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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

The health reform bill passed by a slim margin in the House on Saturday is still a long way from being law. However, it's worth noting the bill's huge focus on "high-value healthcare," defined in the House bill as "the efficient delivery of high quality, evidence-based, patient-centered care." The word "value" is mentioned 112 times in the 1,990-page document. Getting more ink is "prevention," which appears 226 times — as in diabetes prevention, obesity prevention, prevention of alcohol and substance abuse, suicide prevention, and many other programs aimed at improving the overall health status of our nation.

In the meantime, Mississippi has one of the nation's highest obesity rates, along with high rates of diabetes, poverty and medical need. The Mississippi Health First Collaborative announced last week by CMS wants to change those statistics by improving care for patients with diabetes in that state. The non-traditional approach, profiled in this issue, will deliver diabetes self-management education in community centers and senior centers instead of the usual healthcare settings. Partnering in the collaborative are community groups, health experts, faith-based organizations, housing providers, healthcare providers and others to reach the insured and uninsured across the state.

Poorly managed, uncontrolled diabetes leads to many serious and costly complications. Health First can learn a great deal from Community Care Plan of Eastern North Carolina, which began establishing medical homes for diabetics in its Medicaid population in 2000. Case managers embedded in primary practices called enrollees, sent out information on community support groups, diabetes health fairs and medications — even went to patients' homes and taught them one-on-one how to test glucose levels and do a foot exam. An external program evaluation by the Cecil G. Sheps Center for Health Services Research estimated a $2.1 million savings from that diabetes program.

In a recent podcast, Community's nurse case manager Roberta Burgess described the provider and patient education aspects of the diabetes medical home program.

Your colleague in the business of healthcare,
Patricia Donovan
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to pdonovan@hin.com.

HIN Associate Editor Jessica Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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November 9, 2009
Vol. XI, No. 42

Sponsored by:
Effective Case Management in the Medical Home

This week's industry news:

  1. ROI Opportunities from the 'Gap Group' and Low Utilizers in Disease Management
  2. Real ROI from Health Management
  3. Flu Vaccine Given to Pregnant Women Keeps Infants Out of Hospital
  4. Hospitals in a Medical Home
  5. Healthcare Business White Paper: Reduce Preventable Medical Errors
  6. Medicaid Enrollees at High Risk for Overdose Deaths from Prescription Opioids
  7. Delivering Disease Management to Medically Underserved Populations
  8. Medicare Launches Diabetes Care Collaborative for Medically Underserved
  9. Case Studies from Diabetes Medical Home Pilots
  10. FDA 'Safe Use' Program Targets Preventable Harm from Medication Use
  11. Medication Reconciliation Strategies
  12. HealthSounds Podcast: Medical Home Case Management Built on Relationships, Contact and Education
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.) ROI Opportunities from the 'Gap Group' and Low Utilizers in Disease Management

Ariel Linden, Dr.P.h., M.S., president of Linden Consulting Group, describes opportunities for ROI in chronic care management, based on 10 years of observing individual companies, large movement and trends in the chronically ill population in the U.S. and around the world, and development of interventions.

I don’t like the term ‘disease management;’ I prefer ‘chronic care’ or ‘chronic disease,’ which is more than a given disease. In this world, we’re moving more toward that kind of terminology. In the management of chronic care, low to moderate utilizers concern me most because the entire group falls between the cracks.

Get the full story.

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

Real ROI from Health Management In this resource, experts detail the measures to look at when evaluating health coaching and population health programs and provide case studies of how they are using these measures to demonstrate a health management ROI.

Learn more about this resource.

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3.) Flu Vaccine Given to Pregnant Women Keeps Infants Out of Hospital

Infants born to women who received influenza vaccine during pregnancy were hospitalized at a lower rate than infants born to unvaccinated mothers, according to preliminary results of an ongoing study by researchers at Yale School of Medicine.

Get the full story.

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4.) Hospitals in a Medical Home: Partners in Enhancing Access, Health Status and Cost Avoidance

Hospitals in a Medical Home In this resource, the director of a medical home network demonstrates how hospitals can partner with medical homes to deliver patient-centered care to uninsured and low-income patients while reaping the financial benefits associated with decreased utilization and duplication of services.

Learn more about this resource.

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5.) Healthcare Business White Paper: Reduce Preventable Medical Errors

In this paper, you will learn about the patient identity hub: The foundation for patient safety, barriers and challenges in improving patient safety, risks associated with incomplete patient information andfive best practices to reduce preventable medical errors.

Download this complimentary white paper.

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6.) Medicaid Enrollees at High Risk for Overdose Deaths from Prescription Opioids

Medicaid enrollees may be a high-risk group for poisoning deaths from prescription opioid painkillers, according to a study published in the CDC's October 29 Morbidity and Mortality Weekly Report. This study highlights the prominence of methodone in prescription opioid deaths.

Get the full story.

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7.) Delivering Disease Management to Medically Underserved Populations Plus 21 Strategies for Making and Keeping Contact with Hard-to-Reach Clients

Delivering Disease Management to Medically Underserved Populations This special report describes how to successfully connect with Medicaid beneficiaries and others in need of healthcare assistance and engage them in successful DM programs. Industry experts share real-life case studies to illustrate how out-of-the-box thinking, community collaborations and multi-channel approaches to client identification are yielding positive results in health outcomes and cost containment. Additionally, HIN's non-scientific online survey on this topic yielded further contact strategies from more than 65 healthcare organizations. This report includes a summary of their suggestions for preventing medical complications and improving the overall health of medically underserved patients, members and clients.

Learn more about this resource.

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8.) Medicare Launches Diabetes Care Collaborative for Medically Underserved

CMS has launched Mississippi Health First Collaborative, a statewide effort to improve care for patients with diabetes across Mississippi, particularly for patients considered to be medically underserved. Participating patients will receive diabetes self-management training in their home communities, in locations such as community centers or senior centers, instead of in hospitals or other traditional healthcare settings, such as doctors’ offices or outpatient clinics.

Get the full story.

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9.) Case Studies from Diabetes Medical Home Pilots: Key Processes, Tools, Metrics and Outcomes

Case Studies from Diabetes Medical Home Pilots This resource offers a detailed look at two physician-health plan partnerships in diabetes disease management — a care coordination pilot for New Jersey state employees with diabetes and a hands-on case manager-driven initiative for Medicaid beneficiaries with diabetes in North Carolina.

Learn more about this resource.

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10.) FDA 'Safe Use' Program Targets Preventable Harm from Medication Use

The U.S. FDA has launched 'Safe Use,' a program aimed at reducing the likelihood of preventable harm from medication use. The FDA will collaborate with healthcare professionals and other stakeholders to identify drugs and drug classes that are linked to preventable harm. The agency will also develop a list of specific problems, cross-sector interventions for reducing harm from these problems and the metrics for success.

Get the full story.

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11.) Medication Reconciliation Strategies to Reduce Hospital Adverse Drug Events

Medication Reconciliation Strategies In this special report, two experts describe their hospital's emphasis on quality and perfect care processes and provide the inside details on their medication management programs, which have a goal of eliminating adverse drug events.

Learn more about this resource.

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12.) HealthSounds Podcast: Medical Home Case Management Built on Relationships, Contact and Education

Medical Home Case Management Case managers are the backbone of the Geisinger Health Plan (GHP) Health Navigator(SM) program, a medical home partnership between primary care providers and GHP that has reduced 30-day hospital readmissions by 15 to 20 percent. Providing benchmarks for case manager caseloads and contact frequency, tools to support the case management effort, the key to smooth placement of case managers in the medical home and tips for better management of patients discharged to nursing facilities are Diane Littlewood, R.N., and Joann Sciandra, R.N., who are both regional managers of case management for health services at Geisinger Health Plan.

Listen to this podcast.

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