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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

When you consider that about a fifth of hospital readmissions are preventable, the findings in a March 2009 Mathematica Policy Research report are particularly noteworthy. The report identifies three types of interventions with potential for reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions — a group accounting for the lion's share of Medicare spending. Of special note are transitional care interventions — in which patients are first engaged while in the hospital and then followed intensively over the four to six weeks after discharge; self-management education interventions that engage patients for four to seven weeks in community-based programs designed to “activate” them in the management of their chronic conditions; and coordinated care interventions that identify patients with chronic conditions at high risk of hospitalization in the coming year.

While the report notes that no single program has yet combined all three types of interventions, it mentions two approaches that show great promise: the patient-centered medical home (PCMH) model of care and the Guided Care model developed by Dr. Chad Boult and colleagues at the Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health. We recently spoke to Dr. Boult about the Guided Care Model, in which the Guided Care Nurse administers a patient care plan developed by the physician and nurse with data from the EHR.

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

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

Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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March 30, 2009
Vol. XI, No. 12

Sponsored by:
Medical Home Metrics and Measurements for Achieving ROI

This week's industry news:

  1. Upper Peninsula Health Plan Provides Online Registry for Members
  2. Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance
  3. U.S. Hospital Use of EHRs Abysmally Low
  4. Risks and Liabilities in EMRs: Protecting Privacy, Avoiding Penalties and Litigation
  5. Featured Healthcare Business White Paper: ROI for Medical Billing
  6. Nation’s Mental Healthcare System Receives Average Grade of D in New Report Card
  7. Managing Behavioral Healthcare, 3rd edition
  8. Alzheimer’s Disease and Dementia Triple Healthcare Costs for Elderly
  9. Alzheimer's Disease — The Evaluation and Management of Dementia
  10. Recovery Act Increases Funding for Hospitals Treating Uninsured, Vulnerable Patients
  11. Healthcare Trends & Forecasts in 2009: Performance Expectations for the Healthcare Industry
  12. Featured HealthSounds Podcast: Physician Engagement with Aetna 'Care Considerations' Pays Off in Medical Home Pilot
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This week's industry news

1.) Upper Peninsula Health Plan Provides Online Registry for Members

The Upper Peninsula Health Plan (UPHP), a consumer-centered, Upper Peninsula-based, provider service organization of physicians, hospitals, clinics and ancillary providers, describes the evolution of its Online Healthcare Management Registry.

According to UPHP, "we currently have one registry, although we do have other registry projects in development. The Online Healthcare Management Registry was in a pilot demonstration phase for a couple of years. We began on-site training sessions with provider offices in late 2007."

Get the full story.

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2.) Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance

Simple Steps to a Patient Registry In this 25-page report, physician practices, health plans and quality organizations describe how they use patient registries to improve care coordination and compliance with preventive care, respond to ever-expanding external demands for data and prepare for the eventual transformation to a medical home.

Learn more about this resource.

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3.) U.S. Hospital Use of EHRs Abysmally Low

Contrary to conventional wisdom, only a tiny fraction of U.S. hospitals have full HIT systems in place to improve how they deliver care, says a new study. A survey of nearly 3,000 hospitals shows that less than 2 percent use comprehensive EHRs, and about 8 percent use a basic EHR in at least one care unit that includes physician or nurse notes.

Get the full story.

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4.) Risks and Liabilities in EMRs: Protecting Privacy, Avoiding Penalties and Litigation

Risks and Liabilities in EMRs During this audio conference, authoritative panelists identified the challenging legal issues, outlined the major risks and potential liabilities in managing EHRs, and offered best practices and practical solutions to avoid litigation and penalties.

Learn more about this resource.

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5.) Featured Healthcare Business White Paper: ROI for Medical Billing

Discover how medical billing departments and organizations can realize a significant return on investment from digital document management with integrated workflow technology.

Download this complimentary white paper.

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6.) Nation’s Mental Healthcare System Receives Average Grade of D in New Report Card

The National Alliances on Mental Illness (NAMI) has released a new report, Grading the States, assessing the nation's public mental healthcare system for adults and finding that the national average grade is a D. Fourteen states improved their grades since NAMI's last report card three years ago, but 12 states fell backwards.

Get the full story.

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7.) Managing Behavioral Healthcare, 3rd edition

Managing Behavioral Healthcare This 424-page manual provides behavioral health medical review policies, ‘benefit interpretations’ criteria, benchmarks and guidelines for inpatient, day hospital, residential and outpatient care. A practical model for a quality-based and cost-effective care management approach as well as coverage determinations. The manual also contains numerous policies, procedures, tools and forms vital to prepare for accreditation or certification surveys and strategies for quality-based efficient delivery of integrated behavioral healthcare.

Learn more about this resource.

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8.) Alzheimer’s Disease and Dementia Triple Healthcare Costs for Elderly

Total healthcare costs are more than three times higher for people with Alzheimer’s and other dementias than for other people age 65 and older, according to the Alzheimer’s Association’s 2009 Alzheimer’s Disease Facts and Figures.

Get the full story.

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9.) Alzheimer's Disease — The Evaluation and Management of Dementia

Alzheimer's Disease This 70-page report details diagnosis, non-pharmaceutical and pharmaceutical management of this common cluster of disabling disorders. It also includes references, web links and other resources.

Learn more about this resource.

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10.) Recovery Act Increases Funding for Hospitals Treating Uninsured, Vulnerable Patients

HHS has announced that states can access an additional $268 million authorized by the American Recovery and Reinvestment Act to help pay hospitals to treat their most vulnerable patients. Eligible hospitals are those that serve a disproportionate share of low-income or uninsured individuals and are known as Disproportionate Share Hospitals (DSH).

Get the full story.

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11.) Healthcare Trends & Forecasts in 2009: Performance Expectations for the Healthcare Industry

Medicare Disease Management In Healthcare Trends & Forecasts in 2009: Performance Expectations for the Healthcare Industry, two key thought leaders reflect upon the volatile economic climate and historical election results to frame an industry outlook for 2009.

Learn more about this resource.

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12.) Featured HealthSounds Podcast: Physician Engagement with Aetna 'Care Considerations' Pays Off in Medical Home Pilot

Dr. Don Liss Aetna's practice of sending its providers periodic "care considerations" — detailed clinical data that identify opportunities to improve care — has been formalized in its patient-centered medical home (PCMH) pilot with Partners in Care (PIC), explains Dr. Don Liss, the regional medical director of Aetna's mid-Atlantic region. PIC providers' engagement with the care considerations is now a factor in the pay for performance aspect of the pilot. Dr. Liss shares some short-term indicators that demonstrate that the PCMH is working, as well as his longterm view for medical home ROI, which can vary greatly for payors and providers.

Listen to this podcast.

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