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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

From antibiotic-resistant superbugs to salmonella to the seasonal flu, infectious diseases are disrupting lives throughout the country at an alarming rate, and driving up medical costs, and most states are unable to counter them, according to a report by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

The problem? Outdated systems and limited resources. In fact, 34 states scored five or lower out of 10 key indicators of policies and capabilities to protect against infectious disease threats.

One solution offered in this comprehensive analysis is to be more vigilant with vaccinations; only one-quarter of states vaccinated at least half of their population against the seasonal flu, which affects 20 percent of Americans each year. Details inside.

Rising medical costs were the primary driver of recent rate increases by health insurers, accounting for three-quarters or more of the larger premium hikes requested between July 2012 and June 2013, a new Commonwealth Fund study finds.

The analysis is the first such report to take a national look at the explanations insurers file with federal and state authorities to justify rate increases of 10 percent or more, as required by the ACA. Currently, insurers are only required to submit rate increase explanations for non-grandfathered plans, or those plans that became available after the enactment of the health reform law.

People whose existing healthcare insurance has been canceled because of the ACA will not be hit with tax penalties for failing to line up new coverage as required under the law, according to Health and Human Services Secretary Kathleen Sebelius. Under a "temporary hardship exemption," they will be able to buy a bare-bones catastrophic plan regardless of their age. For more information, click here.

Reducing health insurance premiums is one strategy employers are using to incent their employees to self-manage their health. Healthcare companies have grown increasingly creative in their use of economic and benefit-based incentives to drive engagement and participation in health and wellness programs, according to Healthcare Intelligence Network research.

Reducing joint replacement payments specifically knees, which, at 600,000 annually, are the most commonly performed knee replacement procedure in the United States is the aim of Florida Blue and Mayo Clinic’s knee replacement bundled payment agreement, first introduced in 2012. They have announced they are extending it, and their overall network agreement to include thousands of Florida Blue’s commercially insured members throughout the state who are now able to access Mayo Clinic as an in-network provider.

And lastly, there is no replacement for a little TLC, in the form of paraprofessionals or nurses visiting the homes of low income pregnant women and their children. Researchers from the University of Colorado School of Medicine found that these helpers, part of the Nurse-Family Partnership, helped improve the health and development outcomes for the children ages six through nine.

Don't forget to take our latest online survey, Reducing Hospital Readmissions in 2013. Describe 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 23, 2013
Vol. XV, No. 48

Sponsored by:
Award Winning Readmission Prevention Protocols — Navigating Care Transitions with Preferred SNF and Home Health Providers


This week's industry news:

  1. Medical Costs Drive New Health Plan Increases Above 10 Percent
  2. Healthcare Trends & Forecasts in 2014
  3. Home Visits by Nurses Benefit Low-Income Pregnant Women, Children
  4. New Horizons in Healthcare Home Visits
  5. Healthcare Business White Paper: Telehealth in 2013
  6. Majority of States Unable to Counter Infectious Disease Rates
  7. New Chart: Top Behavior Change Tools in Health Coaching
  8. Profiting from Population Health Management
  9. Florida Blue, Mayo Clinic Extend Bundled Payment Program for Knee Replacement
  10. Blueprint for Bundled Payments
  11. Benefit-Based Incentives Remain Top Draws for Health and Wellness Participation
  12. 38 Disease Management Metrics
  13. Infographic: Shortage of Primary Care Physicians
  14. Award Winning Readmission Prevention Protocols
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.) Medical Costs Drive New Health Plan Increases Above 10 Percent

Rising medical costs were the primary driver of recent rate increases by health insurers, accounting for three-quarters or more of the larger premium hikes requested between July 2012 and June 2013, a new Commonwealth Fund study finds.

Get the full story.

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2.) Healthcare Trends & Forecasts in 2014: A Strategic Planning Session

Healthcare Trends & Forecasts in 2014: A Strategic Planning Session This webinar presents Steven Valentine, president, The Camden Group, and Catherine Sreckovich, managing director, healthcare, Navigant, who provide a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014, including the strategic importance of health insurance exchanges for health plans and providers even if they’re not participating in the initial enrollment period.

Learn more about this resource.

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3.) Home Visits by Nurses Benefit Low-Income Pregnant Women, Children

Home visits by nurses to low-income pregnant women and parents of young children helped improve health and development outcomes for the children, according to results of a clinical trial published by JAMA Pediatrics.

Get the full story.

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4.) New Horizons in Healthcare Home Visits

New Horizons in Healthcare Home Visits This resource explores two separate home visit interventions that are helping to reduce hospital readmissions and emergency room visits, while enhancing the patient experience. HIN’s 2013 Home Visits market survey found that 75 percent of respondents visit some percentage of patients or health plan members at home.

Learn more about this resource.

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5.) Healthcare Business White Paper: Telehealth in 2013 — Videoconferencing, Virtual Visits and Smartphones Power Population Health Management

Telehealth in 2013 Healthcare is leaning on videoconferencing more than ever to monitor discharged patients, conduct remote consultations and facilitate communication, according to responses to 2013 Telehealth Survey by the Healthcare Intelligence Network. Respondents reported an increase in the use of videoconferencing — from 41 percent in 2010 to 59 percent in 2013. Download this HINtelligence report for more telehealth trends for 2013 as reported by 129 healthcare companies in HIN's third annual Telehealth Survey. Included in the report are the greatest barriers or challenges to telehealth implementation, top funding to support telehealth efforts, telehealth use in clinical applications, and much more.

Download this complimentary white paper.

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6.) Majority of States Unable to Counter Infectious Disease Rates

A majority of states are failing to prevent, control and treat infectious disease outbreaks due to outdated systems and limited resources, according to a report by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

Get the full story.

>>Return to this week's industry news


7.) New Chart: Top Behavior Change Tools in Health Coaching

New Chart: Top Behavior Change Tools in Health Coaching Motivational interviewing (MI) is the top behavior change tool being used in health coaching, say 68 percent of healthcare companies that responded to HIN's fourth annual Health Coaching e-survey. We wanted to see which other behavior change tools are being used in health coaching.

Click here to view the chart.

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8.) Profiting from Population Health Management: Applying Analytics in Accountable Care

Profiting from Population Health Management This resource provides both a primer in population health management (PHM), identifying the challenges and opportunities of a robust population health management program, and an advanced case study in the use of analytics in PHM.


Learn more about this resource.

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9.) Florida Blue, Mayo Clinic Extend Bundled Payment Program for Knee Replacement

Florida Blue and Mayo Clinic are extending their knee replacement bundled payment agreement, introduced in 2012, for Florida Blue’s members, according to Florida Blue.

Get the full story.

>>Return to this week's industry news

10.) Blueprint for Bundled Payments: Strategies for Payors and Providers

Blueprint for Bundled Payments This resource provides perspectives on payment bundling, including definitions of key elements, advice for payors and providers, what's ahead in bundled payments for primary care, and examples of the payment model at work in one organization.


Learn more about this resource.

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11.) Benefit-Based Incentives Remain Top Draws for Health and Wellness Participation

While benefit-based incentives, like health insurance premium reductions, generate significant employee interest, gift cards and even cash continue to motivate employees to take better care of themselves, according to market research from the Healthcare Intelligence Network (HIN).

Get the full story.

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12.) 38 Disease Management Metrics: Population Health Benchmarks to Drive Accountable Care

38 Disease Management Metrics This resource dives deep into several years of market research to document the role and outcomes of disease management in 11 key areas, as well as the high-focus diseases and health conditions of such initiatives as obesity and weight management, diabetes management, medication adherence and healthcare case management.

Learn more about this resource.

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13.) Infographic: Shortage of Primary Care Physicians

With the implementation of the Affordable Care Act, millions of people are gaining health coverage and access to healthcare. However, there may be a shortage of doctors to treat these patients in many parts of the United States, suggests a new infographic from the Commonwealth Fund. For example, the infographic shows the number of primary care physicians in several counties in Texas, ranging from 83 residents per one PCP in one county to 14,081 residents per PCP in another. Thirty-five Texas counties have more than 3,000 resident per primary care provider.

Read this blog post.

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14.) Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers

Josh Luke With hospital readmission rates under close scrutiny by CMS, Torrance Memorial Health System launched a readmission program in early 2013 that has been recognized as a program of excellence for its innovation and impact on the community. Navigators work with patients prior to discharge from the hospital to educate them on the hospital's Care Transitions program, which includes a network of Skilled Nursing Facilities, or SNF's and one home health agency. And once the patient is discharged, ambulatory case managers keep watch on the patients after the 30-day penalty phase is over.

Listen to this podcast.

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