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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

The good news: Medicaid coverage has increased diabetes diagnoses by more than 3 percent and diabetes-related medication compliance by more than 5 percent; it has also reduced rates of depression by over 9 percent, and virtually eliminated out-of-pocket catastrophic medical expenses.

The bad news: Medicaid coverage has not significantly impacted the prevalence of such chronic diseases as diabetes (despite catching more occurrences of it), cardiovascular disease and high blood pressure.

Researchers from the Harvard School of Public Health conducted the first study of Medicaid coverage on previously uninsured, low income adults by polling more than 12,000 people who won a lottery for coverage (90,000 residents applied for 10,000 slots) and those who were not selected. This first such study of the impact of Medicaid coverage is particularly timely given upcoming Medicaid expansion in 2014, researchers say, and is part of an ongoing research program examining the many different effects of Medicaid, representing a collaboration between non-profit and academic researchers and state policy makers. More of this detailed study inside.

More good news: the rates of uninsured young adults between 19 and 25 decreased by nearly 8 percent between 2010 and 2012, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey. The drop is attributed to the 2010 ACA provision allowing parents to claim their children on their health insurance until they are 26.

But there is bad news as well: nearly half of all working age adults in the United States — or 84 million people — went without health insurance for a time last year, or had out-of-pocket costs that were so high relative to their income they were considered underinsured. An estimated 80 million people reported that they did not go to the doctor when they were sick or did not fill a prescription due to cost. and 41 percent of working-age adults, or 75 million people, had problems paying their medical bills or were paying off medical bills over time, up from 58 million in 2005. More details on this comprehensive report inside also.

More good news: a new initiative called ARC (Avoid Readmissions through Collaboration) has helped participating San Francisco Bay Area hospitals reduce the number of discharged patients readmitted to hospitals in 2011 and 2012 by more than 3,300, saving an estimated $32 million in medical costs, according to ARC officials. This is an 11 percent reduction compared to 2010, putting ARC more than one-third of the way to its goal of reducing readmissions 30 percent by the end of 2013.

ARC has played a key role by supporting hospitals as they improve the transition of care process. This includes ensuring patients understand discharge instructions and encouraging closer collaboration between hospital staff and post-hospital medical care providers.

In other news, a new reimbursement program between Trinity Health-Michigan and Blue Cross Blue Shield of Michigan will move hospitals away from traditional fee-for-service (FFS) payments towards a value-based reimbursement arrangement, according to officials from both healthcare organizations.

The focus of the new healthcare model will be on creating better hospital-specific efficiency and population health outcomes, to be achieved by the hospitals working in close concert with affiliated physicians. The arrangement rewards the hospitals with a share of the savings achieved when hospitals and physicians successfully coordinate the delivery of care to enable efficient and effective treatments, eliminate redundancies and errors in care and prevent re-hospitalizations.

The arrangement will provide hospitals funding for infrastructure improvements needed to better coordinate care between the hospitals and their physician partners.

And lastly, we’d like you to share your news on your case management strategies with us in our fourth annual Healthcare Case Management Survey. Care coordination by healthcare case managers is helping to drive clinical and financial outcomes in population health management and bolster emerging models of care such as the patient-centered medical home and the accountable care organization. If you take our survey by May 17 you will receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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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May 6, 2013
Vol. XV, No. 17

Sponsored by:
Medicare Pioneer ACO: Case Study on Atrius Health's Focus on the Triple Aim


This week's industry news:

  1. 84 Million People Uninsured for a Time or Underinsured in 2012: Study
  2. Healthcare Trends & Forecasts in 2013
  3. Collaborative Effort Avoids 3,300 Hospitalizations, Saves $32 Million
  4. 33 Metrics for Care Transition Management
  5. Healthcare Business White Paper: Accountable Care Organizations in 2012
  6. New BCBS Michigan-Trinity Health Reimbursement Model Rewards Hospital Efficiency
  7. New Chart: Top Measures of Incentive Program Success
  8. 2012 Healthcare Benchmarks: Population Health Management
  9. Expanding Medicaid Lowers Depression, Financial Strain, But Doesn’t Improve Physical Health
  10. 38 Disease Management Metrics
  11. Business Case for Pharmacist-Led Medication Therapy Management
  12. Pharmacists and Medication Adherence
  13. Infographic: Mapping Healthcare Performance Variation Across Regions
  14. Atrius Health's Experience as a Medicare Pioneer ACO
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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Take our monthly e-survey:
Healthcare Case Management in 2013

You'll be emailed a synopsis of the survey results.

Interested in all open surveys? Review them here.


This week's industry news

1.) 84 Million People Uninsured for a Time or Underinsured in 2012: Study

Nearly half of all working age adults in the United States — or 84 million people — went without health insurance for a time last year, or had out-of-pocket costs that were so high relative to their income they were considered underinsured, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey.

Get the full story.

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2.) Healthcare Trends & Forecasts in 2013: A Strategic Planning Session

Healthcare Trends & Forecasts in 2013: A Strategic Planning Session This webinar replay features Steven Valentine, president, The Camden Group, Hank Osowski, managing director of Strategic Health Group and Dennis Eder, also a managing director at Strategic Health Group, giving a look ahead to help shape strategic plans.

Learn more about this resource.

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3.) Collaborative Effort Avoids 3,300 Hospitalizations, Saves $32 Million

A new initiative called ARC (Avoid Readmissions through Collaboration) has helped participating San Francisco Bay Area hospitals reduce the number of discharged patients readmitted to hospitals in 2011 and 2012 by more than 3,300, saving an estimated $32 million in medical costs, according to ARC officials.

Get the full story.

>>Return to this week's industry news


4.) 33 Metrics for Care Transition Management

33 Metrics for Care Transition Management This resource provides a graphic compendium of performance benchmarks in key areas impacting care transitions — from key tasks performed at hospital discharge to the prevalence of home visits in programs to improve medication adherence.


Learn more about this resource.

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5.) Healthcare Business White Paper: Accountable Care Organizations in 2012 — ACO Participation Doubles in 12 Months

Accountable Care Organizations in 2012 Participation in accountable care initiatives has more than doubled in the last 12 months, according to 200 healthcare companies who completed the second annual Healthcare Intelligence Network survey on Accountable Care Organizations (ACOs). The typical ACO is smaller, too, as the number of active ACOs with 100 to 500 physicians dropped almost 50 percent in the last 12 months. This year’s survey provided new data on other healthcare professionals in the ACO, ACO reimbursement models, and ACO impact.

Download this complimentary white paper.

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6.) New BCBS Michigan-Trinity Health Reimbursement Model Rewards Hospital Efficiency

A new reimbursement program between Trinity Health-Michigan and Blue Cross Blue Shield of Michigan will move hospitals away from traditional fee-for-service (FFS) payments towards a value-based reimbursement arrangement, according to officials from both healthcare organizations.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top Measures of Incentive Program Success

New Chart: Top Measures of Incentive Program Success According to 71 percent of healthcare companies who responded to HIN's health & wellness incentives survey, participation is the top measure of program success. We wanted to see which other data is reviewed for program success.

Click here to view the chart.

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8.) 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.

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9.) Expanding Medicaid Lowers Depression, Financial Strain, But Doesn’t Improve Physical Health

While Medicaid coverage has helped to increase diabetes diagnoses and medication compliance among the poor, and reduce depression and out-of-pocket medical expenses, it has not helped to reduce the prevalence of diabetes, high cholesterol, or high blood pressure, according to a study by The Oregon Health Insurance Experiment, and which appears in the New England Journal of Medicine.

Get the full story.

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10.) 38 Disease Management Metrics: Population Health Benchmarks to Drive Accountable Care

38 Disease Management Metrics This resource dives deep into several years of market research to document the role and outcomes of disease management in 11 key areas, as well as the high-focus diseases and health conditions of such initiatives as obesity and weight management, diabetes management, and healthcare case management.

Learn more about this resource.

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11.) Business Case for Pharmacist-Led Medication Therapy Management

The image of the pharmacist standing behind his counter in isolation from everyone is only partially prevalent, explains Beth Chester, PharmD, MPH, FCCP, BCPS, senior director of pharmacy clinical operations and quality for Kaiser Permanente Colorado. With many years of education behind them, and a familiarity with the kind of patients that need medication therapy management (MTM) the most, i.e. those taking multiple medications, having multiple chronic conditions, or having a history of reticence, the pharmacist can be the best choice to perform this service.

Get the full story.

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12.) Pharmacists and Medication Adherence: Brief Interventions, Motivational Interviewing and Telepharmacy

Pharmacists and Medication Adherence This 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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13.) Infographic: Mapping Healthcare Performance Variation Across Regions

WhyNotTheBest.org, The Commonwealth Fund's benchmarking site, includes an interactive map enabling users to compare regions, counties, and states on measures of healthcare quality and safety, outcomes, and patient experiences. This infographic shows the best and worst regions on three different measures of healthcare performance: readmissions for heart failure, patient satisfaction and the patient experience, and surgical care improvement.

Read this blog post.

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14.) Atrius Health's Experience as a Medicare Pioneer ACO

Emily Brower A core desire to create a single population-focused model of care for all Medicare beneficiaries, rather multiple payor-driven approaches, drives Atrius Health’s participation in the CMS Pioneer ACO program, explains Emily Brower, executive director of accountable care programs at Atrius Health. The success of the Atrius ACO hinges on several preferred partnerships it has cultivated, including a collaboration with skilled nursing facilities, as well as outreach by population health managers, who guide patients in the management of chronic illness and prevention.

Listen to this podcast.

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