diabetic patients. Included will be how to identify and assess patients for diabetes management, including an analysis of literacy and learning and social barriers that could impact outcomes for complex patients, and training staff and reporting quality data to drive further performance improvement.

Learn more about this resource.

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11.) Insurance Premium Increases in 5 States Deemed 'Unreasonable' by HHS

After independent expert review, HHS determined that Trustmark Life Insurance Company proposed unreasonable health insurance premium increases in five states — Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.

Get the full story.

>>Return to this week's industry news


12.) Health Insurance Exchanges: Strategies and Stakeholders

Health Insurance Exchanges: Strategies and Stakeholders This 35-page resource provides timely insights on how health insurance exchanges operate, what the products will look like, which health insurers will participate and who will enroll, keeping healthcare organizations up to date on the rapidly changing landscape of health insurance exchanges.

Learn more about this resource.

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13.) Gastric Bypass Surgery — Extreme Makeovers for Obese Teens

It seems that gastric bypass surgery is way more popular than Justin Bieber.

At a time when most teens should be contemplating their friendsí latest Facebook post, thereís instead a large segment weighing the pros and cons of lap banding versus stomach stapling versus sleeve gastrectomy, the current crop of bariatric surgeries now targeted towards teenagers.

Read this blog post.

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14.) HealthSounds Podcast: Evaluating CMS' Bundled Payment Initiative — Operational, Financial and Clinical Considerations

Jim Reilly CMS learned a few things from its first foray into bundled payments, explains Jim Reilly, managing partner with TRG Health Care Solutions. Having worked with all five participants in the Acute Care Episode (ACE) pilot a few years back, Reilly is ideally positioned to identify the three key benefits of participation in the upcoming CMS bundled payment initiative. But in order for episodic payments, bundled pricing and other alternative payment methodologies to be implemented successfully a key organizational process must take place, Reilly notes.

Listen to this podcast.

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