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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

The recession hasn't impacted high medical cost burdens for a majority of Americans, according to a recent study from the Center for Studying Health System Change (HSC). Nearly one in five families spent at least 10 percent of their pre-tax family income on out-of-pocket health insurance premiums and medical care in 2009, roughly the same as 2006 despite widespread job losses, more uninsured, and declining incomes during the recession. Researchers attributed decreasing family income among the reasons for the lack of change.

CMS financial penalties haven't impacted the rate of hospital-acquired infections (HAIs), according to a report from the Harvard Pilgrim Health Care Institute. The study included data on 398 hospitals from 41 states and found no evidence that 2008 CMS policies reducing Medicare payments to hospitals for HAIs had a positive impact. Instead, the study found that infection rates declined steadily throughout this period independent of penalties. Among the reasons cited in the report was the size of the financial incentives — they were very small and failed to spark reform.

Population health management strategies could have an impact on patient care, and healthcare costs, but physician practices need to put readiness plans together. Chief among the challenges to implementation are increased administrative burdens, cost, and time, but researchers stress that the short-term disruptions to patient care are worth the longer term benefits.

What might have an impact on our offices here on the Jersey coast is Hurricane Sandy, set to land right around the time this newsletter goes to press. So we're in readiness mode, hoping that a boardwalk clogged with sand will be the only short-term disruption from the storm, but well worth the ocean viewing afterward.

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 29, 2012
Vol. XIV, No. 40

Sponsored by:
Readmission Penalties in 2013 — A Cross-Continuum Approach To Lessen the Financial Impact


This week's industry news:

  1. Cigna’s Growing ACO Program Improves Health Outcomes, Lower Costs
  2. Case Studies From Private-Sector ACOs: What Works and Why?
  3. 5 Core Elements of Horizon’s Patient-Centered Medical Home
  4. New Models in the Patient-Centered Medical Home
  5. Healthcare Business White Paper: Reducing Readmissions in 2012
  6. Preparing Physician Practices for Population Health Management
  7. New Chart: What's the Preferred Education Level of a Case Manager?
  8. Population Health Management Tools for ACOs
  9. Number of Americans Paying High Medical Costs Mostly Unchanged Despite Recession
  10. Health Insurance Exchanges
  11. Hospital Infection Rates Unchanged by CMS Penalties
  12. 2012 Healthcare Benchmarks: Reducing Avoidable ER Visits
  13. Healthcare Delivery Advice for 2013: Shore Up Payment Before Shifting Model
  14. Advanced Illness Care Coordination
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This week's industry news

1.) Cigna’s Growing ACO Program Improves Health Outcomes, Lower Costs

Cigna is on track to reach its goal of 100 initiatives for 1 million customers by the end of 2014, Cigna officials report.

Get the full story.

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2.) Case Studies From Private-Sector ACOs: What Works and Why?

Case Studies From Private-Sector ACOs This resource provides details from those already navigating the many business decisions that must be made in setting up ACOs — on how the most successful private-sector ACO initiatives were formed, how they achieved results, and how they surmounted the hurdles that hamper delivery system reforms.

Learn more about this resource.

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3.) 5 Core Elements of Horizon’s Patient-Centered Medical Home

Engaging, educating and empowering patients is one of the core pieces that make up the PCMH, says Jay Driggers, director of consumer experience and engagement, Horizon Blue Cross Blue Shield of New Jersey.

Get the full story.

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4.) New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care

New Models in the Patient-Centered Medical Home Beginning with an overview of 2012 PCMH trends, this 57-page special report offers snapshots of thriving medical home initiatives and their particular area of focus.



Learn more about this resource.

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5.) Healthcare Business White Paper: Reducing Readmissions in 2012 — Home Visits Double for the Recently Discharged

Reducing Readmissions in 2012 Participation in accountable care initiatives has more than doubled in the last 12 months, according to 200 healthcare companies who completed the second annual Healthcare Intelligence Network survey on Accountable Care Organizations (ACOs). The typical ACO is smaller, too, as the number of active ACOs with 100 to 500 physicians dropped almost 50 percent in the last 12 months. This year’s survey provided new data on other healthcare professionals in the ACO, ACO reimbursement models, and ACO impact.

Download this complimentary white paper.

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6.) Preparing Physician Practices for Population Health Management

A new Health Dialog report surveys physicians’ population health management (PHM) readiness and recommends success strategies from early adopters.

Get the full story.

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7.) New Chart: What's the Preferred Education Level of a Case Manager?

What's the Preferred Education Level of a Case Manager? Post-reform redesign of clinical care delivery and reimbursement underscore the healthcare case manager's dual roles as care coordinator and utilization manager. Case manager work locations, job focus and caseloads are evolving in response to these shifts in the healthcare landscape. We wanted to see what the preferred education level is of a case manager.

Click here to view the chart.

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8.) Population Health Management Tools for ACOs: Technologies and Tactics to Support Accountable Care

Population Health Management Tools for ACOs This resource examines the building blocks of population health management that drive improvements in healthcare quality and efficiency in ACOs — while positioning healthcare organizations for core measure improvement and increased reimbursement.


Learn more about this resource.

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9.) Number of Americans Paying High Medical Costs Mostly Unchanged Despite Recession

Nearly one in five families — 18.8 percent — experienced high medical cost burdens in 2009, roughly the same as 2006 despite widespread job losses, more uninsured and declining incomes during the recession, according to a study by the Center for Studying Health System Change (HSC) published in Health Affairs.

Get the full story.

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10.) Health Insurance Exchanges: Preparing for the Brave New Marketplace Ahead

Health Insurance Exchanges This resource examines the hurdles state lawmakers and stakeholders are facing in developing models and establishing exchanges. It also provides insight from industry consultants, state lawmakers and regulators, scholars and other key industry observers on various topics including how many insurers will participate, and what states have done so far.


Learn more about this resource.

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11.) Hospital Infection Rates Unchanged by CMS Penalties

The rate of hospital-acquired infections (HAIs) has not been impacted by CMS penalties, according to a study from the Harvard Pilgrim Health Care Institute.

Get the full story.

>>Return to this week's industry news


12.) 2012 Healthcare Benchmarks: Reducing Avoidable ER Visits

2012 Healthcare Benchmarks: Reducing Avoidable ER Visits This 50-page report, now in its second year, is designed to meet business and planning needs of hospitals, health plans, physician practices and others by providing critical benchmarks that show how the industry is working to reduce avoidable hospital emergency department visits.


Learn more about this resource.

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13.) Healthcare Delivery Advice for 2013: Shore Up Payment Before Shifting Model

Eying a move to an ACO or the patient-centered medical home model in 2013? First, adjust the payment structure to support it, advises Steven Valentine, president of the Camden Group.

Read this blog post.

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14.) Advanced Illness Care Coordination: A Case Study on Aetna's Compassionate Care Program

Advanced Illness Care Coordination Aetna's Compassionate Care Program is a case management initiative that specifically targets health plan members with advanced illness, focusing on improving the quality of care they receive. As a result, explains Dr. Joseph Agostini, senior medical director of Aetna Medicare, these patients get more of the type of care that they want and spend less time in the hospital. Patient satisfaction with the program is high, he says, which reflects the strong bond between Aetna members and nurse case managers. In this interview, Dr. Agostini explains the key elements of the Compassionate Care program as well as some of the challenges the case managers may face in the management of advanced illness.

Listen to this podcast.

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