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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Women are in charge when it comes to choosing their family’s healthcare coverage needs.

That’s the bottom line from a new survey from Cigna, which says that, regardless of where they live or who their insurer is, women are the CFOs and CMOs of their households.

Among their top concerns about healthcare coverage, in light of new reforms, are whether they can afford insurance, and care for their elderly parents. The extensive survey covers everything from how many women understand reform (1 in 10) to what steps they’re taking to manage costs (94 percent are using lower cost prescriptions).

A lack of family and social support is one of the seven chief barriers to medication adherence, says Thom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy at CIGNA® Pharmacy Management. If a patient has no friends or family to discuss their health and required medications with, they are more likely to skip them, which is why it’s important to understand which barrier applies to a particular individual when trying to resolve medication compliance issues, and then find a solution around it.

Breast cancer screening, cervical cancer screening, and weight assessment and nutrition counseling for children were among the areas Kaiser Permanente received top marks in, according to the NCQA’s Quality Compass® data, which ranked the company number one in 13 out of 43 effectiveness of care measures. Out of nearly 500 commercial health plans in the nation, no other health plan received more than five No.1 rankings, according to Kaiser officials.

Regions of the United States where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations (ACOs), according to a new RAND Corporation study.

Other factors associated with the formation of ACOs include a greater occurrence of payment risk sharing at hospitals, larger integrated hospital systems and primary care physicians practicing in large groups.

A region's average household income, per capita Medicare spending, enrollment in Medicare Advantage Plans and physician density were not associated with formation of accountable care organizations.

Same-hospital readmission rates are an unreliable predictor for all-hospital readmissions rates, but that rate is what CMS penalizes hospitals for, according to research from the University of Michigan (U-M) Health System, presented at the 2013 Clinical Congress of the American College of Surgeons.

By tracking readmission rates solely within their own facility, instead of looking at rates at other hospitals, officials aren't getting enough information to effectively target areas for quality improvement, researchers say.

And lastly, 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 14, 2013
Vol. XV, No. 38

Sponsored by:
Aligning Value-Based Reimbursement with Physician Practice Transformation


This week's industry news:

  1. Cigna Survey: Women Confident Now, Yet Worried about Future Health Concerns
  2. Healthcare Trends & Forecasts in 2014
  3. NCQA Ranks Kaiser Permanente Number One in 13 of 43 Quality Measures
  4. Formula for CMS Five-Star Quality Population Health Management
  5. Healthcare Business White Paper: Telehealth in 2013
  6. Consolidated Health Networks Lead to Greater Creation of ACOs
  7. New Chart: Top 5 Health Targets of Telehealth
  8. Guide to Accountable Care Organizations
  9. Same-Hospital Readmission Rate Unreliable Predictor for All-Hospital Readmission Rate
  10. 2012 Healthcare Benchmarks: Reducing Hospital Readmissions
  11. 7 Barriers to Medication Adherence
  12. Guide to Improving Medication Adherence
  13. Infographic: The $18B Impact of Medicare Hospital Readmissions
  14. Features of WellPoint’s Physician Practice Transformation Initiative
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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Health Risk Assessments in 2013

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This week's industry news

1.) Cigna Survey: Women Confident Now, Yet Worried about Future Health Concerns

Women are confident in their ability to choose the right health plan, but they’re fearful about their future needs, according to a new national survey from Cigna.

Get the full story.

>>Return to this week's industry news


2.) Healthcare Trends & Forecasts in 2014: A Strategic Planning Session

Healthcare Trends & Forecasts in 2014 This webinar will provide a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014. This 10th annual, must-attend event will highlight the strategic importance of health insurance exchanges for health plans and providers even if they’re not participating in the initial enrollment period, among other key issues

Learn more about this resource.

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3.) NCQA Ranks Kaiser Permanente Number One in 13 of 43 Quality Measures

Kaiser Permanente ranked number one in 13 out of 43 effectiveness of care measures, according to the 2013 NCQA Quality Compass® data.

Get the full story.

>>Return to this week's industry news


4.) 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 Permanente's successful care management efforts that have made this "star czar" a leader in the five-star space.




Learn more about this resource.

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5.) Healthcare Business White Paper: Telehealth in 2013 — Videoconferencing, Virtual Visits and Smartphones Power Population Health Management

Telehealth in 2013 Healthcare is leaning on videoconferencing more than ever to monitor discharged patients, conduct remote consultations and facilitate communication, according to responses to 2013 Telehealth Survey by the Healthcare Intelligence Network. Respondents reported an increase in the use of videoconferencing — from 41 percent in 2010 to 59 percent in 2013. Download this HINtelligence report for more telehealth trends for 2013 as reported by 129 healthcare companies in HIN's third annual Telehealth Survey. Included in the report are the greatest barriers or challenges to telehealth implementation, top funding to support telehealth efforts, telehealth use in clinical applications, and much more.

Download this complimentary white paper.

>>Return to this week's industry news


6.) Consolidated Health Networks Lead to Greater Creation of ACOs

Regions of the United States where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations (ACOs), according to a new RAND Corporation study.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top 5 Health Targets of Telehealth

New Chart: Top 5 Health Targets of Telehealth Congestive heart failure (CHF) is one of the top health conditions targeted by telehealth programs, according to about 53 percent of healthcare companies who responded to HIN's third annual industry survey on telehealth and telemedicine. We wanted to see which other health conditions are targeted by telehealth programs.

Click here to view the chart.

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8.) Guide to Accountable Care Organizations

Guide to Accountable Care Organizations This resource lays the groundwork for an ACO program, delivering a comprehensive set of 2012 ACO benchmarks from 200 companies, a framework for clinical integration, a key ACO prerequisite that puts participating providers on the same performance and payment page, and more.

Learn more about this resource.

>>Return to this week's industry news


9.) Same-Hospital Readmission Rate Unreliable Predictor for All-Hospital Readmission Rate

Same-hospital readmission rates are an unreliable predictor for all-hospital readmissions rates, but that rate is what CMS penalizes hospitals for, according to research from the University of Michigan (U-M) Health System, presented at the 2013 Clinical Congress of the American College of Surgeons.

Get the full story.

>>Return to this week's industry news

10.) 2012 Healthcare Benchmarks: Reducing Hospital Readmissions

2012 Healthcare Benchmarks: Reducing Hospital Readmissions This resource identifies the key strategies, challenges, target populations and health conditions of 119 healthcare organizations to reduce avoidable rehospitalizations, and provides critical benchmarks that show how the industry is working to reduce rehospitalizations, particularly for the CMS target conditions of heart failure, myocardial infarction and pneumonia.

Learn more about this resource.

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11.) 7 Barriers to Medication Adherence

A lack of social support is one of the chief barriers to medication adherence. If a patient has no friends or family to discuss their health and required medications with, they are more likely to skip them, says Thom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy at CIGNA® Pharmacy Management.

Get the full story.

>>Return to this week's industry news


12.) 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. Additionally, the past president of the Case Management Society of America shares a case manager’s take on what’s needed to move individuals toward medication compliance.

Learn more about this resource.

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13.) Infographic: The $18B Impact of Medicare Hospital Readmissions

Hospital readmissions drive up overall cost of healthcare for everyone. There is a $17.8 billion dollar impact of unnecessary hospital readmissions on Medicare due to poor follow-up, according to a new infographic from DoctorBase.

Read this blog post.

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14.) Features of WellPoint's Physician Practice Transformation Initiative

Julie Schilz In its quest to transform 70 to 80 percent of its physician practices to a patient-centered medical home (PCMH) over the next three years, WellPoint has adopted a "meet the practices where they are" philosophy, reports Julie Schilz, director of care delivery transformation for WellPoint. Each practice is at a different place in the transformation effort and requires specialized supports, she adds.

Smoothing the transformation rollout is the simultaneous participation of 500 WellPoint practices in CMS's Comprehensive Primary Care (CPC) program, whose goals dovetail with key PCMH principles — as though WellPoint had another partner in its transformation initiative, Schilz notes.

Just as important as practice support is transparency with health plan members, Schilz adds, especially when it comes to explaining the concept of the medical home neighborhood — where care coordination is a collaboration between primary care and the specialist.

Listen to this podcast.

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