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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

'Tis the season to welcome those in need, and doctors' offices are a good place to start.

Primary care physician offices need to be more accessible, because the majority of patients are finding their doors closed when they most need them, says a new report from the Center for Studying Health System Change.

Of nearly 10,000 patients surveyed who have a usual source of primary care, more than half said their doctors did not provide care after hours and on the weekend. These patients were more likely to go to the ED as a result, or skip medical care completely, researchers said. At a time when reducing unnecessary ED visits — totaling more than 136 million in 2009, according to the CDC — is a major concern of healthcare experts, this could be a simple, potentially cost-effective solution.

Another reason to expand primary care access? Americans are living longer, given increasing medical advances, according to United Health Foundationís 2012 Americaís Health Rankings®. But theyíre not necessarily healthier, because of increasingly unhealthy behaviors and diets, habits that unfortunately arenít limited to the typically overindulgent holiday season.

While rates of premature, cardiovascular and cancer deaths have declined since 1990 by 18 percent, 34.6 percent and 7.6 percent, respectively, preventable behaviors have increased: nearly a third of adults are obese, 10 percent of the population has diabetes, 31 percent has high blood pressure (BP) and 26 percent of adults are sedentary or do not exercise outside of work, resulting in increasing levels of diabetes and high BP.

There is another population that is living longer — former cancer victims who beat the odds but now have bodies weakened by cancer treatments. These "survivors" need a heavy dose of holiday cheer, in the form of a dedicated line of care, and todayís case managers can provide that care, says Sheryl Riley, managing partner at Clarion LLC. But they need to be trained not only to deal with the physical after-effects of their disease, but their emotional state and their familiesí emotional state as well.

And this could very well be a topic of discussion for our brand new LinkedIn forum: CaseTalk... a Forum for Care Coordinators, where case managers can talk about best practices, news and analysis, and network with others.

In our discussions with case managers over the years, we have found that they would appreciate an online meeting group where they can share ideas and concerns about their craft with the limited amount of time they have, all year round. We hope that CaseTalk becomes that go-to place for many of you, case managers and healthcare professionals alike.

Happy holidays!

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 17, 2012
Vol. XIV, No. 46

Sponsored by:
Physician Hospital Organizations — Developing a Collaborative Structure for Shared Savings Agreements


This week's industry news:

  1. Barriers to Primary Care After Hours Lead to ER Overuse, Neglected Medical Care
  2. 27 Interventions to Reduce Avoidable ER Use
  3. Most Americans Living Longer, But Not Necessarily Healthier
  4. 2011 Benchmarks in Obesity and Weight Management
  5. Healthcare Business White Paper: 2012 Benchmarks in Reducing Avoidable ER Visits
  6. Survivorship Key Challenge for Case Management in 2013
  7. New Table: 4 Domains of Process Improvement for Reducing Hospital Readmissions
  8. Case Management for Advanced Illness
  9. Primary Care Physicians Play Vital Role with Diabetic Patients
  10. 2012 Healthcare Benchmarks: Diabetes Management
  11. Employer Health Insurance Premiums Increased 62 Percent from 2003 to 2011
  12. Health Insurance Exchanges
  13. Infographic: Provider Consolidation
  14. Patient Engagement in the Patient-Centered Medical Home
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This week's industry news

1.) Barriers to Primary Care After Hours Lead to ER Overuse, Neglected Medical Care

Patients who canít reach their primary care physicians after hours are more likely to go to the ED, or go without medical care, according to a study by the Center for Studying Health System Change (HSC).

Get the full story.

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2.) 27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use This 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.

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3.) Most Americans Living Longer, But Not Necessarily Healthier

Americans are living longer given increasing medical advances, but these advances canít offset Americansí unhealthy lifestyles, according to United Health Foundationís 2012 Americaís Health Rankings®.

Get the full story.

>>Return to this week's industry news


4.) 2011 Benchmarks in Obesity and Weight Management

2011 Benchmarks in Obesity and Weight Management This resource takes a comprehensive look at efforts in the healthcare industry to manage obesity and weight, based on recent market research by the Healthcare Intelligence Network. Weight management is one of the top five disease management efforts for which financial and benefit-based incentives are offered.


Learn more about this resource.

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5.) Healthcare Business White Paper: 2012 Benchmarks in Reducing Avoidable ER Visits — Pain Management Patients on Rise

2012 Benchmarks in Reducing Avoidable ER Visits With consensus widespread that much of emergency room use is avoidable and preventable, this white paper details how 134 healthcare organizations are working to staunch the flow and expense of avoidable emergency department use and point low-acuity patients in the direction of appropriate care.

Download this complimentary white paper.

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6.) Survivorship Key Challenge for Case Management in 2013

Oncology case managers, like Sheryl Riley, RN, OCN, CMCN, and managing partner at Clarion LLC, have long accepted that a majority of their patients will not survive. But advanced medical procedures are creating greater numbers of survivors, and a new challenge for case managers, that of dealing with patients whose bodies have been weakened by rigorous treatments and surgeries, and whose families are left emotionally weakened as well.

Get the full story.

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7.) New Table: 4 Domains of Process Improvement for Reducing Hospital Readmissions

New Table: 4 Domains of Process Improvement for Reducing Hospital Readmissions CMS' readmission penalties have rolled out with hospitals facing a penalty cap of 1 percent of their Medicare revenue this fiscal year. In the future, hospitals may also be subject to additional conditions for the penalty beyond the initial heart attack, heart failure and pneumonia DRGs. We wanted to illustrate the four domains of process improvement that hospitals should follow to reduce readmissions after discharge.

Click here to view the table.

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8.) Case Management for Advanced Illness: Best Practices in End-of-Life Care

Case Management for Advanced Illness This resource provides information, tools and resources contributes to higher quality of care for those with advanced illness, and looks at best practices and barriers that commonly arise during the care of advanced illness patients, among other things.


Learn more about this resource.

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9.) Primary Care Physicians Play Vital Role with Diabetic Patients

Primary care physicians (PCPs) provide better care to diabetic patients than other providers in primary care settings because they are more likely to alter medications and provide lifestyle counseling, according to a study at Brigham and Womenís Hospital (BWH).

Get the full story.

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10.) 2012 Healthcare Benchmarks: Diabetes Management

2012 Healthcare Benchmarks: Diabetes Management This resource provides actionable data from 83 organizations on current diabetes management programs and their impact on population health outcomes and healthcare spend.



Learn more about this resource.

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11.) Employer Health Insurance Premiums Increased 62 Percent from 2003 to 2011

The average premium for an employer-sponsored family health insurance plan increased 62 percent between 2003 and 2011, from $9,249 to $15,022 per year, according to a new Commonwealth Fund report.

Get the full story.

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12.) Health Insurance Exchanges: Preparing for the Brave New Marketplace Ahead

Health Insurance Exchanges This resource examines the hurdles state lawmakers and stakeholders face in developing models and establishing exchanges. It also provides insight from industry consultants, state lawmakers and regulators, scholars and other key industry observers on a variety of topics.


Learn more about this resource.

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13.) Infographic: Provider Consolidation

When hospitals consolidate with other hospitals or by buying physician practices, healthcare costs increase, according to a new infographic by AHIP.

Read this blog post.

>>Return to this week's industry news


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

Patient Engagement in the Patient-Centered Medical Home Although the healthcare industry is well-acquainted with the patient-centered medical home, the model is still quite new and novel to patients, notes, Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield of New Jersey. In this interview, Driggers describes what's at stake when moving from a reactive provider model to a proactive model.

Listen to this podcast.

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