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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

The Affordable Care Act (ACA) continues to make headlines, as many online health insurance marketplaces struggle to meet the overwhelming consumer demand of healthcare seekers, and, at least at press time, the government continues to wrestle its merits as the country remains in shutdown mode.

Nearly 85 percent of the health plans offered in the health insurance marketplaces that were scheduled to launch last week are accredited by the National Committee for Quality Assurance (NCQA), the organization reports. Officials say the surge of nearly 60 health plans seeking accreditation prior to the October 1st launch date was one of the largest in NCQA’s 23-year history. Hundreds of other plans that already held NCQA accreditation modified it in order to participate in the exchange marketplaces.

Those who stand to benefit the most from the ACA are newly-insured consumers under an expanded Medicaid program, according to a new RAND Corporation study.

While out-of-pocket medical expenses for most Americans will decline with the new healthcare law, the estimated 11 million Americans who become newly-insured under Medicaid can expect to save approximately $1,420 annually in out-of-pocket expenses, researchers say. Those Americans who become newly insured but don't qualify for government subsidies will most likely see the largest increases in medical spending as they begin paying premiums for health coverage.

The report also details the findings of states that have chosen not to expand Medicaid, and discusses the clearest benefit of the law.

In other news, two healthcare organizations, naviHealth and Cigna-HealthSpring, have joined forces to maximize their acute patient care and outcomes and help reduce escalating costs. The collaboration will utilize naviHealth’s technology (which facilitates better evidenced-based decision-making), and acute inpatient case management processes for Cigna-HealthSpring members receiving skilled nursing facility (SNF) services. Expected benefits of the partnership for Cigna-HealthSpring and its members include improved patient satisfaction with personalized care plans, and more informed and efficient care delivery.

Informed and efficient care delivery also prompted researchers from Penn Medicine to study whether busy intensive care units (ICUs) discharge patients more quickly than usual, compromising patient care and outcomes.

Anticipating increased numbers of patients requiring critical care resources, and a projected shortage in critical care providers, researchers assumed there would be increased competition for ICU beds among greater numbers of more seriously ill patients, and shorter periods of time available in the ICU, leading to declining health outcomes. But researchers found the opposite: reductions in the number of U.S. ICU beds could yield considerable cost savings without reducing the quality of care. The study's findings have important implications for planning U.S. critical care capacity, researchers note.

It’s not too late to participate in our online survey, Health Risk Assessments in 2013. Sophisticated analytics behind today's health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material for the development of prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health by October 15, 2013 and get 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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October 7, 2013
Vol. XV, No. 37

Sponsored by:
Improving Population Health With Embedded Case Managers in an Open, Multi-Payor Community


This week's industry news:

  1. NaviHealth/Cigna-HealthSpring Partner to Improve Post-Acute Care, Costs
  2. 2013 Healthcare Benchmarks: Case Management
  3. Intensive Care Units Do Better Under Pressure: Study
  4. 33 Metrics for Care Transition Management
  5. Healthcare Business White Paper: Mobile Health in 2013
  6. Affordable Care Act Will Reduce Out-of-Pocket Medical Spending for Many Americans
  7. New Chart: Greatest Challenges of Embedding a Case Manager
  8. Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management
  9. 4 Out of 5 Marketplace Health Plans Hold NCQA Accreditation
  10. Health Insurance Exchanges
  11. 4 Steps to Creating a Care Management Team
  12. Tactics from a Top-Performing Pioneer ACO
  13. Infographic: The Current State of EHRs
  14. Embedding Case Managers in an Open, Multi-Payor Community
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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This week's industry news

1.) NaviHealth/Cigna-HealthSpring Partner to Improve Post-Acute Care, Costs

Hoping to improve care quality and outcomes for an estimated 100,000 post-acute patients in the heavily populated Mid-Atlantic and Pennsylvania markets, Cigna-HealthSpring and naviHealth are joining forces, according to releases from both organizations.

Get the full story.

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2.) 2013 Healthcare Benchmarks: Case Management

2013 Healthcare Benchmarks: Case Management This resource provides actionable information from 118 healthcare organizations on the prominence, placement and responsibilities of case managers as well as case management-driven outcomes in healthcare utilization, cost and compliance.


Learn more about this resource.

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3.) Intensive Care Units Do Better Under Pressure: Study

Busy ICUs discharge patients more quickly than usual, but they do so without compromising patient care and outcomes, suggesting that low-value extensions of ICU stays are minimized during times of increased ICU capacity strain, according to a new study from Penn Medicine.

Get the full story.

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4.) 33 Metrics for Care Transition Management

33 Metrics for Care Transition Management This resource provides a graphic compendium of performance benchmarks in key areas impacting care transitions — from key tasks performed at hospital discharge to the prevalence of home visits in programs to improve medication adherence.


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.) Affordable Care Act Will Reduce Out-of-Pocket Medical Spending for Many Americans

While out-of-pocket medical expenses for most Americans will decline with the Affordable Care Act (ACA), newly insured consumers under an expanded Medicaid program will save the most money, according to a new RAND Corporation study.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Greatest Challenges of Embedding a Case Manager

New Chart: Greatest Challenges of Embedding a Case Manager Care coordination by healthcare case managers is helping to drive clinical and financial outcomes in population health management and bolster emerging models of care such as the patient-centered medical home and the accountable care organization. We wanted to see what challenges healthcare organizations face when embedding a case manager.

Click here to view the chart.

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8.) Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management

Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management This webinar shares Wellcare’s strategy for meeting a broad spectrum of a member’s needs with community-based services and how these partnerships contribute to the engagement of duals in self-management of their care.

Learn more about this resource.

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9.) 4 Out of 5 Marketplace Health Plans Hold NCQA Accreditation

Almost 85 percent of the health plans offered in the Health Insurance Marketplaces that launched last week are accredited by the National Committee for Quality Assurance (NCQA).

Get the full story.

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

Health Insurance Exchanges: Product Design, Promotion and Positioning This resource provides a comprehensive overview of this new health insurance marketplace, and outlines factors that are driving carriers’ decisions to participate in exchanges, and includes strategies that will help providers plan for operational costs and challenges to exchange participation, such as enrollment and billing hurdles.


Learn more about this resource.

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11.) 4 Steps to Creating a Care Management Team

Developing a population disease profile, and targeting large patient populations with a fairly common list of conditions, is one of the first steps necessary to developing an effective care management team for the ACO, explains Colin LeClair, executive director of accountable care at Monarch HealthCare.

Get the full story.

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12.) Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care

Tactics from a Top-Performing Pioneer ACO This resource provides first-year advice from Monarch HealthCare’s Medicare accountable care organization, one of 32 original CMS Pioneer ACOs engaged to test alternative payment and program design models for accountable care organizations.


Learn more about this resource.

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13.) Infographic: The Current State of EHRs

More than half of all physicians already use electronic health records (EHRs). While 50 percent of physicians are satisfied with their EHR's features and functionality, 17 percent of EHR users are considering switching systems by the end of 2013, according to a new infographic from CDW Healthcare. This infographic also provides details and statistics about meaningful use, patient engagement, EHR satisfaction and online health.

Read this blog post.

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14.) Embedding Case Managers in an Open, Multi-Payor Community

Annette Watson There's education, there's experience, and then there’s the 'right stuff' — the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA's requirements for the RN case managers it hires for its advanced patient-centered medical homes.

Then there are the not insignificant contributions of the RN case manager to accountable and patient-centered care, which Ms. Watson describes in this interview.

While staff-buy-in and communication continue to challenge the embedded case manager model, the participant in CMS Innovation Center's Comprehensive Primary Care (CPC) initiative says reimbursement for embedded case management is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform.

Listen to this podcast.

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