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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Under a proposed rule, Medicaid will reimburse primary care services for family medicine, general internal medicine, pediatric medicine and related sub-specialists at Medicare levels in 2013 and 2014. Such a ruling could help encourage primary care physicians to continue and expand their services to Medicaid beneficiaries, including providing checkups, preventive screenings, vaccines and other care, CMS officials say.

CMS follows the AMA's recommendations when calculating physicians' fees under Medicare nearly 90 percent of the time, a report from Columbia University finds. The fees, which are based on assessments of time and effort associated with various physician services, often influence how some state and private payors pay doctors. In recent years there have been increasing pay gaps between PCPs and specialists, and PCPS have expressed concerns that the AMA committee is partly responsible for this. More in this issue.

The problem of obesity continues to grow, with the latest findings estimating that nearly half of the U.S. population could be obese by 2030, which means the healthcare system could be burdened with 32 million more obese people by that time, according to research from Duke University, RTI International, and the CDC. Keeping obesity rates level could save nearly $550 billion in medical expenditures over the next two decades, researchers state.

And the age of claimants for critical illness insurance policies decreased in the past year, according to a study from the American Association for Critical Illness Insurance. The majority of claimants were younger than 55, marking a significant increase in claims by younger policyholders compared to those filed in 2010.

Donít forget to participate in our second annual survey on ACOs. If you contribute by May 16th, you will get a FREE executive summary of the compiled results and year-over-year ACO trends.

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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May 14, 2012
Vol. XIV, No. 18

Sponsored by:
Identifying, Engaging and Breaking Down Patient Barriers To Reduce Avoidable ED Use

This week's industry news:

  1. 42 Percent of the U.S. Population Could be Obese by 2030
  2. Obesity & Weight Management Benchmarks and Case Studies
  3. New Rule Would Bring Medicaid Payments for Primary Care in Line with Medicare's
  4. Case Studies in Comprehensive Primary Care
  5. Healthcare Business White Paper: Case Management in 2012
  6. 5 Steps to a Successful Embedded Case Management Program
  7. New Chart: Top Targeted Conditions for Patient Registries
  8. Case Study in Physician Practice and Payment Transformation
  9. Medicare Accepts AMA Recommendations on Doctors' Fees Nine Times Out of Ten
  10. Physician Pay-for-Performance
  11. Nearly Half of All Critical Illness Insurance Claims Begin Prior To Age 55; Cancer Remains Leading Cause
  12. Guide to Health Risk Assessment and Stratification
  13. Self-Examination: Industry Questions Necessity, Cost Irregularities of Healthcare Services
  14. HealthSounds Podcast: Geisinger Reduces All-Cause 30-Day Readmission Rates Through Remote Monitoring Program
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.) 42 Percent of the U.S. Population Could be Obese by 2030

Nearly half of the U.S. population could be obese by 2030, which means the healthcare system could be burdened with 32 million more obese people by that time, according to research from Duke University, RTI International, and the CDC.

Get the full story.

>>Return to this week's industry news


2.) Obesity & Weight Management Benchmarks and Case Studies

Obesity & Weight Management Benchmarks and Case Studies This guide provides actionable information on current obesity and weight management programs for adults, children and adolescents. Whether your organization will focus on obesity and weight management in the near future or retool an existing program, it will benefit from a review of metrics and measurements to evaluate and plan your program and compare performance and utilization data.

Learn more about this resource.

>>Return to this week's industry news


3.) New Rule Would Bring Medicaid Payments for Primary Care in Line with Medicare's

A new proposal by CMS would bring payments for primary care physicians serving Medicaid patients in line with those paid by Medicare in 2013 and 2014.

Get the full story.

>>Return to this week's industry news


4.) Case Studies in Comprehensive Primary Care: Guidance from Group Health Cooperative and Geisinger Health System

Case Studies in Comprehensive Primary Care This 50-page report takes a look at the successful patient-centered approaches by these two innovators, sharing key strategies and lessons learned from program implementation.



Learn more about this resource.

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5.) Healthcare Business White Paper: Case Management in 2012

To adequately prepare for 2012 and beyond, healthcare companies are utilizing case managers in greater numbers to help identify and manage high-cost, high risk patients. This white paper documents the efforts and contributions of case management from 153 healthcare organizations, with a concentration on three new areas: trends in embedded case management, including work locations of co-located case managers and the greatest challenges and benefits of embedding case manager at the point of care; clinical conditions targeted by case managers, and preferred case management certifications.

Download this complimentary white paper.

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6.) 5 Steps to a Successful Embedded Case Management Program

Establishing physician buy-in prior to embedding case managers in their practice is one of the keys to ensuring its success, explains Charlene Schlude, RN, CCM, director of case management at Capital District Physicians Health Plan, because physicians will have to interact closely with the case managers and allow them to become part of the practice.

Get the full story.

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7.) New Chart: Top Targeted Conditions for Patient Registries

Top Targeted Conditions for Patient Registries In the new landscape of accountable and value-based healthcare, patient registries are a straightforward tool for creating realistic views of clinical practices, patient outcomes, provider performance, safety and comparative effectiveness and for supporting evidence-based medicine development and decision-making. We wanted to see which health conditions patient registries target the most.

Click here to view the chart.

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8.) Case Study in Physician Practice and Payment Transformation: The CDPHP Experience

Case Study in Physician Practice and Payment Transformation This 45-page report chronicles the clinical and financial journeys of this network model health plan, sharing practical strategies and lessons learned from this two part-process. It also provides details on readying for practice and payment reform, analyzing the risk-adjusted FFS model and the bonus models, the impact of embedded case managers on hospital readmissions, ER visits and care transitions, and much more.

Learn more about this resource.

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9.) Medicare Accepts AMA Recommendations on Doctors' Fees Nine Times Out of Ten

CMS follows the AMA's recommendations when calculating physicians' fees under Medicare nearly 90 percent of the time, a report from Columbia University finds.

Get the full story.

>>Return to this week's industry news


10.) Physician Pay-for-Performance: Refining the Bonus Structure To Meet Market Realities

Physician Pay-for-Performance During this 45-minute webinar, Julie Hobson, manager of provider engagement, performance and partnership at Highmark Inc., described how Highmark's Pay-for-Performance program has evolved to meet today's healthcare market realities, including new developments slated for 2012 to reflect meaningful use requirements; bonus scoring algorithms currently in place that reward physicians across the measure set, and more.


Learn more about this resource.

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11.) Nearly Half of All Critical Illness Insurance Claims Begin Prior To Age 55; Cancer Remains Leading Cause

Just under half, or 47 percent, of new critical illness insurance claims in 2011 began prior to age 55, according to a study from the American Association for Critical Illness Insurance (AACII) and General Re Life Corporation.

Get the full story.

>>Return to this week's industry news


12.) Guide to Health Risk Assessment and Stratification

Guide to Health Risk Assessment and Stratification In this resource, 12 industry thought leaders describe the processes of health risk assessment (HRA) and stratification as well as applications and benefits of health assessment in the workplace and various healthcare settings. This 140-page guide also examines the HRA's impact on cost, utilization and patient health status. Contains more than 77 images; Q&A chapter answers more than 60 questions on health risk assessment.

Learn more about this resource.

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13.) Self-Examination: Industry Questions Necessity, Cost Irregularities of Healthcare Services

Regardless of whether the Supreme Court overhauls health reform, the industry is seriously thinking about ways to cut healthcare spending, either by reexamining the need for commonly administered services or unraveling the mysteries of medical bills.

Read this blog post.

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14.) HealthSounds Podcast: Geisinger Reduces All-Cause 30-Day Readmission Rates Through Remote Monitoring Program

Dr. Maria Lopes Geisinger Health Plan reduced the relative risk of all-cause 30-day readmissions by 44 percent compared to a matched control group using an interactive voice response (IVR) system developed by AMC Health. The IVR system targeted patients who were at high risk for readmissions following a hospital discharge. Care managers identified those complex patients that were at high risk for post-discharge complications that could lead to a readmission, explained Dr. Maria Lopes, chief medical officer at AMC Health.

The IVR system makes one call per week for four weeks, using branching logic to identify issues with medication adherence, PCP follow-up, and complications, as well as a risk and falls assessment. The program is integrated into the care management workflow to make this impact, she added.

Listen to this podcast.

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