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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Size does matter, at least when it comes to providing preventive services during annual check-ups.

According to a recent report in the American Journal of Preventive Medicine, while more than 20 percent of U.S. adults receive periodic health examinations (PHE) each year, nearly half of them weren’t receiving the recommended preventive screening tests and counseling services that may benefit their health. Researchers from the Cancer Prevention and Control program at Virginia Commonwealth University (VCU) Massey Cancer Center were surprised at some of the findings, including the fact that the busier the physician was, the more services he provided, and the higher a patient’s BMI, the more screenings and services the patient received. The study also listed which services were most likely to be given, and which most likely to be missed. Details in this issue.

Insufficient medical treatment was also revealed to be a problem in a study on patients with mental illness. This segment of healthcare cost the United States an estimated $300 billion in 2002, and accounts for more disability in developed countries than any other group of illnesses, including cancer and heart disease, according to the World Health Organization. The study, from SAMHSA’s National Survey on Drug Use and Health, found that just 4 in 10 people, or 39.2 percent of those experiencing mental illness, received mental health services in a 12 month period. The rate of treatment was higher — 60.8 percent — for those experiencing serious mental illness. The consequences are severe, given that one in five Americans aged 18 or older experienced mental illness in the last 12 months.

Let the ACO NCQA accreditation quest begin. Six health systems have signed on to be early adopters of the NCQA’s accreditation program, among them Crystal Run Healthcare, a frequent contributor to HIN. Benefits of starting this process early are many, including getting independent assessments of their organization’s readiness to be an ACO. The full list of participating health systems, included in this issue, have committed to undergoing a full NCQA survey of their ACO capabilities between March 1 and December 31, 2012.

And don’t forget to take our third annual Reducing Hospital Readmissions Benchmark Survey. Describe how your organization is working to reduce hospital readmissions for 2012 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 30, 2012
Vol. XIV, No. 4

Sponsored by:
Complimentary e-book — Evolution of the Embedded Healthcare Case Manager

This week's industry news:

  1. Crystal Run Healthcare Among First Early Adopters Seeking NCQA ACO Accreditation
  2. Blueprint for ACO Success
  3. Patients Receive Half of Recommended Preventive Health Services at Annual Check-Ups
  4. Guide to Physician Performance-Based Reimbursement
  5. Healthcare Business White Paper: 2012 Benchmarks in Reducing Avoidable ER Visits
  6. The Clinical Pharmacist’s Role in Safe Transitions
  7. New Table: Aetna's Collaborative Care Management for the Medicare Population
  8. Pharmacists and Medication Adherence
  9. Most Medicare Demo Projects Fail to Raise Quality, Cut Costs
  10. Evaluating CMS' Bundled Payment Initiative
  11. 1 in 5 Americans Suffered Mental Illness in 2011: SAMHSA
  12. Benchmarks in Health & Wellness Incentives, 2011 Edition
  13. Snowboarder Video As Much About Miracles as Helmet Safety
  14. HealthSounds Podcast: Diabetes Management in the Medical Home
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.) Crystal Run Healthcare Among First Early Adopters Seeking NCQA ACO Accreditation

Crystal Run Healthcare is one of six early adopters seeking ACO accreditation from the National Committee for Quality Assurance (NCQA) since the agency launched the accreditation program in November.

Get the full story.

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2.) Blueprint for ACO Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization

Blueprint for ACO Success To ensure the ACO's fiscal health, its planners must construct a strong clinical foundation for the ACO while meeting state and federal legal, regulatory and compliance requirements for ACOs. This 40-page resource provides perspectives and lessons learned in both critical areas from two organizations already far along the path to ACO creation.

Learn more about this resource.

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3.) Patients Receive Half of Recommended Preventive Health Services at Annual Check-Ups

Patients getting annual check-ups may not be receiving recommended preventive screening tests and counseling services that may benefit their health, according to a study in the American Journal of Preventive Medicine.

Get the full story.

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4.) Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration

Guide to Physician Performance-Based Reimbursement This 68-page special report explores reimbursement formulas at two health plans and two independent practice associations (IPAs), providing payor and provider perspectives on the formula development process; clinical, quality and efficiency measures in use; physician incentive payments and program outcomes.

Learn more about this resource.

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5.) Healthcare Business White Paper: 2012 Benchmarks in Reducing Avoidable ER Visits — Pain Management Patients on Rise

With consensus widespread that much of emergency room use is avoidable and preventable, this white paper details how 134 healthcare organizations are working to staunch the flow and expense of avoidable emergency department use and point low-acuity patients in the direction of appropriate care.

Download this complimentary white paper.

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6.) The Clinical Pharmacist’s Role in Safe Transitions

One of the ways clinical pharmacists can be a key toward ensuring patients’ safe transitions from the hospital or SNF to home is by reconciling discharge medications with them and their providers within 24 to 48 hours of discharge, explains Beth Chester, PharmD., M.P.H., B.C.P.S., senior director of clinical pharmacy services and quality at Kaiser Permanente Colorado.

Get the full story.

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7.) New Table: Aetna's Collaborative Care Management for the Medicare Population

Aetna's Collaborative Care Management for Medicare Population Aggressive expansion plans aside, Aetna has clearly demonstrated the value of embedded case managers working side-by-side with physicians to serve Aetna's Medicare members. We wanted to see the types of services provided by Aetna's collaborative care management team for Medicare members.

Click here to view the table.

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8.) Pharmacists and Medication Adherence: Brief Interventions, Motivational Interviewing and Telepharmacy

Pharmacists and Medication Adherence This 50-page resource describes a number of interventions in which pharmacists help to guide patients and health plan members to higher levels of medication adherence — programs that take place in the pharmacy, in the physician practice, or virtually.


Learn more about this resource.

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9.) Most Medicare Demo Projects Fail to Raise Quality, Cut Costs

Medicare’s disease management (DM) and value-based payment demonstrations have failed to raise quality and cut healthcare costs, according to a review from the Congressional Budget Office (CBO).

Get the full story.

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10.) Evaluating CMS' Bundled Payment Initiative: Operational, Financial and Clinical Considerations

Evaluating CMS' Bundled Payment Initiative During this webinar, an industry expert from TRG Health Care Solutions examined the key distinctions between each of CMS' four bundled payment models and shared his expertise on the organizational criteria that is most effective in bundled payment programs.

Learn more about this resource.

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11.) 1 in 5 Americans Suffered Mental Illness in 2011: SAMHSA

One in five Americans aged 18 or older experienced mental illness in the last 12 months, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health.

Get the full story.

>>Return to this week's industry news


12.) Benchmarks in Health & Wellness Incentives, 2011 Edition: Data to Drive Health Promotion, Compliance and ROI

Benchmarks in Health & Wellness Incentives, 2011 Edition HIN's third annual market analysis of incentives use in population health management reveals some significant shifts in the adoption, promotion and evaluation of financial- and benefits-based incentives programs — as well as some novel ways incentives are utilized across the healthcare continuum in 2011.

Learn more about this resource.

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13.) Snowboarder Video As Much About Miracles as Helmet Safety

Spoiler: This video has a happy ending. But not all athletes participating in extreme sports are so lucky. Last week’s tragic death of Canadian freestyle skier Sarah Burke underscores the physical risks these athletes face each time they “strap in.”

Read this blog post.

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14.) HealthSounds Podcast: Diabetes Management in the Medical Home — A Diabetes Collaborative Takes Team-Based Approach

Kathy Brieger Hudson River HealthCare (HRHC) takes a team approach to disease management in the 3,400 adult patients with diabetes it serves, explains Kathy Brieger, RD, CDE, HRHC's chief operations officer. Ms. Brieger describes the multiple levels of care available to patients served by the HRHC Diabetes Collaborative, a four-point strategy for weight management that targets the most challenging aspect of managing diabetes, and HRHC's upcoming trial of telepsychiatry at selected FQHCs.

Listen to this podcast.

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