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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Despite a storm that ravaged our coastline with winds upwards of 75 mph, and sadly, many of our friendsí and neighborsí homes and possessions, we made it to the voting stations (many fueled by generators, in addition to our need to voice our opinion) and re-elected President Obama. Reports say that his re-election will neutralize efforts to overturn the ACA, as Republicans vowed to do if elected. With the Supreme Courtís ruling in June upholding the individual mandate, and several provisions already in place, including patientsí access to insurance despite pre-existing conditions and young adultsí access to insurance on their parentsí health plans, an estimated 30 million previously uninsured consumers, among them 17 million on Medicare, will now be able to access doctors and have insurance pay for procedures in surgery centers and hospitals. The times they are a-changing,and we will keep watch on those changes ahead.

We also report on another storm of sorts: mental illness and substance abuse, two conditions that impact 26 percent of the U.S. population, 6 percent of whom suffer from serious mental illness. Many of these individuals, whose mental health status can dramatically impact how they engage with and respond to medical treatment, die 25 years earlier than the general population, researchers note. The NQF has taken steps to address this potentially preventable scourge by endorsing 10 quality measures focused on behavioral health, including such issues as alcohol and tobacco abuse, antipsychotic medication adherence, and post-care follow-up after hospitalization for mental illness.

Attempts to curb the storm of rising healthcare costs continue, with a new Walgreens study indicating that 90-day medication refills at community pharmacies for Medicaid patients drive greater medication adherence, improved cost savings and generate nominal waste across fourtherapeutic categories. This is in stark contrast to beliefs that shorter prescription refill times (30 days) result in greater savings. Many of these patients have chronic conditions and face major economic challenges affecting their ability to remain adherent to medication. Almost half (45 percent) of Medicaid beneficiaries have three or more chronic illnesses, and this population accounts for 75 percent of total Medicare costs.

And lastly, the one storm we canít reverse: the end of life. A Medicare rule currently blocks thousands of nursing home residents with advanced dementia who have Medicare SNF care from receiving simultaneous reimbursement for hospice care, resulting in those patients receiving aggressive treatment and hospitalization, according to a new study from Brown University. Deciding between hospice and SNF care is not easy, but it makes a tremendous difference in patients' end of life care, researchers note, both emotionally and financially.

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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November 12, 2012
Vol. XIV, No. 41

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


This week's industry news:

  1. 90-Day Medication Supply Drives Better Adherence, Reduces Medicaid Costs
  2. Guide to Medication Adherence
  3. Colorado ACO Yields Big Savings, Reduced Readmissions
  4. The Colorado Accountable Care Collaborative: Practical Lessons from an ACO
  5. Healthcare Business White Paper: Asthma Management in 2012
  6. Medicare Rule Prevents Simultaneous Fees for Hospice and SNF
  7. New Table: Healthcare Trends to Monitor in 2013
  8. 46 Healthcare Metrics to Boost Profitability: Charting 2012 Trends
  9. NQF Endorses 10 Behavioral Health Measures
  10. 2012 Healthcare Benchmarks: Population Health Management
  11. Identifying Opportunities in Care Coordination of Dual Eligibles
  12. Healthcare Trends & Forecasts in 2013: A Strategic Planning Session
  13. Surviving Sandy: The Aftermath
  14. Population Health Management: Achieving Results in a Value-Based Healthcare System
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Healthcare Trends for 2013

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This week's industry news

1.) 90-Day Medication Supply Drives Better Adherence, Reduces Medicaid Costs

When compared to 30-day refills, 90-day medication refills at community pharmacies for Medicaid patients drive greater medication adherence, improved cost savings and generate nominal waste across four therapeutic categories, according to a new Walgreens study.

Get the full story.

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2.) Guide to Medication Adherence

Guide to Improving Medication Adherence This report 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, Connie Commander, past president of the Case Management Society of America and president of Commanders Premier Consulting Corporation, 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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3.) Colorado ACO Yields Big Savings, Reduced Readmissions

A new Colorado ACO proved to be beneficial in its first year of operation, yielding significant cost savings, quality of care, patient outcomes, and utilization of services, according to the Colorado Department of Health Care Policy and Financing.

Get the full story.

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4.) The Colorado Accountable Care Collaborative: Practical Lessons from an ACO

New Models in the Patient-Centered Medical Home During this 45-minute webinar now available as a CD-ROM, via On Demand Web access or as a training DVD, Laurel Karabatsos, deputy Medicaid director and Jerry Smallwood, Medicaid reform unit manager, walked us through the ACO development process in Colorado.

Learn more about this resource.

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5.) Healthcare Business White Paper: Asthma Management in 2012

Asthma Management in 2012 This HINtelligence Report provides data highlights on asthma management program components, key stakeholders in improving asthma challenges, reimbursement and ROI, as well as management in a population. Customized reports, including benchmark results by industry sector, are available upon request.

Download this complimentary white paper.

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6.) Medicare Rule Prevents Simultaneous Fees for Hospice and SNF

Nursing home residents with advanced dementia who have Medicare skilled nursing facility (SNF) care cannot receive simultaneous reimbursement for hospice care, resulting in those patients receiving aggressive treatment and hospitalization, according to a new study from Brown University.

Get the full story.

>>Return to this week's industry news


7.) New Table: Healthcare Trends to Monitor in 2013

New Table: Healthcare Trends to Monitor in 2013 With the healthcare industry moving ahead to implement the upcoming requirements of the Affordable Care Act following the Supreme Court decision to uphold the law, a noticeable jump in the formation of accountable care organizations, and new healthcare delivery models, including the patient-centered medical home and bundled payment programs, healthcare organizations have much to monitor in the year ahead.

Click here to view the table.

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8.) 46 Healthcare Metrics to Boost Profitability: Charting 2012 Trends

46 Healthcare Metrics to Boost Profitability: Charting 2012 Trends This 70-page desktop resource is designed exclusively for the busy healthcare executive who seeks a high-level summary of industry trends and benchmarks.


Learn more about this resource.

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9.) NQF Endorses 10 Behavioral Health Measures

The National Quality Forum (NQF) has endorsed 10 quality measures focused on behavioral health, including such issues as alcohol and tobacco abuse, antipsychotic medication adherence, and post care follow-up after hospitalization for mental illness.

Get the full story.

>>Return to this week's industry news

10.) 2012 Healthcare Benchmarks: Population Health Management

2012 Healthcare Benchmarks: Population Health Management This resource delivers an in-depth analysis of population health management (PHM) trends, including prevalence of PHM initiatives, program components, professionals on the PHM team, incentives, challenges and ROI.


Learn more about this resource.

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11.) Identifying Opportunities in Care Coordination of Dual Eligibles

Coordinating the care of dual eligibles — individuals covered by both Medicare and Medicaid — is a significant business opportunity for healthcare organizations in 2013, advises Hank Osowski, managing director of Strategic Health Group.

Get the full story.

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12.) Healthcare Trends & Forecasts in 2013: A Strategic Planning Session

Healthcare Trends & Forecasts in 2013: A Strategic Planning Session This 60-minute webinar, now available for replay, features Steven Valentine, president, The Camden Group, Hank Osowski, managing director of Strategic Health Group and Dennis Eder, also a managing director at Strategic Health Group.

Learn more about this resource.

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13.) Surviving Sandy: The Aftermath

Rumor has it the "Jersey Shore" cast will reunite for a fundraiser to benefit victims of Hurricane Sandy. Their efforts will certainly be appreciated. In the meantime, residents up and down the coast of the Garden State are coping heroically in the aftermath of the deadly storm. Our hearts go out to our staff, customers, friends and families that have been impacted by this devastating storm.

Read this blog post.

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14.) Population Health Management: Achieving Results in a Value-Based Healthcare System

Population Health Management: Achieving Results in a Value-Based Healthcare System Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants' National Clinical Practice — from researching the population's culture to examining its patterns of healthcare usage and cost trends. In this interview, Ms. Curran describes the four key research areas, as well as some of the barriers encountered along the road to population health management.

Listen to this podcast.

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