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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

As families gather this week to celebrate Thanksgiving, we offer several stories that demonstrate the strength of partnerships.

To begin, a first-of-its-kind patient-centered medical home (PCMH) model for oncology from Aetna and Consultants in Medical Oncology and Hematology, PC (CMOH).

The collaboration combines evidence-based decision support in cancer care with enhanced personalized services and realigned payment structure and is designed to increase treatment coordination and improve quality outcomes and costs for cancer patients. Researchers found that more than half of all new cancer patients are 65 or older, and most have one or more health conditions in addition to cancer. Given their frequency of contact with patients, oncologists are well positioned to help their patients coordinate care for multiple conditions.

Physician-led, team-based models of care are the future of healthcare, according to the AMA, which has issued a set of recommendations for implementing these models, including a report for the development of payment mechanisms that promote satisfaction and sustainability of team-based models in various practice settings. Among the recommendations: establishing payment distribution models that foster physician-led team based care, and reimbursing those physicians who lead these teams accordingly.

High-risk heart failure patients receiving nursing interventions were four times as likely to take their medication, but their hospital readmission rates were not impacted, according to a new study at Duke Medicine.

Patients who were tutored about managing their symptoms, taking their pills on schedule, and developing an action plan for addressing their symptoms were more likely to take their prescribed medications. They were encouraged to use doctors' offices and clinics rather than the emergency department.

But when the researchers looked at the hospital readmission rate, they found that readmissions were not significantly different between the two groups. Medication management is just one of many issues facing patients most at risk for their conditions to worsen, researchers found, and redesigning care to confront the issues that are keeping the vulnerable from regaining their health has to be addressed.

Developing a communication hub, virtually and in person, is critical to a successful care coordination plan for dual eligibles, says Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan. It ensures that all members of the immediate and long-term support team are in sync with each other.

Seniors also want to stay connected. According to a new Accenture survey, more than half of seniors 65 years and older are seeking digital options for managing their health services remotely. In fact, researchers found that at least three-fourths of Medicare recipients access the Internet at least once a day for e-mail (91 percent) or to conduct online searches (73 percent) and a third access social media sites, such as Facebook, at least once a week.

And lastly, a way for you to connect with us: participate in our fourth comprehensive online survey, Reducing Hospital Readmissions Benchmark Survey, and we will send you a free e-summary of the results once they are compiled.

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 Fornarotto
Associate Editor:
Jessica Fornarotto, jfornarotto@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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Accountable Care Organizations in 2013 — ACO Leadership Shifts to Physician-Hospital Organizations

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November 25, 2013
Vol. XV, No. 44

Institute for HealthCare Consumerism's IHC FORUM Sponsored by:

Institute for HealthCare Consumerism's IHC FORUM

The Institute for HealthCare Consumerism's IHC FORUM is the only national event focused 100 percent on innovative health and benefits management, bringing to life IHCís collaborative online community and informative publications. Through workshops, general sessions and networking opportunities, attendees obtain insights from key policy makers, legal experts, thought leaders and peers. The IHC FORUM allows employers, brokers, consultants and health plan administrators to LEARN, CONNECT, SHARE to arrive at actionable, cost-saving strategies for their businesses.

Click here to visit the conference Web site.


This week's industry news:

  1. Aetna, CMOH Launch First Oncology Medical Home
  2. Medical Home Neighborhoods
  3. 3 Recommendations for Funding New Team-Based Healthcare Models
  4. Case Study in Physician Practice and Payment Transformation
  5. Healthcare Business White Paper: Mobile Health in 2013
  6. Staying on Medication May Not Lower Hospital Readmissions
  7. New Chart: What's the ROI from Care Transition Management?
  8. 2013 Healthcare Benchmarks: Improving Medication Adherence
  9. Tech-Savvy Seniors Seek Digital Tools to Manage Health
  10. 2013 Healthcare Benchmarks: Telehealth & Telemedicine
  11. 6 Keys to a Successful Care Management Program for Dual Eligibles
  12. Guide to Dual Eligibles Care Coordination
  13. HINfographic: The Medical Home Neighborhood
  14. Medicare Pioneer ACO Year One
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.

Missed the last issue? Read it here.

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Take our monthly e-survey:
Reducing Hospital Readmissions in 2013

You'll be emailed a synopsis of the survey results.

Interested in all open surveys? Review them here.


This week's industry news

1.) Aetna, CMOH Launch First Oncology Medical Home

Designed to increase treatment coordination, and improve quality outcomes and costs for cancer patients, Aetna and Consultants in Medical Oncology and Hematology, PC (CMOH) have launched a first-of-its-kind patient-centered medical home (PCMH) model for oncology.

Get the full story.

>>Return to this week's industry news


2.) Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care

Medical Home Neighborhoods This webinar examines the trend toward patient-centered medical neighborhoods and effective strategies for building out the neighborhood. The director of BDC Advisors shares his expertise in developing these systems of care.

Learn more about this resource.

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3.) 3 Recommendations for Funding New Team-Based Healthcare Models

Physician-led, team-based models of care are the future of healthcare, according to the AMA, as evidenced by its successes in such healthcare organizations as Mayo Clinic, Geisinger Health System, Intermountain Healthcare and Kaiser Permanente.

Get the full story.

>>Return to this week's industry news


4.) Case Study in Physician Practice and Payment Transformation: The CDPHP Experience

Case Study in Physician Practice and Payment Transformation This resource chronicles the clinical and financial journeys of this network model health plan, sharing practical strategies and lessons learned from this two part-process.



Learn more about this resource.

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5.) Healthcare Business White Paper: Mobile Health in 2013 — Diabetes, Heart Disease Top Targets for Technologies

Mobile Health in 2013 The use of mobile health (mHealth) technologies has transformed the exchange of healthcare data, with mobile apps monitoring everything from blood sugar to medication adherence, and text-based reminders urging smokers not to give into that craving. In its first mHealth e-survey conducted in March 2013, the Healthcare Intelligence Network (HIN) captured current trends in emerging mHealth technologies. Nearly 150 healthcare organizations describe the technologies they use, the conditions and populations they target, and the challenges and successes they've encountered along the way.

Download this complimentary white paper.

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6.) Staying on Medication May Not Lower Hospital Readmissions

High-risk heart failure patients receiving nursing intervention were four times as likely to take their medication, but their hospital readmission rates were not impacted, according to a study at Duke Medicine.

Get the full story.

>>Return to this week's industry news


7.) New Chart: What's the ROI from Care Transition Management?

New Chart: What's the ROI from Care Transition Management? Proper management of transitions in care — the handover of an individual's care from one health setting to another — has the potential to dramatically hasten that person's return to health, as well as reduce the likelihood of a return ER visit or rehospitalization. We wanted to see what ROI was generated by care transition management programs.

Click here to view the chart.

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8.) 2013 Healthcare Benchmarks: Improving Medication Adherence

2013 Healthcare Benchmarks: Improving Medication Adherence This resource provides actionable information from more than 100 healthcare organizations on efforts to improve medication adherence and compliance in their populations. Now in its third year, this annual analysis documents the impact of these programs on adherence and compliance levels, medication costs, ER visits, hospital and skilled nursing facility admissions, risk of death, and other areas of concern.

Learn more about this resource.

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9.) Tech-Savvy Seniors Seek Digital Tools to Manage Health

More than half of seniors 65 years and older are seeking digital options for managing their health services remotely, according to a new Accenture survey.

Get the full story.

>>Return to this week's industry news

10.) 2013 Healthcare Benchmarks: Telehealth & Telemedicine

2013 Healthcare Benchmarks: Telehealth & Telemedicine This resource provides actionable new information from more than 125 healthcare organizations on their utilization of telehealth and telemedicine, and documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to present.

Learn more about this resource.

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11.) 6 Keys to a Successful Care Management Program for Dual Eligibles

Developing a communication hub is critical to a successful care coordination plan for dual eligibles, says Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan. It ensures that all members of the immediate and long-term support team are in sync with each other.

Get the full story.

>>Return to this week's industry news


12.) Guide to Dual Eligibles Care Coordination

Guide to Dual Eligibles Care Coordination This resource provides the principles of a comprehensive care coordination effort for Medicare-Medicaid beneficiaries, taking into account the medical, behavioral, social and functional needs of this vulnerable population.


Learn more about this resource.

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13.) HINfographic: The Medical Home Neighborhood

There are more than 6,037 PCMH sites in the United States, according to the NCQA. To further reduce fragmented care, many PCMHs are expanding to house the entire care continuum — a phenomenon known as the Medical Neighborhood. Medical home neighbors include specialists along with primary care clinicians to better coordinate care, according to a new infographic from the Healthcare Intelligence Network. This HINfographic also includes successful tactics for medical home 'neighbors,' signs of a desirable medical neighborhood, and more.

Read this blog post.

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14.) Medicare Pioneer ACO Year One: Lessons from a Top-Performer

Colin LeClair Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO — among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions reductions and four disease management conditions — ESRD, COPD, CHF and diabetes — and creating a care coordination team that included the newly created care navigator, case managers, and pharmacist, the organization has improved patient compliance, reduced negative drug interactions and hospital days and improved patients access to community services.

Listen to this podcast.

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