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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

More than half of today's physicians believe that healthcare reform will improve patient care, according to a new trends report from the Physicians Foundation. The changing healthcare landscape is also pushing the majority of physicians to leave primary care practices for hospitals and group practices. These and other trends detailed in this issue.

Children with special healthcare needs are less likely to receive care that meets the criteria for having a medical home, according to a new national report from the Health Resources and Services Administration (HRSA), the first such report on this segment of the population and its counterparts: children without special needs. These children are also being exposed to less than ideal conditions at home; secondhand smoke and poor nutrition are just two situations cited in the report, which based their data on a national survey of more than 90,000 children in the United States.

Depression and diabetes can trigger dementia within three to five years of diagnosis, say researchers from the University of Washington and Kaiser Permanente. Contributors to the study, among the first and largest to date to examine dementia in diabetes patients with and without depression, hope these findings will ultimately slow the advent of dementia.

The CMS has issued a final rule that will give qualified organizations access to health claims data that can help them identify high quality healthcare providers, or create online tools to help consumers make educated healthcare choices. The final rule makes a number of important changes from the original proposed rule, one of them being that data is less costly than previously thought for qualified entities.

And we wanted to make you aware of our new complimentary e-book on the use of embedded case managers in healthcare, a trend embraced by Geisinger, Aetna, CDPHP, Advocate Physician Partners, Marshfield Clinic, Bon Secours and others. This downloadable e-book provides some early metrics on the emerging trend of placing case managers alongside care teams in physician practices and describes some of the benefits that can result.

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: 2011 Benchmarks in the Patient-Centered Medical Home

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December 12, 2011
Vol. XIII, No. 46

Sponsored by:
Mapping the way to ICD-10 Readiness: Blue Cross Blue Shield of Michigan's Approach

This week's industry news:

  1. CMS Final Rule on Accessing Health Claims Data Upholds Patients' and Providers' Privacy
  2. Health Management Tools for ACOs
  3. Using Motivational Interviewing to Improve Medication Adherence
  4. Guide to Improving Medication Adherence
  5. Complimentary e-book: Evolution of the Embedded Healthcare Case Manager
  6. 5 Key Trends for Physicians in 2012
  7. New Chart: Top Percentages of Reduction in Avoidable ER Visits
  8. Guide to Physician Performance-Based Reimbursement
  9. Depression Increases Risk of Dementia in Patients with Type 2 Diabetes
  10. Obesity & Weight Management Benchmarks and Case Studies
  11. 1 in 5 Households Have Children with Special Needs and Inadequate Healthcare
  12. Guide to Medical Home Reimbursement
  13. Q&A: How Ohio Reduces Avoidable ER Visits by Medicaid Beneficiaries
  14. HealthSounds Podcast: Aligning Physician Incentives for Shared Risk and Reward Across the Healthcare Continuum
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.) CMS Final Rule on Accessing Health Claims Data Upholds Patients' and Providers' Privacy

CMS has issued a final rule allowing qualified organizations to access its claims database to develop public ratings reports on physicians, hospitals and other healthcare providers.

Get the full story.

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2.) Health Management Tools for ACOs: Improving Outcomes in Accountable Care Organizations

Health Management Tools for ACOs This 40-page guide examines the building blocks of population health management that drive improvements in healthcare quality and efficiency in ACOs while positioning healthcare organizations for core measure improvement and increased reimbursement.


Learn more about this resource.

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3.) Using Motivational Interviewing to Improve Medication Adherence

Empathetic communication is one of the key ingredients in effective motivational interviewing which can improve medication adherence, says Dr. Janice Pringle, director of the program evaluation research unit at the University of Pittsburgh School of Pharmacy.

Get the full story.

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4.) Guide to Improving Medication Adherence

Guide to Improving Medication Adherence This 150-page guide analyzes trends in improving medication adherence at more than 160 healthcare companies, and takes an in-depth look at pioneering efforts by Kaiser Permanente Colorado and CIGNA Pharmacy Management to improve medication compliance levels in their populations. Additionally, the past president of the Case Management Society of America and president of Commanders Premier Consulting Corporation, shares a case manager's take on what's needed to move individuals toward medication compliance.

Learn more about this resource.

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5.) Complimentary e-book: Evolution of the Embedded Healthcare Case Manager

This new e-book presents the latest industry benchmarks on the embedded case management strategy as well as a look at how Geisinger Health System, Bon Secours Health System and others are colocating case managers at points of care.

Download this complimentary e-book.

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6.) 5 Key Trends for Physicians in 2012

Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, according to the Physicians Foundation in a new report.

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top Percentages of Reduction in Avoidable ER Visits

Reduction in Avoidable ER Visits As consumers and payors take on greater responsibility for the efficiency of the healthcare system, healthcare organizations are targeting avoidable ER use. We wanted to see how much healthcare organizations have reduced avoidable ER visits in their populations.

Click here to view the chart.

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8.) Guide to Physician Performance-Based Reimbursement: Payoffs from Incentives, Data Sharing and Clinical Integration

Guide to Physician Performance-Based Reimbursement This 68-page special report explores newly minted reimbursement formulas at two health plans and two independent practice associations (IPAs), providing payor and provider perspectives on the formula development process; clinical, quality and efficiency measures in use; physician incentive payments and program outcomes.

Learn more about this resource.

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9.) Depression Increases Risk of Dementia in Patients with Type 2 Diabetes

Patients with diabetes who also suffer from depression are twice as likely to develop dementia than patients with just diabetes alone, according to researchers from the University of Washington and Kaiser Permanente.

Get the full story.

>>Return to this week's industry news


10.) Obesity & Weight Management Benchmarks and Case Studies

Obesity & Weight Management Benchmarks This 32-page provides actionable information on current obesity and weight management programs for adults, children and adolescents. Whether your organization will focus on obesity and weight management in the near future or retool an existing program, it will benefit from a review of metrics and measurements to evaluate and plan your program and compare performance and utilization data.

Learn more about this resource.

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11.) 1 in 5 Households Have Children with Special Needs and Inadequate Healthcare

Nearly one-fifth of households in the United States have children with special healthcare needs who are not receiving adequate care, according to the Health Resources and Services Administration (HRSA).

Get the full story.

>>Return to this week's industry news


12.) Guide to Medical Home Reimbursement

Guide to Medical Home Reimbursement This 145-page resource delivers comprehensive analyses of emerging payment models for patient-centered care from early adopters that are working overtime to put a fair price on care coordination tasks and adequately reward providers for medical home adoption. More than 70 illustrations; Q&A chapter answers 75 questions on medical home reimbursement.

Learn more about this resource.

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13.) Q&A: 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. Dr. Chang works for the Bureau of Health Services Research for the Ohio Department of Job & Family Services.

Read this blog post.

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14.) HealthSounds Podcast: Aligning Physician Incentives for Shared Risk and Reward Across the Healthcare Continuum

Babette Apland Money may talk, but after 14 years of administering pay for performance (PFP) programs for its providers and specialists, HealthPartners has figured out what motivates physicians even more than financial incentives. Babette Apland, HealthPartners senior vice president of health and care management, shares this insight, as well as the measures by which HealthPartners evaluates pharmacies and specialists in its PFP program.

Listen to this podcast.

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