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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Several stories this week focus on reducing readmissions, and cite discharge instructions and follow-up as key to reducing these rates. But while Irene Zolotorofe, clinical operations director at Bon Secours Health System, explains how crucial nurse navigators are to the process, ensuring patients be seen within five to seven days of discharge; we run another story that stresses it is who is in charge of the patient at the time of admissions that is key to subsequent readmission rates.

A recent study from the Minneapolis Heart Institute Foundation found that rates for heart failure patients were significantly lower when the attending physician was a cardiologist as compared to a hospitalist (16 vs. 27 percent). The study also found that that one in five cardiac heart failure patients did not understand their diagnosis, and less than that understood their medication regimen.

Transparency is key to a new tool for measuring healthcare costs and utilization across payors throughout Colorado, and is designed to improve care and reduce costs. Colorado's All-Payor Claims Database (APCD) is a comprehensive health claims data resource, giving patients, purchasers, providers, payors and policymakers the tools to make informed decisions, officials say. The tool has been particularly effective at highlighting price discrepancies for common healthcare services like diagnostic imaging. A current APCD imaging payment report shows variation in payments for MRIs of the knee, ranging from $297 to $1,261. Payments for high cost imaging services (including both MRIs and CT scans) ranged from as low as $385 to high as $2,049. The tool is now available for viewing online.

URAC, a leading healthcare accreditation, education, and measurement organization, is seeking public comment on proposed initial standards for clinically integrated networks.

These initial standards will become part of the organization's Clinically Integrated Network accreditation program, designed in anticipation of ACA reforms calling for new care delivery models to provide better care for individuals and populations while reining in costs. Some key areas of focus for the accreditation are operations and structure, clinical management and health information technology.

Some progress on bending the healthcare cost curve: growth in the average total health benefit cost per employee slowed from 6.1 percent last year to just 4.1 percent in 2012, the smallest increase since 1997, according to the National Survey of Employer-Sponsored Health Plans. Moving more employees into low-cost, consumer-directed health plans and optimizing health management programs were two reasons for the slowed growth, the survey found.

And lastly, many thanks for your continued support of our services. We wish you all a very happy Thanksgiving.

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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This week's featured download: Health & Wellness Incentives in 2012

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November 19, 2012
Vol. XIV, No. 42

Sponsored by:
Care Coordination for Dual Eligibles: A Results-Oriented Approach


This week's industry news:

  1. HF Patients Treated by Cardiologist Rather Than Hospitalist Have Fewer Readmissions
  2. 27 Interventions to Reduce Avoidable ER Use
  3. URACís Proposed Clinical Integration Standards Emphasize Collaboration, Care Coordination
  4. Case Study in Clinical Integration: The Advocate Physician Partners Experience
  5. Healthcare Business White Paper: Diabetes Management in 2012
  6. Coloradoís All-Payor Claims Database Highlights Payment Discrepancies for Common Services
  7. New Chart: What Do Hospitals Do for Patients at Discharge?
  8. A Best Practice Roadmap to ICD-10 Readiness
  9. Health Benefits Cost Growth Increases by Smallest Margin in 15 Years
  10. 2012 Healthcare Benchmarks: Population Health Management
  11. 3 Steps to Improve Hospital Discharges
  12. Essentials of Embedded Case Management: Training, Case Loads and Technology for Practice-Based Care Coordinators
  13. Infographic: Healthcare Waste
  14. Healthcare Trends & Forecasts in 2013: A Strategic Planning Session
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This week's industry news

1.) HF Patients Treated by Cardiologist Rather Than Hospitalist Have Fewer Readmissions

When heart failure (HF) patients are treated by a cardiologist rather than a hospitalist, their rates of hospital readmissions are lower, according to a new study from the Minneapolis Heart Institute Foundation (MHIF).

Get the full story.

>>Return to this week's industry news


2.) 27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use This 45-page resource details provider- and patient-focused interventions that target the high numbers of avoidable visits, high and ultra-high utilizers and the sub-populations noted for frequent ER use.

Learn more about this resource.

>>Return to this week's industry news


3.) URACís Proposed Clinical Integration Standards Emphasize Collaboration, Care Coordination

URAC, a leading healthcare accreditation, education, and measurement organization, is seeking public comment on proposed initial standards for clinically integrated networks.

Get the full story.

>>Return to this week's industry news


4.) Case Study in Clinical Integration: The Advocate Physician Partners Experience

Case Study in Clinical Integration: The Advocate Physician Partners Experience This primer is for organizations wishing to duplicate the experience of Advocate Physician Partners (APP), whose CI program encompasses 3,800 physicians and has resulted in improvements in patient outcomes and significant cost savings, according to its 2011 Value Report.

Learn more about this resource.

>>Return to this week's industry news


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

Diabetes Management in 2012 An overwhelming majority of respondents to the December 2011 "10 Questions" e-survey are using a disease-specific approach to manage diabetes. Responses to the latest Healthcare Intelligence Network survey provided qualitative data on strategies and tactics for management of this disease, program components and challenges, and outcomes, metrics and ROI, which are summarized in this white paper.

Download this complimentary white paper.

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6.) Coloradoís All-Payor Claims Database Highlights Payment Discrepancies for Common Services

A new tool for measuring healthcare costs and utilization across payors throughout Colorado, and designed to improve care and reduce costs, is now available.

Get the full story.

>>Return to this week's industry news


7.) New Chart: What Do Hospitals Do for Patients at Discharge?

New Chart: What Do Hospitals Do for Patients at Discharge? Now that CMS' readmission penalties have been rolled out, hospitals are reexamining the hospital discharge to ensure the transition out of the hospital and the reception into the next site of care is a successful one. See which workflows hospitals have established for their patients upon discharge.

Click here to view the table.

>>Return to this week's industry news


8.) A Best Practice Roadmap to ICD-10 Readiness

A Best Practice Roadmap to ICD-10 Readiness In this valuable resource Dennis Winkler, ICD-10 technical program director for Blue Cross Blue Shield of Michigan (BCBSM), shares the health plan's mapping strategy, tips for assembling a transition team and a host of other organizational ICD-10 readiness tactics.


Learn more about this resource.

>>Return to this week's industry news


9.) Health Benefits Cost Growth Increases by Smallest Margin in 15 Years

Growth in the average total health benefit cost per employee slowed from 6.1 percent last year to just 4.1 percent in 2012, the smallest increase since 1997, according to the National Survey of Employer-Sponsored Health Plans, conducted annually by Mercer. Moving more employees into low-cost, consumer-directed health plans and optimizing health management programs were two reasons for the slowed growth, the survey found.

Get the full story.

>>Return to this week's industry news

10.) 2012 Benchmarks: Health & Wellness Incentives

2012 Benchmarks: Health & Wellness Incentives A best seller for three years running and a canít-miss planning tool for health and wellness program administrators, this valuable resource is packed with actionable new data on current and planned incentives activity, presented in more than 50 easy-to-follow graphs and tables.


Learn more about this resource.

>>Return to this week's industry news


11.) 3 Steps to Improve Hospital Discharges

Getting patients back in for follow-up appointments within five to seven days of hospital discharge is key in preventing unnecessary readmissions, explains Irene Zolotorofe, administrative director of clinical operations at Bon Secours Health System.

Get the full story.

>>Return to this week's industry news


12.) Essentials of Embedded Case Management: Training, Case Loads and Technology for Practice-Based Care Coordinators

Essentials of Embedded Case Management: Training, Case Loads and Technology for Practice-Based Care Coordinators This report documents the experiences of Aetna and Bon Secours in the recruitment, education, workload management and IT support of practice-based case managers.

Learn more about this resource.

>>Return to this week's industry news


13.) Infographic: Healthcare Waste

Thirty cents of every dollar spent on U.S. healthcare ó a total of $750 billion ó was wasted in 2009 on unnecessary services, excessive administrative costs, fraud and other problems, according to the prestigious Institute of Medicine. This infographic released by PBS Newshour illustrates what the United States could buy with the $750 billion wasted annually on healthcare.

View this infographic.

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

A presidential election, more post-ACA milestones and a remodeling of healthcare funding and delivery will no doubt make for an exciting year ahead in healthcare. In this preview of their October 17, 2012 strategic planning session for healthcare executives, Dennis Eder and Hank Osowski, managing directors of Strategic Health Group, and Steven Valentine, president of the Camden Group, predict the direction of physician reimbursement, trends in ACO administration, the technology to embrace in the year to come, and the industry's response to a softened demand for service.

Listen to this podcast.

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