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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Primary care outside the doctor's office is getting its due. According to a final ruling from CMS, payment rates and policies for 2014 are focusing on improved care coordination, including a major proposal to support care management outside the routine office interaction.

The ruling also includes other policies to promote high quality care and efficiency in Medicare. CMS officials consider the care coordination policy a milestone, demonstrating Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015.

But there is a time and place for face-to-face visits: namely, between nurses and newly diagnosed cancer patients. According to a new study from the Group Health Research Institute, cancer patients who received support from a nurse navigator or advocate soon after being diagnosed had better experiences and fewer problems with their care, particularly in the areas of health information, care coordination and psychological and social care. Patients reported feeling that the healthcare team had gone out of its way to make them feel better emotionally. The extra help is especially welcome with new cancer patients, given that they and their caregivers need help translating medical jargon and navigating the healthcare maze, researchers say.

While the covering of catastrophic illnesses like cancer is one of the key issues behind healthcare reform, it is not enough to sell the nearly 30 percent of Americans opting out of coverage. According to the latest tracking poll from Gallup, one out of four uninsured Americans are planning on paying the government penalty rather than buy health insurance. The reason? Not what you think; details inside.

An automated prediction tool that identifies newly admitted patients at risk for readmission within 30 days of discharge has been successfully incorporated into the EHR of the University of Pennsylvania Health System.

The tool predicts at-risk patients as those who have been admitted to the hospital two or more times in the 12 months prior to admission. Once it identifies these high-risk patients, it creates a flag in their EHR, which appears next to the patient’s name in a column titled “readmission risk” once the patient is admitted.

We'd love to hear how your organization is working to reduce hospital readmissions by taking HIN's fourth comprehensive Reducing Hospital Readmissions Benchmark Survey. Respond by January 3, 2014 and receive an 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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December 9, 2013
Vol. XV, No. 46

Sponsored by:
Home Visits — Assessing Complex Patients Post-Discharge To Reduce Readmissions


This week's industry news:

  1. Nurse Navigators Help Cancer Patients Cope Early in Care
  2. Essentials of Embedded Case Management
  3. Automated Predictor Flags Patients at Risk for 30-Day Readmission: Study
  4. 2012 Healthcare Benchmarks: Reducing Avoidable ER Visits
  5. Healthcare Business White Paper: Care Transitions in 2013
  6. 1 in 4 Uninsured Americans Plan to Remain That Way; Politics Influence Decisions
  7. New Table: 3 Impacts of ACA Marketplaces on Health Plans in 2014
  8. Designing Pharmacy Benefits in Health Insurance Exchanges
  9. Final 2014 CMS Physician Payments Support Care Outside Face-to-Face Visits
  10. Patient Engagement in the Patient-Centered Medical Home
  11. 3 Pioneer ACO Tips to Improve Patient Engagement
  12. 7 Value-Based Priorities for Healthcare's Smart Money
  13. HINfographic: Risk-y Business — HRAs Take Temperature of Population Health
  14. Motivational Interviewing by Ochsner Health Coaches Drives Results in 4 Key Areas
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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Reducing Hospital Readmissions in 2013

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This week's industry news

1.) Nurse Navigators Help Cancer Patients Cope Early in Care

Cancer patients who received support from a nurse navigator or advocate soon after being diagnosed had better experiences and fewer problems with their care, particularly in the areas of health information, care coordination and psychological and social care, according to a study from the Group Health Research Institute.

Get the full story.

>>Return to this week's industry news


2.) Essentials of Embedded Case Management: Hiring, Training, Caseloads and Technology for Practice-Based Care Coordinators

Essentials of Embedded Case Management This resource documents the experiences of Aetna and Bon Secours in the recruitment, education, workload management and information technology (IT) support of practice-based case managers.



Learn more about this resource.

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3.) Automated Predictor Flags Patients at Risk for 30-Day Readmission: Study

An automated prediction tool that identifies newly admitted patients at risk for readmission within 30 days of discharge has been successfully incorporated into the EHR of the University of Pennsylvania Health System.

Get the full story.

>>Return to this week's industry news


4.) 2012 Healthcare Benchmarks: Reducing Avoidable ER Visits

2012 Healthcare Benchmarks: Reducing Avoidable ER Visits This resource provides critical benchmarks that show how the industry is working to reduce avoidable hospital ED visits, and is designed to meet business and planning needs of hospitals, health plans, physician practices and others.


Learn more about this resource.

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5.) Healthcare Business White Paper: Care Transitions in 2013 — Interventions Surge in Response to Payor Scrutiny; Home-Grown Approaches Trump Traditional Models

Care Transitions in 2013 In its third annual e-survey on Care Transition Management, the Healthcare Intelligence Network (HIN) captured efforts by 86 organizations to strive for Triple Aim goals of better care at improved cost during transitions of care. Conducted in April 2013, the survey measures existing and planned programs, targeted transitions and populations, transition team members and responsibilities, and much more. This HINtelligence Report provides data highlights on care transition program components, the most successful tools for care transition management, results and ROI; and much more.

Download this complimentary white paper.

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6.) 1 in 4 Uninsured Americans Plan to Remain That Way; Politics Influence Decisions

One in four uninsured Americans plan on paying the government fine imposed for not having insurance, a percentage that has remained the same in the last month, according to the latest results of a daily tracking Gallup poll that began in September.

Get the full story.

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7.) New Table: 3 Impacts of ACA Marketplaces on Health Plans in 2014

New Table: 3 Impacts of ACA Marketplaces on Health Plans in 2014 Sustained growth in emerging reimbursement models, including accountable care, bundled payments and shared savings, will continue to impact innovation within the healthcare industry in 2014 as providers and payors struggle to find more ways to reduce costs within their systems and better manage the care they provide. We wanted to see the impact of ACA's health insurance marketplaces on health plans in 2014.

Click here to view the table.

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8.) Designing Pharmacy Benefits in Health Insurance Exchanges

Designing Pharmacy Benefits in Health Insurance Exchanges This resource sheds light on the tactics insurers should employ to nail down drug benefit designs that avoid adverse selection, fulfill government requirements and win healthy members.



Learn more about this resource.

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9.) Final 2014 CMS Physician Payments Support Care Outside Face-to-Face Visits

A final rule setting payment rates and policies for 2014 is focusing on improved care coordination, including a major proposal to support care management outside the routine office interaction, according to CMS.

Get the full story.

>>Return to this week's industry news

10.) Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach

Patient Engagement in the Patient-Centered Medical Home This webinar shares how Horizon BCBS approaches patient engagement, including seven key consumer engagement objectives and the impact of stand-alone pilots on consumer engagement, from iPhone apps to telemonitoring.

Learn more about this resource.

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11.) 3 Pioneer ACO Tips to Improve Patient Engagement

As a top performer in year one of the CMS Pioneer ACO program, Monarch HealthCare is paving the way to accountable care with a foundation of patient and provider-centered strategies that support Triple Aim goals, says Colin LeClair, Monarch’s executive director of ACO. Identifying opportunities to yield patient engagement is crucial to success, and here he cites three ways do so.

Get the full story.

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12.) 7 Value-Based Priorities for Healthcare's Smart Money

7 Value-Based Priorities for Healthcare's Smart Money This resource shares tactics, lessons learned and results from some of the most recognizable names in healthcare — Kaiser Permanente, Mayo Clinic Health System, Monarch HealthCare, HealthFitness, WellCare, and others, as well as 2013 benchmarks in telehealth and telemedicine applications from 129 healthcare companies.

Learn more about this resource.

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13.) HINfographic: Risk-y Business — HRAs Take Temperature of Population Health

Seventy percent of healthcare organizations use health risk assessments (HRAs) to measure health risk factors, according to a recent 2013 HIN survey. The individuals most eligible to take HRAs include employee and health plan members, spouses and dependents over 18, according to a new infographic from the Healthcare Intelligence Network. This infographic also provides metrics on HRA completion rates, target populations, HRA formats and contents, and HRA inputs and outputs.

Read this blog post.

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14.) Motivational Interviewing by Ochsner Health Coaches Drives Results in 4 Key Areas

Alicia Vail When health coaches employ motivational interviewing during patient encounters, expect upticks in medication adherence, weight loss, HbA1c levels and overall engagement, notes Alicia Vail, RN health coach for Ochsner Health System. Ochsner's eight health coaches focus on patients with diabetes, hypertension and obesity who have come to their attention by way of physician referrals, health screenings and pre-chart reviews.

In this podcast, Ms. Vail describes how Ochsner Health System incorporates health coaches in its clinic structure and describes the benefits that result from the coaching intervention.

Listen to this podcast.

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