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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

The coverage on the games continues, with Americans winning two more gold medals and…oops, wrong story.

The coverage on Medicaid expansion continues, with a new study from the University of Michigan’s Center for Healthcare Research & Transformation, which finds that there are currently at least 40 different ways for Michigan residents to qualify for Medicaid, and each category has varying eligibility requirements. In 2014, the ACA will require states to streamline eligibility criteria and simplify enrollment, enabling more people to obtain coverage. All categories, mandated or optional, will be placed into three categories. Michigan has not declared whether it will opt-in to expand Medicaid as of yet.

General acute care and long-term care hospitals will receive payment increases under a final rule from CMS. The agency is projecting that total Medicare spending on inpatient hospital services will increase by about $2 billion in FY 2013 relative to FY 2012. Other related provisions in the final rule include a central line-associated bloodstream infecton measure that rewards hospitals for avoiding the kinds of life-threatening blood infections that can develop during inpatient hospital stays, and a hospital readmissions reduction incentive program.

Reducing readmissions is one of the goals of a new pilot program from Johns Hopkins, which finds specially trained nurse-pharmacist teams to be highly effective in preventing medication errors among those patients admitted to or recently discharged from the hospital. These teams are being used to find discrepancies between drugs patients are taking at home and those they are scheduled to take in the hospital, ultimately improving patient safety and reducing the high cost of avoidable readmissions.

Cost savings take center stage again in a new accountable care collaboration between Aurora Health Care and Aetna, that offers price guarantees to employers. In what is possibly the first of its kind among such healthcare models, say Aetna officials, employers could potentially get an average 10 percent reduction based on their past claims expenses. The plans are designed to provide more coordinated, personalized experience for patients and better healthcare outcomes.

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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August 6, 2012
Vol. XIV, No. 29

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

This week's industry news:

  1. Medicaid Changes Under the ACA Will Simplify Enrollment, Reduce Number of Uninsured in Michigan
  2. Medicaid Compliance Strategies for Hospitals and Other Providers
  3. Nurse-Pharmacist Collaboration Could Prevent Medication Errors and Reduce Readmissions
  4. 2012 Healthcare Benchmarks: Reducing Hospital Readmissions
  5. Healthcare Business White Paper: Accountable Care Organizations in 2012
  6. Aetna, Aurora ACO Offers Price Guarantee to Employers
  7. New Chart: Which Populations Participate in ACOs?
  8. Roadmap to the ACO Rule
  9. CMS Final Rule Increases Payments to Hospitals, Seeks to Improve Patient Care
  10. Case Study in Bundled Payments
  11. Key Challenges of Transforming to a Medical Home Model
  12. Guide to Physician Performance-Based Reimbursement
  13. 13 States Cutting Medicaid Benefits
  14. Bending the Cost Curve with a Commercial Value-Based Payment Contract
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Health & Wellness Incentives in 2012

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This week's industry news

1.) Medicaid Changes Under the ACA Will Simplify Enrollment, Reduce Number of Uninsured in Michigan

Medicaid changes effective in 2014 under the ACA will streamline eligibility categories and help between 400,000 and 500,000 citizens to become newly eligible for Medicaid coverage in Michigan, according to the Center for Healthcare Research & Transformation (CHRT), which is based at the University of Michigan.

Get the full story.

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2.) Medicaid Compliance Strategies for Hospitals and Other Providers

Medicaid Compliance Strategies for Hospitals and Other Providers This resource is filled with articles that will help Medicaid providers understand what to expect when state or federal auditors come calling, and show how certain facilities handled major cases and settlements.



Learn more about this resource.

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3.) Nurse-Pharmacist Collaboration Could Prevent Medication Errors and Reduce Readmissions

Specially created nurse-pharmacist teams could help to prevent medication errors among those patients admitted to or recently discharged from the hospital, according to a new pilot study from Johns Hopkins.

Get the full story.

>>Return to this week's industry news


4.) 2012 Healthcare Benchmarks: Reducing Hospital Readmissions

2012 Healthcare Benchmarks: Reducing Hospital Readmissions This resource is designed to meet business and planning needs of hospitals, health plans, managed care organizations, physician practices and others by 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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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). This year’s survey provided new data on other healthcare professionals in the ACO, ACO reimbursement models, and ACO impact. Respondents said care coordination has improved as a result of ACO activity, and hospital readmissions for patients in ACOs has declined.

Download this complimentary white paper.

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6.) Aetna, Aurora ACO Offers Price Guarantee to Employers

A new accountable care collaboration between Aurora Health Care and Aetna is offering a price guarantee to employers that their model will improve quality, outcomes and the patient experience.

Get the full story.

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7.) New Chart: Which Populations Participate in ACOs?

Which Populations Participate in ACOs? Participation in accountable care initiatives has more than doubled in the last 12 months, and 76 percent of healthcare companies include Medicare beneficiaries in their ACOs. However, the number of ACOs with Medicaid participants dropped from 44 percent in 2011 to 22 percent in 2012. We wanted to see which other populations participate in ACOs.

Click here to view the chart.

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8.) Roadmap to the ACO Rule: 25 Key Considerations from CMS’s Proposal for Accountable Care Organizations

Roadmap to the ACO Rule This resource extracts 25 common sense factors to consider while weighing participation in an accountable care organization (ACO) — whether as a healthcare provider or private payor.



Learn more about this resource.

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9.) CMS Final Rule Increases Payments to Hospitals, Seeks to Improve Patient Care

CMS has issued a final ruling increasing payments by nearly 3 percent for inpatient stays at general acute care and long-term care hospitals (LTCHs), and provisions for improving patient care.

Get the full story.

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10.) Case Study in Bundled Payments: The Baptist Health System Experience

Case Study in Bundled Payments This resource documents the care payment experience of Baptist Health System in the CMS ACE demonstration pilot, which aligned payment for services delivered across episodes of care or “bundled” care. ACE focused on the cardiac and orthopedic diagnosis-related group (DRGs), two of the public payor’s most frequent and largest cost disease areas.

Learn more about this resource.

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11.) Key Challenges of Transforming to a Medical Home Model

Establishing a team-based care environment is key toward transforming to a medical home model, says Dr. Paul Kaye, medical director at Taconic IPA. Revamping and improving on patient accessbility, and scheduling and improving existing documentation procedures are also key challenges of the process.

Get the full story.

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

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

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13.) 13 States Cutting Medicaid Benefits

Despite a new study from the Harvard School of Public Health (HSPH) touting the benefits of expanded Medicaid for the elderly and disabled, many states are cutting Medicaid benefits in order to balance their budgets.

Read this blog post.

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14.) Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners

Dr. Carrie Nelson A value-based contract between Advocate Physician Partners (APP) and Blue Cross Blue Shield of Illinois (BCBSIL) has reduced inpatient admissions and emergency room visits and has bent the cost curve after its first year. In this interview, Dr. Carrie Nelson, APP's medical director for special projects, describes how APP's eight-year clinical integration of 4,000 physicians and 10 hospitals has laid the groundwork for this value-based contract.

Listen to this podcast.

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