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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Transparency and clarity are the objectives in HHS’s "Plain English" ruling on health plan benefits and coverage. Under the rule, health insurers must provide consumers with simple, understandable summaries about their plans. Roughly 150 million Americans have private health insurance today, and should benefit from the ruling. More on this in our feature story.

Transparency is also a key objective in CMS’s new data for its Hospital Compare Web site. Consumers can now access hospital infection rates at the more than 4700 hospitals listed. According to the CMS, hospital-acquired infections result in thousands of deaths each year and nearly $700 million in added costs to the U.S. healthcare system.

Healthcare costs are key to a recent study from Virginia Commonwealth University, which finds that the managed care medical home for the uninsured will help curb costs and reduce ER visits for the uninsured. The study, which focused on nearly 27,000 uninsured adults over a seven-year period, found that when they had access to regular healthcare their ED visits and inpatient admissions declined, while their primary care visits increased. Researchers concluded that savings in healthcare costs were cut by nearly half.

And lastly, costs are also key to a recent Rand Corporation study on declining prescription drug costs. While costs on brand name drugs have decreased because of increased purchases of generic drugs, drug costs in general remain a hardship for many American families.

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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February 13, 2012
Vol. XIV, No. 6

Sponsored by:
Telephonic Case Management: Protocols for Behavioral Healthcare Patients

This week's industry news:

  1. CMS Hospital Compare Site to Post Hospital Infection Rates
  2. Infection Prevention Manual for Behavioral Health
  3. Prescription Drug Costs Drop, but Cost Still Burdens Families
  4. Pharmacists and Medication Adherence
  5. Healthcare Business White Paper: Diabetes Management 2012
  6. Managed Care Medical Home May Curb Cost, ER Visits for Uninsured
  7. New Chart: Top 5 Incentive-Based Health Improvement Programs
  8. Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions
  9. Geisinger Goes with Gut When Selecting a Case Manager
  10. New Horizons in Healthcare Case Management
  11. Health Insurers Must Provide “Plain English” Summaries of Benefits, Coverage
  12. Health Insurance Exchanges
  13. Two Medical Home Approaches Behind $1 Billion in N.C. Medicaid Savings
  14. HealthSounds Podcast: The Role of Embedded Case Managers in Clinical Transformation
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.) CMS Hospital Compare Site to Post Hospital Infection Rates

Consumers can now access hospital infection rates on CMS’ Hospital Compare Web site.

Get the full story.

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2.) Infection Prevention Manual for Behavioral Health

Infection Prevention Manual for Behavioral Health This manual provides facilities with a comprehensive resource for policies and procedures reflecting the standards for infection prevention. The policies are written for compliance with, OSHA regulations, CDC recommendations, JCAHO standards and national standards of practice. The manual format includes information on surveillance of infections, infection control education, isolation and employee health.

Learn more about this resource.

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3.) Prescription Drug Costs Drop, but Cost Still Burdens Families

Because of competition from generic drugs, prescription drug prices have fallen. However, for many people with low incomes, affording prescription medicine is still a difficulty.

Get the full story.

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4.) 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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5.) Healthcare Business White Paper: Diabetes Management 2012

An overwhelming majority of respondents to the December 2011 "10 Questions" e-survey are using a disease-specific approach to manage diabetes. Responses to the latest Healthcare Intelligence Network survey provided qualitative data on strategies and tactics for management of this disease, program components and challenges, and outcomes, metrics and ROI, which are summarized in this white paper.

Download this complimentary white paper.

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6.) Managed Care Medical Home May Curb Cost, ER Visits for Uninsured

The managed care medical home may reduce the costs of caring for the uninsured population by almost half, according to a new study from Virginia Commonwealth University researchers.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top 5 Incentive-Based Health Improvement Programs

Health Improvement Programs Healthcare companies have grown increasingly creative in their use of economic and benefits-based incentives to drive engagement and participation in health and wellness programs. We wanted to see for which health improvement programs companies will offer incentives.

Click here to view the chart.

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8.) Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions

Reducing Avoidable ER Visits by Medicaid Patients An Ohio collaborative of Medicaid plans is using a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid beneficiaries. One of the five regions targeted by the collaborative is Toledo, Ohio — known for having the highest emergency department utilization in the nation. In this webinar, find out how the collaborative is developing actionable interventions to address the patient streams most likely to use the ED inappropriately.

Learn more about this resource.

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9.) Geisinger Goes with Gut When Selecting a Case Manager

Key to hiring the right case manager is including the primary care provider in the selection process, explains Diane Littlewood, RN, BSN, CDE, and Joann Sciandra, RN, BSN, CCM, regional managers of case management for health services at Geisinger Health Plan. “Going with your gut,” is also important to the process, they add.

Get the full story.

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10.) New Horizons in Healthcare Case Management

New Horizons in Healthcare Case Management This 200-page resource examines the latest trends in healthcare case management, the impact of case managers across the care continuum and what's working in embedded or colocated case management, an emerging strategy of positioning case managers inside primary care practices.

Learn more about this resource.

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11.) Health Insurers Must Provide “Plain English” Summaries of Benefits, Coverage

Those seeking health insurance will soon have clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services, according to final regulations published by the HHS.

Get the full story.

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12.) Health Insurance Exchanges: Strategies and Stakeholders

Health Insurance Exchanges This resource provides timely insights on how exchanges operate, what products will look like, which health insurers will participate and who will enroll.




Learn more about this resource.

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13.) Two Medical Home Approaches Behind $1 Billion in N.C. Medicaid Savings

Aggressive care management and preventive care saved North Carolina Medicaid nearly $1 billion over four years, according to a new analysis by Milliman Inc., a national healthcare consulting firm.

Read this blog post.

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14.) HealthSounds Podcast: The Role of Embedded Case Managers in Clinical Transformation

Lisa Sasko and Charlene Schlude Embedded case managers are the latest step in CDPHP's clinical transformation, which began in 2008 with a transition to the patient-centered medical home model and continued with the introduction of new payment models in 2009 and 2010. Lisa Sasko, CDPHP director of clinical transformation, and Charlene Schlude, the organization's director of case management, describes the embedded case manager's role in a new era of healthcare, targeted patients and disease states and some of the operational and cultural issues surrounding the co-location of case managers in physician practices.

Listen to this podcast.

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