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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

On the heels of the inauguration, a new poll from the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health reports that while lawmakers are split along party lines about the creation of state-based health insurance exchanges, most Americans, regardless of their party affiliation, consider it a top healthcare priority.

The extensive survey goes on to discuss the differences in how Americans vs. lawmakers feel about a wide range of healthcare issues, including Medicaid expansion, Medicare cuts, and federal spending for such projects as finding new cures and treatments for major disease threats, research for health problems resulting from natural or man-made disasters, ways to prevent the spread of infectious diseases, and help for chronic illnesses, such as heart disease, cancer, and diabetes. Full details inside.

Reducing hospital readmissions transcends party politics, and a new transitional care program is taking aim at this increasingly costly issue. Launched by Univita Health and Aetna, members and their caregivers are engaged immediately upon admission to a hospital. Specially trained nurses from Univita and case managers from Aetna discuss their condition and discharge plan in order to determine the type of support they will need when they go home. Once home, both professionals continue to help the member in a number of different ways, including assessing their living conditions, and explaining the signs and symptoms that may warrant a call to the doctor.

Care managers are crucial to another collaboration, this one between Franciscan Alliance and Cigna. Care managers employed by Franciscan Alliance will become part of the physician-led care team and serve as clinical care coordinators. They will help patients with chronic conditions or other health challenges navigate the healthcare system by helping them identify patients discharged from the hospital who might be at risk for readmission, and helping them get follow-up care and any needed screenings.

Transitional care continues to get its due with the announcement that Medicare has accepted two codes, categorized as transitional care management services, that allow for efficient reporting of time spent discussing a care plan, connecting patients to community services, transitioning them from inpatient settings and preventing readmissions. Medicareís acceptance of the new codes signals that the agency recognizes the importance of the work involved in transitioning patients from one care setting to the next, and its contributions towards improving the overall quality of healthcare, AMA officials say.

And in late breaking news, CMS announced that over 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative. The initative includes four models of bundling payments, depending on the types of healthcare providers involved and the services included in the bundle. They are: Retrospective Acute Care Hospital Stay Only, Retrospective Acute Care Hospital Stay Plus Post-Acute Care, Retrospective Post-Acute Care Only, and Acute Care Hospital Stay Only. Through this new initiative, CMS will test how bundling payments for episodes of care can result in more coordinated care for beneficiaries and lower costs for Medicare.

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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February 4, 2013
Vol. XV, No. 5

Sponsored by:
Health and Wellness Incentives — Positioning for Outcome-Based Rewards


This week's industry news:

  1. Transition Care Program Coordinates Home-Based Care Following Hospitalizations
  2. Care Transitions Toolkit
  3. Complex Case Managers Crucial to New ACO
  4. 2012 Healthcare Benchmarks: Accountable Care Organizations
  5. Healthcare Business White Paper: Healthcare Trends in 2013
  6. More Than Half of Americans Favor State Insurance Exchanges; Lawmakers Split Along Party Lines
  7. New Chart: Top 5 Medical Home Strategies for Patient Engagement
  8. Health Insurance Exchanges
  9. New CPT Codes Support Medicare Payment for Care Coordination
  10. 2012 Healthcare Benchmarks: Reducing Hospital Readmissions
  11. 3 Ways to Improve Medication Adherence
  12. Pharmacists and Medication Adherence
  13. Infographic: Does a Tweet a Day Keep the Doctors Away?
  14. Health and Wellness Incentives: Positioning for Outcome-Based Rewards
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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This week's industry news

1.) Transition Care Program Coordinates Home-Based Care Following Hospitalizations

A transitional care program aimed at providing newly discharged patients with home-based care has been launched for Aetna Medicare Advantage members in Texas, according to Univita.

Get the full story.

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2.) Care Transitions Toolkit

Care Transitions Toolkit This resource examines trends in care transition management, providing actionable data and case studies from industry thought leaders on key elements of their care transition programs. The program profiles in this 130-page resource cover everything from enhancements in the hospital discharge process to better utilization of home visits during care transitions.


Learn more about this resource.

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3.) Complex Case Managers Crucial to New ACO

Complex care managers will be key to a new ACO between Franciscan Alliance and Cigna aimed at enhancing care coordination and lowering overall costs, according to Cigna.

Get the full story.

>>Return to this week's industry news


4.) 2012 Healthcare Benchmarks: Accountable Care Organizations

2012 Healthcare Benchmarks: Accountable Care Organizations This resource documents the numerous ways in which accountable care is transforming healthcare delivery, population health management, reimbursement for care and, most importantly to this yearís survey respondents, the patient experience.



Learn more about this resource.

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5.) Healthcare Business White Paper: Healthcare Trends in 2013 — Industry Shows More Faith in Healthcare Reform

Healthcare Trends in 2013 Despite perennial financial constraints, a majority of respondents to HIN's ninth annual Healthcare Trends survey gave 2012 a financial thumbs-up. This HINtelligence Report provides data highlights on the top business areas affected by economic conditions in 2012, the most impactive care delivery systems, successful programs launched in 2012, business mistakes and lessons learned as well ACA impacts for the coming year.

Download this complimentary white paper.

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6.) More Than Half of Americans Favor State Insurance Exchanges; Lawmakers Split Along Party Lines

More than half of Americans believe that the creation of state-based health insurance exchanges should be a main healthcare priority, contrary to lawmakers who are split along partisan lines on the exchanges, according to a survey released by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

Get the full story.

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7.) New Chart: Top 5 Medical Home Strategies for Patient Engagement

New Chart: Top 5 Medical Home Strategies for Patient Engagement The patient-centered medical home (PCMH) model has been called a stepping stone to accountable care. The most recent market data from the Healthcare Intelligence Network found that one of the top ways to educate and engage patients in PCMHs is by training physicians to do so. We wanted to see which other strategies are being used to educate and engage patients in the medical home.

Click here to view the chart.

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8.) Health Insurance Exchanges: Preparing for the Brave New Marketplace Ahead

Health Insurance Exchanges This resource provides information on the hurdles state lawmakers and stakeholders are facing in developing models and establishing exchanges, through insights from industry consultants, state lawmakers and regulators, scholars and other key industry observers.


Learn more about this resource.

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9.) New CPT Codes Support Medicare Payment for Care Coordination

New Current Procedural Terminology (CPT) codes for care coordination are now being accepted by Medicare, according to the American Medical Association (AMA).

Get the full story.

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10.) 2012 Healthcare Benchmarks: Reducing Hospital Readmissions

2012 Healthcare Benchmarks: Reducing Hospital Readmissions This resource presents market research on current and planned programs to reduce readmissions, and is supported by more than 40 charts and graphs assembled from responses to HINís third annual survey on Reducing Hospital Readmissions conducted in February 2012.


Learn more about this resource.

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11.) 3 Ways to Improve Medication Adherence

Once you understand the basic underlying reasons for medication adherence, which include expense and safety, practices such as motivational interviewing can help the pharmacist steer them towards adherence, explains Dr. Janice Pringle, director of the Program Evaluation Research Unit (PERU) and an associate professor at the University of Pittsburgh School of Pharmacy.

Get the full story.

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

Pharmacists and Medication Adherence This 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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13.) Infographic: Does a Tweet a Day Keep the Doctors Away?

Social health is the mash-up of social media and healthcare, and itís starting to gain traction. In fact, a third of all consumers use social media for matters regarding their health. Thanks to social networking sites and the increased availability of broadband and mobile technology, people are forming online patient support groups, becoming better educated on medical topics and diagnoses, and sharing doctor and product reviews — wherever and whenever they want.

Read this blog post.

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14.) Health and Wellness Incentives: Positioning for Outcome-Based Rewards

John Riedel Outcomes-based rewards have a place in an overall incentives offering, notes John Riedel, president, Riedel & Associates Consultants, Inc., but despite the growth in these offerings, companies should keep their incentive options open. To maximize effectiveness, programs should include something for all: simple items like gift cards and tee shirts for sign-on, progress-based rewards to move individuals along, and outcomes-based incentives for individuals who take their health seriously. Reidel examines the staying power of extrinsic incentives and suggests eight questions companies should ask themselves to determine whether they've truly constructed a culture of health for the population they serve.

Listen to this podcast.

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