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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

In a post-PPACA world, the healthcare case manager is not only a cornerstone of care delivery, but also a wise investment. In a featured story this week, Lutheran Medical Center's Toni Cesta makes the business case for embedding a case manager in a hospital emergency department.

Many organizations are following the lead of organizations like Lutheran and co-locating case managers at the point of care. Another widely emulated example is Geisinger's successful ProvenHealth NavigatorSM model, which embeds a nurse case manager in a primary care practice. This tactic is greatly reducing hospital readmissions and ER visits for the health system.

The practice of co-locating case managers is on the upswing, according to preliminary data from our 2011 Case Management survey. For example, the number of case managers working in hospital admissions offices has doubled in the last year, according to more than 200 survey respondents. To receive an e-summary of 2011 case management trends once it is compiled, please e-mail me at pdonovan@hin.com.

Your colleague in the business of healthcare,
Patricia Donovan
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to pdonovan@hin.com.

HIN Associate Editor Jessica Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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March 7, 2011
Vol. XIII, No. 9

Sponsored by:
Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges

This week's industry news:

  1. 6 Reasons to Embed a Case Manager in the Emergency Department
  2. Best Practices in Contemporary Case Management
  3. 3 Ways to Improve Care Coordination, Reduce Costs
  4. The Medical Home Case Manager
  5. Healthcare Business White Paper: 2011 Benchmarks in Accountable Care Organizations
  6. Most Substance Abuse Treatment Programs Accept Private Health Insurance
  7. New Chart: Who is Administering ACOs?
  8. Model Medical Homes
  9. New York Tops in Nursing Facility-Generated Economic Activity Among States
  10. 2011 Healthcare Benchmarks Yearbook
  11. Early Retiree Reinsurance Program Cut Care Costs, Benefited Over 4 Million Retirees
  12. Health Reform 2011
  13. HealthSounds Video: How Healthcare Uses HRAs
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This week's industry news

1.) 6 Reasons to Embed a Case Manager in the Emergency Department

There are six compelling reasons to launch or expand an ED case management program, explains Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center.

Get the full story.

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2.) Best Practices in Contemporary Case Management

2011 Benchmarks in Accountable Care Organizations This resource examines three separate case management initiatives as well as the impact of these programs on health outcomes, care delivery and resource utilization. It provides the details on case management programs being utilized at Sutter Health Sacramento Sierra Region, CareOregon and Lutheran Medical Center.

Learn more about this resource.

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3.) 3 Ways to Improve Care Coordination, Reduce Costs

A new study from HIMSS Analytics™ stresses the urgency for healthcare organizations to engage with emerging care delivery models, including health information exchanges (HIE), the patient-centered medical home (PCMH) and accountable care organizations (ACO), to improve care coordination and reduce costs in practices and hospitals.

Get the full story.

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4.) The Medical Home Case Manager: Profiting from Patient-Centered Care Coordination

The Medical Home Case Manager This resource provides an inside look at the selection, training, skill set, processes and benefits of the Geisinger Health Plan case managers embedded within the payor's medical home practices. Working within the ProvenHealth NavigatorSM — Geisinger's home-grown medical home model — case managers are carefully matched with primary care practices, where they help the practice to identify its highest-risk population and develop customized care plans to guide those individuals to better self-management of their condition and more judicious use of healthcare resources.

Learn more about this resource.

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5.) Healthcare Business White Paper: 2011 Benchmarks in Accountable Care Organizations

A significant segment of the healthcare industry is reframing its care delivery structure as an accountable care organization (ACO) or will do so in the near future, according to new market research by the Healthcare Intelligence Network. This white paper summarizes awareness of and readiness for ACOs at 228 healthcare organizations, based on their responses to a February 2011 ACO Readiness Assessment. This research was conducted before CMS released its proposed rule governing ACOs.

Download this complimentary white paper.

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6.) Most Substance Abuse Treatment Programs Accept Private Health Insurance

A new nationwide SAMHSA survey of substance abuse treatment facilities reveals that in 2008, nearly two thirds (65 percent) of treatment facilities accepted some private health insurance payment.

Get the full story.

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7.) New Chart: Who is Administering ACOs?

Who is Administering ACOs? Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. We wanted to see who is administering ACOs in today's marketplace.

Click here to view the chart.

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8.) Model Medical Homes: Benchmarks and Case Studies in Patient-Centered Care

Model Medical Homes This landmark publication documents the healthcare industry's adoption of the patient-centered medical home (PCMH) model of care, and highlights programs working to integrate mental health into the medical home model. This exclusive 65-page report contains case studies on medical home adoption by Geisinger Health Plan, MetCare, Reardon Consulting, the HealthQuilt Quality Health Record and Hagen Wall Consulting.

Learn more about this resource.

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9.) New York Tops in Nursing Facility-Generated Economic Activity Among States

New York ranks first nationally in nursing facility–generated economic activity ($21.35 billion annually) and employment (141,151 jobs), according to a new 50–state analysis detailing the significance of the U.S. skilled nursing sector to the strength of America's national and state economies.

Get the full story.

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10.) 2011 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations

2011 Healthcare Benchmarks Yearbook Ready for healthcare reform rollout? Landmark efforts in case management, care transitions management, health risk stratification, reducing readmissions and curbing avoidable ER use are transforming the healthcare landscape. This 450-page resource delivers more than 23,000 data points from 1,000 healthcare responders on adoption, activity and ROI in these areas and more. Contains year-over-year data and more than 400 graphs and tables.

Learn more about this resource.

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11.) Early Retiree Reinsurance Program Cut Care Costs, Benefited Over 4 Million Retirees

The Early Retiree Reinsurance Program (ERRP), created by the Affordable Care Act, is reducing healthcare costs for early retirees, according to a HHS report.

Get the full story.

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12.) Health Reform 2011: Impact on Health Plans, Hospitals, Providers and Purchasers

Health Reform 2011 In this resource, insiders close to HHS and in leadership positions at health plans, provider organizations and PBMs identify the strategic impact of the reform law across all sectors of the industry, and the business implications and compliance issues raised by new rules covering dozens of topics — from dependent coverage expansions and high-risk pools to bans on pre-existing condition exclusions and annual and lifetime limits.

Learn more about this resource.

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13.) HealthSounds Video: How Healthcare Uses HRAs

How Healthcare Uses HRAs Top uses for health risk assessments (HRAs) in health promotion and disease management are featured in this new video, based on the 2010 Healthcare Intelligence Network survey on Health Risk Assessment Use. Includes commentary by HIN VP Melanie Matthews and Dr. Marcia Wade, senior medical director at Aetna Medicare. Part of the HIN Healthcare Benchmarks video series.

Watch the video.

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