HIN logo
From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Federally qualified health centers (FQHC) and their “look-alikes” are as effective as primary care practices, and better on some quality measures, according to a new study from the University of California, San Francisco. Because they serve the poor and uninsured, there have been concerns that they provide less effective care because they are serving more medically and socially complex patients. Researchers refute this, and the clinics will receive $11 billion from the federal government to expand their operations in the wake of anticipated primary care shortages as an estimated 32 million people seek healthcare under the ACA.

Family and primary care physicians could receive as much as 7 percent increases in payments under a proposed ruling from the CMS. The ruling is Intended to help primary care doctors improve patient care and lower healthcare costs long term by helping to transition patients back into the community following a hospitalization or SNF stay. If passed, CMS will make separate payments to a patient’s community physician or practitioner to coordinate the patient’s care after they are discharged.

More good news for primary care: of the 89 new ACOs selected to participate in the Medicare Shared Saving Program (MSSP), half are physician-driven, serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs. This correlates to our research, conducted in March 2012, that found that physician-led ACOs were the most common.

Following several years of slowing growth, global spending on pharmaceuticals could reach nearly $1.2 trillion by 2016, according to a report from the IMS Institute for Healthcare Informatics. Studies indicate that the market for drugs will nearly double by 2016, reaching $1.2 trillion compared with about $956 billion in 2011, an annual growth rate of 3 to 6 percent. Suggested factors for the growth are volume increases in the pharmerging markets and an uptick in spending in developed nations.

Looking for new ideas on cost reductions in the ER? We present several stories on this topic, from Mina Chang’s detailed pre-ER interventions, to those presented from the Center for Studying Health System Change in our blog post.

It’s not too late to participate in our survey on asthma management. Describe your organization's efforts to manage asthma in your population by July 27, 2012 and you'll receive a free e-summary of the survey results once it is compiled.

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

>>Return to top

HIN podcasts
HIN blog
HIN videos
New HIN products

Contact HIN:
www.hin.com
(888) 446-3530
(732) 449-4468
Fax: (732) 449-4463
Email: info@hin.com

This week's featured download: Medication Adherence in 2011 — More Help from Community Pharmacists

Medication Adherence in 2011 — More Help from Community Pharmacists

Featured download










For advertising and sponsorship opportunities in the Healthcare Business Weekly Update, please e-mail sales@hin.com or call 888-446-3530

>>Return to top

July 16, 2012
Vol. XIV, No. 26

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. Half of 89 New Medicare ACOs Are Physician-Driven
  2. Physician-Owned ACOs
  3. Federally Funded Clinics as Effective as Private Practices on Most Quality Measures
  4. Prescription for Profitability
  5. Healthcare Business White Paper: 2012 Benchmarks in Reducing Avoidable ER Visits
  6. Proposed CMS Primary Care Payment Hike Rewards Post-Discharge Care Coordination
  7. New Chart: Top 5 Methods to Identify Patients for Diabetes Management
  8. Guide to Physician Performance-Based Reimbursement
  9. Global Spending on Medicines to Reach Nearly $1.2 Trillion By 2016
  10. Managing Specialty Drugs Across the Medical and Pharmacy Benefits
  11. 3 Key Questions to Ask Pre-ER Intervention
  12. 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population
  13. Nonelderly Medicaid Patients Utilizing ED for Urgent Problems
  14. HealthSounds Podcast: Telephonic Case Management
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.

Missed the last issue? Read it here.

Join our Online Communities:

Twitter Facebook LinkedIn YouTube


Take our monthly e-survey:
10 Questions on Asthma Management

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

Interested in all open surveys? Review them here.


This week's industry news

1.) Half of 89 New Medicare ACOs Are Physician-Driven

Of the 89 new ACOs selected to participate in the Medicare Shared Saving Program (MSSP), half are physician-driven, according to the CMS.

Get the full story.

>>Return to this week's industry news


2.) Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges

Physician-Owned ACOs During this webinar, details were provided on how the Queens County Medical Society anticipated CMS program details; achieved and maintained compliance for existing FTC requirements while positioning for possible changes; developed a multi-disciplinary compliance approach; and created policies and procedures for ongoing compliance monitoring.

Learn more about this resource.

>>Return to this week's industry news


3.) Federally Funded Clinics as Effective as Private Practices on Most Quality Measures

Federally Qualified Health Centers (FQHC) and their “look-alikes” will receive $11 billion from the federal government to expand their operations in the wake of anticipated primary care shortages as an estimated 32 million people seek healthcare under the ACA, according to a study from the University of California, San Francisco.

Get the full story.

>>Return to this week's industry news


4.) Prescription for Profitability: 50 Ideas to Stimulate Healthcare Savings

Prescription for Profitability In this resource are quick-references on key programs and innovations that can help to put money back on the table for stakeholders by improving the quality of healthcare and curtailing avoidable utilization and cost.



Learn more about this resource.

>>Return to this week's industry news


5.) Healthcare Business White Paper: 2012 Benchmarks in Reducing Avoidable ER Visits — Pain Management Patients on Rise

With consensus widespread that much of emergency room use is avoidable and preventable, this white paper details how 134 healthcare organizations are working to staunch the flow and expense of avoidable emergency department use and point low-acuity patients in the direction of appropriate care.

Download this complimentary white paper.

>>Return to this week's industry news


6.) Proposed CMS Primary Care Payment Hike Rewards Post-Discharge Care Coordination

Family and primary care physicians could receive as much as 7 percent increases in payments under a proposed ruling from the CMS that includes separate payments for care coordination in the 30 days following hospital discharge.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top 5 Methods to Identify Patients for Diabetes Management

Top 5 Methods to Identify Patients for Diabetes Management Proper control of diabetes goes beyond prescribed pills and injections to encouraging individuals with diabetes to self-manage their condition, paying critical and ongoing attention to weight, diet, glucose levels, blood pressure and other clinical metrics. We wanted to see which methods healthcare organizations use to identify participants for diabetes management programs.

Click here to view the chart.

>>Return to this week's industry news


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

Guide to Physician Performance-Based Reimbursement In this resource, newly minted reimbursement formulas at two health plans and two independent practice associations (IPAs) are explored, 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.

>>Return to this week's industry news


9.) Global Spending on Medicines to Reach Nearly $1.2 Trillion By 2016

Following several years of slowing growth, global spending on pharmaceuticals could reach nearly $1.2 trillion by 2016, according to a report from the IMS Institute for Healthcare Informatics.

Get the full story.

>>Return to this week's industry news


10.) Managing Specialty Drugs Across the Medical and Pharmacy Benefits

Managing Specialty Drugs Across the Medical and Pharmacy Benefits This resource is a practical report filled with details of strategies health plans are employing to effectively manage specialty drugs under the medical benefit using pharmacy benefit principles. It includes outcomes being seen — and pitfalls to avoid — at companies like Blue Cross Blue Shield of Florida, RegenceRx, CVS Caremark and Express Scripts.


Learn more about this resource.

>>Return to this week's industry news


11.) 3 Key Questions to Ask Pre-ER Intervention

Looking to develop an intervention to reduce avoidable ER use? Establishing a timetable by asking three key questions, including when patients realized they needed to go the ED, is particularly crucial for the Medicaid population, which often has specific social service issues, explains Mina Chang, Ph.D., chief of the health services research and program development section of the Bureau of Health Services Research for the Ohio Department of Job and Family Services.

Get the full story.

>>Return to this week's industry news


12.) 5 Interventions to Reduce Avoidable ER Use by the Medicaid Population

5 Interventions to Reduce Avoidable ER Use by the Medicaid Population This resource looks at the collaborative effort among five regions of Ohio to target the key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.



Learn more about this resource.

>>Return to this week's industry news


13.) Nonelderly Medicaid Patients Utilizing ED for Urgent Problems

While non-elderly Medicaid patients do use the ED more than their privately insured counterparts, the majority of visits are for urgent or more serious medical problems, according to a national study from the Center for Studying Health System Change (HSC).

Read this blog post.

>>Return to this week's industry news


14.) HealthSounds Podcast: Telephonic Case Management — Protocols for Behavioral Healthcare Patients

Jay Hale Though adult mental health patients, substance abusers and children and adolescents may face different behavioral health issues, there's a common reason behind their frequent hospital and ER visits, explains Jay Hale, LPC, CEAP, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance. Hale's organization uses a set of telephonic case management protocols to reduce avoidable inpatient and ER use by these populations. He describes some of the barriers telephonic case managers might face during member outreach, red flags that indicate a physician visit is warranted, and the role of primary care providers in the member's care continuum.

Listen to this podcast.

>>Return to this week's industry news


Thank you for your readership! Please urge your colleagues to subscribe by forwarding this email or visiting http://www.hin.com/freenews2.html or by calling (888) 446-3530 or visiting the HIN Web site.

While we encourage you to forward this email to your colleagues, these articles may not be redistributed in any other publication, reproduced for publication in any form, distributed on an intranet or network or by e-mail distribution or distributed for commercial purposes without the expressed written permission of the Healthcare Intelligence Network.


Copyright 1997-2012 Healthcare Intelligence Network. All rights reserved.
Healthcare Intelligence Network
Gateway to Healthcare Business Information on the Internet
800 State Highway 71, Suite 2, Sea Girt, N.J. 08750