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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

From an early surge in Medicare accountable care collaborations to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 was nothing short of unpredictable.

But in this issue, as in "Best of" issues past, we bring you the stories that resonated most with you. Your top story was one that ran nearly a year ago: Post-Hospital Telephonic Outreach Reduces Readmissions by 22 Percent for High Risk Patients. This initiative from Cigna monitored telephonic outreach by health plan case managers within 24 hours of hospital discharge, finding that they reduced future readmissions by 22 percent. Resulting in more physician visits and prescription drug fills, the timing and prioritizing of the calls was critical to its success.

Case managers' roles in long term care also spiked your interest in our featured white paper: Case Management in 2013: Achieving Results with Cardiovascular Disease; Long-Term Care Next Frontier for Embedded Case Managers. As care coordination by healthcare case managers continues to drive clinical and financial outcomes in population health management, expect to see lots more case managers — not just coordinating care telephonically like Cigna, but co-located in nursing home, long-term care (LTC) and assisted living settings.

Other top stories included CMS' announcement that Medicare beneficiaries saw significant out-of-pocket savings due to the ACA, including provisions to close the prescription-drug "donut hole" that saved more than 7.1 million seniors and people with disabilities $8.3 billion on their prescription drugs since it took effect.

How the ACO model figures in most hospitals' futures also topped your reading list, as did a story on how 24 states and the District of Columbia chose a benchmark health insurance plan that met the ACA's essential health benefit requirement, which is scheduled to begin next month, January 2014. Researchers found that 19 of the states that selected plans chose existing small-group plans, employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans.

An infographic on 2013's Most Significant Healthcare Issues, and our podcast on Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements also attracted the most views.

We will continue to provide you with the kind of up-to-the-minute coverage you need to stay informed.

And as with issues past, we send our best wishes to all of you for a happy, healthy, prosperous and peaceful new year.

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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This week's featured download:

Case Management in 2013 — Achieving Results with Cardiovascular Disease; Long-Term Care Next Frontier for Embedded Case Managers

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December 30, 2013
Vol. XV, No. 49

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


This week's industry news:

  1. Post-Hospital Telephonic Outreach Reduces Readmissions by 22 Percent for High Risk Patients
  2. Avoiding the Readmissions Penalty Zone
  3. CMS Announces Major Savings for Medicare Beneficiaries
  4. Managed Medicare and Medicaid Factbook: 2013
  5. Healthcare Business White Paper: Healthcare Trends in 2014
  6. The ACO Model Figures in Most Hospitals' Futures
  7. New Chart: Pharmacist Incentives for Improving Medication Adherence
  8. A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings
  9. 24 States and D.C. Select Benchmark Health Insurance Plans That Meet Essential Health Benefit Requirement
  10. Futurescan 2013
  11. 5 Core Elements of the Patient-Centered Medical Home
  12. New Models in the Patient-Centered Medical Home
  13. Infographic: 2013's Most Significant Healthcare Issues
  14. Physician Hospital Organizations
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.) Post-Hospital Telephonic Outreach Reduces Readmissions by 22 Percent for High Risk Patients

Telephonic outreach by health plan case managers within 24 hours of hospital discharge reduced future readmissions by 22 percent, according to a study from Cigna, which was published in the American Journal of Managed Care.

Get the full story.

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2.) Avoiding the Readmissions Penalty Zone: Population Health Management for High-Risk Populations

Avoiding the Readmissions Penalty Zone This resource delivers winning process improvements and interventions that can help organizations make measurable progress toward reducing readmissions in high-risk populations, including a look at a health system-SNF network that has curbed rehospitalizations and length of stay for participants.

Learn more about this resource.

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3.) CMS Announces Major Savings for Medicare Beneficiaries

Medicare beneficiaries are seeing significant out-of-pocket savings due to the Affordable Care Act (ACA), according to the Centers for Medicare and Medicare Services (CMS).

Get the full story.

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4.) Managed Medicare and Medicaid Factbook: 2013

Managed Medicare and Medicaid Factbook: 2013 This resource presents all-new information on enrollment, benefit designs, company activity and trends for the Medicare Advantage, Medicare Part D and managed Medicaid programs.



Learn more about this resource.

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5.) Healthcare Business White Paper: Healthcare Trends in 2014 — Putting Money on Population Health, Care Coordination and Integrated Care Delivery

Healthcare Trends in 2014 Respondents to HIN's tenth annual Healthcare Trends and Forecasts survey identified a trifecta of value-based priorities for the coming year, deeming population health management (56 percent), care coordination (51 percent) and integrated care delivery (42 percent) initiatives most worthy of their attention in 2014. Download this HINtelligence report to learn more about how 136 healthcare companies fared in 2013 and what trends they expect to emerge in 2014. Included in this report are data highlights on the top business areas affected by economic conditions in 2013, successful programs and services launched in 2013, and much more.

Download this complimentary white paper.

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6.) The ACO Model Figures in Most Hospitals' Futures

Over 80 percent of surveyed hospitals are making future plans to join or are already participating in an accountable care organization (ACO), according to a new study from L.E.K. Consulting, a global strategy consulting firm.

Get the full story.

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7.) New Chart: Pharmacist Incentives for Improving Medication Adherence

New Chart: Pharmacist Incentives for Improving Medication Adherence The cost of medication non-adherence is great: in 2009, the New England Healthcare Institute (NEHI) blamed medication non-adherence for $290 billion in 'otherwise avoidable medical spending' in the United States alone each year. Last year, the NEHI reported that a significant portion of hospital readmissions of Medicare patients — a metric closely examined by CMS and private payors — is caused by medication-related adverse events. We wanted to see for which tasks pharmacists are reimbursed or incented for in medication adherence (MA) programs.

Click here to view the chart.

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8.) A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings

A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings This 45-minute webinar shares how to stratify and prioritize strategies to improve quality ratings and insight into the future direction of the CMS Star Quality program, and is presented by Joseph Johnson, vice president of L.E.K. Consulting.

Learn more about this resource.

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9.) 24 States and D.C. Select Benchmark Health Insurance Plans That Meet Essential Health Benefit Requirement

Twenty-four states and the District of Columbia have chosen a benchmark health insurance plan that meets the ACA's essential health benefit requirement, which is scheduled to begin January 2014, according to a new Commonwealth Fund study.

Get the full story.

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10.) Futurescan 2013: Healthcare Trends and Implications 2013-2018

Futurescan 2013 This resource highlights eight key trends affecting the nation's healthcare organizations. The expert insight in these pages is supported by data from a survey of 625 healthcare leaders across the country.




Learn more about this resource.

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11.) 5 Core Elements of the Patient-Centered Medical Home

When creating a patient-centered medical home (PCHM) model, it is only as strong as your patient engagement component, says Jay Driggers, director of consumer engagement at Horizon BCBS-NJ. If you don't focus on engaging your patient in the model, you won't be as successful as you need to be.

Get the full story.

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12.) New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care

New Models in the Patient-Centered Medical Home This resource begins with an overview of 2012 PCMH trends, and offers snapshots of thriving medical home initiatives and their particular area of focus.




Learn more about this resource.

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13.) Infographic: 2013's Most Significant Healthcare Issues

More than two years after it was passed, healthcare reform topped the list of the most significant issues facing the healthcare industry in 2013, according to a poll of 2,800 LinkedIn users from the healthcare industry. As illustrated in this infographic from Zurich Insurance, 50 percent identified healthcare reform as the most significant issue, followed by the financial impact of reform (39 percent) and physician integration (5 percent).

Read this blog post.

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14.) Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements

Greg Mertz Travis Ansel Physician-hospital organizations have been around before, but it's the emphasis on quality that sets today's PHO apart from the 80's version. In PHO 2.0, where healthcare value is favored over volume, clinical integration of participating physicians is a prerequisite, agree Greg Mertz, director of Healthcare Strategy Group, and Travis Ansel, its manager of strategic services. In this interview, they talk about the essential first steps of PHO creation and the perennial challenges of physician engagement and clinical leadership in this emerging collaborative model.

Listen to this podcast.

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