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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

The insurance marketplace rollout continues to be problematic for many consumers, but there is some good news for Medicare beneficiaries: they are seeing significant out-of-pocket savings since the ACA was implemented, savings that will most likely continue through 2014, CMS officials say. Plus, they don't need to sign up for the new health insurance marketplaces, as they are already covered by Medicare.

Some disturbing news from the Annual American Academy of Pediatrics: mental health diagnoses for children have jumped 30 percent in the last four years, with ADHD leading the pack, followed by anxiety, depression, and eating disorders. Mental health diagnoses run about a third higher for children with Medicaid insurance compared with commercial coverage, researchers say, and clinicians need to seek a deeper understanding as to why. More inside.

Nearly 440,000 Americans are dying annually from preventable hospital errors, making them the third leading cause of death in the United States, according to a Fall 2013 update to The Leapfrog Group Hospital Safety Score report.

The annual report, which also assigns A, B, C, D and F grades to more than 2,500 U.S. general hospitals, shows that many hospitals are making headway in addressing errors, accidents, injuries and infections that kill or hurt patients, but overall progress is slow.

The extensive report also lists the states that earned the highest and lowest grades: among them, Maine claims the number one spot for the state with the highest percentage of "A" hospitals.

A significant and growing performance gap exists between dual eligible and non-dual eligible members when it comes to CMS Five-Star Quality rating measures, according to a study from Inovalon, Inc., a leading provider of data-driven healthcare solutions.

The study finds that a significant association exists between Medicare-Medicaid dual eligible status and lower performance on specific Part C and D measure Star ratings. The results point to the integral role that income, race/ethnicity, and gender play on the HEDIS® and CMS Part D measures used in the Five-Star rating system.

It's not too late to take our Healthcare Trends in 2014 survey; from an early surge in Medicare ACOs to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 has been nothing short of unpredictable. Please tell us about the last 12 months and how your organization is preparing for 2014 by completing HIN's ninth annual survey on Healthcare Trends by November 18, 2013. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

One respondent will win a training DVD of the 2014 Healthcare Trends and Forecasts webinar recorded on October 30, 2013.

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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November 4, 2013
Vol. XV, No. 41

Sponsored by:
Medical Home Neighborhoods — Uplinking Specialists To Create Integrated Systems of Care


This week's industry news:

  1. CMS Announces Major Savings for Medicare Beneficiaries
  2. Managed Medicare and Medicaid Factbook: 2013
  3. Pediatric Mental Health Diagnoses Jump 30 Percent in Last Four Years
  4. Emergency Room Triage of the Mental Health Patient
  5. Healthcare Business White Paper: Dual Eligibles Care Management in 2013
  6. Hospital Errors Third Leading Cause of Death in United States
  7. New Chart: Top 5 Challenges of Home Visits
  8. Guide to Reducing Medicare Readmissions, Vol. II
  9. Study of CMS Star Ratings Finds Discrepancies Between Dual Eligibles, Non-Duals
  10. Formula for CMS Five-Star Quality Population Health Management
  11. PHO 2.0: Opportunities Abound in Physician-Hospital Organization Model
  12. Essential Guide to Physician-Hospital Organizations
  13. Infographic: The Prescription Drug Price Tsunami — Are We Powerless?
  14. A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings
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.) CMS Announces Major Savings for Medicare Beneficiaries

Medicare beneficiaries are seeing significant out-of-pocket savings due to the Affordable Care Act (ACA), according to the Centers for Medicare and Medicare Services (CMS).

Get the full story.

>>Return to this week's industry news


2.) Managed Medicare and Medicaid Factbook: 2013

Managed Medicare and Medicaid Factbook: 2013 This resource presents all-new information on enrollment, benefit designs, company activity and trends for the Medicare Advantage, Medicare Part D and managed Medicaid programs.


Learn more about this resource.

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3.) Pediatric Mental Health Diagnoses Jump 30 Percent in Last Four Years

Pediatricians are seeing an increase in behavioral health problems among children, including sharp increases in Attention Deficit Hypertension Disorder (ADHD), anxiety, depression, and eating disorders, according to a study from athenahealth, Inc.

Get the full story.

>>Return to this week's industry news


4.) Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion

Emergency Room Triage of the Mental Health Patient This resource describes how two emergency department veterans' backup plans are sometimes necessary to manage the flow of behavioral health patients in the emergency room.

Learn more about this resource.

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5.) Healthcare Business White Paper: Dual Eligibles Care Management in 2013 — Case Management, Education Boost Compliance, Satisfaction

Dual Eligibles Care Management in 2013 Education and engagement are key to managing the health of dual eligibles but also the most formidable challenges, say a third of respondents to a new survey on Care Management of Dually Eligible by the Healthcare Intelligence Network. Care coordination of the 9 million Americans eligible for both Medicare and Medicaid is a growing priority for the nation's payors who wish to address this population's unique medical, social and functional needs in a coordinated and cost-efficient manner. Download this HINtelligence report for more data on dual eligibles as reported by 72 healthcare companies in HIN's 10 Questions on Care Coordination of Dual Eligibles Survey, including dual eligible care coordination program components, results and ROI, and successful care coordination strategies for dual eligibles in respondents' own words.

Download this complimentary white paper.

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6.) Hospital Errors Third Leading Cause of Death in United States

Nearly 440,000 Americans are dying annually from preventable hospital errors, making them the third leading cause of death in the United States, according to a Fall 2013 update to The Leapfrog Group Hospital Safety Score report.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top 5 Challenges of Home Visits

New Chart: Top 5 Challenges of Home Visits Forget yesterday's house calls: doctor and dusty medical bag tending a swooning patient. Today's home visits provide a unique perspective on the patient experience while helping individuals meet everyday needs, avoid rehospitalization or an ER visit, and connect with community resources. We wanted to see what the top five challenges are for conducting home visits.

Click here to view the chart.

>>Return to this week's industry news


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

Guide to Reducing Medicare Readmissions, Vol. II This resource examines innovative interventions to reduce preventable admissions, rehospitalizations and ER visits by high-utilizing Medicare beneficiaries, by looking at four multidisciplinary collaborative interventions aimed at key factors fueling readmissions in this population.


Learn more about this resource.

>>Return to this week's industry news


9.) Study of CMS Star Ratings Finds Discrepancies Between Dual Eligibles, Non-Duals

A significant and growing performance gap exists between dual eligible and non-dual eligible members when it comes to CMS Five-Star Quality rating measures, according to Inovalon, Inc., a leading provider of data-driven healthcare solutions.

Get the full story.

>>Return to this week's industry news

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

Learn more about this resource.

>>Return to this week's industry news


11.) PHO 2.0: Opportunities Abound in Physician-Hospital Organization Model

With acquisition and consolidation rampant on the value-based healthcare landscape, it's time to take another look at the physician-hospital organization (PHO) model, suggest healthcare thought leaders Travis Ansel, manager of strategic services, Healthcare Strategy Group, and Greg Mertz, director of consulting operations, Healthcare Strategy Group.

Get the full story.

>>Return to this week's industry news


12.) Essential Guide to Physician-Hospital Organizations: 7 Key Elements for PHO Success

Essential Guide to Physician-Hospital Organizations This resource describes the seven critical areas of PHO development, from defining the PHO mission to creating a data environment conducive to registry use, analytics and active patient management.


Learn more about this resource.

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13.) Infographic: The Prescription Drug Price Tsunami — Are We Powerless?

Prescription drugs use are the source of a significant amount of healthcare costs. Over the last decade, the percentage of Americans using five or more prescription drugs increased by 70 percent, according to a new infographic from Healthcoverageally.com.

Read this blog post.

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14.) A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings

Joseph Johnson Low scores on patient outcomes measures within the CMS Star Quality ratings program — metrics CMS weights most heavily in its assignment of stars — can typically be traced to poor provider and member engagement, notes Joseph Johnson, vice president of L.E.K. Consulting. Johnson suggests ways to enlist support from these two stakeholder groups, and describes how MA plans should prepare for the possible display in 2014 of CAHPS care coordination ratings along with with its star scores (though the care coordination ratings will not be factored into star ratings).

Listen to this podcast.

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