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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Are physicians prescribing unnecessary medications or performing unnecessary tests?

That is the $64,000...err, $6.7 billion dollar question this week, given the results of a recent study from Mount Sinai Research. The answer? Well, according to this data, 86 percent of the excess spending is attributed to the prescription of brand-name rather than generic statin medications for the treatment of high cholesterol. Other reported areas of excess spending included the over-prescription of antibiotics for sore throats in children ($116 million in costs) unnecessary bone density scans ordered for younger women ($527 million in costs) and needless CT scans, MRIs, and x-rays for people with back pain ($175 million) We list more details in this issue.

Also contributing to excess healthcare costs — $17 billion annually — are hospital readmissions, which persist, especially among the elderly. According to a new Dartmouth Atlas Project Report, roughly one in six Medicare patients end up back in the hospital within 30 days of being discharged for a medical condition. Given the upcoming financial penalties from CMS for excessive readmissions, hospitals need to address this problem. One place to start could be by maintaining contact with the patient upon discharge: the Dartmouth study also found that more than half of Medicare patients discharged home do not see their primary care physician within two weeks of leaving the hospital.

And here’s one possible solution: embedded case managers. They were crucial to CDPHP’s clinical transformation, helping chronically ill patients to better manage their diseases and helping to reduce hospitalizations and costs and improve quality of life.

Another possible strategy? The new medication adherence tool being introduced by Merck. Targeting the high percentage of Americans that fail to take their medications as directed, Merck is hoping its online Web site will help consumers stay on course with treatment and have more informed discussions with their physicians about the medications they have been prescribed.

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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October 10, 2011
Vol. XIII, No. 37

Sponsored by:
Evaluating CMS' Bundled Payment Initiative: Operational, Financial and Clinical Considerations

This week's industry news:

  1. 1 in 6 Medicare Patients Readmitted to Hospital Within 30 Days
  2. Guide to Reducing Medicare Readmissions, Vol. II
  3. Merck Introduces New Medication Adherence Tools for Consumers
  4. 2010 Benchmarks in Improving Medication Adherence
  5. Healthcare Business White Paper: Patient Flow Logistics and Tracking Software
  6. Motivations for Developing an SNF Care Coordination Network
  7. New Chart: Top 5 Ways to Fund Telehealth
  8. Care Transitions Toolkit
  9. CDPHP Calls Embedded Case Managers 'Crucial' to Clinical Transformation
  10. Best Practices in Contemporary Case Management
  11. Mount Sinai Research: $6.7 Billion Spent on Unnecessary Treatment in One Year
  12. Real ROI from Health Management
  13. 6 Reasons to Include a Health Coach in an ACO
  14. HealthSounds Podcast: Evaluating Participation in CMS's Upcoming Bundled Payment Initiative
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This week's industry news

1.) 1 in 6 Medicare Patients Readmitted to Hospital Within 30 Days

Roughly one in six Medicare patients wind up back in the hospital within a month after being discharged for a medical condition, says a new Dartmouth Atlas Project report, in collaboration with the Robert Wood Johnson Foundation.

Get the full story.

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2.) Guide to Reducing Medicare Readmissions, Vol. II

Guide This resource examines innovative interventions to reduce preventable admissions, rehospitalizations and ER visits by high-utilizing Medicare beneficiaries. It looks at four multidisciplinary collaborative interventions aimed at key factors fueling readmissions in this population — and that support an accountable care vision.

Learn more about this resource.

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3.) Merck Introduces New Medication Adherence Tools for Consumers

Targeting the high percentage of Americans that fail to take their prescribed medicines as directed, Merck has added medication adherence resources to its consumer health and wellness Web site.

Get the full story.

>>Return to this week's industry news


4.) 2010 Benchmarks in Improving Medication Adherence

2010 Benchmarks in Improving Medication Adherence This 50-page resource provides actionable information from 107 healthcare organizations on their efforts to improve medication adherence and compliance in their populations and the impact that medication therapy management programs are having on adherence levels, medication costs, ER visits, hospital and nursing home admissions, risk of death and other areas of concern.

Learn more about this resource.

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5.) Healthcare Business White Paper: Patient Flow Logistics and Tracking Software Solving Patient Throughput and Capacity Challenges

While the clinical outcome of the patient stay is the most critical component of a patient’s experience with the healthcare provider, the other crucial aspect is the process by which the patient moves through the hospital. Regardless of how capable the clinician or advanced the medical technology, patients will perceive their care to be substandard when delays and clumsy interdepartmental handoffs occur. Inefficient handoffs also have a negative impact on other stakeholders — the family, the providers, the staff, and the executive team. Discover what is needed to manage the patient flow process in this white paper.

Download this complimentary white paper.

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6.) Motivations for Developing an SNF Care Coordination Network

Improving the flow of information during patient transfers was one of the prime motivations for developing a care coordination network, says Carolyn Holder, MSN, RN, GCNS-BC, manager of transitional care for Summa Health System. The lack of quality information had resulted in poor transfer outcomes, unnecessary readmissions and ER visits, and inefficient patient care.

Get the full story.

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7.) New Chart: Top 5 Ways to Fund Telehealth

Ways to Fund Telehealth With an increase in telehealth use to expand healthcare access and curb costs, we wanted to see how healthcare organizations fund telehealth and telemedicine.

Click here to view the chart.

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8.) Care Transitions Toolkit

Care Transitions Toolkit This 130-page resource examines current and emerging trends in care transition management, providing actionable data and case studies from industry thought leaders on key elements of their care transition programs.

Learn more about this resource.

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9.) CDPHP Calls Embedded Case Managers 'Crucial' to Clinical Transformation

Embedding case managers in primary care can not only help patients to better manage diabetes and end-stage renal disease, but can aid in reducing hospitalizations and costs and improve quality of life.

Get the full story.

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10.) Best Practices in Contemporary Case Management

Best Practices in Contemporary Case Management Healthcare organizations are positioning case managers along the healthcare continuum — and at routes of entry — to coordinate care for complex patients, manage transitions between care sites and reduce avoidable consumption of health resources. This 60-page resource explains how embedding a case manager at the point of care is increasingly good business.

Learn more about this resource.

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11.) Mount Sinai Research: $6.7 Billion Spent on Unnecessary Treatment in One Year

Nearly $7 billion was spent in one year performing unnecessary tests or prescribing unnecessary medications in primary care, researchers at Mount Sinai School of Medicine recently found.

Get the full story.

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12.) Real ROI from Health Management: Cost Savings through Coaching and Disease Management

Real ROI from Health Management This 50-page report from the Healthcare Intelligence Network provides strategies, models and advice for achieving ROI from health improvement initiatives from various thought leaders.

Learn more about this resource.

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13.) 6 Reasons to Include a Health Coach in an ACO

In a very funny video about health reform and accountable care organizations that was recently brought to my attention (thank you, Health2 Resources), the computer-generated help clerk asks a bewildered healthcare executive what he knows about health coaches. It got me to thinking about the role of the health coach in an ACO, which led me to a very interesting discussion on the topic by Patrick T. Buckley, MPA, IHC, for HealthLeaders Media.

Read this blog post.

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14.) HealthSounds Podcast: Evaluating Participation in CMS's Upcoming Bundled Payment Initiative

Jim Reilly CMS learned a few things from its first foray into bundled payments, explains Jim Reilly, managing partner with TRG Health Care Solutions. Having worked with all five participants in the Acute Care Episode (ACE) pilot a few years back, Reilly is ideally positioned to identify the three key benefits of participation in the upcoming CMS bundled payment initiative. But in order for episodic payments, bundled pricing and other alternative payment methodologies to be implemented successfully a key organizational process must take place, Reilly notes.

Listen to this podcast.

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