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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Insurance policy holders just might have some extra spending money this summer.

According to the HHS, insurance companies that donít meet the 80/20 healthcare rule of spending, which requires them to spend at least 80 percent of consumersí premium dollars on medical care and quality improvement, and the remainder on administrative costs, must provide their policyholders a rebate for as much as $151 no later than Aug. 1, 2012. Consumers can expect a notice from their insurance company informing them of the 80/20 rule, whether their company met the standard, and, if not, how much of the difference between what the insurer did or did not spend on medical care and quality improvement will be returned to them.

Eligible healthcare organizations have already been reimbursed by the government for adopting EHRs for meaningful use. In fact, the CMS met its goal of getting 100,000 organizations on board with its EHR incentive program three months earlier than planned: more than 110,000 eligible healthcare professionals and over 2,400 eligible hospitals have received over $5.7 billion in payments as of the end of May. The end of 2012 was the original target goal. Officials hope the increasing use of EHRs will provide better patient care, cut down on paperwork, and eliminate duplicate screenings and tests.

Pharmacists could help manage the countryís healthcare costs if the results of a new study from Walgreens prove fruitful. Walgreens pharmacists trained over 4,500 patients starting self-injectable diabetes medication for the first time on appropriate injection technique, side effect management and the importance of adherence to therapy. Pharmacists also provided a follow-up assessment at the patientsí next refill meeting. Initial results showed that patients who received two counseling sessions with a pharmacist were 24 percent more adherent after 90 days and had an additional eight days of therapy compared to a usual care control group.

Employers, too, are looking for ways to keep their costs down, with employee healthcare plans a prime target. A study from J.D. Power and Associates reveals that almost 50 percent of employers might pursue alternate methods of employee healthcare coverage, including defined contributions, vouchers and exchange purchasing. A smaller percentage of fully insured and self-funded employers said they might discontinue sponsoring employee coverage completely. Details in this issue.

And lastly, we have a new survey on site on asthma management. Asthma drives a lot of healthcare utilization — half a million hospitalizations and nearly 2 million emergency department visits in 2009 alone. We invite you to share how your organization is managing asthma in the populations you serve by July 27, 2012. In return, we'll e-mail you an executive summary of trends in asthma management.

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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June 25, 2012
Vol. XIV, No. 23

Sponsored by:
Bending the Cost Curve with a Commercial Value-Based Payment Contract — A Case Study from Advocate Physician Partners

This week's industry news:

  1. 1 out of 5 Medicare and Medicaid-Eligible Professionals Received Incentive Payments for Using EHRs: CMS
  2. 2012 Benchmarks in Patient Registry Use for Accountable Care
  3. Pharmacist-Led Training and Counseling Improves Diabetics' Medication Adherence by 24 Percent
  4. Diabetes Management in the Medical Home
  5. Healthcare Business White Paper: 2012 Trends in Embedded Case Management
  6. Healthcare 80/20 Law Saves Consumers Over $1 Billion
  7. New Chart: Top 5 Tools to Identify Patients at Risk for Readmissions
  8. Healthcare Trends & Forecasts in 2012
  9. Case Managers Positively Impact Patient Experience and Satisfaction
  10. Case Management Metrics
  11. 6 Key Factors Determine Employers' Likelihood to Pursue Alternate Healthcare Coverage for Employees
  12. Health Insurance Exchanges
  13. UPMC Home Visits Target Unplanned Care in Emergency Departments
  14. HealthSounds Podcast: Advanced Illness Care Coordination
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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Patient-Centered Medical Homes in 2012

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This week's industry news

1.) 1 out of 5 Medicare and Medicaid-Eligible Professionals Received Incentive Payments for Using EHRs: CMS

More than 110,000 healthcare providers are being reimbursed for using EHRs that meet federal standards, according to the CMS.

Get the full story.

>>Return to this week's industry news


2.) 2012 Benchmarks in Patient Registry Use for Accountable Care

2012 Benchmarks in Patient Registry Use for Accountable Care This 49-page resource provides actionable data from more than 100 healthcare companies on their current and planned use of registries and the impact of registry use on healthcare quality, efficiency and cost.



Learn more about this resource.

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3.) Pharmacist-Led Training and Counseling Improves Diabetics' Medication Adherence by 24 Percent

Diabetics receiving self-injection training and counseling by pharmacists were 24 percent more likely to be medication adherent, according to a new study from Walgreens.

Get the full story.

>>Return to this week's industry news


4.) Diabetes Management in the Medical Home

Diabetes Management in the Medical Home During this 45-minute webinar, Kathy Brieger, R.D., C.D.E., chief operations officer at Hudson River HealthCare (HRHC), shares the inside details on the diabetes management program and the program's impact on its diabetic patients.


Learn more about this resource.

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

Despite challenges ranging from physician and practice buy-in to recruitment and retention, the number of healthcare companies embedding or co-locating case managers in care sites continues to rise. Just over half of respondents to the Healthcare Intelligence Network's third annual Healthcare Case Management e-survey, conducted in February 2012, said they embed case managers at the point of care; of those 2012 respondents, nearly 60 percent cited the primary care practice as the most likely work site for an on-site case manager. This executive summary examines the responses of companies who embed case managers, providing a high-level look at work locations, program components, and the greatest challenges and benefits of this case management strategy.

Download this complimentary white paper.

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6.) Healthcare 80/20 Law Saves Consumers Over $1 Billion

Nearly 13 million Americans will benefit from $1.1 billion in rebates this summer from insurance companies if they fail to meet a previously established 80/20 rule of spending.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top 5 Tools to Identify Patients at Risk for Readmissions

Top 5 Tools to Identify Patients at Risk for Readmissions Anxious to avoid looming financial penalties for excessive hospital readmissions, healthcare organizations have tightened coordination of care and management of care transitions for Medicare beneficiaries at risk of rehospitalization. We wanted to see how healthcare organizations identify patients most at risk for returning to the hospital.

Click here to view the chart.

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

Healthcare Trends & Forecasts in 2012 Key thought leader Steven Valentine covers all of the top-of-mind issues, from the new and influential role of physicians to the strategy and technology to-dos for health systems and hospitals.



Learn more about this resource.

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9.) Case Managers Positively Impact Patient Experience and Satisfaction

Case managers continue to positively impact healthcare delivery. According to 19 percent of respondents to our recent survey on improving patient experience and satisfaction who said that case managers were primarily responsible for this area of care, 90 percent said that their case managers had significantly increased patient satisfaction.

Get the full story.

>>Return to this week's industry news


10.) Case Management Metrics: Charting Care Coordination Across the Continuum

Case Management Metrics This 50-page resource dives deep into several years of market research to identify case managers' influence and contributions in 10 key areas, including patient education and outreach, medication adherence, disease management, care transitions management and home visits.

Learn more about this resource.

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11.) 6 Key Factors Determine Employers' Likelihood to Pursue Alternate Healthcare Coverage for Employees

Almost 50 percent of employers might pursue alternate methods of employee healthcare coverage, including defined contributions, vouchers, exchange purchasing or cutting coverage altogether, according to a study from J.D. Power and Associates.

Get the full story.

>>Return to this week's industry news


12.) Health Insurance Exchanges: Preparing for the Brave New Marketplace Ahead

Health Insurance Exchanges This 64-page resource provides timely insights on how health insurance exchanges may operate, what the products will look like, which health insurers will participate and who will enroll.




Learn more about this resource.

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13.) UPMC Home Visits Target Unplanned Care in Emergency Departments

UPMC members who treat the ER as a primary care provider can expect a home visit from the health planís community teams of nurses and social workers. Community teams visit these members at home to perform assessments and care management.

Read this blog post.

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14.) HealthSounds Podcast: Advanced Illness Care Coordination — A Case Study on Aetna's Compassionate Care Program

Dr. Joseph Agostini Aetna's Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare, these patients get more of the type of care that they want and spend less time in the hospital. Patient satisfaction with the program is high, he says, which reflects the strong bond between Aetna members and nurse case managers. In this interview, Dr. Agostini explains the key elements of the Compassionate Care program as well as some of the challenges the case managers may face in the management of advanced illness.

Listen to this podcast.

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