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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

On the eve of July 4th, as the country prepares to celebrate its independence, the Supreme Court issued its own fireworks when it finally released its ruling on the constitutionality of the healthcare reform law.

As most of you have heard by now, the court ruled that the ACA’s individual insurance mandate was constitutional, but struck down the ACA’s plan to penalize states that do not expand their Medicaid coverage via federal guidelines.

The rulings were controversial decisions that kept the public waiting for months, and have spawned their fair share of approval and criticism, discussions that will likely continue as the healthcare industry takes steps to implement the mandate and other uncontested facets of the ACA. To hear some of the conversations on the ruling, read our blog post on it.

Obesity remained on the forefront of the country’s consciousness with the U.S. Preventive Services Task Force weighing in with several final recommendations of its own, sparking its own set of reactions. In an attempt to prevent the complications that can arise from obesity, like CV disease and diabetes, the task force is recommending that doctors screen for it in adults, and refer those who are obese for weight loss and management counseling. But what type of weight loss program is optimal, and what’s the most effective diet to follow? We explore these questions in our blog post inside.

Speaking of weighty issues, that so-called donut hole that has plagued Medicare beneficiaries could potentially close up by 2020, according to the CMS. Data shows that over 5 million people with Medicare saved nearly $4 billion on prescription drugs since the ACA was first enacted in 2010, and 745,000 people with Medicare have saved almost $500 million on prescription drugs in “donut hole” coverage gaps, or an average of $651 per person in savings, in the first five months of this year.

And researchers from the University of Chicago Medicine weighed in on the benefits of the patient-centered medical home, revealing that while the healthcare model can decrease healthcare spending by reducing hospitalizations and inappropriate ED use, most physicians are not benefiting from these savings.

Don’t forget to weigh in with your own opinions on your asthma management programs. All participants will receive a free e-summary of the results when compiled.

Happy Fourth!

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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July 2, 2012
Vol. XIV, No. 24

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. Supreme Court Upholds Individual Insurance Mandate, Strikes Down Medicaid Expansion
  2. 46 Healthcare Metrics to Boost Profitability
  3. Patient-Centered Medical Homes Decreasing Healthcare Spending, Increasing Physician Costs
  4. The Patient-Centered Medical Home — Lessons from a Statewide Rollout
  5. Healthcare Business White Paper: Accountable Care Organizations in 2012
  6. New Obesity Screening Recommendations Issued for Adults
  7. New Table: Case Identification for Aetna's Compassionate Care Program
  8. 2011 Benchmarks in Population Health Management
  9. Over 5.2 Million People with Medicare Save $3.7 Billion on Prescription Drugs
  10. CMS Star Quality Ratings
  11. 13 Ways to Engage PCPs in Reducing Avoidable ER Utilization
  12. 27 Interventions to Reduce Avoidable ER Use
  13. Diets, Doctors and Obesity: Heavier Weight for Primary Care
  14. HealthSounds Podcast: Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach
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.) Supreme Court Upholds Individual Insurance Mandate, Strikes Down Medicaid Expansion

The U.S. Supreme Court has largely upheld the constitutionality of the Affordable Care Act's (ACA) healthcare reform law, including the controversial individual mandate, which states that all Americans must have health insurance by 2014 or pay a tax penalty, according to several news sources including the L.A. Times and the New York Times.

Get the full story.

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2.) 46 Healthcare Metrics to Boost Profitability: Charting 2012 Trends

46 Healthcare Metrics to Boost Profitability: Charting 2012 Trends This 70-page resource delivers charts and tables on 46 actionable metrics carefully curated from 2011 market research data by the Healthcare Intelligence Network. These charts and tables are enhanced by commentary and interviews with industry thought leaders from Aetna, CDPHP, Ohio Medicaid, TRG Healthcare Solutions, St. David's Healthcare and other organizations at the cutting edge of healthcare delivery.

Learn more about this resource.

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3.) Patient-Centered Medical Homes Decreasing Healthcare Spending, Increasing Physician Costs

Shifting patient care to PCMHs can decrease healthcare spending by reducing hospitalizations and inappropriate ED use, but most physicians are not benefitting from these savings, says a new study published in the Journal of the American Medical Association (JAMA.)

Get the full story.

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4.) The Patient-Centered Medical Home: Lessons from a Statewide Rollout

The Patient-Centered Medical Home: Lessons from a Statewide Rollout In this 45-minute webinar, Barbara Haasis, R.N., CCRN, senior clinical lead, quality reward and recognition programs at Florida Blue, shared how the health plan transitioned into a medical home model.

Learn more about this resource.

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5.) Healthcare Business White Paper: 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 Obesity Screening Recommendations Issued for Adults

Doctors should screen adults for obesity, and those considered obese should be referred for weight loss and management interventions in the first year, according to the U.S. Preventive Services Task Force.

Get the full story.

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7.) New Table: Case Identification for Aetna's Compassionate Care Program

Case Identification for Aetna's Compassionate Care Program Aetna's Compassionate Care Program, a case management program that targets patients with advanced illness, has had an enormous impact on the number of inpatient stays, average length of stay, ER visits, ICU days and hospice selection rate for the patients it serves, according to a study published in the Journal of Palliative Medicine. We wanted to learn how Aetna identifies members with advanced illness for this program.

Click here to view the table.

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8.) 2011 Benchmarks in Population Health Management: What's Working in Coaching, Weight Control and Tobacco Cessation

2011 Benchmarks in Population Health Management This resource takes a comprehensive look at industry activity in health coaching as a whole, then drills down to condition-specific programs. The disease management data contained in this benchmarks report are derived from three separate surveys conducted in 2010 by the Healthcare Intelligence Network, to which a total of 425 organizations responded.

Learn more about this resource.

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9.) Over 5.2 Million People with Medicare Save $3.7 Billion on Prescription Drugs

More than 5,254,000 seniors and people with disabilities have saved a total of $3.7 billion on prescription drugs since the ACA was enacted in 2010, according to the CMS.

Get the full story.

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10.) CMS Star Quality Ratings: Shifting Strategies for Medicare Advantage and Part D Plans and Providers

CMS Star Quality Ratings This resource provides an in-depth look at the impact and implications of CMS's star-ratings system so far, as well as how the star-rating program is likely to change in 2012 and subsequent years.



Learn more about this resource.

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11.) 13 Ways to Engage PCPs in Reducing Avoidable ER Utilization

Locating case managers in the ER, and ensuring that follow-up PCP appointments are scheduled and kept are two of the steps healthcare organizations are taking to engage PCPs in efforts to reduce avoidable use of the hospital ER, say respondents to a 2010 Reducing Avoidable Emergency Room Visits e-survey conducted by the Healthcare Intelligence Network.

Get the full story.

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12.) 27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use This 45-page resource details provider- and patient-focused interventions that target the high numbers of avoidable visits, high and ultra-high utilizers and the sub-populations noted for frequent ER use. Five interventions target these sub-populations: asthma patients, those recently discharged from the hospital, non-network patients, nursing home and assisted living residents and dual-eligibles (Medicare and Medicaid).

Learn more about this resource.

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13.) Diets, Doctors and Obesity: Heavier Weight for Primary Care

The U.S. Preventive Services Task Force has recommended that primary care doctors screen adult patients for obesity. The task force further suggested that healthcare professionals offer or refer obese persons to a comprehensive weight loss and behavior management program with 12 to 26 sessions in the first year.

Read this blog post.

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14.) HealthSounds Podcast: Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach

Laura Linebach Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality improvement at L.A. Care Health Plan. As part of a health plan-hospital collaboration with a goal of reducing non-acute ER use by children ages 1 to 19, L.A. Care Health Plan has launched a Nurse Advice Line and developed a range of materials to educate parents about appropriate use of the ER. Ms. Linebach describes these tools as well as a metric in L.A. Care Health Plan's pay for performance program that measures group providers' appropriate resource use.

Listen to this podcast.

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