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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

The Medicaid population is the big winner this week, given the results of a new study from the Harvard School of Public Health. In the first published study since the Supreme Court’s ruling on the effect of recent state Medicaid expansions on mortality among low-income adults, the findings suggest that expanding coverage to the uninsured may save lives. The groups that benefited from the expansion the most are those that traditionally had higher mortality rates and faced greater barriers to care. States now have the option to expand their Medicaid coverage, and researchers hope this study will help state policymakers in their decisions.

The CMS also scores big, with provisions that have saved over 5 million Medicare beneficiaries nearly $4 billion on prescription drugs. In the first six months of this year alone, over 1 million seniors and people with disabilities have saved an estimated $687 million on prescription drugs in the “donut hole” coverage gap. CMS officials predict that coverage for both brand and generic drugs in the gap will continue to increase in time until 2020 when it will be closed.

Cigna is a contender, as its collaborative care programs continue to grow throughout the country. The health provider’s widening roster of initiatives, which aim to expand patient access to healthcare, improve care coordination, and achieve the gold standard of healthcare, the “triple aim” of improved health outcomes, affordabiity and patient satisfaction, are now based in six new states, including California, Ohio and Maine. Cigna now has 32 collaborative initiatives in 16 states servicing more than 300,000 customers. Key to the programs is the use of RNs as clinical care coordinators, and a PFP reimbursement structure.

And small employers are trying to stay in the race by looking into self-insurance as a way to protect themselves against potentially catastrophic medical claims, reports a new study from the Center for Studying Health System Change. Researchers say that increasingly competitive markets for stop-loss insurance and third-party administrators are making self-insurance attractive to more employers, particularly small firms with fewer than 100 workers. But the trend may pose challenges for policy makers, researchers add.

Happy Olympics viewing!

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 30, 2012
Vol. XIV, No. 28

Sponsored by:
Patient Engagement in the Patient Centered-Medical Home: A Continuum Approach

This week's industry news:

  1. Over 5.2 Million Medicare Beneficiaries Have Saved $3.9 Billion on Prescription Drugs: CMS
  2. 2011 Benchmarks in Improving Medication Adherence
  3. Patient Access, Preventive Care Key to Cigna’s Growing Accountable Care Initiatives
  4. Essential Guide to Accountable Care Organizations
  5. Healthcare Business White Paper: Diabetes Management in 2012
  6. Self-Insurance Gaining Momentum Among Small Firms
  7. New Chart: Top 5 Conditions Targeted by Embedded Case Managers
  8. Health Insurance Exchanges
  9. Expanding Medicaid to Low-Income Adults Leads to Improved Health, Fewer Deaths
  10. Futurescan 2012
  11. 4 Desired Outcomes of Embedded Case Management
  12. Case Managers in the Primary Care Practice
  13. Advocate Physician Partners’ Contract Strategy Promotes Value Over Volume
  14. Patient Engagement in the Patient-Centered Medical Home
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This week's industry news

1.) Over 5.2 Million Medicare Beneficiaries Have Saved $3.9 Billion on Prescription Drugs: CMS

More than 5 million seniors and people with disabilities have saved nearly $4 billion on prescription drugs since the ACA was first enacted, CMS officials report.

Get the full story.

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2.) 2011 Benchmarks in Improving Medication Adherence

2011 Benchmarks in Improving Medication Adherence In this resource, actionable information from 162 healthcare organizations is presented on their efforts to improve medication adherence and compliance in their populations. This second annual analysis of medication adherence programs documents the impact of these programs on adherence levels, medication costs, ER visits, hospital and nursing home admissions, risk of death and other areas of concern.

Learn more about this resource.

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3.) Patient Access, Preventive Care Key to Cigna’s Growing Accountable Care Initiatives

Cigna has added six states to its growing roster of collaborative care programs that use registered nurses and physician groups to improve health outcomes.

Get the full story.

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4.) Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model

Essential Guide to Accountable Care Organizations This resource answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating an ACO in wake of ongoing healthcare reform.



Learn more about this resource.

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

An overwhelming majority of respondents to the December 2011 "10 Questions" e-survey are using a disease-specific approach to manage diabetes. Responses to the latest Healthcare Intelligence Network survey provided qualitative data on strategies and tactics for management of this disease, program components and challenges, and outcomes, metrics and ROI, which are summarized in this white paper.

Download this complimentary white paper.

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6.) Self-Insurance Gaining Momentum Among Small Firms

A growing number of small firms are looking into self-insurance as a way to protect themselves against potentially catastrophic employee medical claims, a trend that may pose challenges for policy makers, says a new study from the Center for Studying Health System Change (HSC).

Get the full story.

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7.) New Chart: Top 5 Conditions Targeted by Embedded Case Managers

Top 5 Conditions Targeted by Embedded Case Managers 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. We wanted to see which conditions are targeted most by embedded case managers.

Click here to view the chart.

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

Health Insurance Exchanges This resource is filled with articles about the hurdles state lawmakers and stakeholders are facing in developing models and establishing exchanges, the impact of exchanges on various stakeholders, benefit design strategies, and much more.


Learn more about this resource.

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9.) Expanding Medicaid to Low-Income Adults Leads to Improved Health, Fewer Deaths

Expanding Medicaid benefits for low-income adults leads to widespread gains in coverage, access to care, and improved health and reduced mortality, according to a study from Harvard School of Public Health (HSPH).

Get the full story.

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10.) Futurescan 2012: Healthcare Trends and Implications 2012-2017

Futurescan 2012 This resource highlights eight key trends affecting the nation’s healthcare organizations. Each chapter identifies the implications of the trend and helps providers prepare for them. In this era of constant change, every healthcare leader can benefit from this report.


Learn more about this resource.

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11.) 4 Desired Outcomes of Embedded Case Management

Provider and member satisfaction is key when discussing desired outcomes of embedded case management practices, particularly from a regulatory viewpoint, says Charlene Schlude, RN, CCM, director of case management at Capital District Physicians Health Plan (CDPHP). Evaluating the medical cost trends of embedded versus telephonic case managers is also essential for establishing their viability.

Get the full story.

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12.) Case Managers in the Primary Care Practice: Tools, Assessments and Workflows for Embedded Care Coordination

Case Managers in the Primary Care Practice This resource examines two promising pilots in embedded case management: Nurse Navigators working alongside physicians in Bon Secours Health System’s Advanced Medical Home program, and Nurse Case Managers at the heart of CDPHP’s Enhanced Primary Care effort.


Learn more about this resource.

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13.) Advocate Physician Partners’ Contract Strategy Promotes Value Over Volume

Anticipating the advent of accountable care organizations, Advocate Physician Partners (APP) has crafted a value-based payment contract on its strong foundation of clinical integration.

Read this blog post.

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14.) Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach

Jay Driggers Although the healthcare industry is well-acquainted with the patient-centered medical home, the model is still quite new and novel to patients, notes, Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield of New Jersey. In this interview, Driggers describes what's at stake when moving from a reactive provider model to a proactive model.

Listen to this podcast.

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