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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Contrary to popular opinion, young adults between the ages of 19 and 26 do not think they’re immortal and do think they need health insurance. In fact, according to a study from The Commonwealth Fund, if members of this population don’t have health insurance, it’s because they can’t afford it.

Nearly half of the 15 million young adults enrolled in a parent’s health plan last year most likely would not have been eligible for coverage without the health reform law’s dependent coverage provision.

The survey also found that only 27 percent of young adults were aware of the state health insurance marketplaces launching October 1. The demographic that would benefit most from these marketplaces are those without coverage and those from low- or middle-income households, or, those least likely to be aware of them.

But these young adults, and all other adults, can seek out help through a coterie of navigators funded by the HHS. The agency has granted $67 million to 105 applicants in federally run and state partnership marketplaces, for navigators trained to help Americans who need assistance in shopping for and enrolling in plans in the health insurance marketplaces beginning this fall.

Navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new HIEs, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program (CHIP). Funding was available to eligible private and public groups and the self-employed who met certain standards to promote effectiveness, diversity, and program integrity, HHS officials say.

If all the health reform changes have made Americans’ blood pressure soar, there is help: a large scale study from Kaiser Permanente found that single pill combinations and consistent follow-ups with hypertension patients helped improve the rate of blood pressure control by nearly twice as much. Through one of the largest community-based hypertension programs in the nation, Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009, helping to reduce the risk of stroke and heart attack for patients.

And speaking of soaring, accountable care organizations are flooding the healthcare landscape; with the number of public and private ACOs nearing 500, participants and pundits alike are looking more closely at the model's structure, challenges and benefits.

How is your organization participating in ACOs? Take HIN's third annual survey on ACOs by September 6, 2013 and receive a FREE executive summary of the compiled results.

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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August 26, 2013
Vol. XV, No. 32

Sponsored by:
Medicare Pioneer ACO Year One — Lessons from a Top-Performer


This week's industry news:

  1. Young Adults Value Health Insurance But Can’t Afford It
  2. Healthcare Trends & Forecasts in 2013
  3. Navigators Guide Consumers through Health Insurance Marketplace
  4. Health Insurance Exchanges
  5. Healthcare Business White Paper: Mobile Health in 2013
  6. Blood Pressure Control Rates Nearly Double with Kaiser Permanente Program
  7. New Chart: Where are Case Managers Embedded?
  8. Guide to Improving Medication Adherence
  9. Patient-Clinician Communication Critical During Transitional Care: Study
  10. Guide to Care Transition Management
  11. 6 Best Practices for Physician Pay-for-Performance Programs
  12. Guide to Value-Based Reimbursement
  13. Infographic: Home Health Patients Versus All Medicare Beneficiaries
  14. Health Coaching’s Value in Accountable Care and Medical Homes
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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Accountable Care Organizations in 2013

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This week's industry news

1.) Young Adults Value Health Insurance But Can’t Afford It

Nearly half of the 15 million young adults enrolled in a parent’s health plan last year most likely would not have been eligible for coverage without the health reform law’s dependent coverage provision, according to a new Commonwealth Fund survey.

Get the full story.

>>Return to this week's industry news


2.) Healthcare Trends & Forecasts in 2013: Performance Expectations for the Healthcare Industry

Healthcare Trends & Forecasts in 2013 This resource provides sector-specific guidance for the next 12 months from three key thought leaders in HIN’s ninth annual industry forecast.




Learn more about this resource.

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3.) Navigators Guide Consumers through Health Insurance Marketplace

Designed to help consumers navigate the health insurance marketplaces (HIEs), the HHS has granted $67 million in awards to 105 applicants in federally run and state partnership marketplaces.

Get the full story.

>>Return to this week's industry news


4.) Health Insurance Exchanges: Product Design, Promotion and Positioning

Health Insurance Exchanges This resource features insights from key industry consultants, state regulators and health insurers on the primary issues that will affect product designs for state health insurance exchanges.



Learn more about this resource.

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5.) Healthcare Business White Paper: Mobile Health in 2013 — Diabetes, Heart Disease Top Targets for Technologies

Mobile Health in 2013 The use of mobile health (mHealth) technologies has transformed the exchange of healthcare data, with mobile apps monitoring everything from blood sugar to medication adherence, and text-based reminders urging smokers not to give into that craving. In its first mHealth e-survey conducted in March 2013, the Healthcare Intelligence Network (HIN) captured current trends in emerging mHealth technologies. Nearly 150 healthcare organizations describe the technologies they use, the conditions and populations they target, and the challenges and successes they've encountered along the way.

Download this complimentary white paper.

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6.) Blood Pressure Control Rates Nearly Double with Kaiser Permanente Program

Single pill combinations and consistent follow-ups with hypertension patients helped improve the rate of blood pressure control by nearly twice as much, according to a study at Kaiser Permanente, as reported in the Journal of the American Medical Association (JAMA).

Get the full story.

>>Return to this week's industry news


7.) New Chart: Where are Case Managers Embedded?

New Chart: Where are Case Managers Embedded? According to nearly 57 percent of healthcare companies, the primary care office is where their case managers are embedded. We wanted to see at which other care sites case managers are embedded.

Click here to view the chart.

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8.) Guide to Improving Medication Adherence

Guide to Improving Medication Adherence This resource analyzes trends in improving medication adherence at more than 160 healthcare companies, and takes an in-depth look at pioneering efforts by Kaiser Permanente Colorado and CIGNA Pharmacy Management to improve medication compliance levels in their populations.


Learn more about this resource.

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9.) Patient-Clinician Communication Critical During Transitional Care: Study

One in five patients are ending up back in the hospital due to faulty communication between doctors and patients, according to two studies from Yale School of Medicine, and published in the Journal of Hospital Medicine (JHM), and JAMA Internal Medicine (JAMA IM).

Get the full story.

>>Return to this week's industry news

10.) Guide to Care Transition Management

Guide to Care Transition Management This resource delivers a comprehensive set of 2013 transitional care management benchmarks from 86 companies as well as select metrics from related interventions influencing the quality of care transitions: Medication Adherence, Reducing Readmissions, Case Management, Patient-Centered Medical Home and Health Coaching.


Learn more about this resource.

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11.) 6 Best Practices for Physician Pay-for-Performance Programs

In order to ensure the success of a best practice project for pay-for-performance programs, there are several requirements, including finding a physician to champion and truly lead it, and targeting as large a population as possible, explains Julie Hobson, RN, BSN, manager of provider engagement, performance and partnership at Highmark, Inc.

Get the full story.

>>Return to this week's industry news


12.) Guide to Value-Based Reimbursement: Profiting from Payment Bundling, PHO Shared Savings, and Pay for Performance

Guide to Value-Based Reimbursement This resource explores emerging models of episode-based payments, physician-hospital organizations (PHOs) and physician bonus structures.




Learn more about this resource.

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13.) Infographic: Home Health Patients Versus All Medicare Beneficiaries

In recent years, the home health benefit has been hit with spending cuts, which have the potential to directly impact the services offered to vulnerable Medicare recipients. Seventy-eight percent of Medicare's Home Healthcare Patients are non dual-eligible patients and are not covered by Medigap insurance, according to a new infographic from the Partnership for Quality Home Healthcare. This infographic explains the differences between Medicare home health beneficiaries and the average Medicare beneficiary, as well as the most chronic conditions treated by home health.

Read this blog post.

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14.) Health Coaching’s Value in Accountable Care and Medical Homes

William Appelgate Primary care and the patient-centered medical home offer a great opportunity for health coaches to become allies with patients in improvement of their health, notes William Appelgate, executive director of the Iowa Chronic Care Consortium. Individuals with the highest health risks should be given priority, but those on the cusp of a serious health event also merit coaching assistance, he says. For providers new to the coaching conversation, Appelgate shares three benefits of incorporating health coaches in the care process — including the upping of their ‘outcomes game.’

Listen to this podcast.

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