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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Nearly one in three Americans die of cardiovascular disease (CVD), including heart disease and stroke, each year, according to the latest Vital Signs report from the CDC. In 2010 alone, more than 200,000 deaths from CVD occurred, with more than half happening to people younger than 65 years of age.

Most CVD can be managed or prevented in the first place by addressing risk factors, such as reducing blood pressure and cholesterol and quitting smoking, CDC officials say, and they offer a list of recommendations for providers, communities and health departments for reducing the death rates.

Contrary to reports that individual health insurance policy costs will jump steeply under the ACA, there will be no widespread premium increase, according to a RAND analysis of 10 states and the United States.

There will be widespread differences in individual policy costs from state to state, however, as well as an increase in health insurance coverage and higher enrollment among people who purchase individual policies.

RAND researchers predicted how the ACA will likely change cost and coverage patterns in both the individual market and small group market in 10 states, including Florida, Kansas, Louisiana, Minnesota and New Mexico. Costs will be influenced by a specific range of individual factors, including age, tobacco use, geographic location, family size and amount of coverage purchases.

Geographic diversity is at the root of another study from the Center for Studying Health System Change (HSC). According to the report, hospital prices for privately insured patients — especially for outpatient care — are much higher than Medicare and vary widely within and across communities.

Within individual communities prices vary widely, even after accounting for differences in the complexity of services provided. The highest-priced hospital typically is paid 60 percent more for the same inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient services, with the highest-priced hospital typically paid nearly double the lowest-priced hospital, according to the study.

In contrast to hospital prices, prices for PCP services generally are close to Medicare rates and vary little within markets, the study found. Prices for specialist physician services, however, are higher relative to Medicare and vary more within and across markets.

And lastly, forget yesterday's house calls: doctor and dusty medical bag tending a swooning patient. Today's home visits provide a unique perspective on the patient experience while helping individuals meet everyday needs, avoid rehospitalization or an ER visit, and connect with community resources. Describe how your organization employs home visits by September 10, 2013 and you will receive a free summary of compiled survey 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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September 9, 2013
Vol. XV, No. 33

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


This week's industry news:

  1. 200,000 Heart Attacks, Stroke Deaths Could Have Been Prevented in 2010: CDC
  2. Chronic Care Professional Manual 5.0
  3. No Widespread Jump in Cost of Individual Health Insurance Under ACA
  4. AISís Directory of Health Plans: 2013
  5. Healthcare Business White Paper: Care Transitions in 2013
  6. Cigna Expands Medical Home, Chronic Care Services with Alegis Care Acquisition
  7. New Chart: Top 5 Technologies Used in Telehealth
  8. 2012 Healthcare Benchmarks: The Patient-Centered Medical Home
  9. Wide Price Variation for Privately Insured Underscores Hospital Market Power
  10. Achieving High Value Healthcare
  11. 3 Steps to a CMS Star Quality Improvement Roadmap
  12. Formula for CMS Five-Star Quality Population Health Management
  13. HINfographic: Medicare Pioneer ACO Year One, Lessons from a Top Performer
  14. Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements
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This week's industry news

1.) 200,000 Heart Attacks, Stroke Deaths Could Have Been Prevented in 2010: CDC

More than 200,000 deaths from heart disease and stroke in the United States in 2010 could have been prevented, according to a new Vital Signs report from the CDC, and more than half of these deaths happened to people younger than 65 years of age.

Get the full story.

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2.) Chronic Care Professional Manual 5.0

Chronic Care Professional Manual 5.0 This resource is the definitive guide to the practice of population health improvement and health coaching for lifestyle management, shared decision-making, treatment adherence and disease self-care support.




Learn more about this resource.

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3.) No Widespread Jump in Cost of Individual Health Insurance Under ACA

Contrary to reports that individual health insurance policy costs will jump steeply under the ACA, there will be no widespread premium increase, according to a RAND analysis of 10 states and the United States.

Get the full story.

>>Return to this week's industry news


4.) AISís Directory of Health Plans: 2013

AISís Directory of Health Plans: 2013 This resource contains enrollment data for all types of health plans, including commercial HMOs/PPOs/POS, Medicare and Medicaid HMOs, state government-run plans such as Medicaid FFS, PCCM, PCIP, SCHIP and other local community plans, managed FFS plans, and other types of primary medical insurance plans offered in the U.S. as of year-end 2012, so you can track trends in product design, funding and market sectors.

Learn more about this resource.

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5.) Healthcare Business White Paper: Care Transitions in 2013 — Interventions Surge in Response to Payor Scrutiny; Home-Grown Approaches Trump Traditional Models

Care Transitions in 2013 In its third annual e-survey on Care Transition Management, the Healthcare Intelligence Network (HIN) captured efforts by 86 organizations to strive for Triple Aim goals of better care at improved cost during transitions of care. Conducted in April 2013, the survey measures existing and planned programs, targeted transitions and populations, transition team members and responsibilities, and much more. This HINtelligence Report provides data highlights on care transition program components, the most successful tools for care transition management, results and ROI; and much more.

Download this complimentary white paper.

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6.) Cigna Expands Medical Home, Chronic Care Services with Alegis Care Acquisition

Designed to expand its medical home and chronic care services, Cigna acquired Alegis Care, a portfolio company of Triton Pacific Capital Partners. The acquisition will enable Cigna-HealthSpring to manage services as part of a coordinated care strategy for seniors.

Get the full story.

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7.) New Chart: Top 5 Technologies Used in Telehealth

New Chart: Top 5 Technologies Used in Telehealth More than 10 million Americans directly benefited from a telemedicine service during the past year, according to American Telemedicine Association estimates. Telehealth's broad reach encompasses telemedicine — the use of telecommunications technology to deliver clinical diagnosis, services and patient consultations — as well as the exploding field of mobile health. We wanted to see the types of technologies used in telehealth programs.

Click here to view the chart.

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8.) 2012 Healthcare Benchmarks: The Patient-Centered Medical Home

2012 Healthcare Benchmarks: The Patient-Centered Medical Home This resource continues to track medical home participation in ACOs; the explosion of practice-based case management in the medical home; medical home accreditation and recognition pathways; and the impact of the healthcare reform law that recently survived a U.S. Supreme Court challenge.


Learn more about this resource.

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9.) Wide Price Variation for Privately Insured Underscores Hospital Market Power

Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients ó especially for outpatient care ó are much higher than Medicare and vary widely within and across communities, according to a new study by the Center for Studying Health System Change (HSC).

Get the full story.

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10.) Achieving High Value Healthcare: Metrics from Medical Homes, Accountable Care and Case Management

Achieving High Value Healthcare This resource looks at efforts by nearly 450 healthcare organizations to reshape healthcare delivery via a trio of emerging care models: the patient-centered medical home (PCMH), the accountable care organization (ACO), and case management.


Learn more about this resource.

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11.) 3 Steps to a CMS Star Quality Improvement Roadmap

Because not all CMS Five-Star Quality Ratings measures are created equal, organizations seeking to improve their ratings need to have a strategy in place, says Joseph Johnson, vice president of L.E.K. Consulting. Finding an area with the greatest financial opportunities is part of Johnsonís three-step approach to star improvement efforts.

Get the full story.

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12.) Formula for CMS Five-Star Quality Population Health Management

Formula for CMS Five-Star Quality Population Health Management This resource examines star quality improvement strategies, including Kaiser Permanenteís successful care management efforts that have made it a leader in the five-star space.




Learn more about this resource.

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13.) HINfographic: Medicare Pioneer ACO Year One, Lessons from a Top Performer

Pioneer ACOs have earned over $76 million in bonus payments by providing coordinated, quality care, according to the Centers for Medicare and Medicaid Services (CMS). The keys to success in year one of the Medicare Pioneer ACO for Monarch HealthCare, as shown in this HINfographic, were engaging vulnerable patients in the ACO and developing a strategy to align non-contracted physicians.

Read this blog post.

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14.) Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements

Greg Mertz Travis Ansel Physician-hospital organizations have been around before, but it's the emphasis on quality that sets today's PHO apart from the 80's version. In PHO 2.0, where healthcare value is favored over volume, clinical integration of participating physicians is a prerequisite, agree Greg Mertz, director of Healthcare Strategy Group, and Travis Ansel, its manager of strategic services. In this interview, they talk about the essential first steps of PHO creation and the perennial challenges of physician engagement and clinical leadership in this emerging collaborative model.

Listen to this podcast.

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