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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

The healthcare industry isn't waiting for CMS's overdue clarification of ACOs to get into gainsharing mode, according to preliminary responses from 175 companies to our Accountable Care Organizations Survey. Nearly 16 percent already belong to an ACO, with two-thirds of these ACOs on board for CMS's 2012 Shared Savings Program. Another 40 percent report they will launch an ACO in the coming year.

To receive a summary of ACO adoption metrics as well as data on ACO membership, reimbursement models and EHR use, take the ACO survey by February 18.

While we wait for the CMS edit, here's one attorney's take on the 5 types of organizations eligible to be ACOs.

In the dark or on the fence about ACOs? In this issue, healthcare consultant Steven Valentine makes the case for ACOs and other emerging models of care integration, excerpted from our second annual Healthcare Benchmarks Yearbook. What's trending for 2011? Integration, collaboration and co-management.

Your colleague in the business of healthcare,
Patricia Donovan
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to pdonovan@hin.com.

HIN Associate Editor Jessica Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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Medical Homes in 2010 — Awareness, Adoption, Tools and Outcomes

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February 14, 2011
Vol. XIII, No. 7

Sponsored by:
Rewarding Primary Care Practice Reform with Physician Payment Reform: A Medical Home's Experience

This week's industry news:

  1. ACOs, Bundled Payments and New Models of Care Integration
  2. 2011 Healthcare Benchmarks Yearbook
  3. Michigan Bluesí Medical Home Program Improves Quality and Cost Management
  4. 27 Interventions to Reduce Avoidable ER Use
  5. Healthcare Business White Paper: 2010 Obesity Benchmarks
  6. Lower Mental Health Co-pays Do Not Help Seniors Seek Care
  7. New Chart: Top 5 Medical Home Reimbursement Models
  8. Emergency Room Triage of the Mental Health Patient
  9. Long-Term Care Insurance Protection Price Increased Dramatically from 2009
  10. Healthcare Trends & Forecasts in 2011
  11. School Menu Changes, BMI Screenings Highlight First Year of Letís Move! Campaign
  12. Obesity & Weight Management Benchmarks
  13. HealthSounds Podcast: Medical Home Practice and Payment Reform
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.

Missed the last issue? Read it here.

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Take our monthly e-surveys:
Healthcare Case Management in 2011

Accountable Care Organizations in 2011

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


This week's industry news

1.) ACOs, Bundled Payments and New Models of Care Integration

Case management, the medical home, telehealth and other efforts are helping to move volume, improve quality, reduce cost through greater throughput and reduce consumption of resources, explains Steven Valentine, president of The Camden Group.

Get the full story.

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2.) 2011 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations

2011 Healthcare Benchmarks Yearbook Ready for healthcare reform rollout? Landmark efforts in case management, care transitions management, health risk stratification, reducing readmissions and curbing avoidable ER use are transforming the healthcare landscape. This 450-page resource delivers more than 23,000 data points from 1,000 healthcare responders on adoption, activity and ROI in these areas and more. Contains year-over-year data and more than 400 graphs and tables.

Learn more about this resource.

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3.) Michigan Bluesí Medical Home Program Improves Quality and Cost Management

In the first half of 2010, Blue Cross Blue Shield of Michiganís (BCBSM) patient-centered medical home (PCMH) program continued to show measurable results in key indicators related to improved quality and cost management.

Get the full story.

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4.) 27 Interventions to Reduce Avoidable ER Use

27 Interventions to Reduce Avoidable ER Use This 45-page resource describes 27 separate initiatives launched by Kaiser and WellPoint around the country that are effectively reducing avoidable emergency department use and redirecting patients to more cost-effective care venues.

Learn more about this resource.

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5.) Healthcare Business White Paper: 2010 Benchmarks in Obesity and Weight Management

This white paper captures the top strategies organizations are implementing to prevent and reduce obesity and related conditions and costs, based on responses from 131 healthcare organizations to the April 2010 Healthcare Intelligence Network Obesity and Weight Management e-survey.

Download this complimentary white paper.

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6.) Lower Mental Health Co-pays Do Not Help Seniors Seek Care

Despite the intent of recent mental health parity legislation, even steep reductions in co-pays for outpatient mental healthcare will not motivate more seniors in managed care plans to seek that care, according to a new study by Brown University researchers.

Get the full story.

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7.) New Chart: Top 5 Medical Home Reimbursement Models

Top 5 Medical Home Reimbursement Models The patient-centered medical home can deliver quality care at little or no added cost while improving patient and provider satisfaction. We wanted to see the top reimbursement models being used in medical homes.

Click here to view the chart.

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8.) Emergency Room Triage of the Mental Health Patient

Emergency Room Triage In this resource, one industry expert explains how the community mental health center's system-wide daily conference call helps to balance work and patient flow, encourages creative problem-solving and dramatically reduces staff time spent on diversion of psychiatric ER patients to other facilities. A second expert describes a pilot program placing a psychiatric nurse in the ED, along with the impact of the program on hospital admits, discharges and resource allocation, and ED staff satisfaction and morale.

Learn more about this resource.

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9.) Long-Term Care Insurance Protection Price Increased Dramatically from 2009

A 55-year-old couple purchasing long-term care insurance protection can expect to pay $2,350 per-year (combined) for about $338,000 of current benefits ($169,000 each) which will grow to about $800,000 of combined coverage for the couple when they turn 80, according to the 2011 Long-Term Care Insurance Price Index, published by the American Association for Long-Term Care Insurance.

Get the full story.

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10.) Healthcare Trends & Forecasts in 2011: Performance Expectations for the Healthcare Industry

Healthcare Trends & Forecasts in 2011 Feeling the squeeze from softening service demands, growing competition, reimbursement cuts and increased regulatory oversight, the healthcare industry is ripe for financial relief. In this 35-page resource, two key thought leaders look ahead to healthcare reform 2.0 — implementation and rollout and craft a healthcare reform strategy checklist, putting the smart money on models of consolidation and clinical integration that will not only increase throughput and market share but also reduce unnecessary utilization and cost.

Learn more about this resource.

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11.) School Menu Changes, BMI Screenings Highlight First Year of Letís Move! Campaign

Groundbreaking legislation enacting the most meaningful and comprehensive change to food in schools seen in a generation is one of many changes brought about during the first year of First Lady Michelle Obamaís Letís Move! Campaign, an initiative to end childhood obesity within a generation.

Get the full story.

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12.) Obesity & Weight Management Benchmarks and Case Studies

Obesity & Weight Management This resource provides actionable information on current obesity and weight management programs for adults, children and adolescents from more than 300 organizations. 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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13.) HealthSounds Podcast: Medical Home Practice and Payment Reform

Dr. Bruce Nash Capital District Physicians' Health Planís (CDPHP) medical home pilot began in 2008, with the dual goals of reforming both the practice of primary care in the CDPHP network and payments to these physicians. Dr. Bruce Nash, CDPHP's senior vice president of medical affairs and chief medical officer, explains what sets the two-phase CDPHP program apart from other medical home pilots, how participants met the challenge of practice transformation, and why preliminary pilot results mirror what's going on in the industry today.

Listen to this podcast.

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