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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

As Dr. Lonnie Fuller says in a featured story this week, "Practice transformation is a buzzword for change, and change is very hard." In recruiting physician practices for its multi-payor medical home pilot, Health TeamWorks (formerly Colorado Clinical Guidelines Collaborative) tries to determine where a practice is on its redesign journey by walking candidates through a readiness assessment.

In last week's webinar on the practice recruitment process, Health TeamWorks medical and executive director Dr. Marjie Harbrecht explained how the Improving Performance in Practice (IPIP) exercise is both an assessment opportunity and a teachable moment:

"We go into the practice with an hour-long brainstorming tool and talk about how they would take three steps for tobacco cessation: to make sure every patient in your practice is being asked about whether they smoked or not, is advised to quit and is then referred to our Colorado quit line for further counseling. We would ask them how they would build a process into their practice to accomplish that. We used that tool as an opportunity not only to teach these skills but also to see whether this practice was ready to start taking on quality improvement."

Dr. Harbrecht describes the financial impact of the medical home model and some of the practice selection criteria in this week's HealthSounds podcast.

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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May 24, 2010
Vol. XII, No. 20

Sponsored by:
Reducing Unnecessary Emergency Room Visits — Strategies To Discourage Inappropriate Use and Reduce Preventable Visits

This week's industry news:

  1. Results of Physician Cost Profiling Can Vary Widely
  2. Medical Home Improvement Guide Vol. III
  3. Five Skills to Transform Physician Practices into Medical Homes
  4. 2010 Healthcare Benchmarks Yearbook
  5. Healthcare Business White Paper: Medical Net Systems EncounterSuite Creates PCMH Framework
  6. Is There Link Between Over-Diagnosis of Bipolar Disorder and Disability Payments?
  7. New Chart: Case Management ROI
  8. Emergency Room Triage of the Mental Health Patient
  9. Alzheimer’s Disease to Cost U.S. $20 Trillion over Next 40 Years
  10. MORE Medical Home Reimbursement Models
  11. Affordable Care Act Includes New Tools to Fight Health Fraud and Protect Medicare
  12. Managed Medicare and Medicaid Factbook
  13. HealthSounds Podcast: Recruiting Practices for Medical Homes
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.) Results of Physician Cost Profiling Can Vary Widely

Profiles created for physicians based on the cost of the care they provide can vary widely depending upon the methods used by insurance companies to create the profiles, according to a new RAND Corporation study.

Get the full story.

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2.) Medical Home Improvement Guide Vol. III: Even More FAQs on Patient-Centered Care

Medical Home Improvement Guide Vol. III This 35-page resource picks up where Volumes I and II leave off, providing insight on emerging reimbursement models like the accountable care organization (ACO) and bundled or episodic payments. It also delves more deeply into the PCMH's care coordination responsibilities for its elderly patients with complex chronic illnesses — including the management of care transitions, medication reconciliation and reducing the possibility of readmission to the hospital. Responses are provided by such medical home heavy hitters as Group Health Cooperative, Geisinger Health Plan, Baptist Health System, Aetna Medicare and many others.

Learn more about this resource.

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3.) Five Skills to Transform Physician Practices into Medical Homes

Dr. Lonnie E. Fuller Jr., medical director for the Pennsylvania Medicaid ACCESS Plus Primary Care Case Management Disease Management (PCCM-DM) Program describes the skills required to transform a physician practice into a medical home and some of the challenges of transformation.

Get the full story.

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4.) 2010 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations

2010 Healthcare Benchmarks Yearbook This resource is a comprehensive collection of benchmarks in key areas of healthcare activity and growth: the patient-centered medical home (PCMH), reducing readmissions, health coaching, patient outreach, financial incentives and telehealth to foster behavior change and reverse healthcare spend.

Learn more about this resource.

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5.) Healthcare Business White Paper: How Medical Net Systems EncounterSuite Creates the Framework for the PCMH

Medical Net Systems EncounterSuite, an online integrated EMR and PHR, provides a unified turnkey software framework for the PCMH. This is accomplished through it's integrated PHR/EMR, point of care wellness and DM guidelines and best practices application, and three tracking modules, patient registries, Inbox (order tracking) and Tracking the Patient at Home module.

Download this complimentary white paper.

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6.) Is There Link Between Over-Diagnosis of Bipolar Disorder and Disability Payments?

A study from Rhode Island Hospital finds patients who were “over-diagnosed” with bipolar disorder were more likely to have received disability payments and for a longer period of time.

Get the full story.

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7.) New Chart: Case Management ROI

Case Management ROI

An increase in healthcare case management programs is significantly influencing medication compliance, hospital readmission rates and healthcare costs. We wanted to see what return on investment has been generated by healthcare case management programs.

Click here to view the chart.

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8.) Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion

Emergency Room Triage of the Mental Health Patient 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.) Alzheimer’s Disease to Cost U.S. $20 Trillion over Next 40 Years

A new report from the Alzheimer's Association shows that in the absence of disease-modifying treatments, the cumulative costs of care for people with Alzheimer’s from 2010 to 2050 will exceed $20 trillion.

Get the full story.

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10.) MORE Medical Home Reimbursement Models: ROI from Risk Adjustment, Shared Savings and Multi-Payor Partnerships

MORE Medical Home Reimbursement Models The newest strategies for generating revenue from the patient-centered medical home (PCMH) are documented in this 45-page resource. Learn how the identification of high-risk patients, meaningful distribution of healthcare data and collaborations with like-minded organizations are increasing medical home profitability for three healthcare organizations.

Learn more about this resource.

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11.) Affordable Care Act Includes New Tools to Fight Health Fraud and Protect Medicare

New tools are now included in the Affordable Care Act that will help fight fraud, strengthen consumer rights and protect taxpayer dollars, according to officials from HHS and the Department of Justice.

Get the full story.

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12.) Managed Medicare and Medicaid Factbook: 2010

Managed Medicare and Medicaid Factbook As the economic downturn leads to more low-income enrollees and the political climate threatens to significantly alter how managed Medicare and Medicaid work, you need up-to-date enrollment data to help you assess the competitive landscape and develop strategic plans. This resource has current and historical statistics so you can easily make plan-by-plan or state-by-state comparisons to suit your analytical needs.

Learn more about this resource.

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13.) HealthSounds Podcast: Recruiting Physician Practices for a Medical Home Pilot

Dr. Marjie Harbrecht As more payors test the patient-centered medical home model of care, what are the pros and cons of participation for physician practices? Dr. Marjie Harbrecht, medical and executive director of Health TeamWorks, describes the financial middle ground that is likely to satisfy payors and providers who sign on for medical home pilots and offers some additional selection criteria her organization (formerly the Colorado Clinical Guidelines Collaborative) may use in the future.

Listen to this podcast.

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