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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

The anxiously awaited final rule on accountable care organizations (ACOs) for Medicare beneficiaries is finally out. Based on the more than 1300 comments CMS received on its proposed ACO ruling first released in March, this new rule will make it easier to establish ACOs by providing organizations with additional funding for support tools, such as new staff or information technology systems. Under this new initiative, the Advanced Payment Model, these payments would be recovered from any future shared savings.

The second initiative, the Medicare Shared Savings Program, will provide incentives for healthcare providers who agree to work together and become accountable for coordinating care for patients. Participants who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program. Both initiatives launched on October 20th .

In other news, the United States earned low marks in healthcare access and affordability in the Commonwealth Fund's third annual scorecard report. According to the report, the nation received a 64 out of a possible 100 when compared to best performers. Among the findings that contributed to the score were the percentage of overweight or obese children (32 percent), the number of prescription errors among elderly Medicare beneficiaries (one out of four) and the percentage of adults that reported not having a primary care provider in 2008 (44 percent) You can read more details in this issue.

Despite the low scores in key quality indicators, the United States is doing something right in the area of heart failure (HF) care. New research from the Yale School of Medicine shows that hospitalization rates for HF dropped by 30 percent from 1998 to 2008. One year mortality rates also dropped slightly during this period. HF ranks as the most frequent cause of hospitalization and re-hospitalization among older Americans, with related costs estimated at $39.2 billion in 2010.

In other news, 46 percent of physician practices do not meet NCQA standards for medical homes. The news, from a recent University of Michigan-led study, found that while larger, multi-specialty practice groups can more easily meet the standards, one in nine Americans receive healthcare from smaller, often solo practices. Researchers recommend initiatives to help these smaller practices team up with larger organizations to establish more medical homes.

More than 50 percent of physicians and hospitals are looking at ways to team up, a trend that is causing medical malpractice concerns. Aon's 12th annual Hospital and Physician Professional Liability Benchmark Analysis states that healthcare systems will face significant risk management challenges associated with integrated physician-hospital arrangements. The study details the growth of integrated self-insurance strategies and highlights the challenges faced by systems as they pursue the cost of risk savings.

And lastly, what are you doing to staunch the flow and expense of avoidable emergency department use? Describe your efforts in this area by October 31 and you will receive a free executive summary of results from this second annual survey. Your responses will be kept strictly confidential.

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 24, 2011
Vol. XIII, No. 39

Sponsored by:
Healthcare Trends in 2012 — A Strategic Industry Forecast

This week's industry news:

  1. ACO Final Rule Accompanied by Advance Payments for Care Coordination Tools
  2. Blueprint for ACO Success
  3. Commonwealth Fund: U.S. Healthcare System Gets Low Scores in Patient Care, Access
  4. Health Reform 2011
  5. Healthcare Business White Paper: Role Based Access Governance and HIPAA Compliance
  6. Nearly Half of Physician Practices Do Not Qualify as Medical Homes
  7. New Chart: Top Targets for Health Plan Medication Adherence Programs
  8. 2011 Medical Home Performance Benchmarks
  9. 5 Domains of Patient Assessment for Case Management
  10. Case Management Metrics
  11. Integrated Hospital/Physician Systems Could Pose Risk Management Challenges
  12. Healthcare Trends & Forecasts in 2011
  13. Standardizing Shift-to-Shift Patient Handoffs Could Reduce Medical Errors
  14. HealthSounds Video: How to Reduce Avoidable ER Use
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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Reducing Avoidable Emergency Room Visits in 2011

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This week's industry news

1.) ACO Final Rule Accompanied by Advance Payments for Care Coordination Tools

Acknowledging the costs inherent in building an ACO, CMS sweetened its long-awaited final rule on ACOs for Medicare beneficiaries with additional funding for support tools — payments that would be recovered from any future shared savings.

Get the full story.

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2.) Blueprint for ACO Success: Clinical, Quality and Compliance Considerations for an Accountable Care Organization

Blueprint for ACO Success This resource provides perspectives and lessons learned in both critical areas from two organizations already far along the path to ACO creation: Advocate Physician Partners' clinical integration (CI) program, which includes over 3,000 physicians, and The Queens County Medical Society, which is launching one of New York State’s largest physician-owned ACOs.

Learn more about this resource.

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3.) Commonwealth Fund: U.S. Healthcare System Gets Low Scores in Patient Care, Access, Affordability

Despite areas of improvement, the U.S. healthcare system as a whole failed to improve when compared to best performers in the United States, and among other nations, according to the third national scorecard report from the Commonwealth Fund Commission (CFC). The U.S. healthcare system scored 64 out of 100 on key measures of performance, the CFC added.

Get the full story.

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4.) Health Reform 2011: Impact on Health Plans, Hospitals, Providers and Purchasers

Health Reform 2011 Packed with articles and illustrations, this comprehensive report outlines the likely impact of health reform on coverage, benefit designs, medical costs, providers and pharmacy benefits. Special sections also address the impact on employers, the transformation of the Medicare and Medicaid programs and the radical changes to fraud, abuse and compliance initiatives.

Learn more about this resource.

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5.) Healthcare Business White Paper: Role Based Access Governance and HIPAA Compliance — A Pragmatic Approach

The Health Information Technology for Economic and Clinical Health Act (HITECH) imposes more stringent regulatory and security requirements to the privacy rules of HIPAA. Compliance with the letter of the guideline can be difficult for organizations without strong access governance processes and policies. This paper focuses on a set of best practices for implementing an access governance framework and the specific access controls requirements for HIPAA/HITECH.

Download this complimentary white paper.

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6.) Nearly Half of Physician Practices Do Not Qualify as Medical Homes

Forty-six percent of physician practices do not meet the national standards necessary to qualify as medical homes, according to a University of Michigan Health System-led study.

Get the full story.

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7.) New Chart: Top Targets for Health Plan Medication Adherence Programs

Health Plan Medication Adherence Programs Medication adherence programs can improve patient care and lower healthcare costs by more effectively managing chronic medication utilization. We wanted to see which populations are in most need of programs to improve medication adherence.

Click here to view the chart.

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8.) 2011 Medical Home Performance Benchmarks: Adoption, Utilization and Results

2011 Medical Home Performance Benchmarks This 84-page report is the Healthcare Intelligence Network's latest annual in-depth analysis of medical home awareness, adoption, tools, technologies, challenges, benefits and outcomes. It delivers the latest metrics and measures on current and planned PCMH initiatives, providing actionable data on PCMH effectiveness, targeted populations and conditions, medical home team members, health IT in use, reimbursement, ROI and much, much more.

Learn more about this resource.

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9.) 5 Domains of Patient Assessment for Case Management

Patient self-management and medical status are two of the five domains explored when assessing the eligibility of patients for case management selection, explains Rebecca Ramsay, senior manager of care support and clinical programs at CareOregon.

Get the full story.

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10.) Case Management Metrics: Charting Care Coordination Across the Continuum

Case Management Metrics This 50-page resource dives deep into several years of market research to identify case managers' influence and contributions in 10 key areas, including patient education and outreach, medication adherence, disease management, care transitions, and more. It is based on responses from hundreds of healthcare organizations to 10 healthcare benchmark surveys between 2009 and 2011.

Learn more about this resource.

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11.) Integrated Hospital/Physician Systems Could Pose Risk Management Challenges

More than half of physicians and hospitals are exploring ways to team up, a trend that could lead to significant collaborative activity, including mergers, acquisitions and joint ventures, says Aon Risk Solutions.

Get the full story.

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12.) Healthcare Trends & Forecasts in 2011: Performance Expectations for the Healthcare Industry

Healthcare Trends & Forecasts in 2011 In this 35-page resource, William Shea, partner of health industry consulting for Cognizant Business Consulting and Steven T. Valentine, president of The Camden Group, review the industry landscape for 2011 and suggest how healthcare organizations can best position themselves for the year.

Learn more about this resource.

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13.) Standardizing Shift-to-Shift Patient Handoffs Could Reduce Medical Errors

Faulty or incomplete handoffs of patients between provider shifts in teaching hospitals may be responsible for more medical errors occurring in hospitals than overworked, sleep-deprived medical residents, suggests an article in the August 7, 2011 New York Times Magazine.

Read this blog post.

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14.) HealthSounds Video: How to Reduce Avoidable ER Use

How to Reduce Avoidable ER Use How healthcare companies promote appropriate use of emergency rooms, based on 2010 market research. With analysis by HIN VP and COO Melanie Matthews and commentary by Sara A. Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.

Watch the video.

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