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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Following a period of public comment, the NCQA launches its ACO accreditation program today. According to the NCQA, ACO accreditation is an independent evaluation of healthcare delivery organizations’ ability to coordinate the high-quality, efficient, patient-centered care expected of ACOs. The program provides a roadmap for provider-led organizations to demonstrate their ability to reach the triple aim: reduce cost, improve quality and enhance the patient experience.

According to PwC’s recent annual report on the top issues facing the health industry in 2012, healthcare and the national deficit rank equally as the second most pressing election concern after job creation on the minds of the American public.

The economy made a major impact on the minds of respondents to our own ongoing survey, Healthcare Trends for 2012, with one respondent stating that “Businesses still faced major economic issues and as a result either closed their doors, downsized their staff or significantly reduced benefits.” You can still voice your opinion on the state of the healthcare industry in our survey; all participants receive a free, downloadable copy of the executive summary once our responses are compiled.

CMS continues its Million Hearts initiative with expanded coverage for the prevention of cardiovascular disease. Medicare will now cover one face-to-face visit each year to allow patients and their providers to determine the best way to prevent cardiovascular disease, according to the CMS. The initiative aims to prevent 1 million heart attacks and strokes in the United States by 2017.

Effective October 13, 2013, healthcare entities must have updated the codes they use regarding diseases and conditions from ICD-9 to ICD-10. It’s a long, involved process, which is why Blue Cross Blue Shield of Michigan (BCBSM) has developed an ICD-10 transitional roadmap, in order to help other organizations reduce the time and effort of implementation. But it’s a necessary process: organizations not ready by the transition date will not be reimbursed for claims. More in this issue.

The mHealth revolution continues, with two out of three healthcare providers saying they will continue to embrace mobile technology, in particular, EMR/EHR systems. Future uses for telemedicine, which garnered only lukewarm interest from survey respondents, include videoconferencing for patient interaction.

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 21, 2011
Vol. XIII, No. 43

Sponsored by:
Demonstrating the Value of the Embedded Case Manager for the Medicare Population

This week's industry news:

  1. BCBSM Develops ICD-10 Transition Roadmap for Providers
  2. ICD-10-CM/PCS Implementation Action Plan
  3. How Clinical Integration Overcomes 4 Key Challenges for ACOs
  4. Case Study in Clinical Integration
  5. Healthcare Business White Paper: The ICD-10 Compliance Challenge
  6. Costs, Drug Shortages Among Top Issues Facing Healthcare Industry
  7. New Table: 9 Responsibilities of an Embedded Case Manager
  8. Health Insurance Exchanges
  9. Two Out of Three Healthcare Providers Embrace Mobile Technologies; Lukewarm Interest in Telemedicine
  10. Telemedicine Technologies
  11. Medicare Expands Coverage of Cardiovascular Disease Prevention Services
  12. 2011 Benchmarks in Reducing Avoidable Healthcare Utilization
  13. How Ohio Reduces Avoidable ER Visits by Medicaid Beneficiaries
  14. HealthSounds Podcast: Aetna Embedded Case Management for Medicare
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This week's industry news

1.) BCBSM Develops ICD-10 Transition Roadmap for Providers

Blue Cross Blue Shield of Michigan (BCBSM) has developed an ICD-10 transitional roadmap for healthcare providers, in order to help them reduce the time and effort of implementing to this new revision, which will be effective Oct. 1, 2013.

Get the full story.

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2.) ICD-10-CM/PCS Implementation Action Plan

ICD-10-CM/PCS Implementation Action Plan With this 135-page book, you will be able to identify the impact that ICD-10-MC/PCS will have on key departments/areas, customize the action and training items using the electronic files provided with the book, determine major differences between ICD-9-CM and ICD-10-CM/PCS, and get updates to new action items via Internet access.

Learn more about this resource.

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3.) How Clinical Integration Overcomes 4 Key Challenges for ACOs

Incorporating small physician practices into its infrastructure and modifying physician reimbursement are some of the ways that Advocate Physician Partners (APP) has overcome the challenges facing ACOs, explains Mark Shields, MD, MBA, senior medical director for APP and vice president of medical management for Advocate Health Care.

Get the full story.

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

Case Study in Clinical Integration This 20-page report is a primer for organizations wishing to duplicate the experience of Advocate Physician Partners (APP), whose clinical integration 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.

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5.) Healthcare Business White Paper: The ICD-10 Compliance Challenge — Automating Trading Partner and Affiliate Readiness

With deadlines for compliance fast approaching, ICD-10 program managers must manage a myriad of tasks spanning the business. A significant component of ensuring compliance involves assessing the readiness of affiliates to transact with the new ICD-10 codes. This white paper presents strategies for bringing automation to reduce cost and minimize risk in ICD-10 compliance.

Download this complimentary white paper.

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6.) Costs, Drug Shortages Among Top Issues Facing Healthcare Industry

Containing healthcare costs, adapting to new state health insurance exchanges, increasing drug shortages and meeting new reporting requirements are among the biggest challenges facing healthcare organizations in the coming year, according to a recent study from PwC’s Health Research Institute.

Get the full story.

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7.) New Table: 9 Responsibilities of an Embedded Case Manager

9 Responsibilities of an Embedded Case Manager Embedded case managers are at the heart of CDPHP's clinical transformation to a patient-centered medical home, working in physician practices to facilitate medical, behavioral and pharmaceutical services for high-risk patients. We wanted to see the most important roles and responsibilities of the CDPHP nurse case managers.

Click here to view the chart.

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8.) Health Insurance Exchanges: Strategies and Stakeholders

Health Insurance Exchanges In this guide, readers will learn about the hurdles states are facing in developing models and establishing exchanges. They will also gain insight from industry consultants, state lawmakers and regulators, scholars and other key industry observers on key topics affecting the industry.

Learn more about this resource.

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9.) Two Out of Three Healthcare Providers Embrace Mobile Technologies; Lukewarm Interest in Telemedicine

While two thirds of healthcare professionals admit to implementing or increasing their mobile technology usage to improve productivity and patient care, just 14 percent express an interest in telemedicine, according to a new study by CompTIA, the nonprofit association for the information technology (IT) industry.

Get the full story.

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10.) Telemedicine Technologies: Information Technologies in Medicine and Telehealth

Telemedicine Technologies In this essential resource, the authors discuss consumer healthcare technology, and explores topics such as communication networks and services, patient monitoring, information processing, system deployment, data security and privacy, information technology in alternative medicine, multimedia and health informatics, and caring for the community.

Learn more about this resource.

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11.) Medicare Expands Coverage of Cardiovascular Disease Prevention Services

Medicare will now cover one face-to-face visit each year to allow patients and their providers to determine the best way to prevent cardiovascular disease, according to the CMS.

Get the full story.

>>Return to this week's industry news


12.) 2011 Benchmarks in Reducing Avoidable Healthcare Utilization: Data to Drive Down ER Visits and Readmissions

Benchmarks in Reducing Avoidable Healthcare Utilization This resource takes a comprehensive look at industry activity in the reduction of hospital readmissions and ER visits as a whole, and then drills down to the health plan and hospital perspectives presented by survey respondents. The utilization reduction data documented in this benchmarks report is derived from two separate surveys conducted in 2010 by the Healthcare Intelligence Network.

Learn more about this resource.

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13.) How Ohio Reduces Avoidable ER Visits by Medicaid Beneficiaries

An Ohio collaborative of Medicaid plans uses a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid population. In an interview prior to her presentation on Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions, Mina Chang, PH.D., provided details on the effort.

Read this blog post.

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14.) HealthSounds Podcast: Aetna Embedded Case Management for Medicare

Dr. Randall Krakauer When healthcare providers and health plan case managers join forces in the physician practice, the end result is "care completion," explains Dr. Randall Krakauer, medical director for Aetna Medicare. In his second HealthSounds interview, Dr. Krakauer describes how the meshing of complementary patient data and knowledge from payor and provider improves the "completion factor" of care that is ordered and provides feedback on the impact of this care.

Listen to this podcast.

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