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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Urgent care centers — alternative care centers for time-challenged patients, or costly care convenience centers?

Thatís the debate in a new study by the Center for Studying Health System Change (HSC) on the rapid growth of these centers throughout the country. Once an occasional independently-owned, standalone facility, there are now 9,000 urgent care centers.

Three key factors are driving the surge, among them, their accessibility. Urgent care centers fill a gap by providing walk-in care, especially during evening and weekend hours, when primary care physician (PCP) offices are generally closed. They are particularly appealing to those patients unable to schedule a PCP appointment during weekday hours, or for those patients without a PCP.

There is little debate over a series of recommendations that could reduce five medical interventions that are commonly used but not always necessary, according to a paper released by The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement ® (PCPI).

Left unchecked, overuse, described as the provision of medical interventions that provide zero or negligible benefit to patients, is a leading contributor to problems with quality and patient safety, can affect millions of patients, and can drive up healthcare costs.

Researchers estimate that $1 billion is spent annually on unnecessary antibiotics for adults with viral upper respiratory infections (URIs) alone, one of the five areas of overuse. Strategies to reduce this include developing clinical definitions for viral and bacterial URIs, aligning contradictory national guidelines, partnering with the CDC and initiating public awareness. Other strategies and treatment areas are outlined inside.

Developing consistent guidelines is key to another set of recommendations tackling an equally common and costly healthcare problem: heart failure readmissions. Researchers have identified six steps hospital staff can take to help heart failure patients avoid readmittance to the hospital within 30 days after theyíre discharged, according to research in the American Heart Associationís journal Circulation: Cardiovascular Quality and Outcomes.

While each step alone has had some impact on patients' recovery, researchers found that if all six recommendations were followed, readmissions could drop as much as two percent. This translates to a savings of more than $100 million a year.

A lack of savings is prompting seven of 32 provider groups that signed up for the Pioneer Accountable Care Organizations (ACOs) program sponsored by CMS to switch to the Medicare Shared Saving Program (MSSP), according to the CMS.

Two other Pioneer ACOs are leaving the program completely, CMS officials say. Overall, more than 250 organizations participate in the Pioneer ACO Model and the MSSP, serving 4 million Medicare beneficiaries.

CMS said in a statement that 13 out of 32 pioneer ACOs produced and shared savings with CMS, generating a gross savings of $87.6 million in 2012 and saving nearly $33 million to the Medicare Trust Funds.

One of the key features of the Pioneer program, and one that differentiates it from the Medicare Shared Savings Program, is that it is accountable for all Medicare A and B benefits, so it includes end stage renal disease patients, hospice patients, and dual-eligibles.

How is your organization meeting the unique care coordination needs of dual eligibles? Share your organization's approach by July 31st by participating in our online survey and you will receive a free summary of 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 Fornarotto
Associate Editor:
Jessica Fornarotto, jfornarotto@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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July 22, 2013
Vol. XV, No. 27

Sponsored by:
Managing Population Health with Integrated Registries and Effective Patient Touchpoints


This week's industry news:

  1. 3 Key Factors Drive Rapid Growth of Urgent Care Centers
  2. 27 Interventions to Reduce Avoidable ER Use
  3. More Than One Quarter Pioneer ACOs to Leave Program: CMS
  4. 2012 Healthcare Benchmarks: Accountable Care Organizations
  5. Healthcare Business White Paper: Medication Adherence in 2013
  6. Healthcare Experts Recommend 5 Strategies to Minimize Overuse of 5 Treatments
  7. New Chart: How Healthcare Identifies Individuals for Care Transition Management
  8. Guide to Population Health Management
  9. 6 Steps Could Cut Heart Failure Readmissions
  10. 2012 Healthcare Benchmarks: Reducing Hospital Readmission
  11. 2 Community Based Approaches to Reducing Readmissions
  12. Rethinking Readmissions
  13. HINfographic: Managing Population Health
  14. Performance Quality Measurement and Reporting for Accountable Care
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:
Care Coordination of Dual Eligibles in 2013

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

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This week's industry news

1.) 3 Key Factors Drive Rapid Growth of Urgent Care Centers

Consumer demand for convenient access to care for illnesses and injuries is driving the rapid growth of urgent care centers across the country, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Get the full story.

>>Return to this week's industry news


2.) 27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use This resource describes 27 separate initiatives launched by Kaiser and WellPoint around the country that are effectively reducing avoidable emergency department use and redirecting patients to more cost-effective care venues.


Learn more about this resource.

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3.) More Than One Quarter Pioneer ACOs to Leave Program: CMS

Seven of 32 provider groups that signed up for the Pioneer Accountable Care Organizations (ACOs) program sponsored by CMS did not produce savings and are switching to the Medicare Shared Saving Program (MSSP), according to the CMS.

Get the full story.

>>Return to this week's industry news


4.) 2012 Healthcare Benchmarks: Accountable Care Organizations

2012 Healthcare Benchmarks: Accountable Care Organizations This resource documents the numerous ways in which accountable care is transforming healthcare delivery, population health management, reimbursement for care and, most importantly to this yearís survey respondents, the patient experience.


Learn more about this resource.

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5.) Healthcare Business White Paper: Medication Adherence in 2013 — Closer Look at Compliance During Care Transitions

Medication Adherence in 2013 In its third annual Medication Adherence e-survey conducted in January 2013, HIN captured emerging trends in efforts to improve medication adherence (MA) among more than 100 healthcare organizations. According to 75 percent of survey respondents, complex patients remain the most common targets of MA programs. This HINtelligence Report provides data highlights on MA program components, the most successful tools for improving MA, and more.

Download this complimentary white paper.

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6.) Healthcare Experts Recommend 5 Strategies to Minimize Overuse of 5 Treatments

A series of five recommendations could reduce five medical interventions or treatments that are commonly used but not always necessary, according to a paper released by The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement® (PCPI).

Get the full story.

>>Return to this week's industry news


7.) New Chart: How Healthcare Identifies Individuals for Care Transition Management

New Chart: How Healthcare Identifies Individuals for Care Transition Management Frequent hospitalizations is a key risk factor for identifying individuals in need of care transition management, say about 82 percent of the healthcare organizations who responded to HIN's third annual e-survey on Managing Care Transitions. We wanted to see which other risk factors are considered when identifying care transition candidates.

Click here to view the chart.

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8.) Guide to Population Health Management

Guide to Population Health Management This resource lays the groundwork for a PHM program, providing a comprehensive set of 2012 PHM benchmarks from 102 companies as well as strategic advice from early adopters of a PHM approach. It also offers a primer in PHM, an advanced case study in the use of analytics in PHM, and an examination of PHM tools at work in the accountable care organization (ACO), a new value-based healthcare delivery model that has emerged post-ACA.

Learn more about this resource.

>>Return to this week's industry news


9.) 6 Steps Could Cut Heart Failure Readmissions

Researchers have identified six steps hospital staff can do to help heart failure patients avoid readmittance to the hospital within 30 days after theyíre discharged, according to research in the American Heart Associationís journal Circulation: Cardiovascular Quality and Outcomes.

Get the full story.

>>Return to this week's industry news

10.) 2012 Healthcare Benchmarks: Reducing Hospital Readmission

2012 Healthcare Benchmarks: Reducing Hospital Readmission This resource identifies the key strategies, challenges, target populations and health conditions of 119 healthcare organizations to reduce avoidable rehospitalizations, providing critical benchmarks that show how the industry is working to reduce rehospitalizations, particularly for the CMS target conditions of heart failure, myocardial infarction and pneumonia.

Learn more about this resource.

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11.) 2 Community Based Approaches to Reducing Readmissions

There is no one size fits all solution to reducing readmissions, says Alicia Goroski, MPH, senior project director for care transitions for the Colorado Foundations of Medical Care (CFMC), the national coordinator for the QIO effort. Instead, itís important to look at the raw data and determine what is driving readmissions in your community.

Get the full story.

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12.) Rethinking Readmissions: Patient-Centered Collaborations in Care Transition Management

Rethinking Readmissions This resource examines the data analytics driving the CMS Care Transitions Demonstration Project as well as some home-grown programs that are supporting patientsí seamless transitions back into their communities.


Learn more about this resource.

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13.) HINfographic: Managing Population Health

Sixty-nine percent of respondents reported seeing an increase in patient compliance as a result of a population health management program, according to a recent Healthcare Intelligence Network survey. Although managing patient populations can be challenging, organizations with these programs have seen many other positive impacts on population metrics.

Read this blog post.

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14.) Performance Quality Measurement and Reporting for Accountable Care

John C. Lincoln When tracked within its electronic medical record, key interventions like transitional care coaching and an expanded Patient Health Questionnaire not only improve the care provided to John C. Lincoln ACOís population but provide a clearer picture of the accountable care organizationís performance, note Karen Furbush, business consultant, and Heather Jelonek, chief operating officer of the John C. Lincoln Network ACO.

Additionally, the ACOís Physician Advisory Network, made up of its leading physicians, tracks patterns and trends within the ACO and helps the care team to adhere to best practices in evidence-based medicine. Monthly webinars with the physician advisory network and its EMR specialists provide opportunities for evaluation and training in these best practices.

Listen to this podcast.

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