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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Participation in a new hospital to home quality improvement initiative from the American College of Cardiology helped to improve hospital readmission strategies, including tracking discharged patients and partnering with local hospitals, according to a study published in JAMA Internal Medicine. Partnerships with other hospitals and post discharge follow-up appointments contributed to some of the key improvements.

While account-based health plans continue to expand, a shift in account types may suggest a change in how the accounts are funded, according to new research from the nonpartisan Employee Benefit Research Institute (EBRI). The latest data shows that employer-funded health reimbursement arrangements (HRAs) declined in 2013 for the first time in a decade.

Patient-centered medical homes (PCMHs) are an effective way to help care for patients with chronic diseases such as diabetes, and placing care managers in them further improve patient outcomes for high-risk diabetes patients, according to a study conducted at Joslin Diabetes Center, an affiliate of Harvard Medical School. Among the key findings: practitioners and patients preferred embedded nurse care managers focusing wholly on the patient, particularly for the highest risk patients.

Three proposals allowing people to keep their individual health insurance policies even if they don't meet the requirements of the ACA are unlikely to threaten new health insurance marketplaces, according to a new RAND Corporation study. An option adopted by the administration is the least disruptive of the three plans; the most disruptive could lead to moderate price hikes and sharply lower enrollment in the new marketplaces.

Nearly half of a health plan's CMS Five-Star Quality rating can be explained by the quality of the providers in a given county or region, says Joseph Johnson, vice president of L.E.K. Consulting. Where those pockets of excellence are, and other factors leading to five-star performances, are detailed in this week's issue.

And lastly, with more organizations focusing on palliative care as a means to enhance the patient experience during advanced or terminal illness, many are strategizing new ways to assess and address patients' needs at this time, from consultations in the ED to face-to-face evaluations in outpatient. Describe your organization's efforts in palliative care by February 7, 2014 and you will receive a free summary of survey results once it is 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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January 27, 2014
Vol. XVI, No. 4

Sponsored by:
Accountable Care Reimbursement Models — Moving from Productivity to Population-Based Incentives


This week's industry news:

  1. New Hospital to Home Initiative Improves Strategies to Prevent Readmissions
  2. 2014 Healthcare Benchmarks: Reducing Hospital Readmissions
  3. HSAs Growing, Health Reimbursement Accounts Declining for First Time
  4. Mastering Healthcare Reimbursement Systems Report
  5. Healthcare Business White Paper: Care Transitions in 2013
  6. Care Managers in Medical Homes Contribute to Improved Diabetes Outcomes
  7. New Chart: Top Behavior Change Tools in Health Coaching
  8. Essentials of Embedded Case Management
  9. 3 Proposals Allowing People to Keep Health Insurance Won't Threaten Marketplaces
  10. AIS's Health Insurance Exchange Directory and Factbook
  11. 40 Percent of Health Plan's Star Rating Attributed to Regional Variation
  12. Formula for CMS Five-Star Quality Population Health Management
  13. HINfographic: 7 Care Transition Models for High-Risk Patients
  14. Three Key Benefits to Prudent Sharing of Physician Performance Data
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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10 Questions on Palliative Care in 2014

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This week's industry news

1.) New Hospital to Home Initiative Improves Strategies to Prevent Readmissions

Participation in a new hospital to home quality improvement initiative has helped to improve hospital readmission strategies, including tracking discharged patients and partnering with local hospitals, according to a study published in JAMA Internal Medicine.

Get the full story.

>>Return to this week's industry news


2.) 2014 Healthcare Benchmarks: Reducing Hospital Readmissions

2014 Healthcare Benchmarks: Reducing Hospital Readmissions This resource documents the latest key initiatives and partnerships to reduce readmissions by patients with costly conditions and others by more than 100 healthcare organizations. This 60-page report, now in its fourth year, for the first time provides details on partnerships with post-acute care to reduce readmissions from these care sites.

Learn more about this resource.

>>Return to this week's industry news


3.) HSAs Growing, Health Reimbursement Accounts Declining for First Time

While account-based health plans continue to expand, a shift in account types may suggest a change in how the accounts are funded, according to new research from the nonpartisan Employee Benefit Research Institute (EBRI).

Get the full story.

>>Return to this week's industry news


4.) Mastering Healthcare Reimbursement Systems Report: An A to Z Guide to Navigating Payment Models in Healthcare

Mastering Healthcare Reimbursement Systems Report This resource provides case managers and care coordination professionals an easy to reference guide to help you master healthcare reimbursement.




Learn more about this resource.

>>Return to this week's industry news


5.) Healthcare Business White Paper: Care Transitions in 2013 — Interventions Surge in Response to Payor Scrutiny; Home-Grown Approaches Trump Traditional Models

Care Transitions in 2013 In its third annual e-survey on Care Transition Management, the Healthcare Intelligence Network (HIN) captured efforts by 86 organizations to strive for Triple Aim goals of better care at improved cost during transitions of care. Conducted in April 2013, the survey measures existing and planned programs, targeted transitions and populations, transition team members and responsibilities, and much more. This HINtelligence Report provides data highlights on care transition program components, the most successful tools for care transition management, results and ROI; and much more.

Download this complimentary white paper.

>>Return to this week's industry news


6.) Care Managers in Medical Homes Contribute to Improved Diabetes Outcomes

Patient-centered medical homes (PCMHs) are an effective way to help care for patients with chronic diseases such as diabetes, and placing care managers in them further improve patient outcomes for high-risk diabetes patients, according to a study conducted at Joslin Diabetes Center, an affiliate of Harvard Medical School.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top Behavior Change Tools in Health Coaching

New Chart: Top Behavior Change Tools in Health Coaching Motivational interviewing (MI) is the top behavior change tool being used in health coaching, say 68 percent of healthcare companies that responded to HIN's fourth annual Health Coaching e-survey. We wanted to see which other behavior change tools are being used in health coaching.

Click here to view the chart.

>>Return to this week's industry news


8.) Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators

Essentials of Embedded Case Management This resource documents the experiences of Aetna and Bon Secours in the recruitment, education, workload management and IT support of practice-based case managers.



Learn more about this resource.

>>Return to this week's industry news


9.) 3 Proposals Allowing People to Keep Health Insurance Won't Threaten Marketplaces

Three plans allowing people to keep their individual health insurance policies even if they don't meet the requirements of the federal Affordable Care Act (ACA) are unlikely to threaten new health insurance marketplaces, according to a new RAND Corporation study.

Get the full story.

>>Return to this week's industry news

10.) AIS's Health Insurance Exchange Directory and Factbook

AIS's Health Insurance Exchange Directory and Factbook This resource provides health industry guidance to health insurance exchange implementation and stakeholder strategies, with in-depth coverage of every big-dollar business issue related to the new marketplaces — including technological infrastructure, consumer support tools, benefit design, marketing and much more.

Learn more about this resource.

>>Return to this week's industry news


11.) 40 Percent of Health Plan's Star Rating Attributed to Regional Variation

Nearly 40 percent of a health plan's CMS Five-Star Quality rating can be explained by the quality of the providers in a given county or region, says Joseph Johnson, vice president of L.E.K. Consulting. Here he points out where those pockets of excellence are, and discusses other factors leading to five-star performances.

Get the full story.

>>Return to this week's industry news


12.) Formula for CMS Five-Star Quality Population Health Management

Formula for CMS Five-Star Quality Population Health Management This resource examines star quality improvement strategies, including Kaiser Permanente's successful care management efforts that have made it a leader in the five-star space.



Learn more about this resource.

>>Return to this week's industry news


13.) HINfographic: 7 Care Transition Models for High-Risk Patients

Many current care transitions models support safer transitions for patients with complex comorbid conditions — initiatives aimed at the patient, hospital, community, or in some cases, a state or region of the country. One initiative reduced 30-day all-cause readmissions by 21 percent, according to a new infographic from the Healthcare Intelligence Network. This HINfographic takes a high-level look at seven popular care transition programs.

Read this blog post.

>>Return to this week's industry news


14.) Three Key Benefits to Prudent Sharing of Physician Performance Data

Cynthia Kilroy There are three key benefits to prudent sharing of performance data among physicians, notes Cynthia Kilroy, senior vice president of provider strategy and business development at Optum, who suggests a four-step systematic approach for data dissemination that moves companies away from simply creating "metrics in a box." Besides the electronic health record, she recommends three other data sources to mine for provider performance metrics.

Listen to this podcast.

>>Return to this week's industry news


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