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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Twenty-four states and the District of Columbia have chosen a benchmark health insurance plan that meets the ACA's essential health benefit requirement, which is scheduled to begin January 2014, according to a new Commonwealth Fund study.

Designed to ensure that people have comprehensive health coverage, the essential health benefit covers 10 broad service categories, including ambulatory patient care, hospitalization, and maternity and newborn care.

Researchers found that these states analyzed plan enrollment and costs, and engaged consumer and patient groups, insurers, and specialty physicians in their decision-making process. The desire to preserve state benefit mandates not included in the federal essential health benefit package was also a factor in choosing benchmark plans.

The results of the intensive study can be found in our story in this issue.

States are increasingly relying on Medicaid managed care health plans to provide coverage for their growing Medicaid populations, according to a new report from Americaís Health Insurance Plans (AHIP).

In 2011, approximately 29 million people — more than half of all Medicaid beneficiaries — were enrolled in a Medicaid health plan. From 2010 to 2011, enrollment in Medicaid health plans grew at nearly twice the rate of total Medicaid enrollment — 9 percent compared to 4.6 percent.

A comprehensive report from AHIP details programs and services offered for this diverse population. One plan includes using case managers to help patients at high risk of hospitalization access the medical, behavioral health, and social services they need; another, involves creating family health programs to provide effective, holistic support for addressing obesity, including group exercise courses and shopping and cooking classes. The full list of programs can be found inside.

In another move to improve healthcare quality and costs, Aetna and the Connecticut-based ProHealth Physicians, a large primary care provider with more than 30,000 Medicare patients, have announced an accountable care collaboration that will support Medicare and privately insured patients.

The ACO will utilize Healthagen, a division of Aetna offering health management solutions and HIT. ProHealth will use Healthagen's population health management and integrated care solutions to identify patients who could benefit from clinical programs and health interventions.

Patients in the collaboration include Aetna's commercial members and ProHealth's Medicare Advantage members. Patients who need care and support for emerging and chronic health issues will be identified through proactive collaborative care management and analytics provided by Healthagen.

And, while the increasing number of workplace wellness incentive programs are proving to decrease hospitalizations and increase patient wellness, they are not necessarily leading to a reduction in healthcare claim costs.

According to a study published in Health Affairs on the effectiveness of a program that tied employees' eligibility for the most generous health plan to participation in a wellness program, researchers found that while it improved employeesí health, and led to a 41 percent decrease in hospitalization rates for conditions targeted by the programs, it did not lead to a significant reduction in health claim costs.

Healthcare costs are complex, researchers say, and there is no one easy answer to reducing them.

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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March 18, 2013
Vol. XV, No. 10

Sponsored by:
Care Transition Management — Strategies for Effective Patient Handoffs


This week's industry news:

  1. 24 States and D.C. Select Benchmark Health Insurance Plans That Meet Essential Health Benefit Requirement
  2. Futurescan 2013
  3. Insurance-Based Wellness Programs Decrease Hospitalizations, But Not Healthcare Costs
  4. 2012 Healthcare Benchmarks: Reducing Hospital Readmissions
  5. Healthcare Business White Paper: Medication Adherence in 2013
  6. Medicaid Managed Care Plans Provide Higher Quality, Value as Enrollment Continues to Grow
  7. New Table: 10 Behavior Change Principles to Guide Incentives Development
  8. Essentials of Embedded Case Management
  9. Aetna, ProHealth Physicians Collaborate on Accountable Care Organization
  10. 2012 Healthcare Benchmarks: Population Health Management
  11. Key Components of Clinical Integration
  12. Guide to Accountable Care Organizations
  13. Infographic: The U.S. Publicís Healthcare Agenda for 2013
  14. Moving Forward with Payment Bundling
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.

Missed the last issue? Read it here.

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Managing Transitions of Care in 2013

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This week's industry news

1.) 24 States and D.C. Select Benchmark Health Insurance Plans That Meet Essential Health Benefit Requirement

Twenty-four states and the District of Columbia have chosen a benchmark health insurance plan that meets the ACAís essential health benefit requirement, which is scheduled to begin January 2014, according to a new Commonwealth Fund study.

Get the full story.

>>Return to this week's industry news


2.) Futurescan 2013: Healthcare Trends and Implications 2013-2018

Futurescan 2013: Healthcare Trends and Implications 2013-2018 This resource highlights eight key trends affecting the nationís healthcare organizations. The expert insight in these pages is supported by data from a survey of 625 healthcare leaders across the country.



Learn more about this resource.

>>Return to this week's industry news


3.) Insurance-Based Wellness Programs Decrease Hospitalizations, But Not Healthcare Costs

Workplace wellness incentive programs may decrease hospitalizations, but not overall health claim costs, according to a study from the University of Arizona Eller College of Management, published in Health Affairs.

Get the full story.

>>Return to this week's industry news


4.) 2012 Healthcare Benchmarks: Reducing Hospital Readmissions

2012 Healthcare Benchmarks: Reducing Hospital Readmissions This resource identifies the key strategies, challenges, target populations and health conditions of 119 healthcare organizations to reduce avoidable rehospitalizations.



Learn more about this resource.

>>Return to this week's industry news


5.) Healthcare Business White Paper: Medication Adherence in 2013 — Closer Look at Compliance During Care Transitions

Medication Adherence in 2013 In its third annual Medication Adherence e-survey conducted in January 2013, HIN captured emerging trends in efforts to improve medication adherence (MA) among more than 100 healthcare organizations. According to 75 percent of survey respondents, complex patients remain the most common targets of MA programs. This HINtelligence Report provides data highlights on MA program components, the most successful tools for improving MA, and more.

Download this complimentary white paper.

>>Return to this week's industry news


6.) Medicaid Managed Care Plans Provide Higher Quality, Value as Enrollment Continues to Grow

States are increasingly relying on Medicaid managed care health plans to provide coverage for their growing Medicaid populations, according to a new report from Americaís Health Insurance Plans (AHIP).

Get the full story.

>>Return to this week's industry news


7.) New Table: 10 Behavior Change Principles to Guide Incentives Development

New Table: 10 Behavior Change Principles to Guide Incentives Development Outcome-based incentives are a valuable and important tool to encourage health behavior change and results in a defined population. However, with the growing trend toward outcome-based incentives, the incentive structure needs to balance this motivation with the sustainability of a program and regulatory requirements. We wanted to share Riedel & Associates Consultants' ten behavior change principles to keep in mind when building an incentive program to reward health behavior change.

Click here to view the table.

>>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.) Aetna, ProHealth Physicians Collaborate on Accountable Care Organization

Aetna and the Connecticut-based ProHealth Physicians, a large primary care provider with more than 30,000 Medicare patients, have announced an accountable care collaboration that will support Medicare and privately insured patients.

Get the full story.

>>Return to this week's industry news

10.) 2012 Healthcare Benchmarks: Population Health Management

2012 Healthcare Benchmarks: Population Health Management This resource delivers an in-depth analysis of population health management (PHM) trends, including prevalence of PHM initiatives, program components, professionals on the PHM team, incentives, challenges and ROI.



Learn more about this resource.

>>Return to this week's industry news


11.) Key Components of Clinical Integration

Clinical integration (CI) of providers is essential for an effective ACO, says Dr. Mark Shields, senior medical director with Advocate Physician Partners (APP) and vice president of medical management for Advocate Health Care. But to truly achieve CI, it cannot be the management philosophy du jour. Clinical integration has to be something that organizations commit to and work on over a long period of time.

Get the full story.

>>Return to this week's industry news


12.) Guide to Accountable Care Organizations

Guide to Accountable Care Organizations This resource lays the groundwork for an ACO program, delivering a comprehensive set of 2012 ACO benchmarks from 200 companies, a framework for clinical integration, a key ACO prerequisite that puts participating providers on the same performance and payment page, and guidelines for physician-led ACOs.

Learn more about this resource.

>>Return to this week's industry news


13.) Infographic: The U.S. Publicís Healthcare Agenda for 2013

This month's Visualizing Health Policy from the Journal of American Medicine (JAMA) Network takes a look at the U.S. public's priorities for healthcare in 2013, including actions by state governments (such as creating a health insurance exchange or marketplace), Medicaid expansion, Medicare spending, and spending for specific types of public health activities. Data provided for analysis is from the Kaiser Family Foundation.

Read this blog post.

>>Return to this week's industry news


14.) Moving Forward with Payment Bundling

Jay Sultan Since the idea of payment bundling was first introduced 10 years ago, justification for the episode-based reimbursement model has shifted from quality and innovation gains to its proven ability to reduce the total cost of healthcare, notes Jay Sultan, associate vice president and chief product portfolio architect for TriZetto®. Healthcare entities testing bundled payments should keep two key factors in mind when trying to engage physicians in the model, Sultan adds, describing the type of message most likely to foster provider support. And finally, Sultan also identifies the major decision primary care must make now that CMS has introduced bundled payments for care coordination tasks.

Listen to this podcast.

>>Return to this week's industry news


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