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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Emergency physicians are increasingly picking up the slack left by difficult or unsuccessful transitions of care, says a new study from the Perelman School of Medicine at the University of Pennsylvania, but these visits, often within 30 days of hospital discharge, are not being counted as hospital readmissions unless they are admitted as inpatients.

In fact, as many as one in four patients discharged from the hospital end up right back there as emergency patients. Failure to measure these visits is leading to faulty hospital utilization and care transition assessments, and needs to be addressed, say researchers. Details inside.

Transforming healthcare payments from a fee-for-service (FFS) system to one that rewards quality and value also needs to be addressed, and is one of five recommendations aimed at improving healthcare quality while lowering costs nationwide.

The recommendations, from five national healthcare organizations and nationally prominent advocates for employers, insurers, consumers, healthcare providers and others, is the result of a yearlong discussion funded by the Robert Wood Johnson Foundation. Among the recommendations: providing a tiered reimbursement strategy that links payment directly to effectiveness, and encouraging consumers to select high-performing providers.

Another strategy for reducing healthcare costs: taking an innovative approach to classifying patient populations, so that health systems can more effectively prevent “triple fail” events — or outcomes that fail to advance population health, reduce healthcare costs and improve patient experiences and satisfaction, according to a recent Walgreen's study published in Health Affairs.

Researchers examine how classifying (or ‘stratifying’) patients according to individual risk and expected response to an intervention can further the “Triple Aim.” The Triple Aim framework, created by the Institute for Healthcare Improvement (IHI), asks that health systems evaluate performance by simultaneously pursuing three dimensions: improved patient experience of care (including quality and satisfaction), improving population health and reducing per capita cost of healthcare.

Identifying the main drivers of cost in a Physician Hospital Organization (PHO) population, and then the biggest cost consumers, are key toward managing that population, says Greg Mertz, MBA, FACMPE, director of consulting operations, Healthcare Strategy Group, in our upcoming book, Essential Guide to Physician-Hospital Organizations: 7 Key Elements for PHO Success, which describes describes the seven critical areas of PHO development.

And lastly, despite the rising popularity of mobile health, and smartphone apps for monitoring everything from blood sugar to heart rhythms, the practice of health coaching remains a critical tool in population health management, helping to boost self-management of disease and reduce risk and associated cost across the health continuum, according to the latest e-survey from the Healthcare Intelligence Network (HIN). The telephone remains the chief modality for health coaching delivery, according to our infographic: "Health Coaching's Call to Manage Weight and Chronic Disease." Weight and chronic disease management remain the top two areas addressed by coaching, but in terms of populations, those considered 'well' are just as likely to receive coaching today as those with chronic diseases.

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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April 15, 2013
Vol. XV, No. 14

Sponsored by:
A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings


This week's industry news:

  1. 1 in 4 Patients Back in ER Within 30 Days of Hospital Discharge
  2. 2012 Healthcare Benchmarks: Reducing Avoidable ER Visits
  3. 5 Recommendations for Improving Healthcare Quality While Lowering Costs
  4. Guide to Physician Performance-Based Reimbursement
  5. Healthcare Business White Paper: Health Coaching in 2013
  6. New Stratified Approach Toward Achieving Triple Aim for ACOs: Study
  7. New Chart: Top Health Professionals Responsible for Improving MA
  8. Guide to Accountable Care Organizations
  9. Health Coaching Conversation Happens Largely by Telephone: HINfographic
  10. 2013 Healthcare Benchmarks: Health Coaching
  11. Analyzing the PHO Population for Cost-Effectiveness
  12. Essential Guide to Physician-Hospital Organizations
  13. Infographic: Ohio Hospitals Rank Facebook As Their Most Important Social Media Channel
  14. Improving CMS Star Quality Ratings
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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Managing Care Transitions in 2013

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This week's industry news

1.) 1 in 4 Patients Back in ER Within 30 Days of Hospital Discharge

As many as one in four patients discharged from the hospital end up right back there as emergency patients, but are not counted as hospital readmissions unless they are admitted as inpatients, says a study from the Perelman School of Medicine at the University of Pennsylvania, and published in the Annals of Emergency Medicine.

Get the full story.

>>Return to this week's industry news


2.) 2012 Healthcare Benchmarks: Reducing Avoidable ER Visits

Case Management for Advanced Illness This resource is designed to meet business and planning needs of hospitals, health plans, physician practices and others by providing critical benchmarks that show how the industry is working to reduce avoidable hospital ED visits. This second annual collection of data points on this aspect of ER utilization management presents year-over-year trends and suggests how to engage the primary care physician, urgent care centers and patient education tools in these efforts.


Learn more about this resource.

>>Return to this week's industry news


3.) 5 Recommendations for Improving Healthcare Quality While Lowering Costs

Transforming healthcare payments from a fee-for-service (FFS) system to one that rewards quality and value is one of five recommendations aimed at improving healthcare quality while lowering costs nationwide.

Get the full story.

>>Return to this week's industry news


4.) Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration

Guide to Physician Performance-Based Reimbursement This resource explores newly minted reimbursement formulas at two health plans and two independent practice associations (IPAs), providing payor and provider perspectives on the formula development process; clinical, quality and efficiency measures in use; physician incentive payments and program outcomes.

Learn more about this resource.

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5.) Healthcare Business White Paper: Health Coaching in 2013 — Weight, Chronic Disease Top Targets in Telephonic Field

Health Coaching in 2013 In its fourth Health Coaching e-survey conducted in January 2013, HIN captured the ways in which healthcare organizations implement health coaching as well as the financial and clinical outcomes that result from this health improvement strategy. HIN found that 75 percent of respondents have a health coaching program in place, a slight increase of 5 percent over 2010, the last year the survey was conducted. This HINtelligence Report provides data highlights on health coaching program components, the most successful tools and workflows in health coaching, results, reimbursement and ROI; and more.

Download this complimentary white paper.

>>Return to this week's industry news


6.) New Stratified Approach Toward Achieving Triple Aim for ACOs: Study

By taking an innovative approach to classifying patient populations, health systems can more effectively prevent “triple fail” events — or outcomes that fail to advance population health, reduce healthcare costs and improve patient experiences and satisfaction, according to a recent Walgreen’s study published in Health Affairs.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top Health Professionals Responsible for Improving MA

New Chart: Top Health Professionals Responsible for Improving MA According to the more than 100 healthcare companies who responded to HIN's latest medication adherence (MA) e-survey, nearly 51 percent say that nurses have primary responsibility for improving MA in their population. We wanted to see which other healthcare professionals are considered responsible for improving MA.

Click here to view the chart.

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8.) 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


9.) Health Coaching Conversation Happens Largely by Telephone: HINfographic

Health coaching is a critical tool in population health management, helping to boost self-management of disease and reduce risk and associated cost across the health continuum, according to the latest e-survey from the Healthcare Intelligence Network (HIN).

Get the full story.

>>Return to this week's industry news

10.) 2013 Healthcare Benchmarks: Health Coaching

2013 Healthcare Benchmarks: Health Coaching This resource presents actionable new data on overall health coaching activity, with the latest metrics on the prevalence of health coaching, program components, delivery methods, preferred behavior change models, coaching case loads, ROI, future programs and much, much more.


Learn more about this resource.

>>Return to this week's industry news


11.) Analyzing the PHO Population for Cost-Effectiveness

Identifying the main drivers of cost in a Physician Hospital Organization (PHO) population, and then the biggest cost consumers, are key toward managing that population, says Greg Mertz, MBA, FACMPE, director of consulting operations, Healthcare Strategy Group. Then you can measure and monitor care on an ongoing basis, and decide on reimbursement models.

Get the full story.

>>Return to this week's industry news


12.) Essential Guide to Physician-Hospital Organizations: 7 Key Elements for PHO Success

Essential Guide to Physician-Hospital Organizations This resource describes the seven critical areas of PHO development, from defining the PHO mission to creating a data environment conducive to registry use, analytics and active patient management.



Learn more about this resource.

>>Return to this week's industry news


13.) Infographic: Ohio Hospitals Rank Facebook As Their Most Important Social Media Channel

A new statewide survey of Ohio hospitals, A Healthy Dose of Social Media, reveals that 90 percent are using social media, and nearly half are devoting more staff time to managing these channels in 2013 and beyond. The study was conducted by the Ohio Hospital Association (OHA) and Mindset Digital LLC. Of the Ohio hospitals surveyed, Facebook was their most popular channel for social media marketing. In all, 88 percent of these hospitals said Facebook was a top priority or a secondary channel. An infographic depicting the survey results also illustrates the focus of social media and organizational responsibility.

Read this blog post.

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14.) Improving CMS Star Quality Ratings

Joseph Johnson Low scores on patient outcomes measures within the CMS Star Quality ratings program — metrics CMS weights most heavily in its assignment of stars — can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president of L.E.K. Consulting. Johnson suggests ways to enlist support from these two stakeholder groups, and describes how MA plans should prepare for the possible display in 2014 of CAHPS care coordination ratings along with with its star scores (though the care coordination ratings will not be factored into star ratings).

Listen to this podcast.

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