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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

While we wait for healthcare reform to clear its next legislative hurdle, a new report from the Business Roundtable, an association of CEOs of leading U.S. companies, identifies the bolder aspects of healthcare reform that could slow the growth of healthcare costs and offer real savings for companies and their employees — by as much as $3,000 per employee in 2019. Their advice shouldn't be taken lightly; as a group, Business Roundtable’s member companies employ more than 12 million employees, provide health coverage to more than 35 million Americans and report annual revenues of more than $5 trillion.

These top business leaders say the following reforms to the U.S. healthcare system would help curb costs:

  • Delivery system reforms, such as value-based purchasing;
  • Innovation centers that identify alternative methods of provider reimbursement;
  • Accountable care organizations that realign financial incentives to improve the quality and the value of the care delivered;
  • Financial penalties for failing to avoid preventable hospital readmissions;
  • Increased individual accountability for healthcare spending decisions, including health reimbursement arrangements and health savings accounts;
  • Cost and quality of care data that is easier for patients and providers to access and use;
  • Elimination of sharp regional variations in practice patterns;
  • Promote wellness and prevention programs and expand financial incentives to participate in specific programs to reduce lifestyle-related illness; and
  • Insurance market reforms that promote competition and choice.

A featured story this week provides an example of realigned financial incentives. Baptist Health System explains its rationale for participating in a CMS pilot of bundled payments, in which savings are shared with providers and patients.

Conversely, the Business Roundtable identified several conditions that could increase healthcare costs: delayed or watered-down cost-saving efforts; failure to implement a strong individual mandate to minimize cost increases in health insurance exchange plans; increases in cost of healthcare to individuals from changes to consumer spending accounts or other actions that discourage consumer-engaged decision-making; and cost-shifting to the private sector.

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 16, 2009
Vol. XI, No. 43

Sponsored by:
Reducing Avoidable Hospital Readmissions — A Case Study from Priority Health

This week's industry news:

  1. International Survey of PCPs Finds U.S. Lags In HIT Access, Quality and Use
  2. Medical Home Compilation
  3. Bundled Payments Demo Shares Savings with Doctors and Patients
  4. Medical Home Reimbursement ABCs
  5. Healthcare Business White Paper: Targeting Depression Through DM
  6. Killing in War Associated with PTSD and Behavioral and Adjustment Problems
  7. Anxiety, Phobias and Panic Disorders Clinical Guidelines
  8. Elderly Depression Lessened when Kept Informed of Family Matters
  9. Health Coaching Playbook Vol. II
  10. HHS Funds Effort to Reduce HAIs in Ambulatory Surgical Centers
  11. CDC Infection Control Guidelines
  12. HealthSounds Podcast: 4 Ways to Empower Patients to Avoid Rehospitalization
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.) International Survey of PCPs Finds U.S. Lags In HIT Access, Quality and Use

Fifty-eight percent of primary care physicians (PCPs) in the U.S. report their patients often have difficulty paying for medications and care, and half of U.S. doctors spend substantial time dealing with restrictions insurance companies place on their patients’ care, according to findings from the 2009 Commonwealth Fund International Health Policy Survey published online in the journal Health Affairs.

Get the full story.

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2.) Medical Home Compilation: Profiles on Pilots and Projects

Medical Home Compilation This comprehensive three-volume set illustrates how medical home projects and pilots are being used to improve primary care access and use. Included are case studies on programs from APS Healthcare, the Commonwealth of Massachusetts, Community Care of North Carolina, Horizon Blue Cross Blue Shield of New Jersey, the Pennsylvania Medicaid Access Program and United Healthcare. The compilation includes the following titles: “The Medical Home: Pathway to Patient-Centric Primary Care,” “Framing the Medical Home Model of Care: Blueprint from Early Adopters,” and “Case Studies from Diabetes Medical Home Pilots: Key Processes, Tools, Metrics and Outcomes.”

Learn more about this resource.

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3.) Bundled Payments Demo Shares Savings with Doctors and Patients

Baptist Health System Chief Development Officer Michael Zucker shares Baptist's motivation for participating in a CMS pilot on shared or bundled payments — a reimbursement model increasingly mentioned in healthcare reform debates.

There were several components of the CMS Acute Care Episode (ACE). First, there was a competitive bidding process. CMS was focused on one geographic region within the country. They chose the Southwest, which included Texas, Colorado, Oklahoma and New Mexico. These four states fall under the fiscal intermediary TrailBlazer, which administers the Medicare program in this region.

Get the full story.

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4.) Medical Home Reimbursement ABCs: Funding Care Delivery through ACOs, Bundled Payments and Concrete Contracts

Medical Home Reimbursement ABCs This resource provides a primer on emerging reimbursement models that are supported in healthcare legislation and getting payors’ and providers’ attention while delivering cost savings. This 50-page report profiles three healthcare organizations that are redefining healthcare reimbursement with their pilots of new payment models and contracting strategies.

Learn more about this resource.

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5.) Healthcare Business White Paper: Targeting Depression Through DM

Nearly 6 percent of men and almost 10 percent of women worldwide will experience a depressive episode in any given year, and in America alone, approximately 18.8 million adults have depression. In an e-survey from the Healthcare Intelligence Network (HIN), 250 healthcare professionals shared how their organizations are targeting depression as part of their disease management (DM) initiatives.

Download this complimentary white paper.

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6.) Killing in War Associated with PTSD and Behavioral and Adjustment Problems

In a study of 1,200 veterans of the Vietnam war, those who reported taking a life in combat had a higher incidence of post-traumatic stress disorder (PTSD), violent behaviors, trouble with daily functioning and other psychological problems than those who did not, even decades after their war experience.

Get the full story.

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7.) Anxiety, Phobias and Panic Disorders Clinical Guidelines

Anxiety, Phobias and Panic Disorders This 83-page report is for the evaluation and management of common anxiety disorders and panic disorder. Plus, separate guidelines for post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). Extensive references and resources follow each of the three guidelines.

Learn more about this resource.

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8.) Elderly Depression Lessened when Kept Informed of Family Matters

The elderly are less likely to feel depressed if their relatives keep them updated about important family matters, a new study indicates. Researchers at the University of Michigan (U-M) and Kyungpook National University looked at how stress and depression affected elders over age 85.

Get the full story.

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9.) Health Coaching Playbook Vol. II: All-Star Tips on Patient Engagement, Activation and Behavior Change

Health Coaching Playbook Vol. II Picking up where Volume I leaves off, this resource delivers suggestions and tactics from veteran health coaches, clinicians, psychologists and researchers to move individuals toward healthier lifestyles and behavior change that can significantly suppress an organization's medical cost trend. With a special focus on coaching individuals with chronic illnesses, this resource answers specific queries about essential coaching tools — stages of change, motivational interviewing, integrative health coaching, patient activation, positive psychology and many others, with responses from leading online and telephonic coaching at the Mayo Clinic, Gordian Health Solutions, Health Management Corporation, Corphealth, PricewaterhouseCoopers and others.

Learn more about this resource.

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10.) HHS Funds Effort to Reduce HAIs in Ambulatory Surgical Centers

To reduce healthcare-associated infections (HAIs) in stand-alone or same-day surgical centers, HHS has appropriated up to $9 million from the American Recovery and Reinvestment Act (ARRA) to state survey agencies in 43 states. HAIs are infections some patients acquire when they are in a healthcare setting such as a hospital or outpatient clinic.

Get the full story.

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11.) CDC Infection Control Guidelines

CDC Infection Control Guidelines This collection, which comes in a three-ring notebook with over 450 pages, is packed with resources invaluable to your infection control program. The OSHA Bloodborne Pathogens regulations have been included as a bonus. This product puts at your fingertips all the major resources used by ICPs on a daily basis.

Learn more about this resource.

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12.) HealthSounds Podcast: 4 Ways to Empower Patients to Avoid Rehospitalization

4 Ways to Empower Patients to Avoid Rehospitalization Priority Health members play an active role in keeping themselves out of the hospital, explains Mary Cooley, manager of case and disease management at Priority Health. She describes the four-point strategy that is reducing readmissions at Priority Health, the challenges that still exist and the essential tool that Priority supplies to help providers identify and close care gaps.

Listen to this podcast.

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