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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Less is more, at least when it comes to the use of stents.

Thatís the conclusion of a recent study published by the American Heart Association that states that limiting the use of drug-eluting stents saves the United States $400 million a year in healthcare costs. The stents, when used on selected patients, did not increase the risk of death or heart attack, and only slightly raised the need for repeat angioplasty procedures. Studies show that nearly 1 million angioplasty procedures are performed in the United States annually. You can read more on this subject in the HIN blog.

In other news, improving preventive and chronic care helped the University of Michigan (U-M) to save Medicare more than $22 million during a five-year Physician Group Practice Demonstration (PGPD), which was designed to show the potential benefits of ACOs. A new transitional care program assisting patients with hospital discharge and follow-up was one of the ways the health system successfully achieved savings.

And HHS has awarded $185 million in grants to 13 states and the District of Columbia to help them establish new state-based health insurance marketplaces. The agency is hoping that individuals, families and small businesses will be able to use the exchanges to purchase private health insurance beginning in 2014.

And lastly, donít forget to participate in our second annual survey on medication adherence. You'll receive a free executive summary of the survey results once they are 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

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August 22, 2011
Vol. XIII, No. 31

Sponsored by:
The Role of Embedded Case Managers in Clinical Transformation

This week's industry news:

  1. U-M's Care Strategies Save Medicare $22 Million, Demonstrate ACO Benefits
  2. Blueprint for ACO Success
  3. HHS Awards $185 Million to Establish Affordable Insurance Exchanges
  4. Health Reform 2011
  5. Healthcare Business White Paper: Role Based Access Governance and HIPAA Compliance
  6. Selective Stent Use Saves $400 Million/Year in U.S. Healthcare Costs
  7. New Table: Regular Meetings Reduce Core Measure 'Misses'
  8. 2011 Benchmarks in Reducing Avoidable Healthcare Utilization
  9. Keys to Success in the ACO
  10. Roadmap to the ACO Rule
  11. APCD Proposes New Uniform Medical Claims Payor Reporting Standard
  12. Guide to Physician Performance-Based Reimbursement
  13. HealthSounds Podcast: Redesigning the Physician Practice for Improved Efficiency, Increased Revenue
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.

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Take our monthly e-survey:
Medication Adherence in 2011

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


This week's industry news

1.) U-M's Care Strategies Save Medicare $22 Million, Demonstrate ACO Benefits

Improving preventive and chronic care helped the University of Michigan (U-M) to save Medicare more than $22 million during a five-year demonstration project.

Get the full story.

>>Return to this week's industry news


2.) Blueprint for ACO Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization

Blueprint This 40-page resource will prepare healthcare organizations considering an ACO for clinical and regulatory success. Areas covered include anticipating the mandates of the CMS Shared Savings program; achieving and maintaining compliance with state and federal regulations governing healthcare while positioning for possible changes; developing a multi-disciplinary compliance approach; and creating policies and procedures for ongoing compliance monitoring.

Learn more about this resource.

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3.) HHS Awards $185 Million to Establish Affordable Insurance Exchanges

HHS has awarded more than $185 million in grants to 13 states and the District of Columbia to help them establish new state-based health insurance marketplaces.

Get the full story.

>>Return to this week's industry news


4.) Health Reform 2011: Impact on Health Plans, Hospitals, Providers and Purchasers

Health Reform 2011 Packed with articles and illustrations, this 165-page comprehensive report outlines the likely impact of health reform on coverage, benefit designs, medical costs, providers and pharmacy benefits. Special sections also address the impact on employers, the transformation of the Medicare and Medicaid programs and the radical changes to fraud, abuse and compliance initiatives.

Learn more about this resource.

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5.) Healthcare Business White Paper: Role Based Access Governance and HIPAA Compliance — A Pragmatic Approach

The Health Information Technology for Economic and Clinical Health Act (HITECH) imposes more stringent regulatory and security requirements to the privacy rules of HIPAA. Compliance with the letter of the guideline can be difficult for organizations without strong access governance processes and policies. This paper focuses on a set of best practices for implementing an access governance framework and the specific access controls requirements for HIPAA/HITECH.

Download this complimentary white paper.

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6.) Selective Stent Use Saves $400 Million/Year in U.S. Healthcare Costs

Limiting the use of drug-eluting stents (DES), which began in 2007, is saving the United States nearly $400 million in healthcare costs annually, researchers say.

Get the full story.

>>Return to this week's industry news


7.) New Table: Regular Meetings Reduce Core Measure 'Misses'

Regular Meetings Reduce Core Measure 'Misses' With CMS moving toward a value-based purchasing system effective October 2012, the industry is struggling to improve core measurement scores before reimbursement levels are impacted. We wanted to see what organizations can do to improve their core measure scores.


Click here to view the chart.

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8.) 2011 Benchmarks in Reducing Avoidable Healthcare Utilization: Data to Drive Down ER Visits and Readmissions

2011 Benchmarks in Reducing Avoidable Healthcare Utilization This 100-page resource takes a comprehensive look at industry activity in the reduction of hospital readmissions and ER visits as a whole, then drills down to the health plan and hospital perspectives presented by survey respondents. The utilization reduction data documented in this benchmarks report are derived from two separate surveys conducted in 2010 by the Healthcare Intelligence Network.

Learn more about this resource.

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9.) Keys to Success in the ACO

As the industry awaits CMSís final ruling on ACOs, we look over some recommendations for success in the ACO models from Greg Mertz, senior project director with the Healthcare Strategy Group.

Get the full story.

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

Roadmap to the ACO Rule Embedded within the 400-plus pages of the Centers for Medicare and Medicaid Services' proposed rule for its Medicare Shared Savings Program are a few dozen key considerations for healthcare organizations evaluating the ACO opportunity. This 22-page quick reference extracts 25 common sense factors to consider while weighing participation in an ACO — whether as a healthcare provider or private payor.

Learn more about this resource.

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11.) APCD Proposes New Uniform Medical Claims Payor Reporting Standard

The All-Payor Claims Database (APCD) Council and the Accredited Standards Committee X12 (ASC X12) have announced a new initiative to develop a Uniform Medical Claims Payor Reporting Standard.

Get the full story.

>>Return to this week's industry news


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.) HealthSounds Podcast: Redesigning the Physician Practice for Improved Efficiency and Increased Revenue

>Dr. David Eitrheim In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don't have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim described how his practice's team-based approach has changed the nature of the patient visit as well as the nurses' workload, and provides the secret to a productive patient visit.

Listen to this podcast.

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