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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Maybe you should think twice before agreeing to that MRI, according to a new campaign underway to identify specific medical tests or procedures that are commonly used but not always necessary. As explained in ABIM Foundation's Choosing Wisely campaign, brain imaging scans like CTs or MRIs aren’t always necessary for patients after fainting if no other seizures or neurologic symptoms are evident. Nine leading physician groups representing nearly 375,000 physicians have created lists of “Five Things Physicians and Patients Should Question” for areas including cardiology, radiology, oncology and gastroenterology, among others. Details in this issue.

The good news: 2011 saw the launch of a record-breaking number of disease treatment drug options, for everything from cancer to multiple sclerosis to CV disease. More orphan drugs, which treat rare diseases affecting less than 200,000 people, were also launched in the past 10 years.

The bad news: Americans continued to ration their healthcare, using less prescription drugs and visiting the doctor less frequently, a trend researchers say has been in effect since 2009, with the onset of the recession. The only group to increase its prescription drug use were those ages 19 to 25 who were able to remain on their parents' healthcare plans.

Some of those young adults were also responsible for a surprising statistic: an increase in ED use. The surge in newly insured adults has led to a surge in visits to the ER. According to data from University of Colorado School of Medicine, many are using the ER as a default option when their primary care office is closed, or co-payments are too high. And with an estimated 32 million adults, the majority of them Medicaid patients, expected to receive insurance with healthcare reform, this could cause problems for the effectiveness of EDs overall.

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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April 9, 2012
Vol. XIV, No. 13

Sponsored by:
Leveraging Case Management Tools and Technology to Improve Outcomes

This week's industry news:

  1. Stress Imaging Tests, Chest X-Rays Among 5 Tests That Might Be Unnecessary
  2. Real ROI from Health Management
  3. Change in Health Insurance Status Linked to Greater ED Use
  4. 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population
  5. Healthcare Business White Paper: Healthcare Trends for 2012
  6. 6 Dimensions of Neutrality in an ICD-10 Transition
  7. New Table: 4 Ways to Engage Members in Telephonic Case Management
  8. Roadmap to ICD-10 Readiness
  9. Medicare to Fund State Health Insurance Counseling Programs
  10. Health Reform 2011
  11. Americans Visit Fewer Doctors and Use Less Prescription Drugs Despite Record-Breaking Treatment Options
  12. Healthcare Trends & Forecasts in 2012
  13. Hospitals Will Spend More on IT, Move Toward ACOs in Near Future
  14. HealthSounds Podcast: Case Management Tools and IT
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.) Stress Imaging Tests, Chest X-Rays Among 5 Tests That Might Be Unnecessary

Nine leading physician specialty societies representing nearly 375,000 physicians have identified specific tests or procedures that they say are commonly used but not always necessary in their respective fields, according to ABIM Foundation's Choosing Wisely campaign.

Get the full story.

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2.) Real ROI from Health Management: Cost Savings through Coaching and Disease Management

Real ROI from Health Management This 50-page report provides strategies, models and advice for achieving ROI from health improvement initiatives from various thought leaders, detailing the measures to look at when evaluating health coaching and population health programs and providing case studies of how they are using these measures to demonstrate a health management ROI.

Learn more about this resource.

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3.) Change in Health Insurance Status Linked to Greater ED Use

Recent changes to individuals' health insurance status, whether they are newly insured or uninsured, are associated with greater use of hospital EDs, according to a study from the University of Colorado School of Medicine.

Get the full story.

>>Return to this week's industry news


4.) 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population

5 Interventions to Reduce Avoidable ER Use by the Medicaid Population This 25-page resource looks at the collaborative effort among five regions of Ohio to target the key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.


Learn more about this resource.

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5.) Healthcare Business White Paper: Healthcare Trends for 2012

In the eighth annual Healthcare Trends and Forecasts survey conducted in October 2011, the Healthcare Intelligence Network identified top-of-mind concerns, business successes and lessons and key trends for 126 healthcare companies.

Download this complimentary white paper.

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6.) 6 Dimensions of Neutrality in an ICD-10 Transition

To avoid duplication of effort in its ICD-10 initiative, Blue Cross Blue Shield of Michigan (BCBSM) created a repeatable process for each dimension of neutrality, explains Dennis Winkler BCBSM’s ICD-10 technical program director. Payment neutrality on the provider side received the most attention and visibility in the industry, and was the easiest to facilitate.

Get the full story.

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7.) New Table: 4 Ways to Engage Members in Telephonic Case Management

4 Ways to Engage Members in Telephonic Case Management Telephonic case management of behavioral health patients by Carolina Behavioral Health Alliance (CBHA) targets high-volume users of the ER and inpatient hospital stays for behavioral health concerns. We wanted to see how CBHA engages members in telephonic case management.

Click here to view the chart.

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8.) Roadmap to ICD-10 Readiness: Best Practices from BCBS-Michigan

Roadmap to ICD-10 Readiness This 24-page report documents the process BCBSM has established to resolve discrepancies between ICD-9 and ICD-10 codes, a milestone that has allowed the payor to complete its version of the General Equivalence Mappings (GEMs) — referred to as the Blue GEM Encyclopedia.

Learn more about this resource.

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9.) Medicare to Fund State Health Insurance Counseling Programs

Nearly $46.5 million in grants will be distributed to State Health Insurance Assistance Programs (SHIPs) to help people with Medicare get more information about their health benefits and choices, according to CMS.

Get the full story.

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

Health Reform 2011 Packed with articles and illustrations, this comprehensive report outlines the likely impact of health reform on coverage, benefit designs, medical costs, providers and pharmacy benefits.



Learn more about this resource.

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11.) Americans Visit Fewer Doctors and Use Less Prescription Drugs Despite Record-Breaking Treatment Options

Despite the launch of more transformative disease treatment options in a decade, Americans visited fewer doctors and used less prescription drugs in 2011, according to a new report from the IMS Institute for Healthcare Informatics.

Get the full story.

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12.) Healthcare Trends & Forecasts in 2012: Performance Expectations for the Healthcare Industry

Healthcare Trends & Forecasts in 2012 In HIN's eighth annual healthcare industry forecast, a planning tool eagerly anticipated by healthcare executives, Steven T. Valentine, president of The Camden Group, returns to parse the industry landscape for the year ahead and propose how healthcare organizations can best position themselves not only for a profitable 2012 but for Medicare eventualities in the years to come.

Learn more about this resource.

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13.) Hospitals Will Spend More on IT, Move Toward ACOs in Near Future

Hospital budgets are on the upswing but cost pressures and changing healthcare models are dictating how hospital leaders are determining their strategic priorities.

Read this blog post.

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14.) HealthSounds Podcast: Case Management Tools and IT

Karen Black With more than 100 case managers working in seven regional offices, Arkansas Blue Cross Blue Shield (BCBS) embraces any tools that can elevate care delivery and efficiency and reduce paperwork. Karen Black, RN, HIPAAP, HIA, Arkansas BCBS quality improvement coordinator, describes how an early interest in computers helped to drive development of two Web-based tools supporting Arkansas BCBS case managers today, the potential for these tools to support other areas of the company, and how one tool from the centralized portal is helping to standardize transitions of care for Arkansas BCBS members.

Listen to this podcast.

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