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From the editor

Dear Healthcare Intelligence Network Client,

HIN Content Editor Cheryl Miller

Welcome to our fourth annual "best of" issue. Without question, the Supreme Courtís ruling on the constitutionality of the ACA was the biggest healthcare story of the year. The effect of the November presidential elections only solidified the impact of the mandate and healthcare reform, and cleared the way for its continued rollout and implementation. There will be much to report on in the coming year, and we will be sure to bring you complete coverage.

But in this issue, as in ďBest of ď issues past, we bring you the stories that resonated most with you. Your top story was one that ran nearly a year ago: Five Percent of Americans Account for More Than Half of all Healthcare Costs. According to this story from the Agency for Healthcare Research and Quality (AHRQ), the 15 most expensive health conditions — the top five being heart disease, cancer, trauma, mental disorders, and pulmonary conditions — account for nearly half of total healthcare expenses, and patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition.

Nearly a year later, mental conditions are being suggested as one impetus for the worst mass killing in this country, when 6 adults and 20 children under the age of 11 were gunned down in a Connecticut elementary school. If any good can possibly come out of such a sad story, it could be that more funds are provided for this very costly, very misunderstood, segment of healthcare.

Geisingerís Remote Monitoring Program Reduces 30-Day Readmissions also sparked your interest. The health plan, using interactive voice response (IVR) and other innovative telemonitoring technology and solutions provided by AMC Health, reported a 44 percent reduction in 30-day readmissions compared to a control group, and increased case manager efficiency in monitoring patients transitioning from hospital to home. The tool is a post-hospital discharge telemonitoring solution that was introduced as an adjunct to existing case management in a managed care population, and designed to reduce hospital readmissions.

In December, AMC announced it received FDA approval to provide an array of telemonitoring technologies for a new clinical drug trial that studies the effects of the widely used blood pressure drug lisinopril in patients who suffer from multiple sclerosis. This will enable researchers to collect data on blood pressure and heart rate, mobility, physical and mental function, symptoms, side effects, quality of life and medication adherence, directly from patients in their homes, eliminating the need for frequent visits to a study site.

You were also interested in Consumer Reports' first patient experience ratings report aimed at selected primary care physician groups in the Massachusetts area. It was the first time the magazine has published such a report, which covered nearly 500 practices, including 329 adult practices and 158 pediatric practices; and posed such questions as how well physicians communicate with their patients, coordinate medical care, know their patients, and whether patients would be willing to recommend their doctor to family and friends. Consumer Reports hopes to partner with and expand the survey to other states, and has since published its first ever hospital ratings report, which includes information from government and independent sources on 1,159 hospitals in 44 states.

You also found HEDISí release of 35 new technical specifications for ACOs for 2013 to be a favorite story; it offered detailed guidance that will help ACOs collect and report their quality performance in standardized ways, according to the NCQA, which published the measures. HEDIS has since updated level 3 status guidelines and added a new ACO workbook.

We hope you will find our upcoming Health Coaching report a comparable read; our survey is closing on January 4th, so if you have the time take a moment to participate in this survey on this critical tool in population health management, which is proving to boost self-management of disease and reduce risk and associated cost across the health continuum. All participants receive a free executive summary of the compiled results.

And as with issues past, we send our best wishes to all of you for a happy, healthy, prosperous, 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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December 31, 2012
Vol. XIV, No. 47

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


This week's industry news:

  1. 5 Percent Of Americans Account For More Than Half Of Healthcare Costs
  2. Comorbidity Care Models
  3. Geisinger Remote Monitoring Program Reduces 30-Day Readmissions
  4. 2011 Performance Benchmarks in Telehealth & Telemedicine
  5. Healthcare Business White Paper: Accountable Care Organizations in 2012
  6. Consumer Reports Publishes First Patient Experience Ratings of Primary Care Practices
  7. New Chart: What's a Case Manager's Average Monthly Caseload?
  8. 2011 Benchmarks in Patient Satisfaction Strategies
  9. HEDIS Releases 35 New Measures for ACOs
  10. Population Health Management Tools for ACOs
  11. 5 Core Elements of Horizonís Patient-Centered Medical Home
  12. New Models in the Patient-Centered Medical Home
  13. Infographic: Trends, Impact of U.S. Healthcare Spending
  14. Population Health Management
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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Health Coaching in 2013

You'll be emailed a synopsis of the survey results.

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This week's industry news

1.) 5 Percent Of Americans Account For More Than Half Of Healthcare Costs

The top five percent of Americans accounted for nearly half of all healthcare expenditures in the United States, a report from the Agency for Healthcare Research and Quality (AHRQ) says. In contrast, half of the population spends little or nothing on healthcare, statistics show.

Get the full story.

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2.) Comorbidity Care Models: Integrated Action Plans for Complex Healthcare Needs

Comorbidity Care Models This 38-page special report presents emerging models of care for comorbidity, with a special focus on the needs of aging multi-morbid patients as well as those whose comorbidity encompasses physical and behavioral health conditions.


Learn more about this resource.

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3.) Geisinger Remote Monitoring Program Reduces 30-Day Readmissions

A new remote monitoring tool from AMC Health has enabled Geisinger Health Plan (GHP) to reduce 30-day readmissions by 44 percent, and increase case manager efficiency in monitoring patients transitioning from hospital to home.

Get the full story.

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4.) 2011 Performance Benchmarks in Telehealth & Telemedicine

2011 Performance Benchmarks in Telehealth & Telemedicine This resource is packed with actionable new information from 111 healthcare organizations on their utilization of telehealth & telemedicine. This 60-page report, now in its second year, documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to 2010.

Learn more about this resource.

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5.) Healthcare Business White Paper: Accountable Care Organizations in 2012 — ACO Participation Doubles in 12 Months

Accountable Care Organizations in 2012 Participation in accountable care initiatives has more than doubled in the last 12 months, according to 200 healthcare companies who completed the second annual Healthcare Intelligence Network survey on Accountable Care Organizations (ACOs). The typical ACO is smaller, too, as the number of active ACOs with 100 to 500 physicians dropped almost 50 percent in the last 12 months. This yearís survey provided new data on other healthcare professionals in the ACO, ACO reimbursement models, and ACO impact.

Download this complimentary white paper.

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6.) Consumer Reports Publishes First Patient Experience Ratings of Primary Care Practices

Consumer Reports (CR) and Massachusetts Health Quality Partners (MHQP) have jointly released the results of patient experience ratings of selected primary care physician groups in the Massachusetts area.

Get the full story.

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7.) New Chart: What's a Case Manager's Average Monthly Caseload?

New Chart: What's a Case Manager's Average Monthly Caseload? Post-reform redesign of clinical care delivery and reimbursement underscore the healthcare case manager's dual roles as care coordinator and utilization manager. Case manager work locations, job focus and caseloads are evolving in response to these shifts in the healthcare landscape. We wanted to see the average monthly caseload for a case manager.

Click here to view the chart.

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8.) 2011 Benchmarks in Patient Satisfaction Strategies: Improving the Healthcare Consumer Experience

2011 Benchmarks in Patient Satisfaction Strategies This 60-page analysis, based on the responses of 146 organizations to the Healthcare Intelligence Network May 2011 survey on Improving Patient Satisfaction and the Patient Experience, presents the all-new data in more than 45 easy-to-follow graphs and tables. This research also drills down to provide sector-specific efforts in patient satisfaction improvement from hospitals and other healthcare providers.

Learn more about this resource.

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9.) HEDIS Releases 35 New Measures for ACOs

HEDIS has released 35 new technical specifications for ACOs for 2013, detailed guidance that will help ACOs collect and report their quality performance in standardized ways, according to the NCQA, which published the measures.

Get the full story.

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10.) Population Health Management Tools for ACOs: Technologies and Tactics to Support Accountable Care

Population Health Management Tools for ACOs This resource 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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11.) 5 Core Elements of Horizonís Patient-Centered Medical Home

Engaging, educating and empowering patients is one of the core pieces that make up the PCMH, says Jay Driggers, director of consumer experience and engagement, Horizon Blue Cross Blue Shield of New Jersey.

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 Beginning with an overview of 2012 PCMH trends, this 57-page special report offers snapshots of thriving medical home initiatives and their particular area of focus.



Learn more about this resource.

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13.) Infographic: Trends, Impact of U.S. Healthcare Spending

U.S. healthcare spending has surged over the past 50 years and continues to grow faster than the economy, according to September's Visualizing Health Policy by the Journal of the American Medical Association.

Read this blog post.

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14.) Population Health Management: Achieving Results in a Value-Based Healthcare System

Population Health Management: Achieving Results in a Value-Based Healthcare System Before shifting from a disease-focused to population health management (PHM) approach, healthcare organizations need to do their homework, advises Patricia Curran, principal in Buck Consultants' National Clinical Practice — from researching the population's culture to examining its patterns of healthcare usage and cost trends. In this interview, Ms. Curran describes the four key research areas, as well as some of the barriers encountered along the road to population health management. She also predicts what the no- or low-health-risk populations can expect in a population health management world that spans the health risk continuum — from incentives to provider and payor contact.

Listen to this podcast.

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